The Working Alliance Inventory's Measurement Properties:A Systematic Review

Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989-2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies

Bacterial Oncotraits Rather than Spatial Organization Are Associated with Dysplasia in Ulcerative Colitis

Background and Aims: Colonic bacterial biofilms are frequently present in ulcerative colitis [UC] and may increase dysplasia risk through pathogens expressing oncotraits. This prospective cohort study aimed to determine [1] the association of oncotraits and longitudinal biofilm presence with dysplasia risk in UC, and [2] the relation of bacterial composition with biofilms and dysplasia risk. Methods: Faeces and left- and right-sided colonic biopsies were collected from 80 UC patients and 35 controls. Oncotraits [FadA of Fusobacterium, BFT of Bacteroides fragilis, colibactin [ClbB] and Intimin [Eae] of Escherichia coli] were assessed in faecal DNA with multiplex quantitative polymerase chain reaction [qPCR]. Biopsies were screened for biofilms [n=873] with 16S rRNA fluorescent in situ hybridiation. Shotgun metagenomic sequencing [n=265], and ki67-immunohistochemistry were performed. Associations were determined with a mixed-effects regression model. Results: Biofilms were highly prevalent in UC patients [90.8%] with a median persistence of 3 years (interquartile range [IQR] 2-5 years). Biofilm-positive biopsies showed increased epithelial hypertrophy [p=0.025] and a reduced Shannon diversity independent of disease status [p=0.015], but were not significantly associated with dysplasia in UC: adjusted odds ratio [aOR] 1.45, 95% confidence interval [CI] 0.63-3.40. In contrast, ClbB independently associated with dysplasia [aOR 7.16, 95% CI 1.75-29.28], and FadA and Fusobacteriales were associated with a decreased dysplasia risk in UC [aOR 0.23, 95% CI 0.06-0.83, p<0.01]. Conclusions: Biofilms are a hallmark of UC; however, because of their high prevalence are a poor biomarker for dysplasia. In contrast, colibactin presence and FadA absence independently associate with dysplasia in UC and might therefore be valuable biomarkers for future risk stratification and intervention strategies

Activity Participation and Perceptions on Informal Public Transport and Bus Rapid Transit in Dar es Salaam

This paper seeks to understand participation in out-of-home activities by inhabitants in Dar es Salaam, and their perceptions toward informal public transport (IPT) and bus rapid transit (BRT) in supporting these activities. Without fixed schedules, IPT (e.g., minibuses, motorcycles, and tricycles) is used as a means of transport for different trips. However, IPT is burdened by poor roads, traffic congestion, and high transport demand. Many developing cities are seeking to replace IPT with formal BRT lines. However, little is known in relation to the ability of IPT and BRT to support out-of-home activity participation of the inhabitants. This paper reports on a study in Dar es Salaam exploring the relative contribution of each type of service. The study took place before the opening of BRT, and encompasses focus group discussions, participatory geographical information systems, and questionnaires carried out in two study zones: one close to a BRT corridor and the other in a peri-urban location. The findings show that IPT was used to support participation in daily activities like work, education, shopping, and social matters; and was perceived to be flexible in providing access to both high and low density unplanned settlements. The BRT was viewed to benefit specific groups of people, especially individuals working in permanent offices in and around the city center, particularly professional workers. This paper sheds light on how the two systems were perceived by the local people and can inform policy makers about possible improvements in public transport systems to support activity participation of their inhabitants

To cloud or not to cloud: A context-aware deployment perspective of augmented reality mobile applications

The resource limitations of mobile devices continue to impose constraints on the development of complex mobile applications. Performance and resource eefficiency remains a challenge. We have examined resource utilization and performance tradeoffs when extending an Augmented Reality (AR) application with context-awareness and cloud computing. The hypothesis is that the cost of these technologies is worth the benefits they result in. Our measurements show that filtered image datasets obtained through context-awareness result in lower latency and a reduced memory load when performing all AR computations on the mobile device. However, a cloud computing AR application does not benefit from in-depth context-awareness, as no part of the dataset is stored locally and the latency is approximately constant, relative to the Internet connectivity.status: publishe

Evaluation of the applicability of internal controls on self-collected samples for high-risk human papillomavirus is needed

Background Self-collection of cervical samples to detect high-risk human papillomavirus (hr-HPV) is a trending topic in primary cervical cancer screening. This study evaluates the applicability of a self-sampling device to routine molecular procedures for hr-HPV detection.Methods In a primary health care facility in Kinshasa, Congo, 187 self-collected samples (Evalyn Brush) were gathered and sent to Ghent University Hospital (UZ Ghent) and Algemeen Medisch Labo (AML) in Belgium where routine tests for hr-HPV were applied (Abbott RealTime hr-HPV and qPCR (E6/E7), respectively). Sample type effect was evaluated by comparing the internal control (IC) between the self-collected samples and routine, clinician-taken samples randomly selected from the UZ Ghent archive.Results In UZ Ghent an error was encountered in 9.1% (17/187) of self-collected samples due to a lack of IC signal. The hr-HPV prevalence in the remaining 170 samples was 18,8%. Comparing IC results between the self-collected and clinician-collected groups, a significant difference (p < 0,001) was found, with higher IC signals in the clinician-collected group. In AML, an error was encountered in 17.6% (33/187) of samples, including 16/17 of the UZ Ghent. The remaining sample with IC error gave a negative result in AML. Among the 154 samples without IC error at AML, a correlation of 90% was seen between both laboratories with a 77% negativity rate.Conclusion Testing the self-collected specimens by 2 routine hr-HPV tests gave a high IC error rate (9.1-17.6%). A possible solution would be to differentiate cut-offs for IC values depending on sample type, as currently used cut-offs are set for clinician-taken samples

Evaluation of the applicability of internal controls on self-collected samples for high-risk human papillomavirus is needed

Abstract Background Self-collection of cervical samples to detect high-risk human papillomavirus (hr-HPV) is a trending topic in primary cervical cancer screening. This study evaluates the applicability of a self-sampling device to routine molecular procedures for hr-HPV detection. Methods In a primary health care facility in Kinshasa, Congo, 187 self-collected samples (Evalyn Brush) were gathered and sent to Ghent University Hospital (UZ Ghent) and Algemeen Medisch Labo (AML) in Belgium where routine tests for hr-HPV were applied (Abbott RealTime hr-HPV and qPCR (E6/E7), respectively). Sample type effect was evaluated by comparing the internal control (IC) between the self-collected samples and routine, clinician-taken samples randomly selected from the UZ Ghent archive. Results In UZ Ghent an error was encountered in 9.1% (17/187) of self-collected samples due to a lack of IC signal. The hr-HPV prevalence in the remaining 170 samples was 18,8%. Comparing IC results between the self-collected and clinician-collected groups, a significant difference (p < 0,001) was found, with higher IC signals in the clinician-collected group. In AML, an error was encountered in 17.6% (33/187) of samples, including 16/17 of the UZ Ghent. The remaining sample with IC error gave a negative result in AML. Among the 154 samples without IC error at AML, a correlation of 90% was seen between both laboratories with a 77% negativity rate. Conclusion Testing the self-collected specimens by 2 routine hr-HPV tests gave a high IC error rate (9.1–17.6%). A possible solution would be to differentiate cut-offs for IC values depending on sample type, as currently used cut-offs are set for clinician-taken samples

Novel LC-MS/MS method for plasma vancomycin: Comparison with immunoassays and clinical impact

Accurate quantification of vancomycin in plasma is important for adequate dose-adjustment. As literature suggests between-method differences, our first objective was to develop a novel liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for total vancomycin in human plasma and to compare frequently used immunoassays with this method. Secondly, we investigated the clinical impact of between-method quantification differences.publisher: Elsevier articletitle: Novel LC–MS/MS method for plasma vancomycin: Comparison with immunoassays and clinical impact journaltitle: Clinica Chimica Acta articlelink: http://dx.doi.org/10.1016/j.cca.2014.12.012 content_type: article copyright: Copyright © 2014 Elsevier B.V. All rights reserved.status: publishe