Lost in translation: Therapeutic Alliance as a mediator in the relationship between teletherapy and marital satisfaction.

The global impact of the SARS-COV-2 pandemic necessitated a rapid shift to online/teletherapy psychotherapy services. While research suggests the feasibility and efficacy of teletherapy, there is limited investigation into couple teletherapy's impact on satisfaction and therapeutic alliance. This study aimed to address this gap by examining changes in couple satisfaction during tele- and in-person therapy sessions over 12 sessions and exploring whether therapeutic alliance development mediates these changes. Using growth curve modeling in a sample of 416 couples, it found that teletherapy participants initially reported higher couple satisfaction, but improvement in this domain was slower than in-person therapy recipients. The development of the therapeutic alliance mediated this effect via two indirect paths. Implications include the need for focused attention on alliance development in teletherapy and more empirically-informed approaches in couple teletherapy.

Validation of the intersession alliance measure: Individual, couple, and family versions.

Monitoring the therapeutic alliance throughout treatment can improve client outcomes and lead to improved care. The individual, couple, and family versions of the intersession alliance measure (IAM) were developed to facilitate routine monitoring of the expanded therapeutic alliance. Psychometric properties of the three versions of the IAM were examined using a clinical sample. Participants were drawn from clinics in the United States participating in the Marriage and Family Therapy Practice Research Network. Using this sample, results indicate that items on each version of the IAM load on one factor, are invariant across sex, and that each version has good internal consistency, test-retest reliability, and concurrent validity. The IAM-C and IAM-F also have good predictive validity, while the IAM-I has more limited evidence for its predictive validity. These results suggest that the IAMs are valid and reliable measures that can facilitate the routine monitoring of the expanded therapeutic alliance in psychotherapy.

Call me maybe? In-person vs. teletherapy outcomes among married couples.

ABSTRACTObjective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance.Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.

Family processes: Risk, protective and treatment factors for youth at risk for suicide.

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components have been incorporated into most youth suicide treatments. Unfortunately research on if these family processes moderator, mediator or change as a result of treatment is limited. Recommendations for future research are offered.

Associations between alcohol use and peripheral, genetic, and epigenetic markers of oxytocin in a general sample of young and older adults.

INTRODUCTION: Human and nonhuman animal research suggests that greater oxytocin (OT) activity is protective against harmful substance use. Most research on this topic is preclinical, with few studies evaluating the association between substance use and individual differences in the human OT system. The present study sought to fill this gap by evaluating the relationship between alcohol use and multiple biological measures of OT activity in an overall low to moderate-drinking sample. METHOD: As part of a larger study, generally healthy young (n = 51) and older (n = 53) adults self-reported whether they regularly used alcohol and how much alcohol they consumed per week. Participants also provided blood samples from which peripheral OT, and in an age-heterogeneous subset of participants (n = 56) variation in the oxytocin receptor gene (the OXTR rs53576 polymorphism) and OXTR DNA methylation levels (at cytosine-guanine dinucleotide sites -860, -924, -934), were obtained. RESULTS: A-allele carriers of the OXTR rs53579 polymorphism were less likely to regularly consume alcohol. Among regular alcohol consumers, number of alcoholic drinks per week was positively associated with peripheral OT in regression models excluding observations of high influence (postdiagnostic models). Number of alcoholic drinks per week was consistently negatively associated with OXTR DNA methylation at site -860; and with OXTR DNA methylation at site -924 in postdiagnostic models. CONCLUSIONS: The significant associations between alcohol use and individual differences in OT activity support the involvement of the OT system in alcohol use, which most likely reflect the role of OT when alcohol use is under control of its rewarding properties and/or the acute impacts of alcohol on the OT system. Additional research with markers of OT activity and alcohol use, particularly longitudinal, is needed to clarify the bidirectional effects of OT and alcohol use in moderate to harmful drinking and dependence.

Family relationships and the interpersonal theory of suicide in a clinically suicidal sample of adolescents.

In a sample of suicidal adolescents (N = 117), we sought to identify how adolescents' attachment to their parents related to a key mechanism of suicide from the Interpersonal Theory of Suicide (IPTS). We tested both attachment-anxiety and attachment-avoidance, to both mother- and father-figures as correlates of the IPTS construct, perceived burdensomeness (PB). In addition, we tested PB as a mediator between these attachment variables and adolescent suicide ideation in a path analysis. Our path analysis indicated both mother- and father-related attachment anxiety were associated with PB and PB was related to suicide ideation. We also found an indirect effect of father-related attachment anxiety on suicide ideation. This study provides empirical support for earlier systemic work that proposes how family relationships may influence an adolescent's suicidal ideation. Finally, we provide practical clinical suggestions for how therapists may implement a systemic framework to address a suicidal adolescent and their family relationships.

Review of family-based treatments from 2010 to 2019 for suicidal ideation and behavior.

Suicide ideation and behavior are pervasive public health issues. Given that positive interpersonal relationships can be a protective factor against suicide risk, we conducted a systematic review to examine peer-reviewed publications from 2010 to 2019 that included empirical data, tested an intervention with at least some family component, and included a suicide-related outcome measure. We reviewed and synthesized findings from 22 articles covering 7 intervention categories with 12 interventions to examine the treatment components and the quality of evidence to support them. Using Southam-Gerow and Prinstein's (Child Adolesc Psychol 43:16, 2014) guidelines, we identified two well-established intervention categories that met the highest standards for interventions and three probably efficacious intervention categories. All interventions found focused solely on suicide risk in adolescent populations. More studies are needed for adult populations and to explore the role of family moderators and mediators to test whether suicide outcomes are reduced by improvement in the family environment.

Superior gluteal artery injury risk from third sacral segment transsacral screw insertion.

OBJECTIVES: Iliosacral (IS) and transsacral (TS) screws are commonly used to stabilize pelvic ring injuries. The course of the superior gluteal artery (SGA) can be close to implant insertion paths. The third sacral segment (S3) has been described as a viable osseous fixation pathway (OFP) but the proximity of the SGA to the S3 screw path is unknown. METHODS: Fifty uninjured patients with contrasted pelvic computed tomograms (CTA) were identified with an S3 path large enough for a 7.0 mm TS screw. Starting sites for S1 IS or TS, S2 and S3 TS screws were located on the volume rendered lateral CTA image and transferred onto the surface rendered 3D CTA with the SGA clearly visible. The distance from screw start sites to the SGA was measured. A distance less than 3.5 mm was considered likely for injury. RESULTS: The average distances from screw start sites to the SGA were 23.0 ± 7.9 mm for S1 IS screws, 14.3 ± 6.4 mm for S2 TS screws and 25.9 ± 6.5 mm for S3 TS screws. No S1 IS screws, 5 S2 TS screws (10%), and no S3 TS screws were projected to cause injury to the SGA. CONCLUSIONS: The osseous start site and soft tissue path for an S3 TS screw is remote from the SGA. The S1 IS and S3 TS pathways are further away from the SGA while the S2 TS pathway is closer and may theoretically pose a higher injury risk in patients with an available S3 OFP.

Chemical surface modification of lithium disilicate needles of a silica-based ceramic after HF-etching and ultrasonic bath cleaning: Impact on the chemical bonding with silane.

OBJECTIVE: Recommendations to obtain the best bonding to silica-based ceramics are to prepare its surface by hydrofluoric-acid HF etching and regular application of a silane. This study investigated how the HF-etching following by ultrasonic water bath cleaning (recommended protocol to improve the bonding with a composite resin), modifies the surface chemistry of a lithium disilicate glass-ceramic and impacts the chemical bonding with silane. METHODS: Lithium disilicate glass-ceramic discs (IPS Emax Press, Ivoclar Vivadent) were mirror polished, etched with 9% HF for 20 s and rinsed 1 min under water. Two post-etching cleaning were compared: (1) no additional cleaning and (2) immersion in water ultrasonic bath for 4 min. Morphology evolution of the surfaces was carried out by scanning electron microscopy. Chemical changes were studied using X-ray Photoelectron Spectroscopy and Nano Auger Electron Spectroscopy analyses. Identification of the compounds formed with fluorine was based on by High Resolution Transmission Tlectronic Microscopy . RESULTS: Residues left on the surface of the discs after etching, the fluorine salts, were eliminated after the ultrasonic bath cleaning. However, analyses showed presence of fluorine on the lithium disilicate needles associated among others with the lithium. HR-TEM validates the presence of Li2SiF6 crystallized phased. A mechanism to explain silane bonding when Li2SiF6 phase is formed on the Li2Si2O5 needles, is proposed. SIGNIFICANCE: HF-etching leads to the formation of lithium and fluorine contain LiSi2F6 nano-precipitates on the Li2Si2O5 needles which helps to improve the bonding with silane.

[Comparison of sterile donor tomography in the eye bank and graft tomography after penetrating keratoplasty]. / Vergleich der sterilen Spendertomographie in der Hornhautbank mit der Tomographie des Transplantates nach perforierender Keratoplastik.

BACKGROUND: Since 2018 we routinely use sterile donor tomography in the eye bank to avoid refractive surprises after keratoplasty. The purpose of this study was to compare donor tomography parameters measured with anterior segment optical coherence tomography (AS-OCT) with tomography parameters of the graft after penetrating keratoplasty (PKP). METHODS: This study enrolled 193 eye bank donor corneal tissues used for PKP (graft diameter 8.2 ± 0.7 mm). Preoperative measurements were taken using the AS-OCT Casia 2 (Tomey, Nagoya, Japan). The measurements were repeated postoperatively after 5 ± 4 months with all sutures in place and after 22 ± 4 months after removal of all sutures. Preoperative and postoperative values were compared using a Wilcoxon signed-rank test. RESULTS: Postoperatively, with all sutures in place (or without sutures), the dioptric power (P) at the anterior surface (a) of the cornea remained unchanged (-0.2 D, p = 0.78) (2.7 D bigger, p < 0.01) in the steep meridian (S) (PaS) and 4.5 D (2.8 D, p < 0.01) smaller in the flat meridian (F) (PaF) in comparison with the donor tomography values. The astigmatism (a) was 4.3 D (5.4 D, p < 0.01) bigger. At the posterior surface (p) the PpS was 0.9 D (0.9 D, p < 0.01) and PpF 0.3 D (p < 0.01) (0.1 D, p = 0.42) smaller, while the astigmatism (p) was 0.7 D (0.9 D) bigger (p < 0.01). The central corneal thickness was 55.7 µm (p < 0.01) (27.5 µm, p = 0.01) smaller. The total power of the transplant after removal of all sutures did not change significantly in comparison with the eye bank measurements. CONCLUSION: Central corneal thickness, dioptric power (P) and astigmatism all changed postoperatively compared to donor tomography values, except P at the steep meridian of the anterior corneal surface with all sutures in place and P at the flat meridian of the posterior corneal surface after removal of all sutures; however, the total power of the transplant after removal of all sutures did not change significantly. This information may be of value for IOL power calculation in the classical triple procedure.

Experiences of Suicide in Transgender Youth: A Qualitative, Community-Based Study.

Objective: The aim was to develop understanding around the experience of suicide in transgender youth. Method: Qualitative analysis with 85 interviews with transgender youth about their histories with suicidality was performed. Participants were recruited from community clinics in three counties (United States, Canada, and Ireland) between 2010 and 2014. Results: Factors that precipitated participants' suicide attempts included rejection based on gender identity and gender dysphoria. Participants demonstrated resilience by attempting to connect with loved ones for support and through self-awareness of mental states, including by regulating behaviors they perceived to adversely affect their mental health. Conclusions: Transgender youth may fear seeking health care due to health professionals' lack of understanding of transgender issues and fear of further victimization. Reframing suicidality as a rational decision-making process in response to stress may further understanding of why people attempt suicide and provide new avenues for intervention.

Testing Basic Assumptions of the Interpersonal Needs Questionnaire-15 in a Sample of Clinically Depressed and Suicidal Youth.

OBJECTIVE: Suicide is a leading cause of death in adolescence. The mechanisms of adolescent suicidality, however, are not fully understood. Although the Interpersonal-Psychological Theory of Suicide, as assessed by the Interpersonal Needs Questionnaire-15 (INQ), may be a promising framework, systematic study of its utility during adolescence is lacking. METHOD: To this end, we utilized factor analyses and hierarchical regression analyses to test the factor structure, correlates, and predictive validity of the INQ in a sample of clinically depressed and suicidal adolescents (N = 120, aged 12-18). The sample was mostly female (81.9%), ethnically diverse (68.2% non-White) and with nearly a third identifying as a sexual minority (31.8%). RESULTS: Contrary to studies including adult samples in which a two-factor solution is identified, results within this sample indicated three factors: perceived burdensomeness, thwarted belongingness, and perceived isolation. Perceived burdensomeness and the interaction between perceived burdensomeness and perceived isolation predicted suicide ideation above and beyond depression, but thwarted belongingness and perceived isolation did not. CONCLUSION: Perceived burdensomeness appears to play a role in adolescent suicidality and may be a point of intervention, yet the notable deviation from previous findings and the relative weakness of two of the factors warrant further study.

Characterization of acute hearing changes in United States military populations.

Until recently, most hearing conservation programs, including those in the military, have used permanent shifts in the pure-tone audiometric threshold as the gold standard for measuring hearing impairment in noise-exposed populations. However, recent results from animal studies suggest that high-level noise exposures can cause the permanent destruction of synapses between the inner hair cells and auditory nerve fibers, even in cases where pure-tone audiometric thresholds eventually return to their normal pre-exposure baselines. This has created a dilemma for researchers, who are now increasingly interested in studying the long-term effects that temporary hearing shifts might have on hearing function, but are also concerned about the ethical considerations of exposing human listeners to high levels of noise for research purposes. One method that remains viable to study the effects of high noise exposures on human listeners, or to evaluate the efficacy of interventions designed to prevent noise-related inner ear damage, is to identify individuals in occupations with unavoidable noise exposures and measure hearing before and as soon as possible after exposure. This paper discusses some of the important factors to be considered in studies that attempt to measure acute hearing changes in noise-exposed military populations.

Anthelmintic drugs used in equine species.

Internal parasites of horses comprise an intractable problem conferring disease, production and performance losses. Parasitism can rarely be controlled in grazing horses by management alone and anthelmintic drugs have formed the basis of therapy and prophylaxis for the last sixty years. The pharmacology of the anthelmintic drugs available dictate their spectrum of activity and degree of efficacy, their optimal routes of administration and characteristics which prevent some routes of administration, their safety tolerance and potential toxicities and as a consequence of their persistence in the body at effective concentrations their use in epidemiological control programmes. Their use has also resulted in the selection of parasites with genetically controlled characteristics which reduce their susceptibility to treatment, characteristics which are often common to whole chemical classes of anthelmintics. Pharmacological properties also confer compatibility in terms of safety and persistence with other anthelmintic drugs and thus the potential of combinations to treat parasites from different phylogenetic groups such as nematodes, cestodes and trematodes and also the potential by agency of their different molecular mechanisms of action to delay the selection of resistant genes. The major groups of anthelmintics now available, the benzimidazoles (BZD), macrocyclic lactones (MLs) and tetrahydropyrimidines are all highly effective against their targeted parasites (primarily nematodes for BZD's and ML's and cestodes for tetrahydropyrimidines) easily administered orally to horses and are well tolerated with wide margins of safety. Nevertheless, some parasitic stages are inherently less susceptible such as hypobiotic stages of the small strongyles (cyathostomins) and for some such as the adult stages of cyathostomins resistance has developed. Furthermore, for some less common parasites such as the liver fluke unlicensed drugs such as the salicylanilide, closantel have been used. A deep understanding of the pharmacology of anthelmintic drugs is essential to their optimal use in equine species.

MR arthrogram of the postoperative glenoid labrum: normal postoperative appearance versus recurrent tears.

OBJECTIVE: The purpose of this study is to describe the MR arthrogram appearance of the postoperative glenoid labrum and to describe the features consistent with recurrent tear. MATERIALS AND METHODS: We identified 30 patients who had undergone glenoid labral repair, had a subsequent MR arthrogram of his or her shoulder, and went on to repeat shoulder arthroscopy. Each MR arthrogram was reviewed blindly, and the glenoid labrum was described as normal, irregular, or torn. Additional findings recorded included the presence or absence of a paralabral cyst and suture anchors in the glenoid. The operative report was also reviewed for each patient to determine the status of the labrum at arthroscopy. RESULTS: Following consensus review, 18/30 MRIs were felt to demonstrate recurrent glenoid labral tear, 11/30 showed an irregular labrum, and 1/30 was called normal. The radiology impression regarding the presence or absence of a recurrent glenoid labral tear agreed with the operative report in 24/30 (80%) cases, and was discrepant in six. This equals 83.3% sensitivity and 81.8% specificity of MR arthrogram in the diagnosis of recurrent labral tear in this study. A paralabral cyst was present in 3/30 (10%) cases, all three of which were torn. CONCLUSIONS: MR arthrogram findings of signal equal to gadolinium or fluid within or underlying the glenoid labrum and markedly diminutive or absent labrum were the most useful features to diagnose recurrent tear. Some signal underlying the labrum, which is confined to the anterosuperior quadrant, may be normal. The secondary finding of a paralabral cyst was also highly sensitive for recurrent tear.

Treatment For Suicidal Thoughts and Behavior: A Review of Family-Based Interventions.

The purpose of this article is to review the scientific evidence on the effects of family based interventions for suicidal ideation and behavior. We conducted an extensive search of electronic databases using a comprehensive search strategy. This search resulted in 16 studies that tested 13 interventions for treating suicidal ideation and behavior using family based interventions. Of the interventions identified, three yielded an overall improvement in suicidal ideation and behavior while an additional three interventions produced partial improvement in mental health symptoms. These studies targeted suicidal ideation and behavior in youth or adolescents while no studies examined family interventions for adults with suicidal ideation and behavior. The limitations of these studies and the need for additional research are examined.

A call to engage youth in health research.

Community-based participatory research (CBPR) is characterized by its collaborative efforts between professional researchers and lay community members to design, implement, and iteratively evaluate interventions. This approach creates knowledge and improves practice in ways that reflect the collective wisdom and expertise of all involved stakeholders. It represents a significant departure from conventional "top down" methods that define "collaboration" as professionals working with each other-but not with patients and families. It is our position, however, that these exciting developments are only most visible in adult medicine. We believe that it is important to engage youth in health-related CBPR for three primary reasons which are provided in this article. Examples of youth-engagement in health research are also provided. It is important that we do not leave our youth on the sidelines as we advance health care research. During this critical time in health care, we must endeavor to engage our youth as active stakeholders. As we use methods that bridge our professional expertise with teens' lived experience and wisdom, we can create sustainable interventions that are effective in preventing or mitigating the conditions that weigh most heavily on us all. (PsycINFO Database Record

In vitro pharmacodynamics of gamithromycin against Mycoplasma mycoides subspecies mycoides Small Colony.

Mycoplasma mycoides mycoides Small Colony (MmmSC) is the causative agent of contagious bovine pleuropneumonia (CBPP), which is responsible for major economic losses in sub-Saharan Africa. Current control relies on live attenuated vaccines, which are of limited efficacy, and antimicrobials are now being assessed as an alternative or adjunct to vaccination. The objective of this study was to determine the in vitro effector kinetics of the macrolide antimicrobial, gamithromycin, against MmmSC in artificial medium and adult bovine serum. Furthermore, it was determined if any differences in gamithromycin activity between these two matrices were mirrored by the older macrolides, tylosin and tilmicosin. Minimum inhibitory concentrations (MICs) for gamithromycin, tylosin and tilmicosin against MmmSC strains B237 and Tan8 were determined in artificial medium and serum. Time-kill curves were constructed at concentrations corresponding to multiples of the MIC for all three macrolides in artificial medium and for gamithromycin in serum. Data were fitted to sigmoid Emax models. Post-antibiotic effects (PAE) were established by exposing strain B237 to antimicrobials at 10× MIC for 1h and monitoring mycoplasma growth thereafter. MICs for gamithromycin, tylosin and tilmicosin were 64-, 8- and 64-fold lower, respectively, in serum than in artificial medium at an inoculum size of 10(6)cfu/mL B237. A similar pattern emerged for Tan8. All three antimicrobials were mycoplasmastatic with maximum effects of -0.44, -0.32 and -0.49log10(cfu/mL) units for gamithromycin, tylosin and tilmicosin, respectively, against B237 in artificial medium. Tylosin and tilmicosin elicited longer PAEs than gamithromycin. In conclusion, gamithromycin, tylosin and tilmicosin all demonstrated in vitro efficacy against MmmSC and represent potential candidates for clinical studies to assess their therapeutic effect against CBPP.

Evaluation of antimicrobial activity against Mycoplasma mycoides subsp. mycoides Small Colony using an in vitro dynamic dilution pharmacokinetic/pharmacodynamic model.

The objectives of this study were to assess the activity of oxytetracycline (OTC), danofloxacin and tulathromycin against Mycoplasma mycoides subsp. mycoides Small Colony, the causative agent of contagious bovine pleuropneumonia, in an in vitro dynamic concentration model and to determine the concentration and/or time dependence of such activity. Time-kill assays that simulated elimination of antimicrobials from the body were performed. Initial antimicrobial concentrations corresponded to various multiples of the MIC and cultures were diluted in a stepwise fashion with either drug-free or drug-containing artificial medium to mimic administration by single-release bolus or infusion, respectively. Where appropriate, data were fitted to sigmoidal E(max) models. OTC produced no change in mycoplasma titre from the initial inoculum size, regardless of the concentration or means of drug exposure. Both danofloxacin and tulathromycin resulted in a decrease in mycoplasma titre but neither was bactericidal (99.9 % kill) over 12 h. A greater antimycoplasmal effect, defined as the change in log(10) (c.f.u. ml(-1)) over 12 h, was achieved when danofloxacin was administered as a single-release bolus, suggesting concentration-dependent activity, whereas the antimycoplasmal effect of tulathromycin was comparable following administration by single-release bolus or infusion, owing to its long half-life.