Development of the scrupulosity inventory: A factor analysis and construct validity study.

BACKGROUND AND OBJECTIVES: Scrupulosity, despite its considerable prevalence and morbidity, remains under-investigated. The present study develops and examines the psychometric properties of a comprehensive assessment tool, the Scrupulosity Inventory (SI). METHODS: The SI, along with other measures of obsessive-compulsive disorder (OCD) and perfectionism, were administered to a sample (N = 150) of college undergraduates similar in size to other scale development studies of related measures. We conducted exploratory and confirmatory factor analyses of the SI, examined its convergent and divergent validity, and assessed its ability to predict categorical diagnoses of scrupulosity using a receiver operator characteristic analysis. RESULTS: We found a well-fitting confirmatory bifactor model (RMSEA = 0.049) with a strong general Scrupulosity factor ( [Formula: see text] ) and specific factors for Personal Violations ( [Formula: see text] ), Ritualized Behavior ( [Formula: see text] ), Interference with Life ( [Formula: see text] ), and Problem Pervasiveness ( [Formula: see text] ). As predicted, we also found the strongest convergence (r = 0.63) between the SI and the Penn Inventory of Scrupulosity (PIOS), intermediate convergence (r = 0.54) between the SI and Perfectionism Inventory (PI), and weaker convergence (r = 0.47) between the SI and YBOCS. Finally, we found that a categorical diagnosis of scrupulosity was highly predicted by the SI (AUC = 0.84), less well-predicted by the PIOS (AUC = 0.75) and less well predicted by the YBOCS (AUC = 0.69). LIMITATIONS: This study was conducted among a sample of undergraduates at a religiously affiliated university. CONCLUSIONS: These results suggest utility in using the SI to measure the severity of scrupulosity symptoms and that scrupulosity and OCD may present significantly different clinical features.

Further structural characterization of ovine forestomach matrix and multi-layered extracellular matrix composites for soft tissue repair.

Decellularized extracellular matrix (dECM)-based biomaterials are of great clinical utility in soft tissue repair applications due to their regenerative properties. Multi-layered dECM devices have been developed for clinical indications where additional thickness and biomechanical performance are required. However, traditional approaches to the fabrication of multi-layered dECM devices introduce additional laminating materials or chemical modifications of the dECM that may impair the biological functionality of the material. Using an established dECM biomaterial, ovine forestomach matrix, a novel method for the fabrication of multi-layered dECM constructs has been developed, where layers are bonded via a physical interlocking process without the need for additional bonding materials or detrimental chemical modification of the dECM. The versatility of the interlocking process has been demonstrated by incorporating a layer of hyaluronic acid to create a composite material with additional biological functionality. Interlocked composite devices including hyaluronic acid showed improved in vitro bioactivity and moisture retention properties.

The structure of depressive symptoms and characteristics and their relation to overall severity in major depressive disorder.

Although many investigators have examined symptoms of major depressive disorder (MDD), the multivariate relations among these features of depression and their relative associations with overall severity of depression are not well understood. The present study is the first to examine the underlying factor structure of depression across a broad set of constructs and to model the multivariate association of these factors with the overall severity of depression. We conducted a large-scale factor analysis and multiple regression in a sample of participants diagnosed with MDD (N = 233) and healthy controls (N = 235). We obtained a five-factor solution composed of the following factors: (1) anxiety; (2) behavioral activation; (3) core symptoms; (4) rumination; and (5) emotional intensity. The core symptoms factor, composed primarily of DSM-5 diagnostic criteria for MDD, was the only factor that showed a consistent, significant association with overall severity of depression and functional impairment. Rumination combined with behavioral inhibition and positive and negative affect combined with each other to form coherent constructs that may be useful in examining differences among depressed individuals. These findings provide an important data-driven framework for the multidimensional symptom structure of depression and suggest several actionable ways for improving clinical assessment and treatment for individuals with MDD.

Meta-analysis of Functional Neuroimaging of Major Depressive Disorder in Youth.

IMPORTANCE: Despite its high prevalence and morbidity, the underlying neural basis of major depressive disorder (MDD) in youth is not well understood. OBJECTIVES: To identify in youth diagnosed as having MDD the most reliable neural abnormalities reported in existing functional neuroimaging studies and characterize their relations with specific psychological dysfunctions. DATA SOURCES: Searches were conducted in PubMed and Web of Science to identify relevant studies published from November 2006 through February 2015. The current analysis took place from August 21, 2014, to March 28, 2015. STUDY SELECTION: We retained articles that conducted a comparison of youth aged 4 to 24 years diagnosed as having MDD and age-matched healthy controls using task-based functional magnetic resonance imaging and a voxelwise whole-brain approach. DATA EXTRACTION AND SYNTHESIS: We extracted coordinates of brain regions exhibiting differential activity in youth with MDD compared with healthy control participants. Multilevel kernel density analysis was used to examine voxelwise between-group differences throughout the whole brain. Correction for multiple comparisons was performed by computing null hypothesis distributions from 10 000 Monte Carlo simulations and calculating the cluster size necessary to obtain the familywise error rate control at P < .05. MAIN OUTCOMES AND MEASURES: Abnormal levels of activation in youth diagnosed as having MDD compared with control participants during a variety of affective processing and executive functioning tasks. RESULTS: Compared with age-matched healthy control participants (n = 274), youth with MDD (n = 246) showed reliable patterns of abnormal activation, including the following task-general and task-specific effects: hyperactivation in subgenual anterior cingulate cortex (P < .05) and ventrolateral prefrontal cortex (P < .05) and hypoactivation in caudate (P < .01) across aggregated tasks; hyperactivation in thalamus (P < .03) and parahippocampal gyrus (P < .003) during affective processing tasks; hypoactivation in cuneus (P < .001), dorsal cingulate cortex (P < .05), and dorsal anterior insula (P < .05) during executive functioning tasks; hypoactivity in posterior insula (P < .005) during positive valence tasks; and hyperactivity in dorsolateral prefrontal cortex (P < .001) and superior temporal cortex (P < .003) during negative valence tasks. CONCLUSIONS AND RELEVANCE: Altered activations in several distributed brain networks may help explain the following seemingly disparate symptoms of MDD in youth: hypervigilance toward emotional stimuli from the overactivation of central hubs in the subgenual anterior cingulate cortex and thalamus that lead to a cascade of other symptoms; ineffective emotion regulation despite increased activation of the dorsolateral prefrontal cortex and ventrolateral prefrontal cortex during affective processing, which may reverse across development or the clinical course; maladaptive rumination and poor executive control from difficulties shifting from default mode network activity to task-positive network activity during cognitively demanding tasks; and anhedonia from hypoactivation of the cuneus and posterior insula during reward processing.

The functional magnetic resonance imaging-based verbal fluency test in obsessive-compulsive disorder.

Clinical use of functional magnetic resonance imaging (fMRI) in obsessive-compulsive disorder (OCD) is limited by a relative absence of fMRI task development, standardization, and normative performance databases. We investigated the fMRI-based verbal fluency test (f-VFT) by quantitatively evaluating brain activation patterns in OCD participants (8 females and 4 males) compared with a normative database (16 females and 16 males). At the group level, OCD participants and references had highly similar activation in left-hemisphere language regions, including the precentral/premotor cortex, thalamus, basal ganglia, and inferior frontal gyrus/frontal operculum. At the interindividual level, however, the OCD group had highly variable activation patterns in the dorsal and ventral regions of the pre-supplementary motor area (pre-SMA) that may correspond with differences in demographic and clinical variables. Further, there were significant correlations in the OCD participants between pre-SMA dorsal and ventral activation and between dorsal pre-SMA activation and perfectionism. Our findings suggest considerable functional anatomical overlap in left-hemisphere language regions between OCD participants and references but significantly higher pre-SMA interindividual variability in OCD compared to the reference group that may be relevant in clinical fMRI application and the theoretical understanding of OCD.

Scrupulosity disorder: an overview and introductory analysis.

Scrupulosity is a psychological disorder primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive. This paper provides a comprehensive overview of scrupulosity and an original conceptualization of the disorder based on an exhaustive literature review to increase awareness of the disorder among practicing clinicians and stimulate further research. It explores the clinical features of scrupulosity, classified as cognitive, behavioral, affective, and social features, as well as the epidemiology, etiology, and treatment of the disorder. Additionally, it is suggested that scrupulosity, despite its similarity to OCD, may merit a distinctive diagnosis, particularly considering its unique constellation and severity of symptoms and its treatment refractoriness, as supported by statistical analysis.

Internal contamination of air-driven low-speed handpieces and attached prophy angles.

BACKGROUND: In an in vitro crossover study, the authors investigated whether the interior of low-speed handpiece/prophy-angle systems becomes contaminated during operation and submersion into Geobacillus stearothermophilus. METHODS: This study involved two types of handpieces attached to eight brands of prophy angles. The researchers operated angles attached to sterile handpieces for 60 seconds. They then analyzed the inside surfaces of the angle, nosecone and motor. They tested each prophy angle and handpiece 10 times. RESULTS: In the 160 tests of handpieces contaminated at the prophy cup end, the spores traveled into the motor gears 32 times (20 percent). In the other 160 tests in which the motor gears were contaminated, the test bacterium traveled through the prophy cup in 75 instances (47 percent). CONCLUSIONS: The in vitro data suggest that low-speed handpiece motors can become contaminated internally during use with prophy angles. Also, internal contaminants appear to have been released from the handpiece. CLINICAL IMPLICATIONS: The results suggest that low-speed hand-pieces can become contaminated internally during use. Unless low-speed handpieces are sterilized properly between patients, they may become cross-contaminated.

Effects of delayed microbial analysis of dental unit water line specimens.

PURPOSE: Monitoring microbial concentrations in water emitted from dental unit water lines (DUWL) is an important safety procedure. Improper handling of test water specimens could give incorrect results. Thus, the objective of this study was to measure the effects delayed culturing might have on DUWL specimens. METHODS: First, 100 mL water specimens were obtained from 10 different handpiece service lines within the School. All units had independent water systems, used DI (deionized water) water and were routinely cleaned using an alkaline peroxide based product. Two specimens of 10 mL were removed from the bottles and placed into individual sterile conical tubes. One set of tubes was processed immediately. 0.05 mL of sterile 1.0% (w/v) sodium thiosulfate solution was added to undiluted and diluted (1:10 and 1:100 with sterile DI water) specimens. After mixing, specimens were spiral plated onto duplicate R2A plates and incubated at 21degrees C for 7 days. Colonies were then counted and the cfu/mL of each original specimen determined. Another set of tubes was placed into a shipping envelope and mailed out to the School. Upon receipt, the tubes were processed as described above. The remaining 80 mL of water in the collection bottles were divided equally into new sterile tubes. One tube was left at 21 degrees C, while the other was placed into a 37 degrees C incubator. Aliquots were processed immediately and then after 1, 3 and 7 days. Next, 30 mL water specimens were obtained from 15 handpiece service lines in three outside clinics. All units had independent water systems, used DI water and were routinely cleaned with an alkaline peroxide-based product. Specimens were then divided equally into three sterile conical tubes. One of the tubes was transported (at 4 degrees C) to the laboratory and immediately processed as described. At the collection site, the second tube was placed into a padded envelope and mailed back to the School. The third tube was returned by overnight delivery using a Cool Pack type container. Upon receipt, all the tubes were processed as described previously. RESULTS: The 10 handpiece waterline specimens processed immediately ranged from 0 to 1000 cfu/mL. Holding specimens at 21 degrees C produced radically higher bacterial counts (1540-866,000 cfu/mL) in water from 90% of the handpieces. Holding at 37 degrees C produced unacceptably high bacterial counts in only 50% of the handpiece specimens. Mailed specimens were cultured 5 days after collection and water of unacceptable quality water was noted in 70% of the specimens. In another experimental set, mailed specimens arrived after 72 hours and were an average of 20 degrees C. Express sent specimens came the next morning at an average temperature of 4.5 degrees C. Only one waterline specimen processed immediately contained more than 500 cfu/mL. In contrast, 80% of specimens returned by post at ambient temperature had unacceptably high bacterial counts (780-376,000 cfu/mL). Express sent specimens produced the same results as those processed immediately.

An investigation of the microbial contamination of dental unit air and water lines.

AIM: The objective of this study was to measure the microbial contamination released from dental unit air lines (DUAL) and dental unit water lines (DUWL). MATERIALS AND METHODS: Emissions from DUAL and DUWL from five dental units supplied by a central water source (tap) and a centralised air supply were sampled three times over a five- week period. Air was forced through sterile water and then plated onto selective agar using apparatus designed to spread the sample solution evenly, and then incubated at room temperature for seven days. Colonies were then counted and the concentration of bacteria present was determined and expressed as colony forming units per millilitre (cfu/ml) per minute. The same procedure was used to evaluate five other dental units, which had attached independent water reservoir (bottle) systems (IWR). Only deionised water was added to the bottles and unit waterlines were cleaned weekly with alkaline peroxide based solution. Values were expressed as cfu/ml. RESULTS: Air and water specimens obtained from dental units supplied with tap water had microbial counts significantly (t-test, p < 0.05) greater than IWR dental units. CONCLUSIONS: Results indicate that IWR can reduce the numbers of micro-organisms released from DUWL. However, the effectiveness of such systems should be routinely monitored. Emissions from DUAL seems to reflect the levels of microbial contamination present in DUWL.

Sterilization update 2003.

Instrument processing is a key part of the office infection control program. Each step in the process must be performed correctly to help ensure patient safety. The instrument processing area must be organized so that contaminated items are not confused with sterilized items, and so that sterilized items do not accidentally become recontaminated. Instruments need to be cleaned completely of visible debris using an ultrasonic cleaner or instrument washer. The cleaned instruments are packaged before sterilization to protect them from recontamination until they are opened for use for the next patient. Processing the packaged instruments through a heat sterilizer (steam, dry heat, or unsaturated chemical vapor) kills any microbes that remain on the instruments. The sterile packages are handled and stored in a manner that preserves the integrity of the packaging material. The use and functioning of the sterilizer is monitored by mechanical, chemical, and biological means, and records are kept to document these evaluations. Sterilization failures are addressed carefully so that patient safety can be maintained.

The effect of distillation and line cleaning on the quality of water emitted from dental units.

PURPOSE: To monitor water emitted from dental units connected to centralized water distillation units fitted with reservoirs for dispensing chemicals designed to control biofilms. METHODS: Three private practice dental offices participated in the study. None of the office operatories had independent water reservoir (bottle) systems or any other type of water treatment equipment. Initially, 5.0 mL water specimens were obtained from the handpiece and three-way syringe service lines as well as from the sink faucets in three operatories in each office. Specimens were collected at the end of the workweek. Specimens were neutralized for residual chlorine, diluted and spiral plated onto R2A agar. Aerobic incubation was allowed for 7 days at 21 degrees C. Numbers of colonies were then determined and expressed as CFU/mL. If water specimens containing more than 200 CFU/mL were detected, the offices were equipped with water distillers with attached cleaning solution dispensers. The units allowed distilled water to move under normal pressure to all connected dental units. When cleaning, the distillers were inactivated, which allowed cleaning fluid to move under pressure from the dispensers through all unit waterlines. The waterline-cleaning scheme followed the manufacturer recommendations. The presence of no more than 200 CFU/mL in emitted water was then established and a regimen of weekly cleanings applied for 3 weeks. Water specimens were always collected on the last workday of the week. Then, cleaning was suspended and weekly monitoring performed. Cleaning was restored immediately after detection of more than 200 CFU/mL. RESULTS: Levels of microbial contamination prior to the initiation of cleaning indicated marked variability (720-332,000 CFU/mL) and that water containing less than 200 CFU/mL was not being emitted from any operatory water source. However, sought-after water was consistently obtained over a period of 3 weeks from all unit sources after line-cleaning processes were completed. Water containing less than 200 CFU/mL was obtained from all unit sources in the three offices after skipping of one weekly cleaning. In one office, cleaning was suspended for 3 weeks without affecting water quality. Resumption of weekly cleanings produced desirable water from all sources in the three offices within 2 weeks. Results indicate that dental units attached to centralized combined water distillation-cleaning solution distribution systems can produce water with less than 200 CFU/mL and that the missing of one weekly cleaning did not negatively affect water quality.