bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractLithuania 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

AbstractWater 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

AbstractAimsThe 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.BackgroundSelf‐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.DesignTwo cross‐sectional studies.MethodsThe 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.ResultsFew 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.ConclusionThere 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

SummaryBackgroundArbutin 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.AimsTo assess the efficacy of the aqueous extract from' leaf of five‐leaf serratula as a skin‐lightening agent.Patients/MethodsWe 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.ResultsThe 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.ConclusionsThe 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

SUMMARYBackgroundSerious complications can occur when patients have difficulty in adhering to fluid and salt recommendations.Objectives and DesignThis 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.ResultsThere 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.ConclusionsThe 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.
AbstractThe 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

AbstractHepatocellular 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.
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.SynthesisWhile 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.
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

IntroductionDementia 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.BackgroundThis systematic review explored the use of interventions that could be used within practice to reduce the occurrences of disruptive vocalisation in people with dementia.MethodsThree 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.ResultsThis 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.ConclusionThe 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 practiceTriggers 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

AimLocated 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.BackgroundQuality 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.MethodThe 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.FindingsFour 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.ConclusionThe 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 practiceMoving 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.