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

Effects of Bark Beetle Attacks on Forest Snowpack and Avalanche Formation – Implications for Protection Forest Management

Healthy, dense forests growing in avalanche terrain reduce the likelihood of slab avalanche release by inhibiting the formation of continuous snow layers and weaknesses in the snowpack. Driven by climate change, trends towards more frequent and severe bark beetle disturbances have already resulted in the death of millions of hectares of forest in North America and central Europe, affecting snowpack in mountain forests and potentially reducing their protective capacity against avalanches. We examined the spatial variability in snow stratigraphy, i.e., the characteristic layering of the snowpack, by repeatedly measuring vertical profiles of snow penetration resistance with a digital snow micro penetrometer (SMP) along 10- and 20-m transects in a spruce beetle-infested Engelmann spruce forest in Utah, USA. Three study plots were selected characterizing different stages within a spruce beetle outbreak cycle: non-infested/green, infested \u3e 3 years ago/gray stage, and salvage-logged. A fourth plot was installed in a non-forested meadow as the control. Based on our SMP measurements and a layer matching algorithm, we quantified the spatial variability in snow stratigraphy, and tested which forest, snow and/or meteorological conditions influenced differences between our plots using linear mixed effects models. Our results showed that spatial variability in snow stratigraphy was best explained by the percentage of canopy covering a transect (R2 = 0.71, p \u3c 0.001), and that only 14% of the variance was explained by the stage within the outbreak cycle. That is, differences between green and gray stage stands did not depend much on the reduction in needle mass, but spatial variability in snow stratigraphy increased significantly with increasing forest canopy cover. At both study plots, a more heterogeneous snow stratigraphy developed, which translates to disrupted and discontinuous snow layers and, therefore, reduced avalanche formation. We attribute this to the effect that small fine branches and twigs still present in the canopy of gray stage trees have on snow interception and unloading, and especially on canopy drip. In contrast, salvage logging that reduced the canopy cover to ∼25%, led to a spatially less variable and similar snow stratigraphy as observed in the meadow. At these two study plots, a homogeneous snow stratigraphy consisting of distinct vertical and continuous slope-parallel soft and hard snow layers including weak layers had formed, a condition which is generally more prone to avalanche release. Our findings therefore emphasize advantages of leaving dead trees in place, especially in protection forests where bark beetle populations have reached epidemic levels

Detection of Potential Transit Signals in the First Three Quarters of Kepler Mission Data

We present the results of a search for potential transit signals in the first three quarters of photometry data acquired by the Kepler Mission. The targets of the search include 151,722 stars which were observed over the full interval and an additional 19,132 stars which were observed for only 1 or 2 quarters. From this set of targets we find a total of 5,392 detections which meet the Kepler detection criteria: those criteria are periodicity of the signal, an acceptable signal-to-noise ratio, and a composition test which rejects spurious detections which contain non-physical combinations of events. The detected signals are dominated by events with relatively low signal-to-noise ratio and by events with relatively short periods. The distribution of estimated transit depths appears to peak in the range between 40 and 100 parts per million, with a few detections down to fewer than 10 parts per million. The detected signals are compared to a set of known transit events in the Kepler field of view which were derived by a different method using a longer data interval; the comparison shows that the current search correctly identified 88.1% of the known events. A tabulation of the detected transit signals, examples which illustrate the analysis and detection process, a discussion of future plans and open, potentially fruitful, areas of further research are included

Photometric Analysis in the Kepler Science Operations Center Pipeline

We describe the Photometric Analysis (PA) software component and its context in the Kepler Science Operations Center (SOC) pipeline. The primary tasks of this module are to compute the photometric flux and photocenters (centroids) for over 160,000 long cadence (~thirty minute) and 512 short cadence (~one minute) stellar targets from the calibrated pixels in their respective apertures. We discuss the science algorithms for long and short cadence PA: cosmic ray cleaning; background estimation and removal; aperture photometry; and flux-weighted centroiding. We discuss the end-to-end propagation of uncertainties for the science algorithms. Finally, we present examples of photometric apertures, raw flux light curves, and centroid time series from Kepler flight data. PA light curves, centroid time series, and barycentric timestamp corrections are exported to the Multi-mission Archive at Space Telescope [Science Institute] (MAST) and are made available to the general public in accordance with the NASA/Kepler data release policy

B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease

Background: Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. Methods: Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. Results: Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. Conclusions: Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. Trial registration: Clinicaltrials.gov, NCT00403351 Registered on 22 November 200

An Algorithm for the Fitting of Planet Models to Kepler Light Curves

We describe an algorithm which fits model planetary system parameters to light curves from Kepler Mission target stars. The algorithm begins by producing an initial model of the system which is used to seed the fit,with particular emphasis on obtaining good transit timing parameters. An attempt is then made to determine whether the observed transits are more likely due to a planet or an eclipsing binary. In the event that the transits are consistent with a transiting planet, an iterative fitting process is initiated: a wavelet-based whitening filter is used to eliminate stellar variations on timescales long compared to a transit; a robust nonlinear fitter operating on the whitened light curve produces a new model of the system; and the procedure iterates until convergence upon a self-consistent whitening filter and planet model. The fitted transits are removed from the light curve anda search for additional planet candidates is performed upon the residual light curve. The fitted models are used in additional tests which identify false positive planet detections: multiple planet candidates with near-identical fitted periods are far more likely to be an eclipsing binary, for example, while target stars in which the model lightcurve is correlated with the star centroid position may indicate a background eclipsing binary, and subtraction of all model planet candidates yields a light curve of pure noise and stellar variability, which can be used to study the probability that the planet candidates result from statistical fluctuations in the data

The Mannose Receptor (CD206) is an important pattern recognition receptor (PRR) in the detection of the infective stage of the helminth Schistosoma mansoni and modulates IFNγ production.

In this study, infective larvae of the parasitic helminth Schistosoma mansoni were shown to contain a large number of glycosylated components specific for the Mannose Receptor (MR; CD206), which is an important pattern recognition receptor (PRR) of the innate immune system. MR ligands were particularly rich in excretory/secretory (E/S) material released during transformation of cercariae into schistosomula, a process critical for infection of the host. E/S material from carboxyfluorescein diacetate succinimidyl ester (CFDA-SE)-labelled cercariae showed enhanced binding by cells lines that over-express the MR. Conversely, uptake was significantly lower by bone marrow-derived macrophages (MΦ) from MR(-/-) mice, although they were more active as judged by enhanced pro-inflammatory cytokine production and CD40 expression. After natural percutaneous infection of MR(-/-) mice with CFDA-SE-labelled parasites, there were fewer cells in the skin and draining lymph nodes that were CFDA-SE(+) compared with wild-type mice, implying reduced uptake and presentation of larval parasite antigen. However, antigen-specific proliferation of skin draining lymph node cells was significantly enhanced and they secreted markedly elevated levels of IFNγ but decreased levels of IL-4. In conclusion, we show that the MR on mononuclear phagocytic cells, which are plentiful in the skin, plays a significant role in internalising E/S material released by the invasive stages of the parasite which in turn modulates their production of pro-inflammatory cytokines. In the absence of the MR, antigen-specific CD4(+) cells are Th1 biased, suggesting that ligation of the MR by glycosylated E/S material released by schistosome larvae modulates the production of CD4(+) cell specific IFNγ

Transiting Planet Search in the Kepler Pipeline

The Kepler Mission simultaneously measures the brightness of more than 160,000 stars every 29.4 minutes over a 3.5-year mission to search for transiting planets. Detecting transits is a signal-detection problem where the signal of interest is a periodic pulse train and the predominant noise source is non-white, non-stationary (1/f) type process of stellar variability. Many stars also exhibit coherent or quasi-coherent oscillations. The detection algorithm first identifies and removes strong oscillations followed by an adaptive, wavelet-based matched filter. We discuss how we obtain super-resolution detection statistics and the effectiveness of the algorithm for Kepler flight data