bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives and concerns of clients at primary health care facilities involved in evaluation of a national mental health training programme for primary care in Kenya
Authors: Othieno Caleb , Jenkins Rachel , Okeyo Stephen , Aruwa Julyan , Wallcraft Jan , Jenkins Ben 
Published: January 2013

Abstract

Background
A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact on the health, disability and quality of life of clients, despite a severe shortage of medicines in the clinics (Jenkins et al. Submitted 2012). As focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transit Rev 4:81–85, 1994), the experiences of the participating clients were explored through qualitative focus group discussions in order to better understand the potential reasons for the improved outcomes in the intervention group.

Methods
Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 clients from the intervention group clinics where staff had received the training programme, and 10 clients from the control group where staff had not received the training during the earlier randomised controlled trial.

Results
These focus group discussions suggest that the clients in the intervention group noticed and appreciated enhanced communication, diagnostic and counselling skills in their respective health workers, whereas clients in the control group were aware of the lack of these skills. Confidentiality emerged from the discussions as a significant client concern in relation to the volunteer cadre of community health workers, whose only training comes from their respective primary care health workers.

Conclusion
Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcomes for clients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.

Trial registration
ISRCTN 53515024.
Short and long term gene expression variation and networking in human proximal tubule cells when exposed to cadmium
Authors: Garrett Scott H , Clarke Kaitlin , Sens Donald A , Deng Youping , Somji Seema , Zhang Ke K 
Published: January 2013

Abstract
Cadmium (Cd2+) is a known nephrotoxin causing tubular necrosis during acute exposure and potentially contributing to renal failure in chronic long-term exposure. To investigate changes in global gene expression elicited by cadmium, an in-vitro exposure system was developed from cultures of human renal epithelial cells derived from cortical tissue obtained from nephrectomies. These cultures exhibit many of the qualities of proximal tubule cells. Using these cells, a study was performed to determine the cadmium-induced global gene expression changes after short-term (1 day, 9, 27, and 45 μM) and long-term cadmium exposure (13 days, 4.5, 9, and 27 μM). These studies revealed fundamental differences in the types of genes expressed during each of these time points. The obtained data was further analyzed using regression to identify cadmium toxicity responsive genes. Regression analysis showed 403 genes were induced and 522 genes were repressed by Cd2+ within 1 day, and 366 and 517 genes were induced and repressed, respectively, after 13 days. We developed a gene set enrichment analysis method to identify the cadmium induced pathways that are unique in comparison to traditional approaches. The perturbation of global gene expression by various Cd2+ concentrations and multiple time points enabled us to study the transcriptional dynamics and gene interaction using a mutual information-based network model. The most prominent network module consisted of INHBA, KIF20A, DNAJA4, AKAP12, ZFAND2A, AKR1B10, SCL7A11, and AKR1C1.
An adult patient with Henoch-Schönlein purpura and non-occlusive mesenteric ischemia
Authors: Oshikata Chiyako , Tsurikisawa Naomi , Takigawa Masakazu , Omori Tomoko , Sugano Satoshi , Tsuburai Takahiro , Mitomi Hiroyuki , Takemura Tamiko , Akiyama Kazuo 
Published: January 2013

AbstractBackgroundOnset of Henoch-Schönlein purpura (HSP) in middle age is uncommon, and adults with renal or gastrointestinal involvement present with more severe disease than do similar pediatric patients.Case presentationWe present the case of a 69-year-old male with HSP who, after treatment with steroids, cyclophosphamide, and continuous intravenous prostaglandin E1 (PGE1), died as a result of severe gastrointestinal involvement with non-occlusive mesenteric ischemia (NOMI). Vascular narrowing associated with the NOMI improved after catheter injection of PGE1 and prednisolone, but the patient died of bleeding from an exposed small vessel. At autopsy there was no active vasculitis in the jejunal submucosa.ConclusionTreatment with PGE1 and prednisolone might improve small-vessel vasculitis associated with NOMI.
Blood CD33(+)HLA-DR(−) myeloid-derived suppressor cells are increased with age and a history of cancer
Authors: Verschoor Chris P , Johnstone Jennie , Millar Jamie , Dorrington Michael G , Habibagahi Mojtaba , Lelic Alina , Loeb Mark , Bramson Jonathan L , Bowdish Dawn M E 
Published: January 2013

Abstract
Myeloid-derived suppressor cells are increased with age and elevated in donors with a history of cancer; an age-related effect has never been shown in humans.
As we age, the composition of our peripheral leukocytes changes dramatically. Many of these alterations contribute to the general immune dysfunction that burdens the elderly, which in turn, contributes to increased susceptibility to disease. MDSCs represent a heterogeneous population of immunosuppressive leukocytes that are elevated in the peripheral blood of cancer patients. Given the relation between cancer incidence and age, this study examined the frequency of peripheral blood CD33(+)HLA-DR(−) MDSCs across three cohorts: healthy adults (19–59 years old), community-dwelling seniors (61–76 years old), and frail elderly (67–99 years old). This analysis is the first to demonstrate that MDSCs and specifically the CD11b(+)CD15(+) MDSC subset are increased with age. Proinflammatory cytokines that are required for the differentiation of MDSCs (e.g., TNF-α, IL-6, and IL-1β) were similarly found to be increased in the serum of the frail elderly. Furthermore, the proportion of MDSCs and the CD11b(+)CD15(+) subset were found to be elevated significantly in elderly donors with a history of cancer. This age-related elevation in the frequency of MDSCs may contribute to the increased cancer incidence that occurs with age. Further investigation into the functional consequences of elevated MDSCs will provide valuable insight into the progression of age-related pathologies.
Randomized Phase III Multi-Institutional Study of TNFerade Biologic With Fluorouracil and Radiotherapy for Locally Advanced Pancreatic Cancer: Final Results
Authors: Herman Joseph M. , Wild Aaron T. , Wang Hao , Tran Phuoc T. , Chang Kenneth J. , Taylor Gretchen E. , Donehower Ross C. , Pawlik Timothy M. , Ziegler Mark A. , Cai Hongyan , Savage Dionne T. , Canto Marcia I. , Klapman Jason , Reid Tony , Shah Raj J. , Hoffe Sarah E. , Rosemurgy Alexander , Wolfgang Christopher L. , Laheru Daniel A. 
Published: January 2013

Purpose TNFerade biologic is a novel means of delivering tumor necrosis factor alpha to tumor cells by gene transfer. We herein report final results of the largest randomized phase III trial performed to date among patients with locally advanced pancreatic cancer (LAPC) and the first to test gene transfer against this malignancy. Patients and Methods In all, 304 patients were randomly assigned 2:1 to standard of care plus TNFerade (SOC + TNFerade) versus standard of care alone (SOC). SOC consisted of 50.4 Gy in 28 fractions with concurrent fluorouracil (200 mg/m2 per day continuous infusion). TNFerade was injected intratumorally before the first fraction of radiotherapy each week at a dose of 4 × 1011 particle units by using either a percutaneous transabdominal or an endoscopic ultrasound approach. Four weeks after chemoradiotherapy, patients began gemcitabine (1,000 mg/m2 intravenously) with or without erlotinib (100 to 150 mg per day orally) until progression or toxicity. Results The analysis included 187 patients randomly assigned to SOC + TNFerade and 90 to SOC by using a modified intention-to-treat approach. Median follow-up was 9.1 months (range, 0.1 to 50.5 months). Median survival was 10.0 months for patients in both the SOC + TNFerade and SOC arms (hazard ratio [HR], 0.90; 95% CI, 0.66 to 1.22; P = .26). Median progression-free survival (PFS) was 6.8 months for SOC + TNFerade versus 7.0 months for SOC (HR, 0.96; 95% CI, 0.69 to 1.32; P = .51). Among patients treated on the SOC + TNFerade arm, multivariate analysis showed that TNFerade injection by an endoscopic ultrasound-guided transgastric/transduodenal approach rather than a percutaneous transabdominal approach was a risk factor for inferior PFS (HR, 2.08; 95% CI, 1.06 to 4.06; P = .032). The patients in the SOC + TNFerade arm experienced more grade 1 to 2 fever and chills than those in the SOC arm (P < .001) but both arms had similar rates of grade 3 to 4 toxicities (all P > .05). Conclusion SOC + TNFerade is safe but not effective for prolonging survival in patients with LAPC.
Pharmacotherapy Considerations in Patients with HIV and Psychiatric Disorders: Focus on Antidepressants and Antipsychotics
Authors: Hill Lucas , Lee Kelly C 
Published: January 2013

OBJECTIVE To review the evidence for the efficacy and safety of pharmacologic agents for the treatment of depressive and psychotic disorders in patients with HIV infection and to provide clinical considerations for the treatment of depression and psychosis in these patients. DATA SOURCES PubMed was searched for articles published between 1966 and August 1, 2012, using the search terms antiretrovirals, HIV, AIDS, depression, psychosis, schizophrenia, antidepressant, antipsychotic, and individual drug names (fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine, duloxetine, mirtazapine, bupropion, haloperidol, perphenazine, fluphenazine, aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone). STUDY SELECTION AND DATA EXTRACTION For the purposes of evaluating efficacy data, we limited our selection to randomized placebo-controlled or active comparator–controlled trials for agents that have been used for depression and psychosis in HIV-infected patients. DATA SYNTHESIS We found 11 studies for depression treatment and 1 study for psychosis treatment that met our inclusion and exclusion criteria. Selective serotonin reuptake inhibitors (SSRIs; especially fluoxetine) and tricyclic antidepressants appear to be effective in treating depressive symptoms in patients with HIV infection without affecting immune status. Testosterone, stimulants, and dehydroepiandrosterone may also be effective in subsyndromal depression; however, studies on these agents in general were limited by small sample size. There are limited data for antipsychotics, with the only controlled study found for haloperidol and chlorpromazine used for AIDS delirium. Drug-drug interactions and potentiation of metabolic syndrome are concerns for the combined use of antidepressants and antipsychotics with antiretrovirals. CONCLUSIONS Larger controlled studies are needed to validate the current findings as well as expand knowledge for non-SSRI antidepressants and second-generation antipsychotics for use in HIV-infected patients.
Fields with few types
Authors: Milliet Cédric 
Published: January 2013

AbstractAccording to Belegradek, a first order structure is weakly small if there are countably many 1-types over any of its finite subset. We show the following results. A field extension of finite degree of an infinite weakly small field has no Artin-Schreier extension. A weakly small field of characteristic 2 is finite or algebraically closed. A weakly small division ring of positive characteristic is locally finite dimensional over its centre. A weakly small division ring of characteristic 2 is a field.
Indifferent sets for genericity
Authors: Day Adam R. 
Published: January 2013

AbstractThis paper investigates indifferent sets for comeager classes in Cantor space focusing of the class of all 1-generic sets and the class of all weakly 1-generic sets. Jockusch and Posner showed that there exist 1-generic sets that have indifferent sets [10]. Figueira, Miller and Nies have studied indifferent sets for randomness and other notions [7]. We show that any comeager class in Cantor space contains a comeager class with a universal indifferent set. A forcing construction is used to show that any 1-generic set, or weakly 1-generic set, has an indifferent set. Such an indifferent set can by computed by any set inwhich bounds the (weakly) 1-generic. We show by approximation arguments that some, but not all,1-generic sets can compute an indifferent set for themselves. We show that allweakly 1-generic sets can compute an indifferent set for themselves. Additional results on indifferent sets, including one of Miller, and two of Fitzgerald, are presented.
Borel's conjecture in topological groups
Authors: Galvin Fred , Scheepers Marion 
Published: January 2013

AbstractWe introduce a natural generalization of Borel's Conjecture. For each infinite cardinal numberκ, let BCκdenote this generalization. Then BCℕ0is equivalent to the classical Borel conjecture. Assuming the classical Borel conjecture, ¬BCℕ1is equivalent to the existence of a Kurepa tree of height ℕ1. Using the connection of BCκwith a generalization of Kurepa's Hypothesis, we obtain the following consistency results:(1) If it is consistent that there is a 1-inaccessible cardinal then it is consistent that BCℕ1.(2) If it is consistent that BCℕ1, then it is consistent that there is an inaccessible cardinal.(3) If it is consistent that there is a 1-inaccessible cardinal withωinaccessible cardinals above it, then ¬BCℕω+ (∀n<ω)BCℕnis consistent.(4) If it is consistent that there is a 2-huge cardinal, then it is consistent that BCℕω(5) If it is consistent that there is a 3-huge cardinal, then it is consistent that BCκfor a proper class of cardinalsκof countable cofinality.
Endothelial Progenitor Cells Are Related to Glycemic Control in Children With Type 1 Diabetes Over Time
Authors: Hörtenhuber Thomas , Rami-Mehar Birgit , Satler Miriam , Nagl Katrin , Höbaus Clemens , Höllerl Florian , Koppensteiner Renate , Schernthaner Guntram , Schober Edith , Schernthaner Gerit-Holger 
Published: January 2013

OBJECTIVE
The risk of cardiovascular death before the age of 40 is 20-fold higher in patients with type 1 diabetes mellitus (T1DM). Endothelial progenitor cells (EPCs) predict cardiovascular morbidity and mortality in patients without diabetes. We hypothesized that EPCs are modified in children with T1DM and are related to characteristics of T1DM such as glycemic control.

RESEARCH DESIGN AND METHODS
Children (n = 190; 156 T1DM subjects and 34 control subjects) were included in an observational cohort study and matched for age and sex. EPCs were enumerated by flow cytometry at the beginning (cross-sectional) and 1 year later (longitudinal). To analyze changes of variables during the observation, Δ values were calculated.

RESULTS
EPCs were significantly reduced in T1DM children versus control subjects (609 ± 359 vs. 1,165 ± 484, P &lt; 0.001). Multivariate regression modeling revealed that glycated hemoglobin A1c (HbA1c) was the strongest independent predictor of EPCs (β = −0.355, P &lt; 0.001). Overall glycemic control at the beginning and end of study did not differ (7.8 ± 1.2 vs. 7.8 ± 1.2 relative %, P = NS), but we observed individual HbA1c changes of −4.30/+3.10 relative %. The strongest EPC increase was observed in the patients with the most favorable HbA1c lowering during the 1-year follow-up. Accordingly, the strongest EPC decrease was demonstrated in the patients with the strongest HbA1c worsening during the time period.

CONCLUSIONS
This is the first prospective study demonstrating diminished EPCs in children with T1DM. The association of better glycemic control with an increase in EPC numbers within 1 year suggests that a reduction of the high cardiovascular disease burden might be mediated likewise.
History of Medically Treated Diabetes and Risk of Alzheimer Disease in a Nationwide Case-Control Study
Authors: Tolppanen Anna-Maija , Lavikainen Piia , Solomon Alina , Kivipelto Miia , Uusitupa Matti , Soininen Hilkka , Hartikainen Sirpa 
Published: January 2013

OBJECTIVE
Type 2 diabetes in midlife or late life increases the risk of Alzheimer disease (AD), and type 1 diabetes has been associated with a higher risk of detrimental cognitive outcomes, although studies from older adults are lacking. We investigated whether individuals with AD were more likely to have a history of diabetes than matched controls from the general aged population.

RESEARCH DESIGN AND METHODS
Information on reimbursed diabetes medication (including both type 1 and 2 diabetes) of all Finnish individuals with reimbursed AD medication in 2005 (n = 28,093) and their AD-free control subjects during 1972–2005 was obtained from a special reimbursement register maintained by the Social Insurance Institute of Finland.

RESULTS
The prevalence of diabetes was 11.4% in the whole study population, 10.7% (n = 3,012) among control subjects, and 12.0% (n = 3,372) among AD case subjects. People with AD were more likely to have diabetes than matched control subjects (unadjusted OR 1.14 [95% CI 1.08–1.20]), even after adjusting for cardiovascular diseases (OR 1.31 [1.22–1.41]). The associations were stronger with diabetes diagnosed at midlife (adjusted OR 1.60 [1.34–1.84] and 1.25 [1.16–1.36] for midlife and late-life diabetes, respectively).

CONCLUSIONS
Individuals with clinically verified AD are more likely to have a history of clinically verified and medically treated diabetes than the general aged population, although the difference is small.
Most Youth With Type 1 Diabetes in the T1D Exchange Clinic Registry Do Not Meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes Clinical Guidelines
Authors: Wood Jamie R. , Miller Kellee M. , Maahs David M. , Beck Roy W. , DiMeglio Linda A. , Libman Ingrid M. , Quinn Maryanne , Tamborlane William V. , Woerner Stephanie E. ,   for the T1D Exchange Clinic Network
Published: January 2013

OBJECTIVE
To assess the proportion of youth with type 1 diabetes under the care of pediatric endocrinologists in the United States meeting targets for HbA1c, blood pressure (BP), BMI, and lipids.

RESEARCH DESIGN AND METHODS
Data were evaluated for 13,316 participants in the T1D Exchange clinic registry younger than 20 years old with type 1 diabetes for ≥1 year.

RESULTS
American Diabetes Association HbA1c targets of &lt;8.5% for those younger than 6 years, &lt;8.0% for those 6 to younger than 13 years old, and &lt;7.5% for those 13 to younger than 20 years old were met by 64, 43, and 21% of participants, respectively. The majority met targets for BP and lipids, and two-thirds met the BMI goal of &lt;85th percentile.

CONCLUSIONS
Most children with type 1 diabetes have HbA1c values above target levels. Achieving American Diabetes Association goals remains a significant challenge for the majority of youth in the T1D Exchange registry.
A Review of Occupational Therapy Research and Development Activity in Scotland, Northern Ireland and Wales
Authors: White Elizabeth , Hampson Helen , Gardiner Leanne , Motion Neil , Broomhall Katherine 
Published: January 2013

Introduction: A review was undertaken of the College of Occupational Therapists' 2002 scoping study of occupational therapy research and development activity in Scotland, Northern Ireland and Wales in order to assess the developments in infrastructure supporting occupational therapy research, to highlight opportunities available to occupational therapists and to identify how the College could best support members' research activities. Method: Within each nation, a literature review and focus group were undertaken. A feature of the research was the opportunity for a student occupational therapist from each country to be involved as co-researcher. Findings: The findings revealed a considerable investment and increase in research capacity developments in all three countries, recognising the need to develop the evidence base to underpin occupational therapy interventions. Barriers to progressing research activity included time and research topic prioritisation, and workplace cultures that did not promote research-related activities. The College of Occupational Therapists was considered to have a key role in influencing policy directions and the launch of the United Kingdom Occupational Therapy Research Foundation was viewed as an opportunity to support occupation-focused research and capacity development. Conclusion: Significant progress reflects the investment in research infrastructure, although further effort is needed to change cultural impacts.
Elevated Nuclear Factor Erythroid-2 Levels Promote Epo-Independent Erythroid Maturation and Recapitulate the Hematopoietic Stem Cell and Common Myeloid Progenitor Expansion Observed in Polycythemia Vera Patients
Authors: Bogeska Ruzhica , Pahl Heike L. 
Published: January 2013

Abstract
The molecular etiology of polycythemia vera (PV) remains incompletely understood. Patients harbor increased numbers of hematopoietic stem cells and display Epo-independent erythroid maturation. However, the molecular mechanism underlying Epo hypersensitivity and stem cell expansion is unclear. We have previously shown that the transcription factor nuclear factor erythroid-2 (NF-E2) is overexpressed in the majority of PV patients. Here we demonstrated that elevation of NF-E2 expression in healthy CD34+ cells to levels observed in PV caused Epo-independent erythroid maturation and expansion of hematopoietic stem cell (HSC) and common myeloid progenitor (CMP) cell numbers. Silencing NF-E2 in PV patients reverted both aberrancies, demonstrating for the first time that NF-E2 overexpression is both required and sufficient for Epo independence and HSC/CMP expansion in PV.