Counselling in primary care : a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services

Provinciality and the Art World: The Midland Group 1961- 1977

This paper takes as its focus the Midland Group Gallery in order to first, make a case for the consideration of the geographies of art galleries. Second, highlight the importance of galleries in the context of cultural geographies of the sixties. Third, discuss the role of provinciality in the operation of art worlds. In so doing it explicates one set of geographies surrounding the gallery – those of the local, regional and international networks that connected to produce art works and art space. It reveals how the interactions between places and practices outside of metropolitan and regional hierarchies provides a more nuanced insight into how art worlds operated during the sixties, a period of growing internationalism of art, and how contested definitions of the provincial played an integral role in this. The paper charts the operations of the Midland Group Gallery and the spaces that it occupied to demonstrate how it was representative of a post-war discourse of provincialism and a corresponding re-evaluation of regional cultural activity

Development and validation of the Measure of Indigenous Racism Experiences (MIRE)

<p>Abstract</p> <p>Background</p> <p>In recent decades there has been increasing evidence of a relationship between self-reported racism and health. Although a plethora of instruments to measure racism have been developed, very few have been described conceptually or psychometrically Furthermore, this research field has been limited by a dearth of instruments that examine reactions/responses to racism and by a restricted focus on African American populations.</p> <p>Methods</p> <p>In response to these limitations, the 31-item Measure of Indigenous Racism Experiences (MIRE) was developed to assess self-reported racism for Indigenous Australians. This paper describes the development of the MIRE together with an opportunistic examination of its content, construct and convergent validity in a population health study involving 312 Indigenous Australians.</p> <p>Results</p> <p>Focus group research supported the content validity of the MIRE, and inter-item/scale correlations suggested good construct validity. A good fit with <it>a priori </it>conceptual dimensions was demonstrated in factor analysis, and convergence with a separate item on discrimination was satisfactory.</p> <p>Conclusion</p> <p>The MIRE has considerable utility as an instrument that can assess multiple facets of racism together with responses/reactions to racism among indigenous populations and, potentially, among other ethnic/racial groups.</p

Simulations of an observed elevated mesoscale convective system over southern England during CSIP IOP 3

Simulations of an elevated mesoscale convective system (MCS) observed over southern England during the Convective Storm Initiation Project (CSIP) provide the first detailed modelling study of a case of elevated convection occurring in the UK. The study shows that many factors can influence the maintenance of elevated deep convection, from large-scale flow through to surface heating processes and diabatic cooling within the convective system. It is also shown that interactions and feedback mechanisms between a stable layer and the storm can act to maintain deep convection. The simulation successfully reproduced an elevated MCS above a low-level stable undercurrent, with a wave in the undercurrent linked to a rear-inflow jet (RIJ). Convection was fed from an elevated (840hPa) source layer with CAPE of about 350Jkg-1. The undercurrent in the simulation was approximately 1km deep, about half that observed. Unlike the observed MCS, a transition from elevated to surface-based convection occurred in the simulation due to the combined effects of a pre-existing large-scale θe gradient, advection and surface heating causing the system to encounter increasingly unstable low-level air and a shallower stable layer that was more susceptible to penetration by downdraughts. The transition to surface-based convection was accompanied by the development of cold-pool outflow and an increase in system velocity from about 6 to 10ms-1. Diabatic cooling from microphysical processes in the simulation enhanced the undercurrent and strengthened the RIJ. This strengthened the wave in the undercurrent and led to more extensive convection. The existence of a positive feedback process between the convection, RIJ and stable layer is discussed. Uncertainty in the synoptic scale generating errors in the undercurrent is shown to be a major source of error for convective-scale forecasts

BART Inhibits Pancreatic Cancer Cell Invasion by PKCα Inactivation through Binding to ANX7

A novel function for the binder of Arl two (BART) molecule in pancreatic cancer cells is reported. BART inhibits invasiveness of pancreatic cancer cells through binding to a Ca2+-dependent, phosphorylated, guanosine triphosphatase (GTPase) membrane fusion protein, annexin7 (ANX7). A tumor suppressor function for ANX7 was previously reported based on its prognostic role in human cancers and the cancer-prone mouse phenotype ANX7(+/−). Further investigation demonstrated that the BART–ANX7 complex is transported toward cell protrusions in migrating cells when BART supports the binding of ANX7 to the protein kinase C (PKC) isoform PKCα. Recent evidence has suggested that phosphorylation of ANX7 by PKC significantly potentiates ANX7-induced fusion of phospholipid vesicles; however, the current data suggest that the BART–ANX7 complex reduces PKCα activity. Knocking down endogenous BART and ANX7 increases activity of PKCα, and specific inhibitors of PKCα significantly abrogate invasiveness induced by BART and ANX7 knockdown. These results imply that BART contributes to regulating PKCα activity through binding to ANX7, thereby affecting the invasiveness of pancreatic cancer cells. Thus, it is possible that BART and ANX7 can distinctly regulate the downstream signaling of PKCα that is potentially relevant to cell invasion by acting as anti-invasive molecules

Acupuncture, Counseling, and Usual care for Depression (ACUDep): study protocol for a randomized controlled trial

Background: The evidence on the effect of acupuncture or counseling for depression is not conclusive yet is sufficient to warrant further research. Our aim is to conduct a full-scale RCT to determine the clinical and cost effectiveness of acupuncture and counseling compared to usual care alone. We will explore the experiences and perspectives of patients and practitioners. Methods/Design: Randomized controlled trial with three parallel arms: acupuncture plus usual care, counseling plus usual care, and usual care alone, in conjunction with a nested qualitative study using in-depth interviews with purposive samples of trial participants. Participants: Patients aged over 18 years diagnosed with depression or mood disorder by their GP and with a score of 20 or above on the Beck Depression Inventory (BDI-II). Randomization: Computer randomization by York Trials Unit to acupuncture, counseling, and usual care alone in proportions of 2:2:1, respectively, with secure allocation concealment. Interventions: Patients allocated to acupuncture and counseling groups receive the offer of up to 12 weekly sessions. Both interventions allow flexibility to address patient variation, yet are constrained within defined protocols. Acupuncture is based on traditional Chinese medicine and counseling is non-directive within the humanistic tradition. Outcome: The PHQ-9 is the primary outcome measure, collected at baseline, 3, 6, 9, and 12 months. Also measured is BDI-II, SF-36 Bodily pain subscale, and EQ-5D. Texted mood scores are collected weekly over the first 15 weeks. Health-related resource use is collected over 12 months. Analysis: The sample size target was for 640 participants, calculated for an effect size of 0.32 on the PHQ-9 when comparing acupuncture with counseling given 90% power, 5% significance, and 20% loss to follow-up. Analysis of covariance will be used on an intention-to-treat basis. Thematic analysis will be used for qualitative data. We will compare incremental cost-effectiveness of the three treatment options at 12 months. Discussion: Ethical approval was obtained in October 2009. There were six subsequent protocol amendments, the last of which was approved in January 2012. Recruitment of 755 participants took place over 18 months. Data collection will be completed by June 2012. No interim analyses have been conducted

OpenSimRoot: widening the scope and application of root architectural models

Research Conducted and Rationale: OpenSimRoot is an open sourced, functional- structural plant model and mathematical description of root growth and function. We describe OpenSimRoot and its functionality to broaden the benefits of root modeling to the plant science community. Description: OpenSimRoot is an extended version of SimRoot, established to simulate root system architecture, nutrient acquisition, and plant growth. OpenSimRoot has a plugin, modular infrastructure, coupling single plant and crop stands to soil nutrient, and water transport models. It estimates the value of root traits for water and nutrient acquisition in environments and plant species. Key results and unique features: The flexible OpenSimRoot design allows upscaling from root anatomy to plant community to estimate 1) resource costs of developmental and anatomical traits, 2) trait synergisms, 3) (inter species) root competition. OpenSimRoot can model 3D images from MRI and X-ray CT of roots in soil. New modules include: 1) soil water dependent water uptake and xylem flow, 2) tiller formation, 3) evapotranspiration, 4) simultaneous simulation of mobile solutes, 5) mesh refinement, and 6) root growth plasticity. Conclusion: OpenSimRoot integrates plant phenotypic data with environmental metadata to support experimental designs and gain mechanistic understanding at system scales