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.     

Prevention of Anxiety Psychopathology: Conceptual, Methodological, and Practical Issues

Feldner, Zvolensky, and Schmidt (this issue) summarize the main findings from studies on universal, selected, and indicated prevention programs as they relate to anxiety psychopathology. Based on their review, Feldner et al. outline a number of conclusions about the status of the empirical literature on the prevention of anxiety and discussed several directions for future research. In this commentary, I focus on some key issues related to prevention research and practice: (a) the definition of prevention; (b) the need for increased emphasis on causal mechanisms; (c) the importance of broad-based assessment; and (d) issues related to cost effectiveness, readiness for change, and dose-response relationships.     

Intrapersonal, Interpersonal, and Contextual Factors in Engaging in and Responding to Extramarital Involvement

Extramarital involvement (EMI) occurs with high prevalence among couples in clinical and community settings, frequently resulting in considerable distress both to participants and their spouses. The field lacks a synthesized review of this literature. Without such a synthesis, it has been difficult for researchers and clinicians to have an understanding of what is and is not known about EMI. This article reviews the large and scattered EMI literature using a framework that encompasses multiple source domains across the temporal process of engaging in and responding to EMI. In addition, this review delineates conceptual and methodological limitations to previous work in this area and articulates directions for further research.     

The reward positivity: From basic research on reward to a biomarker for depression

Feedback indicating monetary loss elicits an apparent negative deflection in the event‐related potential (ERP) that has been referred to as the feedback error‐related negativity, medial frontal negativity, feedback‐related negativity, and feedback negativity—all conceptualizations that suggest a negative ERP component that is greater for loss than gain. In the current paper, I review a programmatic line of research indicating that this apparent negativity actually reflects a reward‐related positivity (RewP) that is absent or suppressed following nonreward. I situate the RewP within a broader nomological network of reward processing and individual differences in sensitivity to rewards. Further, I review work linking reductions in the RewP to increased depressive symptoms and risk for depression. Finally, I discuss future directions for research on the RewP.     

Commentary on "The Role of Emotion Theory and Research in Child Therapy Development"

The article by Suveg, Southam-Gerow, Goodman, and Kendall (2007) provides a spirited argument for the importance of focusing on emotional awareness and emotion processing in prevention and treatment efforts with children. This review notes substantial empirical evidence for the role of emotions in normal development and psychopathology as well as recent evidence of our improved understanding of the aspects of the neuroscience of emotions. Finally, the authors review recent work that focuses on emotion-focused models of prevention and treatment with children. Most importantly, the authors recommend that the developmental understanding of emotions can do much to inform our models of prevention and treatment and improve the healthy development of children. My commentary focuses on conceptual and theoretical clarifications.     

The "atypical" mycobacteria: recognition and disease association

Although techniques based on immunologic or chromatographic analyses have been described for identifying mycobacteria in clinical laboratories, most microbiologists continue to rely on a series of specialized physiological and biochemical tests for this purpose. The recognition of additional significant species over the past decade has required the addition of more tests to the battery used for mycobacterial identification. This paper will review briefly the taxonomic status of species likely to be encountered in clinical specimens and the most useful tests for characterizing them. Strategies will be presented for using these tests in the most efficient way to provide optimal resolution of taxa without use of an unreasonably large battery of tests. A brief survey of techniques that may become more practical in the future will also be included.     

Approaching "HIV elimination": Interventions for acute HIV infection

Recent observations from several groups suggest that individuals with acute (antibody negative) HIV infections (AHI) may present for "routine" HIV testing in unanticipated numbers. Most of these papers have highlighted the use of group testing strategies to screen antibody negative testing sera for HIV RNA using nucleic acid amplification tests. At the same time, accumulating evidence indicates that AHI is a time of briefly, but substantially elevated risk for transmission of HIV. In this paper, we review these new data with attention to their implications for HIV prevention strategies. By calling attention to a subset of patients that are both recently infected and at transiently very high risk of transmitting their new infection to partners, AHI detection makes it possible to use traditional, network notification-based public health strategies effectively in the fight against HIV.     

Alcohol expectancy challenges for college students: a narrative review

Heavy alcohol use among college students has become a substantial health concern. With national survey data indicating that 40% of college students report consuming five or more alcoholic drinks at least monthly (Johnston, O'Malley, Bachman, & Schulenberg, 2009), prevention and intervention programs are needed to address this problem. The Task Force on College Drinking, commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), designated alcohol expectancy challenges (ECs) as a recommended treatment strategy to reduce alcohol use among college students (NIAAA, 2002). This paper is a systematic critical review of the studies that have been conducted to assess for the efficacy of ECs among college students with a focus on changes in expectancies and alcohol consumption, and possible differences in efficacy for men and women. The review revealed that ECs were most efficacious when administered to male-only groups of participants; while ECs for female-only and mixed-gender groups demonstrated less consistent results. The implications of the findings of this critical review for the direction of future research are discussed.     

Mechanisms of Change in Cognitive Behavioral Therapy for Anxious Youth

Davis and Ollendick (this issue) challenge CBT therapists to move beyond the measurement of subjective fear and diagnostic status in the treatment of phobic youth and urge that cognitive, behavioral, and physiological measurements of the emotional response be included. In this paper I highlight the ways in which current measures of child and adolescent anxiety assess the emotional response and discuss the need for reliable and valid measures of these three components. Next, I review some of the current evidence for the mechanisms of change in CBT for anxious youth and highlight the need for future research in this area.     

Secondary HIV Prevention: Novel Intervention Approaches to Impact Populations Most at Risk

This paper reviews recent secondary prevention interventions designed to reduce sexual risk behaviors among people living with HIV/AIDS (PLWHA). A summary of findings from previous meta-analyses and narrative reviews of interventions is provided. Next, novel HIV prevention approaches for PLWHA are reviewed. The review reports on the efficacy of interventions delivered in primary care settings or by technology-formats, interventions that also address mental health difficulties, and programs to address particular at-risk populations (eg, men who have sex with men). A critique of recent interventions for people living with HIV/AIDS is provided as well as suggestions for future research.     

基因捕获技术

基因捕获技术是一种产生大规模基因突变的便利手段，对于揭示大量基因序列所对应的基因功能具有重要应用价值。本文综述基因捕获技术的基本原理和研究方法、发展现状及远景。     

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.     

The role of erythropoietin in the "stroke belt" phenomenon

Global geographic disparities in stroke mortality rates are substantial. In the US alone, higher stroke mortality rates are reported in the Southeast part particularly along the coastline while lower rates have been observed in the Mountain region. The phenomenon has been called the "stroke belt". Although many theories have attempted to explain such nonrandom distribution of stroke mortality rates, no conclusive explanations have been drawn so far. I hypothesize that this nonrandom stroke distribution is related to regional differences in individual levels of erythropoietin (EPO), a hormone, which production depends on the tissue hypoxia due to variation in altitude. If successful, future studies based on this hypothesis may open up new avenues for treatment of such an important health issue as stroke. More importantly, future studies based on this theory may shed the lights on the mechanism of stroke as well as other diseases which have nonrandom geographic distribution not only in the US but also internationally.     

Effect of low-intensity millimeter-range electromagnetic irradiation on the recovery of function in lesioned sciatic nerves in rats

The effects of electromagnetic irradiation (EMI) of wavelength 5.6 mm (frequency 53.57 GHz) and power density 4 mW/cm² on the recovery of function in damaged rat sciatic nerve were studied; damage was produced by nerve section followed by microsuturing. Irradiation was applied to the skin of the thigh in the area of suturing. Total action potential (TAP) recording from the nerve was used to study the functional properties of regenerating nerve fibers five months after lesioning. These experiments demonstrated that EMI had a stimulatory effect on regenerative processes in the nerve, in terms of 25–30% increases in the rate of action potential conduction along nerve fibers, with increases in TAP amplitude. Laboratory for Reception Physiology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 St. Petersburg. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 2, pp. 85–90, February, 1996.     

Precision medicine in the care of rheumatoid arthritis: Focus on prediction and prevention of future clinically-apparent disease

There is an emerging understanding that an individual's risk for future rheumatoid arthritis (RA) can be determined using a combination of factors while they are still in a state where clinically-apparent inflammatory arthritis (IA) is not yet present. Indeed, this concept has underpinned several completed and ongoing prevention trials in RA. Importantly, risk factors can be divided into modifiable (e.g. smoking, exercise, dental care and diet) and non-modifiable factors (e.g. genetics, sex, age). In addition, there are now several biomarkers including autoantibodies, inflammatory markers and imaging techniques that are highly predictive of future clinically-apparent IA/RA. Although none of the prevention studies have yet provided major breakthroughs, several of them have provided valuable insights that can help to improve the design of future clinical trials and enable RA prevention. In aggregate, these findings suggest that the most accurate disease prediction models will require the combination of demographic and clinical information, biomarkers and potentially medical imaging data to identify individuals for intervention. This review summarizes some of the key aspects around precision medicine in RA with special focus on disease prediction and prevention.     

Severe chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) exacts a heavy toll on society, yet its prevention, diagnosis and treatment receives inadequate attention from both the medical community and from society at large. Guidelines released in 2001 from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) are aimed at redressing this inequity. In this review, we integrate information from the GOLD guidelines with recent updates on the prevention, treatment and management as related specifically to the most severe form of this disease. In order to help distinguish COPD from other disorders that may mimic or confound its treatment, we place particular emphasis on the definition, underlying pathophysiology and diagnosis of COPD. In addition, we discuss future directions in pharmacotherapy.     

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     

Allergy prevention

The increase in allergic disease in western, industrialized countries has been phenomenal. Although the reasons for this increase are unknown, it is clear that the primary management of allergies is prevention. There is now significant epidemiologic data suggesting that a program designed and focused on prevention will have a significant impact on the development of allergies. These include not only environmental, but also dietary restrictions. There remain, however, several major problems. Firstly, it is not clear which subjects will respond best to a program focusing on either pre—or postnatal prevention. Secondly, the immunological mechanisms involved remain unclear. For example, it would be highly desirable to have a readout that monitors the improvement in allergen avoidance, other than clinical response. This review will focus on the immunological background of alleregy prevention, including epidemiologic observations and thoughts for future potential allergy prevention.     

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.     

Host-directed therapy targeting the <Emphasis Type="Italic">Mycobacterium tuberculosis</Emphasis> granuloma: a review

Infection by the intracellular bacterial pathogen Mycobacterium tuberculosis (Mtb) is a major cause of morbidity and mortality worldwide. Slow progress has been made in lessening the impact of tuberculosis (TB) on human health, especially in parts of the world where Mtb is endemic. Due to the complexity of TB disease, there is still an urgent need to improve diagnosis, prevention, and treatment strategies to control global spread of disease. Active research targeting avenues to prevent infection or transmission through vaccination, to diagnose asymptomatic carriers of Mtb, and to improve antimicrobial drug treatment responses is ongoing. However, this research is hampered by a relatively poor understanding of the pathogenesis of early infection and the factors that contribute to host susceptibility, protection, and the development of active disease. There is increasing interest in the development of adjunctive therapy that will aid the host in responding to Mtb infection appropriately thereby improving the effectiveness of current and future drug treatments. In this review, we summarize what is known about the host response to Mtb infection in humans and animal models and highlight potential therapeutic targets involved in TB granuloma formation and resolution. Strategies designed to shift the balance of TB granuloma formation toward protective rather than destructive processes are discussed based on our current knowledge. These therapeutic strategies are based on the assumption that granuloma formation, although thought to prevent the spread of the tubercle bacillus within and between individuals contributes to manifestations of active TB disease in human patients when left unchecked. This effect of granuloma formation favors the spread of infection and impairs antimicrobial drug treatment. By gaining a better understanding of the mechanisms by which Mtb infection contributes to irreversible tissue damage, down regulates protective immune responses, and delays tissue healing, new treatment strategies can be rationally designed. Granuloma-targeted therapy is advantageous because it allows for the repurpose of existing drugs used to treat other communicable and non-communicable diseases as adjunctive therapies combined with existing and future anti-TB drugs. Thus, the development of adjunctive, granuloma-targeted therapy, like other host-directed therapies, may benefit from the availability of approved drugs to aid in treatment and prevention of TB. In this review, we have attempted to summarize the results of published studies in the context of new innovative approaches to host-directed therapy that need to be more thoroughly explored in pre-clinical animal studies and in human clinical trials.