Miracle-dz/UniFAR-FTUs huggingface dataset:
Implementation of collaborative depression management at community-based primary care clinics: an evaluation.

OBJECTIVE This study evaluated a large demonstration project of collaborative care of depression at community health centers by examining the role of clinic site on two measures of quality care (early follow-up and appropriate pharmacotherapy) and on improvement of symptoms (score on Patient Health Questionnaire-9 reduced by 50% or ≤ 5). METHODS A quasi-experimental study examined data on the treatment of 2,821 patients aged 18 and older with depression symptoms between 2006 and 2009 at six community health organizations selected in a competitive process to implement a model of collaborative care. The model's key elements were use of a Web-based disease registry to track patients, care management to support primary care providers and offer proactive follow-up of patients, and organized psychiatric consultation. RESULTS Across all sites, a plurality of patients achieved meaningful improvement in depression, and in many sites, improvement occurred rapidly. After adjustment for patient characteristics, multivariate logistic regression models revealed significant differences across clinics in the probability of receiving early follow-up (range .34-.88) or appropriate pharmacotherapy (range .27-.69) and in experiencing improvement (.36 to .84). Similarly, after adjustment for patient characteristics, Cox proportional hazards models revealed that time elapsed between first evaluation and the occurrence of improvement differed significantly across clinics (p<.001). CONCLUSIONS Despite receiving similar training and resources, organizations exhibited substantial variability in enacting change in clinical care systems, as evidenced by both quality indicators and outcomes. Sites that performed better on quality indicators had better outcomes, and the differences were not attributable to patients' characteristics.
Treatment and Outcomes of Acute Coronary Syndrome in the Cancer Population

Randomized trials have established the benefit of medical therapy and revascularization in the treatment of acute myocardial infarction (MI). Cancer and cardiovascular disease are the 2 most common diseases worldwide. In clinical practice, cancer patients are frequently afflicted with MI. The benefit of medical and/or revascularization therapy in the cancer population with MI is less well known.
Author ’ s Accepted Manuscript Predicting the Transition from Anxiety to Depressive Symptoms in Early Adolescence : Negative Anxiety Response Style as a Moderator of Sequential Comorbidity

BACKGROUND: Anxiety often precedes depression. The anxiety response styles theory of comorbidity suggests anxious individuals with a tendency to ruminate or make hopeless attributions about anxiety symptoms (negative anxiety response styles [NARS]) are more vulnerable to subsequent depressive symptoms. However, this theory has never been tested in adolescence, when the anxiety-depression transition may frequently occur, or using an extended (one-year) follow-up period. METHOD: 128 early adolescent girls (M = 12.39 years) participated with caregivers in a one-year longitudinal study. At baseline and follow-up, participants completed diagnostic interviews and self-report measures assessing child NARS and brooding rumination. RESULTS: T1 NARS predicted longitudinal elevations in depressive symptoms and increased associations between T1 anxiety and T2 depressive symptoms. LIMITATIONS: This study examines anxiety and depression comorbidity using a community sample. The sample is relatively low on sociodemographic diversity. CONCLUSIONS: Results support the anxiety response styles theory, with potential implications for early identification of anxious youth at risk for later development of comorbid depression.
Trends in Smoking Cessation Counseling: Experience From American Heart Association‐Get With The Guidelines

Successful smoking cessation in stroke and coronary artery disease (CAD) patients is important, as smoking contributes to significant morbidity and mortality. The American Heart Association developed Get With The Guidelines (GWTG) to improve compliance with national guideline recommendations for cardiovascular care. Using data from GWTG, we examined trends associated with the smoking‐cessation counseling (SCC) performance measure.
Cylindrical Waveguide Electromagnetic Exposure System for Biological Studies with Unrestrained Mice at 1.9 GHz

Abstract This paper presents the development of an in vivo exposure system for exposing small rodents. The system consists of four identical cylindrical waveguide chambers, each with a plastic cage for housing the animal. The chamber is fed by circularly polarized radiofrequency power in the 1.9 GHz cellular frequency band and is vertically mounted so that the long axis of the animal is co-planar with the rotating incident electric field. Power sensors were used along with directional or hybrid couplers and a digital voltmeter for data acquisition for real-time dose rate monitoring. The system was tested to evaluate its dose rate performance when a mouse phantom or a mouse cadaver was inside the cage. The dose rate was quantified in terms of whole-body-average (WBA) specific absorption rate (SAR) per input power using both measurement and computational methods. The exposures of the mouse phantom and cadaver were evaluated for various possible postures and positions. The measurement results showed that the highest WBA-SAR was 16.9 W kg−1 per 1 W incident power when the cadaver was lying prone against the cage wall and the lowest WBA-SAR was 10.4 W kg−1 per 1 W incident power when the cadaver was standing upright in the cage center. These results were found to be in good agreement with those obtained from the computational method.
Differentiation of β‐adrenoreceptors by the use of blocking agents

There is evidence that the P-adrenoreceptor population is comprised of a t least two types designated as 8-1 and 13-2 (Lands, Arnold & others, 1967; Lands, Luduena & Buzzo, 1967). This sub-division was proposed to account for the differing structural requirements of catecholethanolamines for initiating j? -sympathomimetic actions in different organs. The sub-division so proposed has been further supported by the recent discovery of j? -agonists, such as salbutamol, with selective 9-2 actions (Cullum, Farmer & others, 1969). If P-adrenoreceptors differ significantly in their structural requirements for agonists then it is reasonable to suppose that such receptors could have differcnt structural requirements for antagonists. Thus experiments have been made to measure quantitatively the P-adrenoreceptor blocking action (by use of PA, measurements) of two compounds, propranolol and ICI 50 172 (against isoprenaline) at typical p-1 and 8-2 type receptors. Previous workers have shown that tissues with similar receptors can be expected to give the same PA, with a given antagonist (Arunlakshana & Schild, 1959). ICI 50 172 was chosen in addition to propranolol because some selectivity of blocking action for this compound has been described (Dunlop & Shanks, 1968).
Children caring for their “caregivers”: exploring the caring arrangements in households affected by AIDS in Western Kenya

Abstract Reflecting dominant understandings of childhood, many researchers describe orphans as an emotional and financial cost to the households in which they live. This has created a representation of orphans as a burden, not only to their fostering household, but also to society. This article seeks to challenge this representation by exploring children's contributions to their fostering households. Drawing on research from Bondo District in Kenya, this article brings together the views of 36 guardians and 69 orphaned children between the ages of 11 and 17, who articulated their circumstances through photography and drawing. Nearly 300 photos and drawings were selected by the children and subsequently described in writing. An additional 44 in-depth interviews and three focus group discussions were conducted to explore findings further. The data suggest that many fostering households benefit tremendously from absorbing orphaned children. All orphans were found to contribute to their fostering household's income and provide valuable care or support to ageing, ailing or young members of their households. The article concludes that caution should be exercised in using the term “caregiver” to describe foster parents due to the reciprocity, and indeed at times a reversal, of caring responsibilities.
“I look forward. I feel insecure but I am ok with it”. The experience of young HIV+ people attending transition preparation events: a qualitative investigation

Abstract Transition programmes which prepare young people with HIV to manage the medical, social and psychological consequences of the condition can provide clinical benefits for both young people and their families. The London-based Looking Forward Project (LFP) is embedded within a National Health Service HIV family clinic. The project uses a group work approach and aims to equip HIV+ young people over the age of 12 years who know their status with the emotional, psychological and behavioural skills necessary to face the challenges of living with HIV. This small scale qualitative study investigated the experience of attendance, explored factors which facilitated participation in the groups and investigated the impact on their lives as a result of participation. Participants reported that the LFP events were educational but different to school-like activities, being with other young people reduced isolation and that receiving a voucher was an incentive to attend. Participation was facilitated through family support. Attendance at the LFP facilitated a positive attitude towards medication and hope for the future.
Angiotensin Receptor Blockers Worsen Renal Function and Dyspnea on Ticagrelor: A Potential Ticagrelor‐Angiotensin Receptor Blocker Interaction?

Ticagrelor is a new antiplatelet agent that was pitted against clopidogrel in the Platelet Inhibition and Patient Outcomes (PLATO) trial. Because ticagrelor is the first oral, reversible, twice‐daily agent, sufficient information on drug interactions is not available. Our objective was to ascertain the safety of ticagrelor with other common medications. The US Food and Drug Administration Complete Response Review indicates that renal adverse events (AEs) and renal function AEs were higher in ticagrelor‐treated patients who were concomitantly treated with angiotensin receptor blockers (ARBs) >50% of study days compared to ticagrelor‐treated patients who did not receive ARBs >50% of study days. Clopidogrel‐treated patients showed a trend for an increase in adverse renal events with ARB use. However, this was not as pronounced as that observed with ticagrelor. Dyspnea was also significantly increased in patients on concomitant ticagrelor‐ARB compared to ticagrelor without concomitant ARB and clopidogrel (21.4% vs 14.6% vs 9.9%, respectively) as well as angioedema (0.15% vs 0.09%). Furthermore, in patients with a baseline estimated glomerular filtration rate (eGFR) <30 mL/min, the risk of major bleeding, death, and renal failure was increased in patients on ticagrelor compared to patients on clopidogrel. In patients on ticagrelor, ARBs significantly increased the frequency of renal related AEs, renal function AEs, and dyspnea. Moreover, in patients with a baseline eGFR <30 mL/min, the risk of major bleeding, death, and renal failure was increased in patients on ticagrelor compared to patients on clopidogrel.
Radiation Carcinogenesis Risk Assessments for Never-smokers

AbstractCigarette smoking, which is presently associated with more than 20% of adult deaths in the United States, is a large confounder to radiation risk estimates derived from epidemiology data. Astronauts and other exposed groups are classified as never-smokers (NS), defined as lifetime use of less than 100 cigarettes. In the past, radiation risk estimates have been made using average U.S. population rates for cancer and all causes of death, which may lead to overestimation of radiation risks for NS. In this report, age- and gender-specific radiation carcinogenesis risk calculations for NS and the average U.S. population are compared. Lung is the major tissue site for smoking and radiation-related cancer. However, other radiogenic cancers where tobacco has been shown to increase population cancer rates are esophagus, oral cavity, salivary gland, bladder, stomach, liver, colorectal, and leukemia. After adjusting U.S. cancer rates to remove smoking effects, radiation risks for lung and other cancers were estimated using the multiplicative risk model and a mixture model, with weighted contributions for additive and multiplicative risk transfer. Radiation mortality risks for NS were reduced compared to the average U.S. population by more than 20% and 50% in the mixture model and multiplicative transfer models, respectively. The authors discuss possible mechanisms of cancer risks from radiation and tobacco that suggest multiplicative effects could occur. These results suggest that improved understanding of possible synergisms between cancer initiators and promoters, such as radiation and tobacco, would greatly improve risk estimates and reduce uncertainties for differentially exposed groups, including NS.
Evaluation of a case management program for HIV clients in Rwanda

Abstract Case management is a standard practice in the United States for the effective care of people living with HIV and AIDS (PLHA); however, application of this approach in developing countries has not been demonstrated. Although great advances have been made in Africa to increase PLHA's access to HIV services, care and support systems often remain fragmented. In September 2004, CARE International initiated a case management program in health facilities in Rwanda designed to enhance linkages between clinical and non-clinical services for PLHA. This paper presents findings from an evaluation of the program conducted in 2006 focusing on its implementation, specifically the responsibilities of case managers, community linkages, and integration within the health facility. Program outcomes of antiretroviral treatment adherence and quality of life among PLHA also were explored. Qualitative data were collected from case managers, clients, health care providers, and CARE staff. A survey was conducted among 75% of the 149 case managers. Results indicate the case management program strengthened linkages between health facility and community service providers for PLHA. However, most case managers (79%) reported inadequate resources to carry out their duties and high client loads, averaging 55 clients each. They also had limited referral networks. Nonetheless, case managers were highly regarded and appreciated by health professionals, who reported that the program helped to enhance patient–doctor relationships and ensure follow-up of patients' needs. Respondents further highlighted benefits of improved psychosocial well-being and better adherence to antiretroviral medications among clients. Issues remain in terms of case management efficacy in developing country environments, notably the availability and accessibility of needed ancillary services. Despite some limitations, data suggest case management is a viable strategy for providing comprehensive support to PLHA in Rwanda and its implementation elsewhere in Africa should be explored. Considerations in replicating this approach are discussed.
Social rebirth and social transformation? Rebuilding social lives after ART in rural Uganda

Abstract This paper examines how HIV diagnosis, illness and anti-retroviral therapy (ART) have an impact on the social dimensions of people's lives in rural Uganda, focusing on identity, relationships and membership of groups. Using concepts drawn from sociological research on experiences of illness and recovery, “getting back to normal”, “rebirth” and “turning point”, we present findings from qualitative research that explored the social changes brought about by HIV and ART among 70 men and women taking ART since 2003. With a second chance at life, some people's narratives revealed a pursuit of getting “back to normal”, restoring and resuming their place in their families and communities. Others sought to change or transform their new lives, what we term a “social rebirth”, moving away from old social networks and lifestyles. Regaining health was associated with a desire to make the most of life by joining social groups and civil society organisations, establishing new relationships and advising and supporting others. However, earlier losses of family and friends due to AIDS-related deaths made “social rebirth” hard for many people. Our findings also show that the process of responding to ART is not linear and the pursuit of change following diagnosis and treatment may be difficult to sustain, as the months and years on ART progress and the struggles of getting on with life take their toll. Sustaining social rebirth was challenging and complex due to the nature of HIV infection itself (for example, new intimate relationships pose challenges) and the harsh economic environment. Maintaining changed lives for those living with HIV and ART is important because this will contribute to better disease self-management and so demands an understanding by support organisations of the nature of these changes and challenges.
How late is too late? Timeliness to scheduled visits as an antiretroviral therapy adherence measure in Nairobi, Kenya and Lusaka, Zambia

Abstract Collecting self-reported data on adherence to highly active antiretroviral therapy (HAART) can be complicated by patients’ reluctance to report poor adherence. The timeliness with which patients attend visits might be a useful alternative to estimate medication adherence. Among Kenyan and Zambian women receiving twice daily HAART, we examined the relationship between self-reported pill taking and timeliness attending scheduled visits. We analyzed data from 566 Kenyan and Zambian women enrolled in a prospective 48-week HAART-response study. At each scheduled clinic visit, women reported doses missed over the preceding week. Self-reported adherence was calculated by summing the total number of doses reported taken and dividing by the total number of doses asked about at the visit attended. A participant's adherence to scheduled study visits was defined as “on time” if she arrived early or within three days, “moderately late” if she was four–seven days late, and “extremely late/missed” if she was more than eight days late or missed the visit altogether. Self-reported adherence was <95% for 29 (10%) of 288 women who were late for at least one study visit vs. 3 (1%) of 278 who were never late for a study visit (odds ratios [OR] 10.3; 95% confidence intervals [95% CI] 2.9, 42.8). Fifty-one (18%) of 285 women who were ever late for a study visit experienced virologic failure vs. 32 (12%) of 278 women who were never late for a study visit (OR 1.7; 95% CI 1.01, 2.8). A multivariate logistic regression model controlling for self-reported adherence found that being extremely late for a visit was associated with virologic failure (OR 2.0; 95% CI 1.2, 3.4). Timeliness to scheduled visits was associated with self-reported adherence to HAART and with risk for virologic failure. Timeliness to scheduled clinic visits can be used as an objective proxy for self-reported adherence and ultimately for risk of virologic failure.
Literacy, education and adherence to antiretroviral therapy in The Gambia

Abstract We examined the relationship of patients’ literacy and education to antiretroviral therapy (ART) adherence in an urban treatment centre in The Gambia. Information on education and literacy systematically collected before ART initiation was compared against selected adherence outcomes. Formally educated patients were significantly more likely to achieve virological suppression at both six and 12 months (87% vs. 67%, OR=3.13, P=0.03; 88% vs. 63%, OR=4.49, P=0.007, respectively). Literate patients had similar benefit at 12 months (OR=3.39 P=0.03), with improved virological outcomes associated with degree of literacy (P=0.003). A trend towards similar results was seen at 6 months for Koranically educated patients; however, this was no longer apparent at 12 months. No significant correlation was seen between socio-demographic characteristics and missed appointments. Our study suggests that literacy, formal education and possibly Koranic education may impact favourably on adherence to ART.
Persistent (current) in the face of adversity … A new class of cardiac anti‐ischaemic compounds on the horizon?

Although a persistent component of the sodium current (INaP) was described in cardiac tissue about three decades ago, its physiological role and potential as a therapeutic target was not immediately apparent. Subsequent demonstrations that INaP is enhanced by hypoxia and ischaemia, and that Na+ influx via INaP may contribute to cellular damage, diastolic dysfunction and arrhythmias during ischaemia and reperfusion, raised interest in INaP as a target for anti‐ischaemic drugs. Several agents have now been developed to clinical stages, which have INaP block as either their main action, or as a useful co‐effect. In this issue of the British Journal of Pharmacology, Vacher et al. report the anti‐ischaemic actions of F15845, which appears to exhibit the most selective block of INaP yet described. Its efficacy in animal models of angina raises the prospect of new, specific, INaP blockers that may represent a largely unexploited opportunity for a new class of anti‐ischaemic compounds.
Arthroscopic Rotator Interval Closure With a Novel Medial-Lateral Technique

Rotator interval lesions are commonly identified in patients with glenohumeral instability, especially multidirectional instability. Numerous arthroscopic superior-to-inferior rotator interval closure techniques have been described but are unable to reproduce the results of open medial-lateral rotator interval closure techniques. We present a technique for arthroscopic medial-lateral rotator interval closure. A double-loaded suture anchor is inserted into the humeral head via an anterior working portal located in the apex of the triangular rotator interval on the proximal humerus at the articular margin. The anterior cannula is then withdrawn slightly so that it rests in the subacromial space, and a BirdBeak suture passer (Arthrex Inc, Naples, Fla) is inserted in this cannula through the rotator interval, including the superior glenohumeral ligament, approximately 1 cm medial to the anchor. This device retrieves one of the suture limbs and is then reinserted approximately 4 mm superior to the first capsular penetration site to retrieve and deliver the other suture. Then, 2 extracapsular knots are tied over the anterior capsule. Biomechanical data suggest that this technique is superior to traditional arthroscopic rotator interval closure techniques in the restoration of range of motion and limiting posterior translation. This technique is safe, easy, effective, and reproducible.
Involvement of PKCα and G‐protein‐coupled receptor kinase 2 in agonist‐selective desensitization of µ‐opioid receptors in mature brain neurons

Background and purpose: The ability of an agonist to induce desensitization of the µ‐opioid receptor (MOR) depends upon the agonist used. Furthermore, previous data suggest that the intracellular mechanisms underlying desensitization may be agonist‐specific. We investigated the mechanisms underlying MOR desensitization, in adult mammalian neurons, caused by morphine (a partial agonist in this system) and DAMGO (a high‐efficacy agonist).