Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada.

Internationally, there is ongoing concern about accessibility to mental health care and training. The goal of this study was to explore commonalities and differences within models of clinical psychology and psychotherapy in Ontario, Canada, and Lombardia, Italy, respectively, to inform improvements to the accessibility of mental health care and training. Using key informant sampling, we recruited ten students and professionals in Italy and Canada who study or work in psychology for semi-structured interviews. We analyzed the interview content using an inductive approach for thematic analysis within countries and meta-theme analysis across countries. The findings indicated three cross-national meta-themes: the need to integrate evidence with practice, the limited accessibility of training for students and treatment for patients, and the importance of the quality of training programs. Despite some differences regarding the amount of scientific training, personal therapy for trainees, and the prominence of cultural diversity training, Canadian and Italian psychology professionals and students shared experiences of psychotherapy practice and clinical psychology training. The three cross-national meta-themes indicate which issues in training and practice may be relevant worldwide and where to focus resources. The findings can inform international collaborations regarding training model structures that may increase access to psychology training and may increase consensus on professional recognition standards to improve mobility for professionals. These changes could reduce barriers to mental healthcare services for patients.

Comparative evaluation of four hydrogen peroxide-based systems to decontaminate N95 respirators.

Objective: Protocols designed to facilitate N95 filtering facepiece respirator (FFR) decontamination by commercial sterilization devices do not recommend that operators verify the device's performance against pathogens deposited on FFRs. Here, we compared the treatment efficacy of 4 hydrogen peroxide-based systems that were authorized for N95 decontamination during the COVID-19 pandemic. Methods: Suspensions prepared from S. aureus ATCC 29213 and 44300, B. subtilis ATCC 6633, a vancomycin-resistant E. faecium isolate (VRE), E. coli ATCC 25922, and P. aeruginosa ATCC 27853 colonies were inoculated onto nine 1-cm2 areas on a 3M 1805, 1860, 1860S, 1870+, 8210, 8110S, or 9105S FFR. Contaminated respirators were treated according to protocols recommended by the STERRAD 100NX, Bioquell Z-2, Sterizone VP4, or Clean Works Mini systems. Decontamination efficacy was determined by comparing colony counts cultured from excised segments of treated and untreated FFR. Results: All devices achieved a 6-log reduction in bacterial burden and met FDA sterilization criteria. The Bioquell Z-2 device demonstrated 100% efficacy against both gram-positive and gram-negative organisms with all FFRs tested. Colonies of S. aureus ATCC 29213 and 44300 and VRE were cultivable from up to 9 (100%) of 9 STERRAD 100NX- and Sterizone VP4-treated segments. Viable B. subtilis ATCC 6633 organisms were recovered from 76.0% of STERRAD 100NX-treated FFR segments. Conclusions: Variability in decontamination efficacy was noted across devices and FFR types. gram-positive organisms were more difficult to completely eliminate than were gram-negative organisms. Prior to initiating FFR decontamination practices, institutions should verify the effectiveness of their devices and the safety of treated FFR.

Engineering functional microvessels in synthetic polyurethane random-pore scaffolds by harnessing perfusion flow.

Recently reported biomaterial-based approaches toward prevascularizing tissue constructs rely on biologically or structurally complex scaffolds that are complicated to manufacture and sterilize, and challenging to customize for clinical applications. In the current work, a prevascularization method for soft tissue engineering that uses a non-patterned and non-biological scaffold is proposed. Human fibroblasts and HUVECs were seeded on an ionomeric polyurethane-based hydrogel and cultured for 14 days under medium perfusion. A flow rate of 0.05 mL/min resulted in a greater lumen density in the constructs relative to 0.005 and 0.5 mL/min, indicating the critical importance of flow magnitude in establishing microvessels. Constructs generated at 0.05 mL/min perfusion flow were implanted in a mouse subcutaneous model and intravital imaging was used to characterize host blood perfusion through the construct after 2 weeks. Engineered microvessels were functional (i.e. perfused with host blood and non-leaky) and neovascularization of the construct by host vessels was enhanced relative to non-prevascularized constructs. We report on the first strategy toward engineering functional microvessels in a tissue construct using non-bioactive, non-patterned synthetic polyurethane materials.

Pro-angiogenic character of endothelial cells and gingival fibroblasts cocultures in perfused degradable polyurethane scaffolds.

Gingival atrophy manifests as exposure of the tooth root surface because of recession of the gingiva, a condition that affects >20% of adults and leads to increased root sensitivity and ultimately, tooth loss. Tissue engineering approaches that employ novel synthetic polymeric scaffolds are being considered for rebuilding the gingival lamina propria lost in the atrophic process. Specifically, polyurethane hydrogels (degradable/polar/hydrophobic/ionic polyurethane [D-PHI]) can enhance the proliferation of human gingival fibroblasts (HGFs) and collagen production in a perfusion system. However, few studies have assessed the potential of synthetic block copolyurethanes to initiate blood vessel formation in an in vitro bioreactor system. As the gingival lamina propria is highly vascular, a coculture system of human umbilical vein endothelial cells (HUVECs) with HGFs was used in perfused D-PHI scaffolds to determine the feasibility of initiating vascularization. Culture conditions were optimized for driving cocultures toward the desired tissue-engineered construct. HUVEC-HGF coculture in perfused D-PHI scaffolds with a cell seeding density of at least 80,000 cells/scaffold in a 50/50 mix of HUVEC and HGF media (by volume) exhibited enhanced cell growth and increased vascular endothelial growth factor and fibroblast growth factor (FGF)-2 production, as well as reduced myofibroblast differentiation. A greater fibroblast proportion (seeding ratio of 1:2) in the coculture resulted in HUVEC cluster formations and increased transforming growth factor-ß1 and FGF-2 production. The combined pro-angiogenic effects provided by these culture conditions are anticipated to be important in the development of a highly vascularized tissue-engineered construct for regenerating the gingival lamina propria and possibly other soft tissues.

Biomaterials in co-culture systems: towards optimizing tissue integration and cell signaling within scaffolds.

Most natural tissues consist of multi-cellular systems made up of two or more cell types. However, some of these tissues may not regenerate themselves following tissue injury or disease without some form of intervention, such as from the use of tissue engineered constructs. Recent studies have increasingly used co-cultures in tissue engineering applications as these systems better model the natural tissues, both physically and biologically. This review aims to identify the challenges of using co-culture systems and to highlight different approaches with respect to the use of biomaterials in the use of such systems. The application of co-culture systems to stimulate a desired biological response and examples of studies within particular tissue engineering disciplines are summarized. A description of different analytical co-culture systems is also discussed and the role of biomaterials in the future of co-culture research are elaborated on. Understanding the complex cell-cell and cell-biomaterial interactions involved in co-culture systems will ultimately lead the field towards biomaterial concepts and designs with specific biochemical, electrical, and mechanical characteristics that are tailored towards the needs of distinct co-culture systems.