Investigation of causes of ceiling effects on working alliance measures.

The presence of ceiling effects on measures of working alliance is important because they (a) may moderate the observed size of the alliance-outcome correlation and (b) have implications for how quickly the alliance is formed and when. Despite this, little is known about ceiling effects on alliance measures, particularly about potential causes. This study attempted to replicate findings of ceiling effects using a 7-item version of the Working Alliance Inventory (WAI) (Horvath and Greenberg, 1989) accessed in an archival database of 616 parolees enrolled in a drug abuse treatment study. Item response patterns on alliance and related measures were examined to explore potential methodological and theoretical factors that could produce ceiling effects. Analyses revealed ceiling effects on alliance measures assessing relationships with counselors and parole officers as well as floor effects (indicating highly positive appraisals) in measures of outcome expectations with counselors and parole officers. No ceiling effects were found with measures of drug use problems or negative affect. Item responses on the alliance and outcome expectations measures evidenced high consistency where many respondents endorsed the same choice on the 5-point response format across all items on the scale. Ceiling effects offer a potential marker of the working alliance at the scale level, while consistent response choice may provide a specific behavioral marker at the item level. Discussion focuses on theoretical implications and directions for future research in psychotherapy.

Meta-regression analyses of relationships between burnout and depression with sampling and measurement methodological moderators.

Despite 35 years of study, burnout researchers have failed to reach a consensus about whether burnout is distinct from depression. This review compiled reports containing zero-order correlations between scores on burnout, depression, and other measures of negative affect (NA) based on (a) reviews published by Kahill (1988), Glass and McKnight (1996), and Bianchi et al. (2015b), and (b) a search of PsycInfo using "depression" and "burnout" as search terms to find relevant studies published after 2014. The resulting data set contained 69 studies with 196 burnout-depression correlations based on 46,191 participants. We found an overall effect size of .492 between scores on burnout and depression measures (essentially equivalent to the .52 value reported in Koutsimani et al.'s, 2019, review) and an effect size of .546 between the Maslach Burnout Inventory emotional exhaustion scale and depression. Similarly, a correlation of .53 between burnout and NA measures is similar in size to the .46 correlation found by Koutsimani et al. Moderator analyses indicated that a larger burnout-depression correlation was associated with a higher proportion of female participants in a study, older participants, participants who had worked longer, and burnout measures with higher reliability estimates. The effects of age and years employed on the burnout-depression relationship suggest that repeated and negative work experiences are required for burnout to develop to the extent that its effects overlap with symptoms of depression. Conceptualizing the empirical relation between burnout and depression as a single point estimate may miss the more complex empirical picture. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ceiling effects indicate a possible threshold structure for working alliance.

This review investigated whether ceiling effects on client-reported working alliance measures represent measurement artifacts or valid information related to the formation of the working alliance. Using data from two previously published meta-analyses, a total of 92 estimates of ceiling effects were calculated based on 37 studies with 6,439 participants. Analyses examined the size of ceiling effects, relation with demographic variables, type of alliance measure, and ceiling effect stability across sessions. Moderate to large ceiling effects appeared across score distributions of multiple measures of client-rated alliance, across time administered, and across different sample characteristics such as gender, age, and ethnicity. When examined with the Session Rating Scale (SRS), analyses indicated ceiling effects had a moderate correlation with session number. When SRS ceiling effects were examined in a single study with a large sample of complete cases (N = 2,990) across seven sessions, large initial ceiling effects continued to increase slightly in size across sessions. Higher ceiling effects were also observed with the Working Alliance Inventory. Given the prevalence and relative stability of ceiling effects on score distributions, working alliance scores do not exhibit the characteristics of a normally distributed continuous variable. While the working alliance has typically been defined in terms of theoretical content such as tasks, goals, and bond, study findings suggest another key element may be a threshold structure where clients shift to an experience of the therapeutic relationship as established. Discussion focuses on directions for alliance research and clinical practice as well as study limitations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using a certified electronic health record technology platform to screen, test and refer patients with prediabetes.

The objective of this study was to determine if certified electronic health record technology (CEHRT) can be used to identify and refer patients with prediabetes to lifestyle change programs (LCPs) recognized by the National Diabetes Prevention Program (DPP). This pilot utilized a prediabetes registry, patient portal, and clinical decision support to increase referrals. Data from 36 primary care providers showed 4930 patients were eligible for DPP LCP, 293 referrals were generated, compared to 20 referrals in the baseline period, and 116 patients enrolled. Referral to enrollment conversion rates were 41% in the study period and 69% in the post-study 1-year period. CEHRT functionalities can support systematic identification and management of prediabetes. The referral rate increased 7-fold compared to the baseline period, with high referral to enrollment conversion rates. CEHRT coupled with active provider engagement can serve as a tool to identify prediabetes patients and facilitate LCP referrals and enrollment.

Burnout and depression in nurses: A systematic review and meta-analysis.

BACKGROUND: Nurses work in stressful and demanding settings and often suffer from depression and burnout. Despite overlapping symptoms, research has been inconclusive regarding the discriminant validity of measures of burnout with regard to measures of depression. Such inconclusive discriminant validity might cause clinicians to fail to recognize and manage depression separately from burnout. OBJECTIVES: This meta-analysis aimed to clarify the distinctiveness of burnout as a separate construct by examining the size of the relationship between burnout and depression among nurses as well as potential moderators. METHOD: A stepwise method was used by searching 4 databases (PubMed, CINAHL, PsycINFO, and EMBASE) to retrieve published papers in English examining the relationship between burnout and depression among nurses and reporting the effect sizes of their findings. RESULTS: We identified a total of 37 eligible studies. The pooled estimate showed a positive association between burnout and depression among nurses (r = 0.403, 95% CI [0.327, 0.474], p < 0.0001) and a slightly higher correlation coefficient for the Emotional Exhaustion subscale of the Maslach Burnout Inventory (MBI) measure (0.494, 95% CI [0.41, 0.57]). CONCLUSIONS AND IMPLICATIONS: This review confirms a large burnout - depression correlation in nursing samples, adding to existing literature encompassing a variety of occupations. Future studies should focus on path analysis to assess the causal relationship as well as investigate potential moderators.

Construct Validity of Outcome Rating Scale (ORS) Scores in Clinical Samples: Extension of Harris, Murphy, and Rakes' (2019) Narrative Review.

PURPOSE: A recent review of 24 studies primarily evaluated psychometric properties of the Outcome Rating Scale (ORS) related to coefficient alpha and convergent validity. METHOD: To provide a fuller picture, this review examined effect size (ES) estimates and the full range of correlations between ORS scores and related measures. RESULTS: Mean ORS ESs equaled 1.00 for 44 comparison periods. ORS scores correlated highest with measures of depression and evidenced larger ESs in depression treatments. DISCUSSION: The ORS functions as a robust measure for detecting client progress in clinical samples that were primarily young, female, and Caucasian. Some results suggest ORS scores primarily reflect a rapid response to interventions. CONCLUSION AND LIMITATIONS: Future research should assess ORS scores' psychometric properties in response to interventions with more heterogeneous client samples as well as its capacity to monitor change beyond initial sessions.

Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units.

BACKGROUND: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments' psychometric properties and determine which best measures family-clinician communication in the ICU. METHOD: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. INSTRUMENTS: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician-Family Caregiver Communication, and Quality of Communication (QOC). RESULTS: Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC's convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families' treatment response in randomized control trials. CONCLUSION: Quality of Communication is the most suitable instrument to measure family's perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family-clinician communication and data about how to improve EOL care in ICUs.

Evaluating the Psychometric Properties of the Conners Adult ADHD Rating Scales.

Objective: Characterized by significant work-related impairments, difficulties with relationships, and higher rates of criminal behavior and substance abuse, ADHD is now understood as a disability that can persist throughout a lifetime. Differing opinions remain, however, regarding adult symptoms of ADHD, particularly with regard to gender differences. These issues add to the challenges of constructing a reliable and valid measure of ADHD for use with adults in research and practice. Method: We review the theoretical foundations of ADHD and psychometric properties of a major assessment device, the Conners' Adult ADHD Rating Scales (CAARS). Results: Results of the literature review found (a) a wide range of internal consistency estimates, with lowest values for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-Hyperactive/Impulsive Symptoms subscale when completed by women, and (b) discriminant validity estimates in the same range as convergent validity estimates. Conclusion: These findings raise questions about the construct validity of the CAARS and suggest directions for future research.

Screening for Delirium: Development and Validation of the Buffalo Delirium Scale for Use in a Home-Based Hospice Setting.

BACKGROUND: Delirium is a challenging occurrence among people at end of life. It can be difficult to detect and treat because of its episodic nature. The Buffalo Delirium Scale (BDS) was designed to identify risk factors for hospice patients in the prodromal stage of delirium. OBJECTIVE: This study evaluated the psychometric properties of items assessing delirium risk factors related to cognitive problems, psychological distress, and sleep problems. METHODS: Hospice nursing staff assessed patients with the 11-item BDS over a 6-month period as part of standard weekly visits to monitor for emerging signs of delirium, for example, sleep patterns, cognition, and behavior. SETTING/PARTICIPANTS: The rating period produced 4992 assessments from 817 hospice home care patients. RESULTS: Factor analysis of nurses' ratings identified 3 factors: (1) cognitive problems, (2) distress, and (3) sleep problems. Coefficient αs for these factors and total score were moderate to high (range = .66-.82). Nurses' ratings of presence of delirium highly correlated with scores on distress ( r = .40, P < .01), while dementia highly correlated with cognitive problems ( r = .50, P < .01). Analysis of at-risk cases with high BDS total scores where no delirium was assessed indicated that quality sleep may mitigate delirium onset. CONCLUSION: Preliminary psychometric testing suggests BDS to be a valid and appropriate measure for hospice patients. Use of BDS may help differentiate individuals in prodromal stage of delirium versus dementia. Examination of BDS scores may help identify patients for whom sleep interventions may delay onset of or reduce the frequency of delirium.

Enrichment of low-abundant protein targets by immunoprecipitation upstream of mass spectrometry.

Immunoprecipitation (IP) is commonly used upstream of mass spectrometry (MS) as an enrichment tool for low-abundant protein targets. However, several aspects of the classical IP procedure such as nonspecific protein binding to the isolation matrix, detergents or high salt concentrations in wash and elution buffers, and antibody chain contamination in elution fractions render it incompatible with downstream mass spectrometry analysis. Here, we discuss two IP workflows that are designed to minimize or eliminate these contaminants: the first employs biotinylated antibodies and streptavidin magnetic beads while the second method utilizes a traditional antibody that is oriented and cross-linked to Protein AG magnetic beads. Both modified magnetic supports have low background binding and both antibody immobilization strategies significantly reduce or eliminate antibody heavy and light chain contamination in the eluent, minimizing potential ion suppression effects and thereby maximizing detection of target antigens and interacting proteins.

Dimensionality, reliability, and validity of the combat experiences scale.

Few studies have measured combat exposure during deployment to a war zone. Valid, reliable, and specific measurement is needed to broaden existing knowledge of combat experiences to accurately answer clinically important questions regarding postcombat treatment and recovery, particularly with the recognition of new kinds of combat and resulting psychological sequelae. The Combat Experiences Scale (CES) is a 33-item measure that assesses deployment-related experiences. The psychometrics of this measure, however, were undefined before this study. The purpose of this study was to examine aspects of internal and external validity of the CES. Data were collected as part of a study of 500 veterans of the conflicts in Iraq and Afghanistan across five Veterans Affairs medical centers in Upstate New York. An exploratory factor analysis suggested that three factors represented the scale well: Exposure to Combat Environment, Physical Engagement, and Proximity to Serious Injury and Death. The CES scores showed adequate internal consistency, and evidence for convergent validity and discriminant validity was also found. This study underscores the importance of casting a wide net with regard to the assessment of deployment-related experiences and provides evidence that probable post-traumatic stress disorder, depression, and anxiety are highly correlated with all forms of deployment-related experiences.

Psychometric study of the Neurobehavioral Symptom Inventory.

The Department of Veterans Affairs (VA) uses the Neurobehavioral Symptom Inventory (NSI) to measure postconcussive symptoms in its comprehensive traumatic brain injury (TBI) evaluation. This study examined the NSI's item properties, internal consistency, and external validity. Data were obtained from a federally funded study of the experiences of combat veterans. Participants included 500 Operations Iraqi and Enduring Freedom veterans, 219 of whom sustained at least one TBI. Data were collected at five VA medical centers and one VA outpatient clinic across upstate New York. Measures included neuropsychological interview, NSI, Beck Anxiety Inventory, Beck Depression Inventory-II, and Posttraumatic Stress Disorder Checklist-Military Version. The NSI demonstrated high internal consistency (total alpha = 0.95; subscale alpha = 0.88 to 0.92). Subscale totals based on Caplan et al.'s factor analysis correlated highly with the NSI total score (r = 0.88 to 0.93). NSI scores differentiated veterans with TBI history from those without but were strongly influenced by variance associated with probable posttraumatic stress disorder, depression, and generalized anxiety. Results suggest that the NSI is a reliable and valid measure of postconcussive symptoms. Scale validity is evident in the differentiation of TBI and non-TBI classifications. The scale domain is not limited to TBI, however, and extends to detection of probable effects of additional affective disorders prevalent in the veteran population.

Interaction of a G protein with an activated receptor opens the interdomain interface in the alpha subunit.

In G-protein signaling, an activated receptor catalyzes GDP/GTP exchange on the G(α) subunit of a heterotrimeric G protein. In an initial step, receptor interaction with G(α) acts to allosterically trigger GDP release from a binding site located between the nucleotide binding domain and a helical domain, but the molecular mechanism is unknown. In this study, site-directed spin labeling and double electron-electron resonance spectroscopy are employed to reveal a large-scale separation of the domains that provides a direct pathway for nucleotide escape. Cross-linking studies show that the domain separation is required for receptor enhancement of nucleotide exchange rates. The interdomain opening is coupled to receptor binding via the C-terminal helix of G(α), the extension of which is a high-affinity receptor binding element.

Pigment epithelium-derived factor binds to cell-surface F(1)-ATP synthase.

Pigment epithelium-derived factor (PEDF), a potent blocker of angiogenesis in vivo, and of endothelial cell migration and tubule formation, binds with high affinity to an as yet unknown protein on the surfaces of endothelial cells. Given that protein fingerprinting suggested a match of a approximately 60 kDa PEDF-binding protein in bovine retina with Bos taurus F(1)-ATP synthase beta-subunit, and that F(1)F(o)-ATP synthase components have been identified recently as cell-surface receptors, we examined the direct binding of PEDF to F(1). Size-exclusion ultrafiltration assays showed that recombinant human PEDF formed a complex with recombinant yeast F(1). Real-time binding as determined by surface plasmon resonance demonstrated that yeast F(1) interacted specifically and reversibly with human PEDF. Kinetic evaluations revealed high binding affinity for PEDF, in agreement with PEDF affinities for endothelial cell surfaces. PEDF blocked interactions between F(1) and angiostatin, another antiangiogenic factor, suggesting overlapping PEDF-binding and angiostatin-binding sites on F(1). Surfaces of endothelial cells exhibited affinity for PEDF-binding proteins of approximately 60 kDa. Antibodies to F(1)beta-subunit specifically captured PEDF-binding components in endothelial plasma membranes. The extracellular ATP synthesis activity of endothelial cells was examined in the presence of PEDF. PEDF significantly reduced the amount of extracellular ATP produced by endothelial cells, in agreement with direct interactions between cell-surface ATP synthase and PEDF. In addition to demonstrating that PEDF binds to cell-surface F(1), these results show that PEDF is a ligand for endothelial cell-surface F(1)F(o)-ATP synthase. They suggest that PEDF-mediated inhibition of ATP synthase may form part of the biochemical mechanisms by which PEDF exerts its antiangiogenic activity.

Trp fluorescence reveals an activation-dependent cation-pi interaction in the Switch II region of Galphai proteins.

Crystal structures of Galpha(i) (and closely related family member Galpha(t)) reveal much of what we currently know about G protein structure, including changes which occur in Switch regions. Galpha(t) exhibits a low rate of basal (uncatalyzed) nucleotide exchange and an ordered Switch II region in the GDP-bound state, unlike Galpha(i), which exhibits higher basal exchange and a disordered Switch II region in Galpha(i)GDP structures. Using purified Galpha(i) and Galpha(t), we examined the intrinsic tryptophan fluorescence of these proteins, which reports conformational changes associated with activation and deactivation of Galpha proteins. In addition to the expected enhancement in tryptophan fluorescence intensity, activation of GalphaGDP proteins was accompanied by a modest but notable red shift in tryptophan emission maxima. We identified a cation-pi interaction between tryptophan and arginine residues in the Switch II of Galpha(i) family proteins that mediates the observed red shift in emission maxima. Furthermore, amino-terminal myristoylation of Galpha(i) resulted in a less polar environment for tryptophan residues in the GTPase domain, consistent with an interaction between the myristoylated amino terminus and the GTPase domain of Galpha proteins. These results reveal unique insights into conformational changes which occur upon activation and deactivation of G proteins in solution.

Helix dipole movement and conformational variability contribute to allosteric GDP release in Galphai subunits.

Heterotrimeric G proteins (Galphabetagamma) transmit signals from activated G protein-coupled receptors (GPCRs) to downstream effectors through a guanine nucleotide signaling cycle. Numerous studies indicate that the carboxy-terminal alpha5 helix of Galpha subunits participates in Galpha-receptor binding, and previous EPR studies suggest this receptor-mediated interaction induces a rotation and translation of the alpha5 helix of the Galpha subunit [Oldham, W. M., et al. (2006) Nat. Struct. Mol. Biol. 13, 772-777]. On the basis of this result, an engineered disulfide bond was designed to constrain the alpha5 helix of Galpha(i1) into its EPR-measured receptor-associated conformation through the introduction of cysteines at position 56 in the alpha1 helix and position 333 in the alpha5 helix (I56C/Q333C Galpha(i1)). A functional mimetic of the EPR-measured alpha5 helix dipole movement upon receptor association was additionally created by introduction of a positive charge at the amino terminus of this helix, D328R Galpha(i1). Both proteins exhibit a dramatically elevated level of basal nucleotide exchange. The 2.9 A resolution crystal structure of I56C/Q333C Galpha(i1) in complex with GDP-AlF(4)(-) reveals the shift of the alpha5 helix toward the guanine nucleotide binding site that is anticipated by EPR measurements. The structure of the I56C/Q333C Galpha(i1) subunit further revealed altered positions for the switch regions and throughout the Galpha(i1) subunit, accompanied by significantly elevated crystallographic temperature factors. Combined with previous evidence in the literature, the structural analysis supports the critical role of electrostatics of the alpha5 helix dipole and overall conformational variability during nucleotide release.

Clinico-pathologic findings in end-stage pediatric heart transplant grafts.

The pathologic patterns existing in end-stage pediatric heart transplant grafts may help explain the symptoms and changes seen by echocardiography and angiography in these children. Retrospective chart review and pathologic study of explanted heart grafts was performed on 12 patients that had undergone 14 heart re-transplantations. Clinical status, echocardiographic and catheterization data at the time of transplantation were correlated to the pathologic findings. At re-OHT, eight were inpatients with heart failure symptoms and/or inotropic support requirements. Echocardiograms were abnormal in all prior to re-OHT with significant diastolic dysfunction, but LVEF >40% in all but one. There was significant epicardial fibrosis in all grafts, and all had severe CAV of epicardial arteries. However, intramyocardial coronary disease was mild in nine (64%) grafts. Moderate or severe interstitial fibrosis occurred in only three grafts, and in a perivascular distribution in eight. End-stage pediatric heart allografts have severe epicardial CAV and epicardial fibrosis, with relative sparing of the myocardium. Epicardial disease with sparing of the myocardium may explain the restrictive hemodynamics and relatively preserved systolic function present in these grafts at the time of re-OHT.