Enteric Populations of Escherichia coli are Likely to be Resistant to Phages Due to O Antigen Production.

Bioinformatic and experimental data show that bacteriophages are ubiquitous in human enteric microbiomes. However, there are gaps in understanding the contribution of these viruses in shaping the bacterial strain and species composition of the gut microbiome and how these phages are maintained over time. To address these questions, we adapted and analyzed the properties of a mathematical model of the population and evolutionary dynamics of bacteria and phage and performed experiments with Escherichia coli and phages isolated from four fecal microbiota transplantation (FMT) doses as representative samples of non-dysbiotic enteric microbiota. Our models predict and experiments confirm that due to production of the O antigen, E. coli in the enteric microbiome are likely to be resistant to infection with co-occurring phages. However, phages can be maintained in these populations in high densities due to high rates of transition between resistant and sensitive states, which we call leaky resistance. Based on these models and observations, we postulate that the phages found in the human gut are likely to play little role in shaping the composition of E. coli in the enteric microbiome in healthy individuals. How general this is for other species of bacteria in enteric microbiota is not yet clear, although O antigen production is broadly conserved across many taxa.

Development of a two-part biomaterial adhesive strategy for annulus fibrosus repair and ex vivo evaluation of implant herniation risk.

Intervertebral disc (IVD) herniation causes pain and disability, but current discectomy procedures alleviate pain without repairing annulus fibrosus (AF) defects. Tissue engineering strategies seal AF defects by utilizing hydrogel systems to prevent recurrent herniation, however current biomaterials are limited by poor adhesion to wetted tissue surfaces or low failure strength resulting in considerable risk of implant herniation upon spinal loading. Here, we developed a two-part repair strategy comprising a dual-modified (oxidized and methacrylated) glycosaminoglycan that can chemically adsorb an injectable interpenetrating network hydrogel composed of fibronectin-conjugated fibrin and poly (ethylene glycol) diacrylate (PEGDA) to covalently bond the hydrogel to AF tissue. We show that dual-modified hyaluronic acid imparts greater adhesion to AF tissue than dual-modified chondroitin sulfate, where the degree of oxidation is more strongly correlated with adhesion strength than methacrylation. We apply this strategy to an ex vivo bovine model of discectomy and demonstrate that PEGDA molecular weight tunes hydrogel mechanical properties and affects herniation risk, where IVDs repaired with low-modulus hydrogels composed of 20kDa PEGDA failed at levels at or exceeding discectomy, the clinical standard of care. This strategy bonds injectable hydrogels to IVD extracellular matrix proteins, is optimized to seal AF defects, and shows promise for IVD repair.

Teaching psychodynamic psychotherapy with the Y model.

The Y model of psychotherapy represents core components of all psychotherapies on the stem of the Y, and the specific components of psychodynamic psychotherapy and cognitive-behavioral therapy (CBT) on the arms of the Y. Familiarity with the Y model can help students cope with the confusion that emerges when trying to learn several different types of psychotherapy. The Y model also can be an important aid to teachers of psychodynamic psychotherapy. Use of the Y model helps students see how specific components of psychodynamic psychotherapy emerge from the core. It also helps students to compare psychodynamic psychotherapy with CBT (and other therapies). A student who has reached a point of confusion while doing psychodynamic psychotherapy can be invited to "zoom out" to the Y model, using it to examine this point of confusion, "zooming back in" for a fresh look at the patient-therapist interaction.

Trends in psychotherapy training: a national survey of psychiatry residency training.

OBJECTIVE: The authors sought to determine current trends in residency training of psychiatrists. METHOD: The authors surveyed U.S. general-psychiatry training directors about the amount of didactic training, supervised clinical experience, and numbers of patients treated in the RRC-mandated models of psychotherapy (psychodynamic, cognitive-behavioral therapy [CBT], and supportive). Questions regarding other models of psychotherapy and about challenges in training were also included. RESULTS: The results demonstrate a wide range of experiences in psychotherapy education. Psychodynamic training is the most robust, but has the greatest variability. CBT training has advanced significantly over the past decade. Supportive psychotherapy is the most widely practiced, but receives the least amount of didactic time and supervision. CONCLUSION: The authors discuss next steps in the evolution of psychotherapy education for psychiatrists.

Is that an unconscious fantasy or an automatic thought? Challenges of learning multiple psychotherapies simultaneously.

Today, psychiatry residents learn multiple psychotherapeutic techniques during their training. Learning these different modalities at the same time can cause confusion in the areas of assessment, making a psychotherapeutic recommendation, and conducting a treatment. To investigate these issues, we presented a complex training case to three psychotherapy experts. Although they had somewhat different ideas about how to treat the patient, there was general consensus that adhering to a single conceptual formulation is key to treating individual patients in psychotherapy. A final discussion addresses the pedagogical implications of this perspective.

Psychopharmacology curriculum field test.

OBJECTIVE: As part of an effort to improve psychopharmacology training in psychiatric residency programs, a committee of residency training directors and associate directors adapted an introductory schizophrenia presentation from the American Society of Clinical Psychopharmacology's Model Psychopharmacology Curriculum to develop a multimodal, interactive training module. This article describes the module, its development, and the results of a field trial to test its feasibility and usefulness. METHODS: Nineteen residency programs volunteered to use the module during the first half of the 2007-2008 academic year. Evaluation consisted of a structured phone interview with the training director or teaching faculty of participating programs during February and early March 2008, asking whether and how they used the curriculum, which components they found most useful, and how it was received by faculty and residents. RESULTS: Of the 19 programs, 14 used the module and 13 participated in the evaluation. The most commonly used components were the pre- and postmodule questions, video-enhanced presentation, standard presentation, problem- or team-based teaching module, and other problem-based teaching modules. No two programs used the module in the same fashion, but it was well received by instructors and residents regardless of use. CONCLUSION: The results of this field trial suggest that a dynamic, adult-centered curriculum that is exciting, innovative, and informative enough for a wide variety of programs can be developed; however, the development and programmatic barriers require considerable time and effort to overcome.