Anxiety and depression: a model for assessment and therapy in primary care

Patients who feel anxious and depressed often turn to primary care for initial professional help. However, systematic service evaluations allege poor standards of diagnosis and treatment, resulting in disappointing clinical outcomes. All the same, special educational and quality improvement initiatives have not raised standards significantly. Why this should be so and possible remedies are suggested by this article, on the basis that the empirical evidence base for criticising primary care standards is weaker than commonly acknowledged. Systematic clinical trials are often premised by assumptions that are not relevant to primary care, they tend to select subject populations unrepresentative of those typically seen by general practitioners and results are often compromised by a series of methodological flaws. This article proposes an alternative conceptualisation of anxiety and depression apposite to primary care assessment and therapy. It draws on an emergent evidence base within psychobiology that recognises that these reactions have two adaptive functions. Firstly, they are responses evoked by actual personal adversity, secondly they have the function of prompting communication to self and to others of the need for practical remedial action to be taken independently, or with assistance, to improve the quality of the recovery environment. A table summarises the phased stages of anxiety and depression and lists their adaptive and communicative functions along with some phase-appropriate primary care interventions. This new model of assessment and therapy is offered to stimulate discussion and inspire future research that is appropriate for primary care service improvement

How to Grow Corn

A lot of things can make the difference between a good and poor corn crop. Some you can control - others you can\u27t. Here\u27s a roundup of present know-how about the factors you can\u27t control

Engineered Carrier with a Long Time of Flight (TOF) to Improve Drug Delivery From Dry Powder Inhalation Aerosols

A lactose carrier with long TOF was engineered to improve drug deposition from DPIs. The particles were engineered by contacting spray-dried particles with a solvent in which these have a poor solubility. The process increased the particles hollow volume without affecting their original shape. The long TOF was demonstrated by carrier deposition in the lower stage of the TSI, which was up to 9 -fold higher compared to the conventional lactose. The highest deposition of the long TOF carrier was obtained at the lowest inhalation flow rate (24 L/min). The % Fine Particle Fraction of salbutamol sulphate was up to 50% when long TOF carrier was used. Importantly, this study has shown that adhesion drug/carrier has no negative effect on drug deposition, when a long TOF carrier is used

Effectiveness and cost-effectiveness of an educational intervention for practice teams to deliver problem focused therapy for insomnia: rationale and design of a pilot cluster randomised trial

Background: Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life. Many of those whose lives are affected seek medical help from primary care. Drug treatment is ineffective long term. Psychological methods for managing sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered. This paper outlines the protocol for a pilot study designed to evaluate the effectiveness and cost-effectiveness of an educational intervention for general practitioners, primary care nurses and other members of the primary care team to deliver problem focused therapy to adult patients presenting with sleep problems due to lifestyle causes, pain or mild to moderate depression or anxiety. Methods and design: This will be a pilot cluster randomised controlled trial of a complex intervention. General practices will be randomised to an educational intervention for problem focused therapy which includes a consultation approach comprising careful assessment (using assessment of secondary causes, sleep diaries and severity) and use of modified CBTi for insomnia in the consultation compared with usual care (general advice on sleep hygiene and pharmacotherapy with hypnotic drugs). Clinicians randomised to the intervention will receive an educational intervention (2 × 2 hours) to implement a complex intervention of problem focused therapy. Clinicians randomised to the control group will receive reinforcement of usual care with sleep hygiene advice. Outcomes will be assessed via self-completion questionnaires and telephone interviews of patients and staff as well as clinical records for interventions and prescribing. Discussion: Previous studies in adults have shown that psychological treatments for insomnia administered by specialist nurses to groups of patients can be effective within a primary care setting. This will be a pilot study to determine whether an educational intervention aimed at primary care teams to deliver problem focused therapy for insomnia can improve sleep management and outcomes for individual adult patients presenting to general practice. The study will also test procedures and collect information in preparation for a larger definitive cluster-randomised trial. The study is funded by The Health Foundation

Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence Them? Application of Theoretical Domains Framework

Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and facilitators (B&Fs) to smoking cessation in pregnancy; to detect priority areas for BCTs development. A Nominal Group Technique with cessation experts (n = 12) elicited an expert consensus on B&Fs most influencing women’s smoking cessation and those most modifiable through behavioral support. Effective cessation interventions in randomized trials from a recent Cochrane review were coded into component BCTs using existing taxonomies. B&Fs were categorized using Theoretical Domains Framework (TDF) domains. Matrices, mapping BCT taxonomies against TDF domains, were consulted to investigate the extent to which BCTs in existing interventions target key B&Fs. Experts ranked ‘smoking a social norm’ and ‘quitting not a priority’ as most important barriers and ‘desire to protect baby’ an important facilitator to quitting. From 14 trials, 23 potentially-effective BCTs were identified (e.g., ‘information about consequences). Most B&Fs fell into ‘Social Influences’, ‘Knowledge’, ‘Emotions’ and ‘Intentions’ TDF domains; few potentially-effective BCTs mapped onto every TDF domain. B&Fs identified by experts as important to cessation, are not sufficiently targeted by BCT’s currently within interventions for smoking cessation in pregnancy

Randomized Controlled Trial to Evaluate an Internet‐Based Self‐Management Program in Systemic Sclerosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148240/1/acr23595.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148240/2/acr23595_am.pd

Do Spectroscopic Dense Gas Fractions Track Molecular Cloud Surface Densities?

We use ALMA and IRAM 30-m telescope data to investigate the relationship between the spectroscopically-traced dense gas fraction and the cloud-scale (120 pc) molecular gas surface density in five nearby, star-forming galaxies. We estimate the dense gas mass fraction at 650 pc and 2800 pc scales using the ratio of HCN (1-0) to CO (1-0) emission. We then use high resolution (120 pc) CO (2-1) maps to calculate the mass-weighted average molecular gas surface density within 650 pc or 2770 pc beam where the dense gas fraction is estimated. On average, the dense gas fraction correlates with the mass-weighted average molecular gas surface density. Thus, parts of a galaxy with higher mean cloud-scale gas surface density also appear to have a larger fraction of dense gas. The normalization and slope of the correlation do vary from galaxy to galaxy and with the size of the regions studied. This correlation is consistent with a scenario where the large-scale environment sets the gas volume density distribution, and this distribution manifests in both the cloud-scale surface density and the dense gas mass fraction.Comment: 11 pages, 4 figures, accepted for publication in The Astrophysical Journal Letter

Cloud-Scale Molecular Gas Properties in 15 Nearby Galaxies

We measure the velocity dispersion, $\sigma$, and surface density, $\Sigma$, of the molecular gas in nearby galaxies from CO spectral line cubes with spatial resolution $45$-$120$ pc, matched to the size of individual giant molecular clouds. Combining $11$ galaxies from the PHANGS-ALMA survey with $4$ targets from the literature, we characterize ${\sim}30,000$ independent sightlines where CO is detected at good significance. $\Sigma$ and $\sigma$ show a strong positive correlation, with the best-fit power law slope close to the expected value for resolved, self-gravitating clouds. This indicates only weak variation in the virial parameter $\alpha_\mathrm{vir}\propto\sigma^2/\Sigma$, which is ${\sim}1.5$-$3.0$ for most galaxies. We do, however, observe enormous variation in the internal turbulent pressure $P_\mathrm{turb}\propto\Sigma\,\sigma^2$, which spans ${\sim}5\rm\;dex$ across our sample. We find $\Sigma$, $\sigma$, and $P_\mathrm{turb}$ to be systematically larger in more massive galaxies. The same quantities appear enhanced in the central kpc of strongly barred galaxies relative to their disks. Based on sensitive maps of M31 and M33, the slope of the $\sigma$-$\Sigma$ relation flattens at $\Sigma\lesssim10\rm\;M_\odot\,pc^{-2}$, leading to high $\sigma$ for a given $\Sigma$ and high apparent $\alpha_\mathrm{vir}$. This echoes results found in the Milky Way, and likely originates from a combination of lower beam filling factors and a stronger influence of local environment on the dynamical state of molecular gas in the low density regime.Comment: Accepted for publication in ApJ. 45 pages, 11 figures, 8 tables, 4 Appendices; key results summarized in Figure 10. Machine-readable table can be downloaded at http://www.astronomy.ohio-state.edu/~sun.1608/datafile3.txt prior to publication. For a brief video describing the main results of this paper, please see https://www.youtube.com/watch?v=-_eL7t1PVq8&