Pilot Validation Study on the Tavistock Relationships Observational Scale for the Assessment of the Quality of Dyadic Relationships in Couples in Which One Partner Has Dementia.

BACKGROUND AND PURPOSE: Many people with dementia are cared for by their spouses. Poor quality of the dyadic relationship is a known risk factor for carer burden and mistreatment of the person with dementia. This study aimed to design and cross validate the Tavistock Relationships Observational Scale (TROS) for assessment of the quality of the relationship in such couples. METHODS: The study was conducted within the context of the therapeutic intervention with n = 11 couples. Couples' video-recorded interactions were assessed independently by three psychologists using the 13-item TROS. RESULTS: Cronbach alphas of the scale computed for the three raters were in the range 0.76-0.88 (on average 0.83), thus demonstrating high internal consistency of the scale. Fleiss Kappa coefficient for the three rates computed for 22 assessed videos ranged between 0.45 (moderate agreement) and 0.85 (almost perfect agreement) with 50% of coefficients being above 0.50, suggesting the good performance of the TROS in terms of yielding a satisfactory inter-rater agreement. The TROS also showed good external validity when using as validation criteria caregiving partner's burden (measured with the Zarid Burden Interview: the scales Social burden [Rho = -0.65, p = 0.021] and Role strain [Rho = -0.68, p = 0.014]), depression of the person with dementia (measured with the Cornell Scale for Depression in Dementia: Rho = -0.78, p = 0.020), and relationship satisfaction of the caregiving partner (measured with the dyadic adjustment scale: Rho = 0.52, p = 0.038). The TROS also showed a good capacity to detect the change in scores from time 1 to time 2; moreover, power analysis showed that the TROS can detect the change in scores even in very small samples (n = 5 couples). CONCLUSIONS: The TROS may be a useful tool for a standardized assessment of the quality of dyadic relationships in couples with dementia in research, nursing, or clinical settings to assist clinical psychologist, nurses, or social workers in a preliminary evaluation of the situation of couples with dementia, to choose a suitable care or intervention, to assess the effectiveness of interventions focusing on improvement of dyadic relationships, or to assess the risk of spousal abuse or neglect of a person with dementia.

Tobacco Hornworm (Manduca sexta) caterpillars as a novel host model for the study of fungal virulence and drug efficacy.

The two leading yeast pathogens of humans, Candida albicans and Cryptococcus neoformans, cause systemic infections in >1.4 million patients worldwide with mortality rates approaching 75%. It is thus imperative to study fungal virulence mechanisms, efficacy of antifungal drugs, and host response pathways. While this is commonly done in mammalian models, which are afflicted by ethical and practical concerns, invertebrate models, such as wax moth larvae and nematodes have been introduced over the last two decades. To complement existing invertebrate host models, we developed fifth instar caterpillars of the Tobacco Hornworm moth Manduca sexta as a novel host model. These caterpillars can be maintained at 37°C, are suitable for injections with defined amounts of yeast cells, and are susceptible to the most threatening yeast pathogens, including C. albicans, C. neoformans, C. auris, and C. glabrata. Importantly, fungal burden can be assessed daily throughout the course of infection in a single caterpillar's feces and hemolymph. Infected caterpillars can be rescued by treatment with antifungal drugs. Notably, these animals are large enough for weight to provide a reliable and reproducible measure of fungal disease and to facilitate host tissue-specific expression analyses. M. sexta caterpillars combine a suite of parameters that make them suitable for the study of fungal virulence.

Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: Environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey).

BACKGROUND: Antibiotic-resistant bacteria (ARB) present a global public health problem. With numbers of community-acquired resistant infections increasing, understanding the mechanisms by which people are exposed to and colonised by ARB can help inform effective strategies to prevent their spread. The role natural environments play in this is poorly understood. This is the first study to combine surveillance of ARB in bathing waters, human exposure estimates and association between exposure and colonisation by ARB in water users. METHODS: 97 bathing water samples from England and Wales were analysed for the proportion of E. coli harbouring blaCTX-M. These data were used to estimate the likelihood of water users ingesting blaCTX-M-bearing E. coli. Having identified surfers as being at risk of exposure to ARB, a cross-sectional study was conducted. Regular surfers and non-surfers were recruited to assess whether there is an association between surfing and gut colonisation by blaCTX-M-bearing E. coli. RESULTS: 11 of 97 bathing waters sampled were found to contain blaCTX-M-bearing E. coli. While the percentage of blaCTX-M-bearing E. coli in bathing waters was low (0.07%), water users are at risk of ingesting these ARB. It is estimated that over 2.5 million water sports sessions occurred in 2015 resulting in the ingestion of at least one blaCTX-M-bearing E. coli. In the epidemiological survey, 9/143 (6.3%) surfers were colonised by blaCTX-M-bearing E. coli, as compared to 2/130 (1.5%) of non-surfers (risk ratio=4.09, 95% CI 1.02 to 16.4, p=0.046). CONCLUSIONS: Surfers are at risk of exposure to and colonisation by clinically important antibiotic-resistant E. coli in coastal waters. Further research must be done on the role natural environments play in the transmission of ARB.

Human recreational exposure to antibiotic resistant bacteria in coastal bathing waters.

Infections caused by antibiotic resistant bacteria (ARB) are associated with poor health outcomes and are recognised globally as a serious health problem. Much research has been conducted on the transmission of ARB to humans. Yet the role the natural environment plays in the spread of ARB and antibiotic resistance genes is not well understood. Antibiotic resistant bacteria have been detected in natural aquatic environments, and ingestion of seawater during water sports is one route by which many people could be directly exposed. The aim was to estimate the prevalence of resistance to one clinically important class of antibiotics (third-generation cephalosporins (3GCs)) amongst Escherichia coli in coastal surface waters in England and Wales. Prevalence data was used to quantify ingestion of 3GC-resistant E. coli (3GCREC) by people participating in water sports in designated coastal bathing waters. A further aim was to use this value to derive a population-level estimate of exposure to these bacteria during recreational use of coastal waters in 2012. The prevalence of 3GC-resistance amongst E. coli isolated from coastal surface waters was estimated using culture-based methods. This was combined with the density of E. coli reported in designated coastal bathing waters along with estimations of the volumes of water ingested during various water sports reported in the literature to calculate the mean number of 3GCREC ingested during different water sports. 0.12% of E. coli isolated from surface waters were resistant to 3GCs. This value was used to estimate that in England and Wales over 6.3 million water sport sessions occurred in 2012 that resulted in the ingestion of at least one 3GCREC. Despite the low prevalence of resistance to 3GCs amongst E. coli in surface waters, there is an identifiable human exposure risk for water users, which varies with the type of water sport undertaken. The relative importance of this exposure is likely to be greater in areas where a large proportion of the population enjoys water sports. Millions of water sport sessions occurred in 2012 that were likely to have resulted in people ingesting E. coli resistant to a single class of antibiotics (3GCs). However, this is expected to be a significant underestimate of recreational exposure to all ARB in seawater. This is the first study to use volumes of water ingested during different water sports to estimate human exposure to ARB. Further work needs to be done to elucidate the health implications and clinical relevance of exposure to ARB in both marine and fresh waters in order to fully understand the risk to public health.

An evaluation of time-limited psychodynamic psychotherapy for couples: a pilot study.

OBJECTIVES: Psychodynamic Couple Psychotherapy has developed as a modality in only a few organizations in the public and voluntary sectors in this country. Varieties of couple therapy have evolved due to economic or other constraints, some more open-ended, others involving differing time limits or behavioural techniques. In this study, a time limit of 40 sessions was imposed on the Psychodynamic therapy to improve comparability with other therapeutic approaches. We examined work with 18 couples, employing various measures which, while not in the context of a full controlled trial, produced some interesting and indicative results. We aimed to investigate (1) the effects of time-limited psychodynamic couple psychotherapy, and (2) whether the measures used produce interesting results after 40 weeks. DESIGN: Within a normal clinical setting, measurements of individual and couple functioning would be taken at fixed points in the course of 40-week couple therapies, and analysed for evidence of significant change. Due to funding and clinical limitations within the setting, a baseline period before therapy started was used instead of a control group. METHOD: Couples were invited to opt in to the study when applying to the agency for therapy. They were provided with 40 weekly sessions of couple therapy. Videotapes of sessions at beginning, middle, and end of the therapies were rated by independent observer, using the Personal Relatedness Profile (PRP) (Hobson, Patrick, & Valentine, 1998) adapted for couples (Lanman, Grier, & Evans, 2003), alongside two individual self-report measures, Clinical Outcomes in Routine Evaluation (CORE) (Evans et al., 2000), and the Golombok Rust Inventory of Marital Satisfaction (GRIMS) (Rust, Bennun, Crow, & Golumbok, 1990). RESULTS: The couples showed improvement as rated both by therapists and observers (rating the videotaped sessions) on the PRP after 40 sessions. On the CORE measure, participants showed improvement at both 20 and 40 sessions. On the GRIMS measure of marital satisfaction, results were non-significant. CONCLUSIONS: The results provide indicative evidence for the effectiveness of 40-session couple psychotherapy and provide some convergent validation for the utility of the PRP (as adapted for couples) as a measure of change.