bluuebunny/crossref_metadata_2025 huggingface dataset:
The immunomodulatory properties of adult skin‐derived precursor Schwann cells: implications for peripheral nerve injury therapy
Authors: Stratton Jo Anne , Shah Prajay T. , Kumar Ranjan , Stykel Morgan G. , Shapira Yuval , Grochmal Joey , Guo Gui Fang , Biernaskie Jeff , Midha Rajiv
Published: June 2015

Skin‐derived precursor Schwann cell (SKPSC) therapy has been identified as a potentially beneficial treatment for peripheral nerve injuries. One hypothesised mechanism by which SKPSCs enhance recovery is via the modulation of macrophages. In the present study, we investigated the immunomodulatory properties of adult rat SKPSCs, and demonstrated that these cells expressed a battery of cytokines, including interferon‐γ (IFN‐γ), interleukin (IL)‐1β, and, most abundantly, IL‐6. Whereas macrophages exposed to depleted or fibroblast‐conditioned medium secreted minimal amounts of tumor necrosis factor‐α (TNF‐α), in the presence of SKPSC‐conditioned medium, macrophages secreted > 500 pg/mL TNF‐α. Following the transplantation of SKPSCs into injured rat sciatic nerves, we observed an SKPSC density‐dependent increase in the number of macrophages (Pearson's r = 0.66) and an SKPSC density‐dependent decrease in myelin debris (Pearson's r = –0.68). To determine the effect of IL‐6 in a proinflammatory context, macrophage cultures were primed with either lipopolysaccharide (LPS)/IFN‐γ/IL‐1β or LPS/IFN‐γ/IL‐1β + IL‐6, and this showed a 212% and 301% increase in the number of inducible nitric oxide synthase (iNOS)‐positive proinflammatory macrophages respectively. In contrast to neurons exposed to conditioned medium from unprimed macrophages, neurons treated with conditioned medium from proinflammatory‐primed macrophages showed a 13–26% reduction in neurite outgrowth. Anti‐IL‐6 antibody combined with SKPSC transplant therapy following nerve injury did not alter macrophage numbers or debris clearance, but instead reduced iNOS expression as compared with SKPSC + IgG‐treated rats. SKPSC + anti‐IL‐6 treatment also resulted in a two‐fold increase in gastrocnemius compound muscle action potential amplitudes as compared with SKPSC + IgG treatment. Understanding the mechanisms underlying immunomodulatory aspects of SKPSC therapy and developing approaches to manipulate these responses are important for advancing Schwann cell‐based therapies.
PACES in epilepsy: Results of a self‐management randomized controlled trial
Authors: Fraser Robert T. , Johnson Erica K. , Lashley Steven , Barber Jason , Chaytor Naomi , Miller John W. , Ciechanowski Paul , Temkin Nancy , Caylor Lisa
Published: June 2015

Objective

Self‐management challenges facing adults with epilepsy include limited understanding of the condition and treatment, associated psychosocial issues, and lack of community integration. Self‐management interventions improve patients' medical, life role, and emotional management. Previous interventions, developed from expert opinion, indicated issues with participant engagement/retention, and limited follow‐up periods. PACES in Epilepsy addressed methodologic concerns by utilizing patient needs assessment data (n = 165) to derive self‐management content and program features for evaluation via randomized controlled trial (RCT).

Methods

Participants were adults with chronic epilepsy (n = 83), without serious mental illness or substantive intellectual impairment, who were recruited from two epilepsy centers. Participants were assigned randomly to intervention or treatment‐as‐usual groups. Outcomes included the Epilepsy Self‐Management Scale (ESMS), Epilepsy Self‐Efficacy Scale (ESES), Quality of Life in Epilepsy‐31 (QOLIE‐31), Patient Health Questionnaire‐9 (PHQ‐9), and the Generalized Anxiety Disorder‐7 (GAD‐7), administered at baseline, postintervention (8 weeks), and 6 months postintervention. The intervention was an 8‐week group of 6–8 adults co‐led by a psychologist and trained peer with epilepsy that met one evening per week at a hospital for 75 min. Topics included medical, psychosocial, cognitive, and self‐management aspects of epilepsy, in addition to community integration and optimizing epilepsy‐related communication. The treatment group provided satisfaction ratings regarding program features.

Results

PACES participants (n = 38) improved relative to controls (n = 40) on the ESMS (p < 0.001) and subscales [Information (p < 0.001); Lifestyle (p < 0.002)]; ESES (p < 0.001); and QOLIE‐31 (p = 0.002). At 6‐month follow up, PACES participants remained improved on the ESMS (p = 0.004) and Information subscale (p = 0.009); and Energy/Fatigue (p = 0.032) and Medication Effects (p = 0.005) of the QOLIE‐31. Attrition in both groups was low (8% in each group) and all program satisfaction ratings exceeded 4.0/5.0, with leadership (4.76), topics (4.53), and location (4.30) as the most highly rated aspects.

Significance

A consumer generated epilepsy self‐management program appears to be a promising intervention from multiple perspectives, particularly in relation to disability management.
An ultrasonographic scoring method for transabdominal monitoring of ascarid burdens in foals
Authors: Nielsen M. K. , Donoghue E. M. , Stephens M. L. , Stowe C. J. , Donecker J. M. , Fenger C.K.
Published: June 2015

Reasons for performing study

Parascaris spp. infections can lead to life‐threatening small intestinal impactions in foals. Currently available diagnostic techniques cannot estimate the magnitude of an ascarid burden, and hence identify foals potentially at risk of developing impactions.

Objectives

To describe and evaluate an ultrasonographic transabdominal scoring technique for monitoring of ascarid burdens in foals and to perform a cost‐benefit analysis of the application of this technique.

Study design

A transabdominal ultrasonographic technique was validated against ascarid worm counts from 10 foals aged 162–294 days. In a treatment trial, 15 foals were randomly allocated to 3 treatment groups: ivermectin, oxibendazole and no treatment. Blinded ultrasound examinations were performed daily for 5 consecutive days following treatment. Foals were examined ultrasonographically twice by the same investigator, and by different investigators for intra‐ and interobserver agreement evaluation. Cost‐benefit analyses identified threshold values for the probability of ascarid impactions above which the screening method becomes cost‐effective.

Methods

The ultrasound technique used 3 locations along the ventral midline. An ascarid scoring system was established that assessed the magnitude of ascarid burden ranging from 1–4. The method was validated against worm burdens of 10 worms and above with calculation of diagnostic specificity, sensitivity, and predictive values. Treatment trial data were evaluated statistically using mixed model analysis. Kappa values were generated for intra‐ and interobserver agreement.

Results

Two consecutive examinations were found to detect worm burdens >10 ascarids reliably. Ascarid scores declined in response to both anthelmintic treatments, although differences were not statistically significant. Kappa values indicated fair to moderate intra‐ and interobserver agreements. The majority of cost‐benefit analyses indicated that ultrasound examinations are cost effective when the probability of ascarid impactions is above a range of 0.0001–0.0082 (i.e. 1 in 10,000 to 8 in 1000 foals).

Conclusions

The ultrasonographic screening techniques can be a useful tool for monitoring ascarid burdens in foals.
IL‐33 induces Egr‐1‐dependent TSLP expression via the MAPK pathways in human keratinocytes
Authors: Ryu Woo‐In , Lee Hana , Kim Jin Hee , Bae Hyun Cheol , Ryu Hwa Jung , Son Sang Wook
Published: June 2015

Atopic dermatitis (AD) is a chronic inflammatory skin disease in which T‐helper type 2 (Th2)‐type immune responses are dominant. Th2 cytokine, interleukin (IL)‐33 and thymic stromal lymphopoietin (TSLP) have been suggested to have an important role in AD. IL‐33 is highly expressed in AD, but its role in AD has not yet been fully understood. To further identify the role of IL‐33 in AD, we investigated the expression of TSLP induced by IL‐33 in keratinocytes. This study revealed that IL‐33 induced TSLP expression in human keratinocytes. Early growth response protein 1 (Egr)‐1, which is an inflammatory transcriptional factor, is induced by IL‐33. IL‐33‐mediated TSLP induction in keratinocytes was suppressed by treatment with mitogen‐activated protein kinase (MAPK) inhibitors or small interfering RNA against Egr‐1. Chromatin immunoprecipitation (ChIP) assay indicated the direct involvement of Egr‐1 in IL‐33‐mediated TSLP induction. Taken together, these findings indicate that IL‐33 may increase TSLP expression through an Egr‐1‐dependent mechanism via ERK1/2, JNK and p38 activation in keratinocytes. These data suggest that the IL‐33‐ERK/JNK/p38/Egr‐1/TSLP axis is involved in allergic skin Th2 inflammation, and it may be a novel therapeutic target.
Short fatigue cracks in intermetallic γ‐TiAl‐alloys
Authors: Wessel W. , Zeismann F. , Brueckner‐Foit A.
Published: June 2015

Fatigue crack growth at room temperature and its relation to the local microstructure is studied for four different γ‐TiAl‐alloys with microstructures ranging from coarse and fully lamellar to fine and partly lamellar. It is shown that the number of cycles to failure depends strongly on the efficiency of the first barrier to crack extension, as crack growth rates may increase rapidly once this barrier has been breached by a specific crack. The crack extension behaviour for two typical barriers (colony boundary and twin boundary) is studied using high‐resolution optical and scanning electron microscopy.
Health sciences journals: an overview of outputs by Chinese authors
Authors: Li Meina , Liu Xiaodong , Zhang Lulu
Published: June 2015

Objectives

To analyse the contributions of authors from three major regions of China – the Mainland (ML), Hong Kong (HK) and Taiwan (TW) – in the field of health care sciences and services.

Methods

Articles published by Chinese authors between 1998 and 2012 in the category of health care sciences and services were retrieved from the Science Citation Index Expanded (scie) database. The numbers of total articles, impact factors, citations, articles included in the top 10 highest impact journals and the 10 journals that published the most papers were recorded.

Results

ML, HK and TW published 615, 415 and 1162, respectively, with accumulated impact factors of 1281.65, 904.29 and 2361.44; average impact factor of 2.08, 2.18 and 2.03; and total citation times of 2313, 2652, and 4818. Regarding the top 10 high‐impact journals, ML, HK and TW accounted for 28.25%, 27.68% and 44.07%, respectively. Total impact factors of the most popular 10 journals for ML, HK and TW were 20.86, 22.08 and 18.92, respectively.

Discussion and Conclusions

Both the quality and quantity of papers published in health care sciences and services journals from ML, HK and TW have greatly improved. ML and HK have different strong points, while the gap with TW diminished.
Combined Lysis of Thrombus with Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization in Acute Ischemic Stroke (Clotbust-ER): Design and Methodology of a Multinational Phase 3 Trial
Authors: Schellinger Peter D. , Alexandrov Andrei V. , Barreto Andrew D. , Demchuk Andrew M. , Tsivgoulis Georgios , Kohrmann Martin , Alleman John , Howard Virginia , Howard George , Alexandrov Anne W. , Brandt Gordon , Molina Carlos A.
Published: June 2015

Background

We designed a Phase 3 clinical trial to determine the safety and efficacy of adding transcranial ultrasound using an operator-independent headframe to recombinant tissue-plasminogen-activator for the treatment of acute ischemic stroke.

Methods

Combined lysis of thrombus with ultrasound and systemic tissue-plasminogen-activator for emergent revascularization in acute ischemic stroke is a randomized, double-blind, placebo-controlled clinical trial that will enroll subjects with the following main inclusion criteria: less than 4·5 hours from symptom onset (three-hours in US and Canada), age 18–80 years, baseline National Institutes of Health Stroke Scale score ≥ 10, and premorbid modified-Rankin-score of 0–1, eligibility for full dose recombinant tissue-plasminogen-activator. Subjects will receive two-hours of 2-MHz pulsed wave transcranial ultrasound (target group) or sham ultrasound (control group). The projected sample size is approximately 824 subjects.

Results

The primary endpoint, based on intention-to-treat criteria of patients enrolled within three-hours of symptom onset is the comparison between target and control groups of modified-Rankin-score scores at day 90 poststroke assessed using the proportional odds method. The study will have two planned interim analyses after approximately one-third and two-thirds of subjects have reached the 90-day modified-Rankin-score evaluation. Safety outcomes are symptomatic intracranial hemorrhage within 24 h and an overall analysis of adverse events.

Conclusions

Since intravenous recombinant tissue-plasminogen-activator remains the only medical therapy to reverse ischemic stroke applicable in the emergency department, our trial will determine if the additional use of transcranial ultrasound improves functional outcomes in patients with severe acute ischemic stroke (NCT#01098981).
A Phase 1 Exercise Dose Escalation Study for Stroke Survivors with Impaired Walking
Authors: Dite Wayne , Langford Zoe N. , Cumming Toby B. , Churilov Leonid , Blennerhassett Jannette M. , Bernhardt Julie
Published: June 2015

Background

Targeted exercise and increased practice can improve the mobility of stroke survivors. However, many stroke survivors continue to have reduced physical work capacity and impaired walking, and experience frequent falls after participating in physical rehabilitation programs.

Aim

In this Phase 1 study, we used a dose escalation method, common in pharmaceutical trials, to determine the maximum tolerable dose of multimodal exercise in community-dwelling stroke survivors with mobility impairment.

Methods

Stroke survivors 14–59 months poststroke participated in a 12-week (36 sessions) multimodal exercise program implemented using a cumulative 3 + 3 dose escalation design (featuring increasing doses in successive cohorts of three participants), with set dose-limiting tolerance criteria. The exercise intervention included challenging balance activities, strength, and endurance training. The program was individualized and focused on task-specific requirements for walking in the community.

Results

Six survivors participated before escalation was ceased. Four participants were able to tolerate up to 10·5 h/week of exercise, which included 283 min of endurance, 182 min of task practice, 138 min of strengthening, and 28 min resting. The program led to increased walking distance (Six-Minute Walk Test) and faster mobility (4 Square Step Test, Timed Up and Go Test), with pre–postimprovements averaging 23–41%.

Conclusions

This is the first multimodal exercise dose escalation study in stroke. The maximal dose of exercise identified was dramatically higher than the dose typically delivered to stroke survivors in current trials. We now plan to confirm safety and feasibility of this program in a larger Phase II trial.
High Levels of von Willebrand Factor and Low Levels of its Cleaving Protease, ADAMTS13, are Associated with Stroke in Young HIV-Infected Patients
Authors: Allie Sameera , Stanley Alan , Bryer Alan , Meiring Muriel , Combrinck Marc I.
Published: June 2015

Background

Stroke associated with human immunodeficiency virus infection may occur through a variety of mechanisms. Von Willebrand factor is a marker of endothelial dysfunction, and is elevated in human immunodeficiency virus infection. High levels of von Willebrand factor, a protein involved in platelet adhesion and aggregation, and low levels of ADAMTS13, a metalloproteinase that cleaves von Willebrand factor, have been associated with an increased risk of thrombosis.

Aim

To investigate the role of von Willebrand factor and ADAMTS13 in the pathogenesis of human immunodeficiency virus-related stroke in young patients.

Methods

A case-control study ( n = 100) comprising three participant groups: human immunodeficiency virus-positive antiretroviral therapy-naïve young strokes ( n = 20), human immunodeficiency virus-negative young strokes ( n = 40), and human immunodeficiency virus-positive antiretroviral therapy-naïve nonstroke controls ( n = 40). von Willebrand factor and ADAMTS13 levels were measured in plasma samples collected five- to seven-days poststroke.

Results

Human immunodeficiency virus-positive stroke participants had higher von Willebrand factor levels than human immunodeficiency virus-negative strokes (173·5% vs. 135%, P = 0·032). They tended to have higher levels of von Willebrand factor than human immunodeficiency virus-positive nonstroke controls (173·5% vs. 129%, P = 0·061). Human immunodeficiency virus-positive stroke participants had lower levels of ADAMTS13 than human immunodeficiency virus-positive nonstroke controls (0% vs. 23·5% P = 0·018) most likely due to the effect of the acute stroke. However, in the nonstroke group, these levels were significantly reduced compared with population norms. von Willebrand factor levels in all human immunodeficiency virus-positive participants were negatively correlated with CD4 counts.

Conclusions

Stroke in human immunodeficiency virus infection is associated with a prothrombotic state, characterized by elevated von Willebrand factor and low ADAMTS13 levels.
A Comparison of Location of Acute Symptomatic vs. ‘Silent’ Small Vessel Lesions
Authors: del C. Valdés Hernández Maria , Maconick Lucy C. , Muñoz Maniega Susana , Wang Xin , Wiseman Stewart , Armitage Paul A. , Doubal Fergus N. , Makin Stephen , Sudlow Cathie L. M. , Dennis Martin S. , Deary Ian J. , Bastin Mark , Wardlaw Joanna M.
Published: June 2015

Background

Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not.

Aim

To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly.

Methods

We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods.

Results

In 188 patients, mean age 67 ± standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0·2/mm3), centrum semiovale (probability density = 0·15/mm3), medial lentiform nucleus/lateral thalamus (probability density = 0·09/mm3), and pons (probability density = 0·02/mm3). Most lacunes were in the lentiform nucleus (probability density = 0·01–0·04/mm3) or external capsule (probability density = 0·05/mm3). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P < 0·01).

Conclusions

Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.
Statins and subarachnoid hemorrhage in Medicare patients with unruptured cerebral aneurysms
Authors: Bekelis Kimon , Smith Jeremy , Zhou Weiping , Mackenzie Todd A. , Roberts David W. , Skinner Jonathan , Morden Nancy E.
Published: June 2015

Background

Statins have been shown to decrease aneurysm progression and rupture in two experimental settings: animals with cerebral aneurysm and humans with abdominal aortic aneurysms.

Aims

To investigate statin use and outcomes in humans with unruptured cerebral aneurysms through Medicare administrative data.

Methods

We used a 40% random sample Medicare denominator file and corresponding inpatient, outpatient (2003-2011), and prescription (2006-2011) claims to conduct a retrospective cohort study of patients diagnosed with unruptured cerebral aneurysms, between 2003 and 2011. We used propensity score-adjusted models to investigate the association between statin use and risk of subarachnoid hemorrhage. Secondary analyses repeated the main models stratified on tobacco use status and separately assessed other composite outcomes.

Results

We identified 28 931 patients with unruptured cerebral aneurysms (average age 72.0 years, 72.6% female); mean follow-up was 30.0 months; 41.3% used statins. Overall, 593 patients developed subarachnoid hemorrhage, and 703 underwent treatment before subarachnoid hemorrhage. Current or recent statin use was not associated with a difference in subarachnoid hemorrhage risk (odds ratio, 1.03; 95% conflict of interest 0.86-1.23); models stratified on tobacco use status were nearly identical. No association was observed between statin use and the composite outcome of subarachnoid hemorrhage or aneurysm treatment (odds ratio, 0.94; 95% conflict of interest, 0.84-1.06). The risk of subarachnoid hemorrhage or out-of-hospital death was lower among statin users (odds ratio, 0.69; 95% conflict of interest, 0.64-0.74).

Conclusions

Statin use by patients with unruptured cerebral aneurysms was not associated with subarachnoid hemorrhage risk. Given the prior animal experimental studies demonstrating a protective effect, further prospective studies are needed to investigate the potential relationship.
The Mass Emigration Context of Lithuania: Patterns and Policy Options
Authors: Klüsener Sebastian , Stankūnienė Vlada , Grigoriev Pavel , Jasilionis Domantas
Published: June 2015

Lithuania represents one of the rare cases in which a state with relatively high standards for maintaining population statistics is experiencing mass emigration. In light of the policy initiatives undertaken by the Lithuanian government to address the issue of emigration, this study aims to improve our understanding of how, in this mass emigration context, emigration events are connected to specific socio‐economic characteristics of individuals and variation in local socio‐economic conditions. We analyse census and vital registration data covering the whole working‐age population of Lithuania during the period 2011‐2012. Our findings indicate that when assessing the likelihood of emigration events, individual‐level characteristics such as employment status, educational attainment, and prior migration experience are highly relevant. However, the importance of these characteristics differs by gender. We also detect considerable spatial variation in emigration rates across Lithuanian municipalities. Our outcomes provide new insights for the development of cohesive migration policies in Lithuania.
Assessing the Spatiotemporal Dynamic of Global Grassland Water Use Efficiency in Response to Climate Change from 2000 to 2013
Authors: Gang C. , Wang Z. , Zhou W. , Chen Y. , Li J. , Chen J. , Qi J. , Odeh I. , Groisman P. Y.
Published: June 2015

Water use efficiency (WUE), which is a ratio of net primary production (NPP) to evapotranspiration (ET), is an important index representing the relationship between carbon and water cycles. This study evaluates the spatiotemporal dynamics of global grassland WUE from 2000 to 2013 to reveal the different responses of each grassland type to climate variations. Their correlations with climate variables are also investigated to reflect their dependence on climate. The average annual WUE of different grassland types follows an order of: closed shrublands > woody savannas > savannas > open shrublands > non‐woody grasslands. Although the NPP of all grassland types has increased from 2000 to 2013, 37.89 % of grassland ecosystems globally experienced a decreased WUE, in which 3.34 % has extremely significantly decreased. The WUE of open shrublands, woody savannas and non‐woody grasslands shows an overall descending trend because of the exceeding increasing rate of ET. By contrast, the decreased ET contributes to the overall ascending trend of the WUE of closed shrublands and savannas over this period. Moreover, the WUE of each grassland type reacts differently to climate variations in the northern and southern hemispheres. The grassland WUE dynamic is more controlled by precipitation than temperature at a global scale.
Self‐management support for chronic pain in primary care: a cross‐sectional study of patient experiences and nursing roles
Authors: Lukewich Julia , Mann Elizabeth , VanDenKerkhof Elizabeth , Tranmer Joan
Published: June 2015

Aims

The aim of this study was to describe chronic pain self‐management from the perspective of individuals living with chronic pain in the context of primary care nursing.

Background

Self‐management is a key chronic pain treatment modality and support for self‐managing chronic pain is mainly provided in the context of primary care. Although nurses are optimally suited to facilitate self‐management in primary care, there is a need to explore opportunities for optimizing their roles.

Design

Two cross‐sectional studies.

Methods

The Chronic Pain Self‐Management Survey was conducted in 2011–2012 to explore the epidemiology and self‐management of chronic pain in Canadian adults. The questionnaire was distributed to 1504 individuals in Ontario. In 2011, the Primary Care Nursing Roles Survey was distributed to 1911 primary care nurses in Ontario to explore their roles and to determine the extent to which chronic disease management strategies, including support for self‐management, were implemented in primary care.

Results

Few respondents to the pain survey identified nurses as being the ‘most helpful’ facilitator of self‐management while physicians were most commonly cited. Seventy‐six per cent of respondents used medication to manage their chronic pain. Few respondents to the nursing survey worked in practices with specific programmes for individuals with chronic pain. Individuals with chronic pain identified barriers and facilitators to self‐managing their pain and nurses identified barriers and facilitators to optimizing their role in primary care.

Conclusion

There are several opportunities for primary care practices to facilitate self‐management of chronic pain, including the optimization of the primary care nursing role.
A double‐blind, placebo‐controlled randomized trial of Serratulae quinquefoliae folium, a new source of β‐arbutin, in selected skin hyperpigmentations
Authors: Morag Monika , Nawrot Joanna , Siatkowski Idzi , Adamski Zygmunt , Fedorowicz Tomasz , Dawid‐Pac Renata , Urbanska Maria , Nowak Gerard
Published: June 2015

Background

Arbutin is one of the most effective lightening substances. Serratula quinquefolia is a new source of its β‐anomer. The HPLC method showed that the solid content of this compound in the dried plant raw material accounts for 6.86%. The leaves of Serratula quinquefolia do not contain hydroquinone.

Aims

To assess the efficacy of the aqueous extract from' leaf of five‐leaf serratula as a skin‐lightening agent.

Patients/Methods

We did a randomized, placebo‐controlled, double‐blind trial. The study involved 102 women aged 26–55, with two kinds of hyperpigmentary diseases: melasma and lentigo solaris. Patients were randomly assigned to one of the treatment groups: a study group (N = 54) or a control group (N = 48). The study group applied the cream with the aqueous extract from leaf of five‐leaf serratula containing 2.51% of arbutin. The cream was applied twice a day on the discolored side for 8 weeks.

Results

The experimental data showed that the cream with the extract causes decreased level of melanin in the skin pigmentation spot. Clinical effect in the form of lightening and evening skin tone on the discolored side was observed in 75.86% of the female patients with melasma and 56.00 % of the female patients with lentigo solaris.

Conclusions

The cream with the aqueous extract from leaf of five‐leaf serratula proved to be an effective and safe preparation for lightening skin discolorations (66.67 % of the female patients in the study group).
THE IMPACT OF CONTROLLED FLUID AND SALT INTAKE TRAINING IN PATIENTS UNDERGOING HAEMODIALYSIS
Authors: Topbaş Eylem , Kavalalı Tuğba , Öztürk Feyza , Can Semih , Dedekoç Şule , Sapcı Yasemin
Published: June 2015

Background

Serious complications can occur when patients have difficulty in adhering to fluid and salt recommendations.

Objectives and Design

This study was designed as an experimental study with the aims of evaluating the effects of controlled fluid and salt intake training on the intra‐dialytic process and on the level of patients’ knowledge. The factors that had an impact on the training process were also evaluated. The effectiveness of the planned training was evaluated at 0, 1, 3 and 6 months.

Results

There were no significant differences in salt intake exceeding 3 g per day (p > 0.05) between the preliminary and final test, although a statistically significant change was observed at months 1 and 3. The effectiveness of the training decreased by the end of the 3rd month. A statistically significant change was obtained prior to and after the training at months 0, 1, 3 and 6 with respect to the rates of daily fluid intake exceeding 1500 ml, hypovolaemia, hypervolaemia, awareness of salt‐rich food and correct calculation of daily fluid intake by the patients. Also a significant reduction was observed in the volume of oedema after the training. The patients’ age, gender, marital status and educational background did not have a significant effect on daily salt intake of more than 3 g, daily fluid intake of more than 1500 ml, and level of knowledge regarding fluid and salt control.

Conclusions

The training was effective at some time points in decreasing salt and fluid intake. This training should be repeated at certain intervals for the behavioural changes to become permanent.
How short should short‐term risk assessment be? Determining the optimum interval for START reassessment in a secure mental health service
Authors: Dickens G. L. , O'Shea L. E.
Published: June 2015

Accessible summary

The Short‐Term Assessment of Risk and Treatability (START) is a tool used in some mental health services to assess patients to see if they are at risk of violence, self‐harm, self‐neglect or victimization. The recommended time between assessments is 3 months but there is currently no evidence to show that this is best practice.

We have investigated whether assessing at 1‐ or 2‐month intervals would be more accurate and therefore facilitate more individualized risk management interventions. We found that many patients who were rated as low risk had been involved in risk behaviours before 3 months had passed; some patients who were rated at increased risk did not get involved in risk behaviours at all.

Results are mixed for different outcomes but on balance, we think that the recommendation to conduct START assessment every 3 months is supported by the evidence. However, reassessment should be considered if risk behaviours are not prevented and teams should always consider whether risk management practices are too restrictive.

The Short‐Term Assessment of Risk and Treatability (START) guides assessment of potential adverse outcomes. Assessment is recommended every 3 months but there is no evidence for this interval. We aimed to inform whether earlier reassessment was warranted. We collated START assessments for N = 217 adults in a secure mental health hospital, and subsequent aggressive, self‐harm, self‐neglect and victimization incidents. We used receiver operating characteristic analysis to assess predictive validity; survival function analysis to examine differences between low‐, medium‐, and high‐risk groups; and hazard function analysis to determine the optimum interval for reassessment. The START predicted aggression and self‐harm at 1, 2 and 3 months. At‐risk individuals engaged in adverse outcomes earlier than low‐risk patients. About half warranted reassessment before 3 months due to engagement in risk behaviour before that point despite a low‐risk rating, or because of non‐engagement by that point despite an elevated risk rating. Risk assessment should occur at appropriate intervals so that management strategies can be individually tailored. Assessment at 3‐month intervals is supported by the evidence. START assessments should be revisited earlier if risk behaviours are not prevented; teams should constantly re‐evaluate the need for restrictive practices.
Hyperinsulinaemia and insulin signalling in the pathogenesis and the clinical course of hepatocellular carcinoma
Authors: Chettouh Hamza , Lequoy Marie , Fartoux Laetitia , Vigouroux Corinne , Desbois‐Mouthon Christèle
Published: June 2015

Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and is one of the leading causes of cancer‐related death. The risk factors for HCC include cirrhosis, chronic viral hepatitis, heavy alcohol intake and metabolic diseases such as obesity, type 2 diabetes and metabolic syndrome. Insulin resistance is a common denominator of all of these conditions and is tethered to hyperinsulinaemia. Here, we give an overview of the recent advances linking hyperinsulinaemia to HCC development and progression. In particular, we summarise the underlying causes of hyperinsulinaemia in the setting of chronic liver diseases. We present epidemiological evidence linking metabolic diseases to HCC risk and HCC‐related mortality, as well as the pathogenic cellular and molecular mechanisms explaining this relation. A better understanding of the mechanisms by which insulin participates in HCC biology might ultimately provide novel opportunities for prevention and treatment.
Mitochondrial dysfunction and Parkinson disease: a Parkin–AMPK alliance in neuroprotection
Authors: Hang Liting , Thundyil John , Lim Kah‐Leong
Published: June 2015

Although a subject of intense research, the etiology of Parkinson disease (PD) remains poorly understood. However, a wide range of studies conducted over the past few decades have collectively implicated aberrant mitochondrial homeostasis as a key contributor to the development of PD. Particularly strong support for this came from the recent demonstration that parkin, a familial PD‐linked gene, is a critical regulator of mitochondrial quality control. Indeed, Parkin appears to be involved in all stages of the mitochondrial life cycle (i.e., from biogenesis to its exit from the cell (via mitophagy). Interestingly, the role of Parkin in the biogenesis and clearance of mitochondria is akin to that performed by the energy sensor AMP‐activated protein kinase (AMPK), suggesting that the two proteins might act in a functionally converging manner to maintain the quality of cellular mitochondria. In this review, we discuss the contribution of mitochondrial dysfunction to PD pathogenesis and the role of Parkin and AMPK in preserving neuronal mitochondrial homeostasis. Alongside this, we will also articulate our thoughts on the potential alliance between Parkin and AMPK in offering neuroprotection through their ability to maintain energy balance in the brain.
Mechanisms of coexistence in diverse herbivore–carnivore assemblages: demographic, temporal and spatial heterogeneities affecting prey vulnerability
Authors: Owen‐Smith Norman
Published: June 2015

Simple models coupling the dynamics of single predators to single prey populations tend to generate oscillatory dynamics of both predator and prey, or extirpation of the prey followed by that of the predator. In reality, such oscillatory dynamics may be counteracted by prey refugia or by opportunities for prey switching by the predator in multi‐prey assemblages. How these mechanisms operate depends on relative prey vulnerability, a factor ignored in simple interactive models. I outline how compositional, temporal, demographic and spatial heterogeneities help explain the contrasting effects of top predators on large herbivore abundance and population dynamics in species‐rich African savanna ecosystems compared with less species‐diverse northern temperate or subarctic ecosystems. Demographically, mortality inflicted by predation depends on the relative size and life history stage of the prey. Because all animals eventually die and are consumed by various carnivores, the additive component of the mortality inflicted is somewhat less than the predation rate. Prey vulnerability varies annually and seasonally, and between day and night. Spatial variation in the risk of predation depends on vegetation cover as well as on the availability of food resources. During times of food shortage, herbivores become prompted to occupy more risky habitats retaining more food. Predator concentrations dependent on the abundance of primary prey species may restrict the occurrence of other potential prey species less resistant to predation. The presence of multiple herbivore species of similar size in African savannas allows the top predator, the lion, to shift its prey selection flexibly dependent on changing prey vulnerability. Hence top–down and bottom–up influences on herbivore populations are intrinsically entangled. Models coupling the population dynamics of predators and prey need to accommodate the changing influences of prey demography, temporal variation in environmental conditions, and spatial variation in the relative vulnerability of alternative prey species to predation.

Synthesis

While re‐established predators have had major impacts on prey populations in northern temperate regions, multiple large herbivore species typically coexist along with diverse carnivores in African savanna ecosystems. In order to explain these contrasting outcomes, certain functional heterogeneities must be recognised, including relative vulnerability of alternative prey, temporal variation in the risk of predation, demographic differences in susceptibility to predation, and spatial contrasts in exposure to predation. Food shortfalls prompt herbivores to exploit more risky habitats, meaning that top–down and bottom–up influences on prey populations are intrinsically entangled. Models coupling the interactive dynamics of predator and prey populations need to incorporate these varying influences on relative prey vulnerability.
Disentangling environmental and spatial processes of community assembly in tropical forests from local to regional scales
Authors: Arellano Gabriel , Tello J. Sebastián , Jørgensen Peter M. , Fuentes Alfredo F. , Loza M. Isabel , Torrez Vania , Macía Manuel J.
Published: June 2015

Understanding patterns and mechanisms of variation in the compositional structure of communities across spatial scales is one of the fundamental challenges in ecology and biogeography. In this study, we evaluated the effects of spatial extent (i.e. size of study region) on: 1) whether community composition can be better explained by environmental (i.e. niche‐based) or spatial (e.g. dispersal‐based) processes ; and 2) how climate and soils contribute to the influence of environment on plant community composition. We surveyed community composition across a network of 398 forest plots spanning a ∼4000 m elevational gradient in the Madidi region in northwestern Bolivia. Using redundancy analyses and hierarchical variation partitioning, we disentangled the effects of environmental and spatial predictors on species composition, further decomposing the environmental effect between its climatic and soil components. We repeated analyses for 200 sub‐regions ranging in spatial extent from ∼250 to ∼17 500 km2. Our analyses show a high degree of idiosyncrasy in results that come from different sub‐regions. Despite this variability, we were able to identify various important patterns in the structure of tropical plant communities in our study system. First, even though sub‐regions varied in size by nearly two orders of magnitude, the total amount of explained variation in community composition was scale independent; at all spatial scales, environment and space accounted for about 25% of the differences in community composition among plots. Second, the measured environmental effect was higher than the spatial effect on average and in the vast majority of sub‐regions. This was true regardless of the spatial extent of analysis. Finally, we found that both climatic and soil variables accounted for significant fractions of variation, but climate was always more important than soils.
What are the relative merits of interventions used to reduce the occurrences of disruptive vocalisation in persons with dementia? – a systematic review
Authors: Randall Edward W , Clissett Philip C
Published: June 2015

Introduction

Dementia is a major health issue, and many people who have the progressive disease express disruptive vocalisation. These behaviours place large burdens on carers, family and on the individual themselves.

Background

This systematic review explored the use of interventions that could be used within practice to reduce the occurrences of disruptive vocalisation in people with dementia.

Methods

Three online databases (CINAHL, MEDLINE and EMBASE) were searched for papers published after 1997 against two concept criteria of dementia and disruptive vocalisation. Any person diagnosed with dementia or suspected of having dementia symptoms were included identifying any interventions. Studies were appraised and data extracted using the Joanna Briggs Institute frameworks.

Results

This systematic review identified eight relevant papers for inclusion, and these assessed the implementation of eight separate interventions that could be used within practice. Three interventions were found to be supported by statistically significant research: a staff training programme, a behavioural management technique using cue cards and hand massage.

Conclusion

The overall conclusion is that the evidence base is insufficient to make recommendations for practice. However, the studies gave some indication of how research and practice might develop in this area. In particular, five elements were identified that appear to promote the best patient outcomes. These include making sure interventions are person‐centred, individualised, adaptable, with the use of multiple approaches, carried out by staff trained in the identification of disruptive vocalisation and ways to avoid triggering these behaviours.

Implications for practice

Triggers which lead to older people with dementia expressing disruptive vocalisation should be identified. Multiple individualised interventions should be used to reduce the occurrences of the disruptive vocalisation.
Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family
Authors: Adra Marina Gharibian , Hopton John , Keady John
Published: June 2015

Aim

Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers.

Background

Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon.

Method

The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi‐structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method.

Findings

Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders.

Conclusion

The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study.

Implications for practice

Moving nursing practice from task‐based care to relationship‐centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care.
Role of Narrowband Ultraviolet B Phototherapy in the Treatment of Childhood Psoriasis in Asian Children
Authors: Wong Yisheng , Koh Mark Jean‐Aan , Chong Wei‐Sheng
Published: June 2015

Narrowband ultraviolet B (NBUVB) phototherapy is a well‐established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5‐year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.
Determinants of Obesity in the Hispanic Preschool Population: An Integrative Review
Authors: Innella Nancy , Breitenstein Susan , Hamilton Rebekah , Reed Monique , McNaughton Diane B.
Published: June 2015

Objective(s)

The purpose of this integrative review was to identify factors associated with obesity in Hispanic preschool children.

Design and Sample

Integrative research review based on strategies described by Whittemore and Knafl. Thirty‐five research reports using qualitative and/or quantitative methods and including a majority of participants (parents or preschool‐aged children) of Hispanic ethnicity.

Measures

Data were analyzed using the Matrix Method.

Results

Decreased physical activity of the child and increased maternal body mass index were found as contributors to obesity in the preschool, Hispanic population. The relationship between maternal feeding practices and beliefs, food choices and childhood obesity are widely studied with little consistency in findings across studies.

Conclusions

Public health nurses can work with communities to promote physical activity and safe outdoor places for exercise. In addition, they can advocate for the availability of healthy food choices in neighborhood schools. Maternal feeding practices, acculturation, and the child's environment require further research.