Perceptions of Counseling Integration: A Survey of Counselor Educators

Counselor educators were surveyed in order to assess their knowledge of integrative counseling approaches, their views regarding the importance of such approaches, and how much emphasis on integrative counseling is given in their counseling courses. A large majority of participants reported that integration in counseling is very important and that they emphasize it in their teaching of counseling theories and/or methods courses. Implications of these findings are discussed, including suggestions for counselor educators and counseling journals

Mental Health Professionals' Comparative Evaluations of the Integral Intake, The Life-Style Introductory Interview, and the Multimodal Life History Inventory

This research study was performed in an attempt to fill an apparent void regarding the relative utility and comprehensiveness of three published, theoretically-based, idiographic, initial assessment inventories: Integral Intake (II), Life-Style Introductory Interview (LI), and Multimodal Life History Inventory (MI). “Experts” -- defined as professors of counseling or psychology and licensed practitioners who have been practicing as counselors or psychologists for at least five years - read through the inventories and then evaluated them by responding to both (qualitative) open-ended questions as well (quantitative) rankings and ratings. The researcher posed three primary research questions: 1) how do participants' evaluations differ regarding the overall helpfulness of the three inventories; 2) how do participants' evaluations differ regarding the comprehensiveness -- both relative to each of the eight dimensions of the client (thoughts, emotions, behaviors, physical aspects of the client, physical aspects of the client's environment, culture, spirituality, and what is most meaningful to the client) and overall -- of the three inventories; and 3) how do participants' evaluations differ regarding the efficiency with which the three inventories assessed the eight dimensions. Results indicated that participants consistently evaluated the II and MI as more helpful, comprehensive, and efficient than the LI - both overall and relative to the eight specific dimensions. The LI was consistently evaluated as the worst of the three inventories -- on all dimensions. The MI was evaluated as the best inventory on four dimensions: the client's thoughts, emotions, behaviors, and physical aspects. The II was evaluated as the best inventory on seven dimensions: physical aspects of the client's environment, client's culture, client's spirituality, what is most meaningful to the client, and, notably, on overall comprehensiveness, overall efficiency, and overall helpfulness. Another goal of this research was to obtain feedback from the participants relative to how to improve the II. This goal was also accomplished and the researcher will implement this feedback into subsequent versions of the Integral Intake

The Utilization of Video-Conference Shared Medical Appointments in Rural Diabetes Care

Aim To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. Methods We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013–2014. Six groups of 4–6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient’s perceptions. Results Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usual-care (9.1 ± 1.9 to 8.3 ± 1.8 vs. 8.6 ± 1.4 to 8.7 ± 1.6, P = 0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P = 0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care. Conclusion Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting. Abbreviations ACE-inhibitor, angiotensin converting enzyme-inhibitor; ARB, angiotensin receptor blocker; CBOC, community-based outpatient clinic; DM, diabetes mellitus; ED, emergency department; PACIC, patient assessment of care in chronic conditions; VAMC, Veterans Affairs Medical Center; VHA, Veterans Health Administration; video-SMA, video-shared medical appointment

Predictive significance of the six-minute walk distance for long-term survival in chronic hypercapnic respiratory failure

Background: The 6-min walk distance ( 6-MWD) is a global marker of functional capacity and prognosis in chronic obstructive pulmonary disease ( COPD), but less explored in other chronic respiratory diseases. Objective: To study the role of 6-MWD in chronic hypercapnic respiratory failure ( CHRF). Methods: In 424 stable patients with CHRF and non-invasive ventilation ( NIV) comprising COPD ( n = 197), restrictive diseases ( RD; n = 112) and obesity-hypoventilation- syndrome ( OHS; n = 115), the prognostic value of 6-MWD for long- term survival was assessed in relation to that of body mass index (BMI), lung function, respiratory muscle function and laboratory parameters. Results: 6-MWD was reduced in patients with COPD ( median 280 m; quartiles 204/350 m) and RD ( 290 m; 204/362 m) compared to OHS ( 360 m; 275/440 m; p <0.001 each). Overall mortality during 24.9 (13.1/40.5) months was 22.9%. In the 424 patients with CHRF, 6-MWD independently predicted mortality in addition to BMI, leukocytes and forced expiratory volume in 1 s ( p <0.05 each). In COPD, 6-MWD was strongly associated with mortality using the median {[} p <0.001, hazard ratio ( HR) = 3.75, 95% confidence interval (CI): 2.24-6.38] or quartiles as cutoff levels. In contrast, 6-MWD was only significantly associated with impaired survival in RD patients when it was reduced to 204 m or less (1st quartile; p = 0.003, HR = 3.31, 95% CI: 1.73-14.10), while in OHS 6-MWD had not any prognostic value. Conclusions: In patients with CHRF and NIV, 6-MWD was predictive for long- term survival particularly in COPD. In RD only severely reduced 6-MWD predicted mortality, while in OHS 6-MWD was relatively high and had no prognostic value. These results support a disease-specific use of 6-MWD in the routine assessment of patients with CHRF. Copyright (C) 2007 S. Karger AG, Basel

Structural plasticity of the cardiac nuclear pore complex in response to regulators of nuclear import

Abstract-Communication between the cytoplasm and nucleoplasm of cardiac cells occurs by molecular transport through nuclear pores. In lower eukaryotes, nuclear transport requires the maintenance of cellular energetics and ion homeostasis. Although heart muscle is particularly sensitive to metabolic stress, the regulation of nuclear transport through nuclear pores in cardiomyocytes has not yet been characterized. With the use of laser confocal and atomic force microscopy, we observed nuclear transport in cardiomyocytes and the structure of individual nuclear pores under different cellular conditions. In response to the depletion of Ca 2ϩ stores or ATP/GTP pools, the cardiac nuclear pore complex adopted 2 distinct conformations that led to different patterns of nuclear import regulation. Depletion of Ca 2ϩ indiscriminately prevented the nuclear import of macromolecules through closure of the nuclear pore opening. Depletion of ATP/GTP only blocked facilitated transport through a simultaneous closure of the pore and relaxation of the entire complex, which allowed other molecules to pass into the nucleus through peripheral routes. The current study of the structural plasticity of the cardiac nuclear pore complex, which was observed in response to changes in cellular conditions, identifies a gating mechanism for molecular translocation across the nuclear envelope of cardiac cells. The cardiac nuclear pore complex serves as a conduit that differentially regulates nuclear transport of macromolecules and provides a mechanism for the control of nucleocytoplasmic communication in cardiac cells, in particular under stress conditions associated with disturbances in cellular bioenergetics and Ca 2ϩ homeostasis. (Circ Res. 1999;84:1292-1301.

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The integral intake: A guide to comprehensive idiographic assessment in integral psychotherapy.

Using formal assessment instruments in counseling and psychotherapy is an efficient and systematic way to obtain information about clients and to subsequently tailor a counseling approach most likely to serve clients optimally. The more information a counselor obtains during the initial interview and first sessions, the more likely the client will be deeply understood by the counselor, which in turn increases the likelihood that an appropriate course of counseling will be taken, and ultimately leading to a more successful outcome. The Integral Intake is an idiographic, biographical, multidimensional assessment instrument based upon the Integral Psychology pioneered by Ken Wilber. From the perspective of Integral theory, comprehensive and holistic conceptualization of clients seeking counseling and psychotherapy includes knowledge of four distinct perspectives (quadrants) of each client: the client’s experience (the individual viewed subjectively/from within), the client’s behavior (the client viewed objectively/from without), the client’s culture (the client’s system viewed subjectively/from within), and the client’s social system (the client’s system viewed objectively/from without). The intake form is designed to provide the practitioner with a range of background information that can then be used to more quickly and effectively formulate a counseling/treatment approach. The assessment form and accompanying materials will be included on a companion CD, formatted to be printed and reproduced for use with each new client. The book will provide an overview of the Integral Psychology model, describe the development of the assessment form and its use, and provide general guidelines for the evaluation of responses and planning for an appropriate counseling approach. A series of case examples, based on actual completed intake forms, will provide insight into the use of the Integral Intake

What is integral theory?

Integral theory is a way of knowing that helps foster the recognition that disparate aspects of reality—such as biological constitution, cultural world-views, felt-sense of selfhood, and social systems—are all critically important to any knowledge quest. Integral theory provides an “all quadrants, all levels” (K. Wilber, 2006, p. 26) metatheoretical framework that simultaneously honors the important contributions of a broad spectrum of epistemological outlooks while also acknowledging the parochial limits and misconceptions of those perspectives. In other words, integral theory affords a perspective that allows counselors to situate diverse knowledge approaches in such a way that they synergistically complement, rather than contradict, one another