bluuebunny/crossref_metadata_2025 huggingface dataset:
The Clinician’s Subjective Experience during the Interaction with Adolescent Psychiatric Patients: Validity and Reliability of the Assessment of Clinician’s Subjective Experience
Authors: Picardi Angelo , Panunzi Sara , Misuraca Sofia , Di Maggio Chiara , Maugeri Andrea , Fonzi Laura , Biondi Massimo , Ferrara Mauro , Pallagrosi Mauro
Published: March 2021

Introduction: The last decade has witnessed a resurgence of interest in the clinician’s subjectivity and its role in the diagnostic assessment. Integrating the criteriological, third-person approach to patient evaluation and psychiatric diagnosis with other approaches that take into account the patient’s subjective and intersubjective experience may bear particular importance in the assessment of very young patients. The ACSE (Assessment of Clinician’s Subjective Experience) instrument may provide a practical way to probe the intersubjective field of the clinical examination; however, its reliability and validity in child and adolescent psychiatrists seeing very young patients is still to be determined. Methods: Thirty-three clinicians and 278 first-contact patients aged 12–17 years participated in this study. The clinicians completed the ACSE instrument and the Brief Psychiatric Rating Scale after seeing the patient, and the Profile of Mood State (POMS) just before seeing the patient and immediately after. The ACSE was completed again for 45 patients over a short (1–4 days) retest interval. Results: All ACSE scales showed high internal consistency and moderate to high temporal stability. Also, they displayed meaningful correlations with the changes in conceptually related POMS scales during the clinical examination. Discussion: The findings corroborate and extend previous work on adult patients and suggest that the ACSE provides a valid and reliable measure of the clinician’s subjective experience in adolescent psychiatric practice, too. The instrument may prove to be useful to help identify patients in the early stages of psychosis, in whom subtle alterations of being with others may be the only detectable sign. Future studies are needed to determine the feasibility and usefulness of integrating the ACSE within current approaches to the evaluation of at-risk mental states.
Study Design and Baseline Characteristics of the CARDINAL Trial: A Phase 3 Study of Bardoxolone Methyl in Patients with Alport Syndrome
Authors: Chertow Glenn M. , Appel Gerald B. , Andreoli Sharon , Bangalore Sripal , Block Geoffrey A. , Chapman Arlene B. , Chin Melanie P. , Gibson Keisha L. , Goldsberry Angie , Iijima Kazumoto , Inker Lesley A. , Knebelmann Bertrand , Mariani Laura H. , Meyer Colin J. , Nozu Kandai , O’Grady Megan , Silva Arnold L. , Stenvinkel Peter , Torra Roser , Warady Bradley A. , Pergola Pablo E.
Published: March 2021

Introduction: Alport syndrome is a rare genetic disorder that affects as many as 60,000 persons in the USA and a total of 103,000 persons (<5 per 10,000) in the European Union [1, 2]. It is the second most common inherited cause of kidney failure and is characterized by progressive loss of kidney function that often leads to end-stage kidney disease. Currently, there are no approved disease-specific agents for therapeutic use. We designed a phase 3 study (CARDINAL; NCT03019185) to evaluate the safety, tolerability, and efficacy of bardoxolone methyl in patients with Alport syndrome. Methods: The CARDINAL phase 3 study is an international, multicenter, double-blind, placebo-controlled, randomized registrational trial. Eligible patients were of ages 12–70 years with confirmed genetic or histologic diagnosis of Alport syndrome, eGFR 30–90 mL/min/1.73 m2, and urinary albumin to creatinine ratio (UACR) ≤3,500 mg/g. Patients with B-type natriuretic peptide values >200 pg/mL at baseline or with significant cardiovascular histories were excluded. Patients were randomized 1:1 to bardoxolone methyl or placebo, with stratification by baseline UACR. Results: A total of 371 patients were screened, and 157 patients were randomly assigned to receive bardoxolone methyl (n = 77) or placebo (n = 80). The average age at screening was 39.2 years, and 23 (15%) were <18 years of age. Of the randomized population, 146 (93%) had confirmed genetic diagnosis of Alport syndrome, and 62% of patients had X-linked mode of inheritance. Mean baseline eGFR was 62.7 mL/min/1.73 m2, and the geometric mean UACR was 141.0 mg/g. The average annual rate of eGFR decline prior to enrollment in the study was −4.9 mL/min/1.73 m2 despite 78% of the patient population receiving ACE inhibitor (ACEi) or ARB therapy. Discussion/Conclusion: CARDINAL is one of the largest interventional, randomized controlled trials in Alport syndrome conducted to date. Despite the use of ACEi or ARB, patients were experiencing significant loss of kidney function prior to study entry.
Telemedicine versus Physical Examination in Patients’ Assessment during COVID-19 Pandemic: The Dubai Experience
Authors: Elhennawy Amr , Alsalem Fateh Almohammed , Bahri Salah , Alarfaj Noor
Published: March 2021

Introduction: With the large number of cases during the COVID-19 pandemic, a smart tool was urgently needed to handle all the positive cases at proper time such as using the technology and implementing telemedicine for triage. Objective: The purpose of this study is to detect the accuracy and effectiveness of telemedicine as an assessment tool for triage compared to physical assessment. Methods: In a random sample of 1,086 COVID-19 positive cases during the pandemic in Dubai, all the patients were initially assessed by trained staff using telemedicine following a standardized guidelines and accordingly action was taken by sending the patient to an isolation facility or for hospital admission; the second phase of assessment was conducted physically at the facility. We compared the accuracy of assessment by telemedicine encounter versus physical assessment by detecting any changes of the initial action within 12 h. Results: Telemedicine was accurate in 1,080 out of 1,086 screened patients (99.4%). Discussion: Telemedicine offers fast and convenient response to patients needs with standardization of triage guidelines. Telemedicine has reduced exposure of the medical workers which reduced the possibility of infection as well as reduction of crowds at the medical centers. Recommendations: Telemedicine is very useful during the COVID-19 pandemic for following up the positive and suspected cases as well as cases with history of close contact with a confirmed positive case.
Calcium Electroporation for Keloids: A First-in-Man Phase I Study
Authors: Falk Hanne , Vissing Mille , Wooler Gitte , Gehl Julie
Published: March 2021

Background: Keloid scarring is a pathologic proliferation of scar tissue that often causes pruritus, pain, and disfigurement. Keloids can be difficult to treat and have a high risk of recurrence. Recent studies have shown promising results in the treatment of cutaneous metastases with intralesional calcium combined with electroporation (calcium electroporation). As calcium electroporation has shown limited side effects it has advantages when treating benign keloid lesions, and on this indication we performed a phase I study. Methods: Patients with keloids were treated with at least 1 session of calcium electroporation and followed up for 2 years. Calcium was administered intralesionally (220 mM) followed by the application of eight 100-µs pulses (400 V) using linear-array electrodes and Cliniporator (IGEA, Italy). Treatment efficacy was evaluated clinically (size, shape, erythema), by patient self-assessment (pruritus, pain, other) and assessed histologically. Results: Six patients were included in this small proof of concept study. Treatment was well tolerated, with all patients requesting further treatment. Two out of 6 patients experienced a decrease in keloid thickness over 30%. A mean reduction of 11% was observed in volume size, and a mean flattening of 22% was observed (not statistically significant). Five out of 6 patients reported decreased pain and pruritus. No serious adverse effects or recurrences were observed over a mean follow-up period of 338 days. Conclusion: In this first phase I clinical study on calcium electroporation for keloids, treatment was found to be safe with minor side effects. Overall, patients experienced symptom relief, and in some patients keloid thickness was reduced.
The Prevalence of Allergic Rhinitis, its Triggers, and Associated Factors in Commonwealth of Independent States Countries (Ukraine, Kazakhstan, and Azerbaijan): Results of the CORE Study
Authors: Nugmanova Damilya , Feshchenko Yuriy , Khegay Yelena , Iashyna Liudmila , Gyrina Olga , Vasylyev Averyan , Mustafayev Ilgar , Aliyeva Gulzar , Moibenko Marina , Tariq Luqman , Makarova Janina
Published: March 2021

Background: In the Commonwealth of Independent States (CIS) countries the epidemiology of allergic rhinitis (AR) is poorly characterized. The rationale and design of the CORE (Chronic Obstructive REspiratory diseases) study have been described elsewhere. Methods: A total of 2,842 adults (≥18 years) were recruited (964 in Kiev, Ukraine, 945 in Almaty, Kazakhstan, and 933 in Baku, Azerbaijan) between 2013 and 2015 and interviewed during household visits. Two-step cluster randomization was used for the sampling strategy. “Doctor-diagnosed AR” was considered when the respondent had previously been diagnosed with AR by a doctor, “self-reported AR symptoms” (was defined as watery runny nose during the last 12 months alone or in combination with any of the following: sneezing, nasal obstruction, nasal itching, or conjunctivitis). Results: The prevalence of doctor-diagnosed AR was 33.4, 92.1, and 82.7 per 1,000 persons, and the prevalence of self-reported AR symptoms was 44.7, 97.4, and 85.7 per 1,000 persons, in Ukraine, Kazakhstan, and Azerbaijan, respectively. In Ukraine, the peak of AR symptoms was in May, in Kazakhstan – in May–September, and in Azerbaijan in March–May. Sneezing and nasal congestion were the most frequent symptoms. Pollen as AR trigger was reported by 71.9% respondents in Ukraine, 70.1% in Kazakhstan, and 68.8% in Azerbaijan. Only 35–56% respondents with doctor diagnosed AR have had specific investigations (skin test, analysis for immunoglobulin etc.). The percent of subjects with chronic (nonrespiratory) health condition was higher in the respondents with self-reported AR symptoms compared to rest of the respondent: 100 versus 42% in Ukraine, 100 versus 21% in Kazakhstan, and 100 versus 50% in Azerbaijan, respectively. Conclusion: In CIS countries, the prevalence of self-reported AR symptoms was slightly higher than the prevalence of doctor-diagnosed AR. Compared to countries from other continents, the prevalence of doctor-diagnosed AR was similar; however, the prevalence of AR symptoms seems to be relatively lower.
Revisiting Redemption: A Life Span Developmental Account of the Functions of Narrative Redemption
Authors: Perlin Joshua D. , Fivush Robyn
Published: March 2021

We propose an interdisciplinary developmental model of narrative redemption. Although redemption is one of the most thoroughly studied constructs in the narrative identity literature, research to date has not sufficiently addressed the qualitative structures of redemption, which in turn has led to a lack of attention to the developmental functions that redemption serves in different periods of the life span. Based on a review of existing perspectives on redemption across a variety of disciplines, we propose 2 forms of redemption – return and emergent – that correspond to the dual functions of the life story – stability and change. These forms of redemption also interact with the thematic focus of the narrative, which constitutes the second component of our model. Namely, narratives may emphasize either situation themes or identity themes. We use this revised conceptualization of the structures of redemption to explore the developmental functions of redemption, both theoretically and through narrative examples. We conclude that redemption is an autobiographical tool that can be adapted for different psychosocial functions across the life span.
Melanoma of the Nail Apparatus: An Analysis of Patients’ Survival and Associated Factors
Authors: Seyed Jafari S. Morteza , Lieberherr Sven , Cazzaniga Simone , Beltraminelli Helmut , Haneke Eckart , Hunger Robert E.
Published: March 2021

Background: There are no proper management guidelines for nail apparatus melanoma (NAM). Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. Methods: A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients’ characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis. Results: Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness <1 mm had a significantly higher chance of DFS and OS (90.0 and 94.1% at 5 years, respectively) than those with thicker NAM (58.3 and 55.6% at 5 years, respectively). A total of 53.3% of 30 patients underwent primary excision and covering with a full-thickness skin graft, while 13.3% of our 30 patients underwent digit amputation. The patients who underwent excision and covering with a full-thickness skin graft showed a complete overall survival (100% at 5 years). Conclusion: Primary tumor location in the hand and lower tumor thickness might be correlated with better patients’ survival. The study results suggest that total amputation might not be necessary in all NAM cases.
The Usefulness of Dermoscopy for the Recognition of Malignant Collision Tumors
Authors: Zaballos Pedro , Álvarez Salafranca Marcial , Medina Carolina , Bañuls José , Puig Susana , del Pozo Luis Javier , Malvehy Josep , Karaarslan Isil K. , Thomas Luc , Landi Christian , Argenziano Giuseppe , Llambrich Àlex , Vera Ángel , Gomez-Martín Ignacio , Moscarella Elvira , Aviles José Antonio , Martin Jose María , Pizarro Ángel , Flores Gemma
Published: March 2021

Background: Preoperative diagnosis of malignant collision tumors (MCT) is extremely difficult. The value of dermoscopy to improve the correct detection of these tumors has not been previously studied. This study aims to evaluate the diagnostic accuracy of MCT with and without dermoscopy and to describe the dermoscopic features of a large series of MCT. Methods: Dermoscopic images of 161 MCT were evaluated. Clinical and dermoscopic images of histopathologically proven MCT intermingled with other tumors were randomly presented to clinicians with different levels of experience, blinded to the diagnosis and objective of the study. The clinical and dermoscopic diagnostic accuracies were measured separately. Results: A total of 161 histopathologically proven cases of MCT were collected. The most frequent MCT was basal cell carcinoma-seborrheic keratosis collision tumor (CT; 37.9%), followed by basal cell carcinoma-melanocytic nevus CT (19.9%), and melanoma-seborrheic keratosis CT (6.8%). Diagnostic accuracy among experts on dermoscopy was 71.4%. The study included 119 participants. The percentage of correct diagnoses was 8% by naked eye examination and 36.4% by dermoscopy (p < 0.001). The presence of the malignant component in the cases of MCT was not recognizable in 19.1% of cases by naked eye examination and in 11.8% of cases by dermoscopy (p < 0.001). Conclusions: The diagnosis of MCT can be assisted and clarified by dermoscopy. However, many of these lesions manifest complex morphologies and continue to be challenging, even for experts on dermoscopy. Atypical, uncertain, or non-classifiable lesions still need a complete excision for the final diagnosis.
Gastrointestinal Stromal Tumor of the Ampulla of Vater: A Narrative Review
Authors: Geramizadeh Bita , Shojazadeh Alireza
Published: March 2021

Background: Gastrointestinal stromal tumor (GIST) of the ampulla of Vater is a rare occurrence. To the best of our knowledge, there has been no published review on this rare tumor in the English literature so far. Summary: In this review, we will discuss all the reported details of the published cases, including demography, clinical presentation, imaging, gross pathology and histopathology, immunohistochemical findings, treatment modalities, and outcome of cases with the diagnosis GIST from the ampulla of Vater in the last 20 years. Key Message: Twenty-five cases of GIST in the ampulla of Vater have been reported in the last 20 years in the English literature. GIST in the ampulla of Vater are usually small tumors (<5 cm) in middle-age patients. The majority of the patients present with lower GI bleeding and abdominal pain. Imaging findings are not characteristic, and most of the patients without biopsy and with no histologic diagnosis were operated with the primary impression of adenocarcinoma, neuroendocrine tumor, and GIST. Perioperative tissue biopsy has been accurate in <70% of the cases. The majority of the reported cases of GISTs in the ampulla of Vater have been low risk with spindle-cell morphology, low mitotic figures, and minimal atypia; reactive for C-KIT and DOG-1; and nonreactive for SMA, desmin, and S100. In the majority of the cases, duodenectomy with or without Whipple’s operation has been performed, and most of the cases showed good prognosis.
Neonatal-Onset Familial Mediterranean Fever in an Infant with Human Parainfluenza Virus-4 Infection
Authors: Michev Alexandre , Borghesi Alessandro , Tretti Caterina , Martella Maddalena , Di Comite Amelia , Biffi Alessandra , Marzollo Antonio , Bresolin Silvia
Published: March 2021

Unusual, severe infections or inflammatory episodes in newborns and infants are largely unexplained and often attributed to immature immune responses. Inborn errors of immunity (IEI) are increasingly recognized as the etiology of life-threatening inflammatory and infectious diseases in infancy. We describe a patient with a unique neonatal-onset Familial Mediterranean Fever (FMF) due to compound heterozygous variants in MEFV, presenting as pleuritis following human parainfluenza virus-4 infection. Diagnostic challenges of FMF in infancy include the interpretation of the attacks as infectious episodes. Newborns and infants with acute, recurrent, or chronic, unusually severe infectious or inflammatory conditions should be screened for IEI, including both disorders with defective immunological responses and autoinflammatory disorders.
Branchial Cyst in the Parapharyngeal Space: A Case Report
Authors: Hamadi Iyad Said , Lutfi Lubna , Mohammed Asma Anan , Alkhadem Zahr
Published: March 2021

Branchial cleft cysts are congenital anomalies that most commonly arise from a failure of fusion of the second branchial arch during embryonic life. They usually present as a swelling in the lateral side of the neck, below the mandible. In this article, we present a case of a 28-year-old female patient with a right branchial cyst measuring 7 × 6 × 5 cm, who presented with an asymptomatic, rapidly growing mass in the right anterior triangle of the neck that abutted the right external carotid artery, leading to stenosis of the vessel that is preceded by dilatation above the site of compression. She underwent excision of the cystic mass with preservation of the facial nerve and presented no active complaints on follow-up a few weeks postoperatively.
Sustained Chemosensory Dysfunction during the COVID-19 Pandemic
Authors: Schwab Janne , Jensen Caroline Damsgaard , Fjaeldstad Alexander Wieck
Published: March 2021

Introduction: Chemosensory dysfunction (CD) has proven valuable in prediction of COVID-19, as it is a frequent and specific symptom of the disease. The aim of this study was to investigate the duration of CD in patients with sudden subjective olfactory and/or gustatory loss during the SARS-CoV-2 pandemic. The secondary aim was to identify possible prognostic factors for the duration of CD. Methods: An online baseline questionnaire was designed to assess subjective CD. Three rounds of follow-up questionnaires were sent out to any participants with persistent CD in 6-week intervals, prospectively assessing subjective chemosensory function and extending the follow-up time of this cohort significantly. Results: In total, 467 participants completed the baseline questionnaire. The most significant improvement and recovery of chemosensory function was observed within the first month after the initial loss. Rates became stagnant after about 2 months, and only little improvement and recovery was seen after 2–4 months. After a mean follow-up of 95.9 days (olfactory dysfunction) and 94.0 days (gustatory dysfunction), 86.7% of participants reported gustatory improvement and 82.6% reported olfactory improvement, while 55.0% reported full gustatory recovery and 43.8% reported full olfactory recovery. Female gender was associated with better improvement of gustatory function. High subjective severity of chemosensory loss was associated with lower rates of olfactory and gustatory recovery as well as improvement of olfactory function. Young age was not associated with a better prognosis. Discussion/Conclusion: Rates of improvement and recovery of chemosensory function decreased after 2–4 months after initial chemosensory loss, possibly indicating that prolonged and perhaps permanent chemosensory loss may be a complication of SARS-CoV-2 infections. High subjective severity of CD may worsen the prognosis for improvement and recovery of chemosensory function.
Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection
Authors: Hoffman Arthur , Atreya Raja , Rath Timo , Neurath Markus Ferdinand
Published: March 2021

Background: Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. Summary: Endoscopic treatment is now regarded as first-line therapy for benign lesions. Key Message: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.
Spatial Intratumoral Heterogeneity Expression of PD-L1 Antigen in Head and Neck Squamous Cell Carcinoma
Authors: Hirshoren Nir , Al-Kharouf Issa , Weinberger Jeffrey M. , Eliashar Ron , Popovtzer Aron , Knaanie Ariela , Fellig Yakov , Neuman Tzahi , Meir Karen , Maly Alexander , Vainer Gilad W.
Published: March 2021

Introduction: Immune-checkpoint inhibitors have demonstrated a significant survival benefit in metastatic and non-resectable head and neck squamous cell carcinoma (HNSCC). Patients with a combined positivity score (CPS) of 20 and higher benefit the most from therapy. Inaccurate definition of the CPS category might lead to the incorrect stratification of patients to immunotherapy. This study’s main aim was to investigate programmed death-ligand 1 (PD-L1) antigen expression in HNSCC in diverse clinical situations and histological settings. Materials and Methods: This is a prospective cohort study conducted in a tertiary referral medical center. Tissues were investigated for PD-L1 expression using the FDA-approved 22C3 immunohistochemistry assay (Dako). We analyzed potential associations between the CPS category and meaningful demographic, clinical, and outcome metrics. Furthermore, we investigated morphologically separate sites for CPS scores in whole surgical tissue specimens and matched preoperative biopsies. Results: We analyzed 36 patients, of whom 26 had oral cavity SCC and 10 had laryngeal SCC. The overall, disease-specific, and progression-free survival of the HNSCC group of patients were not associated with the CPS category (p = 0.45, p = 0.31, and p = 0.88, respectively). There was a significant (18%, 95% CI 0.65–0.9) inconsistency between the CPS category determined in biopsies versus whole carcinoma analyses. We also found an uneven distribution of whole-tumor CPS attributed to spatial carcinoma invasiveness, tumor differentiation, and inflammatory cell infiltration heterogeneity. Discussion and Conclusions: Our data suggest that careful selection of tumor area for CPS analysis is important. PD-L1 antigen expression, clinically represented by CPS, may be up- or down-categorized in different clinical and pathological circumstances. The high whole-tissue CPS category scatter may clinically result in potential treatment modifications. We argue that CPS analysis requires not only adequacy (at least 100 viable tumor cells), but also correct representation of the tumor microenvironment.
Efficacy and Safety of Ginger regarding Human Milk Volume and Related Clinical Outcomes: A Systematic Review of Randomized Controlled Trials
Authors: Dilokthornsakul Witoo , Rinta Atcharapan , Dhippayom Teerapon , Dilokthornsakul Piyameth
Published: March 2021

Background: Ginger has been used as a galactagogue in Southeast Asian countries. However, limited evidence of its effect has been reported. This systematic review summarizes the efficacy and safety of ginger regarding human milk volume. Methods: A systematic review was conducted. Randomized controlled trials (RCTs) which studied the effect of ginger on human milk volume were included. The primary outcome was 24-h human milk volume. Results: We found five RCTs. Two studies reported ginger as a single intervention, while three studies reported ginger in a combination with other herbs. We found that ginger could enhance human milk volume in mothers with vaginal births. It failed to improve human milk volume in mothers with cesarian section (C-section). Ginger in several combination products has been shown to be effective in enhancing human milk volume, including ginger with pandan, with turmeric and fenugreek, and with Xiong-gui-tiao-xue-yin. No adverse effect directly related to ginger was reported. Discussion: Ginger could be used to enhance human milk volume in mothers with vaginal births, but not in mothers with C-section. Combined ginger products could also be considered to improve human milk volume. These findings could guide healthcare providers or mothers to consider using ginger to increase human milk production.
Modification of Calgary Cambridge for Indonesian medical students: Communication guidelines
Authors: Wijayanti Galih Cahya , Syakurah Rizma Adlia , Fadilah Mariatul
Published: March 2021

Effective communication skill applied by doctors in the doctor-patient consultation process becomes one of important factors that can improve the consultation outcomes such as patient satisfaction, adherence to treatment and recovery process. However, effective doctor-patient communication is rarely applied in practice. Limited consultation time, patient overload, doctor burnout, and poor communication skills are among the factors that cause ineffective doctor-patient communication process. This study aimed to develop a new effective communication guideline for doctor-patient communication in Indonesia by modifying the Calgary Cambridge medical interview guide. This study uses qualitative approach within four stages: expert panel, student panel and focus group discussion, expert review, and trials. Informants were chosen purposively. Three points of high category, 24 points of middle category and 44 points of low category are resulted from expert panel stage which consists of specialist representatives from 12 clinical divisions in Dr. Moehammad Hoesin central public hospital (RSMH), Palembang, South Sumatera, Indonesia. The high and middle category were discussed by two groups of internships doctors in RSMH in student panel and focus group discussion (FGD) session. The results were validated by a doctor-patient communication expert (expert reviewer) and then tested by the internship doctors through role play at the trial stage. The final result yields eight main points and eleven effective tips of the Calgary Cambridge Guide checklist modification with five to six minutes effective consultation time. This modified guideline is appropriately applicable for doctor-patient communication in daily consultation in Indonesian practical, social and cultural context.
Subjective well-being among street mothers community
Authors: Tentama Fatwa , Situmorang Nina Zulida , Fitrianur Fitrianur
Published: March 2021

The goal of this research was to understand the subjective well-being of mothers who work in the streets. This qualitative phenomenological study collected data using a semi-structured interview. Data were collected from six street mothers aged 18-40 years living in the dense residence of Kali Code, Karanganyar, Brontokusuman, Mergangsan, and Yogyakarta, Indonesia. The content analysis was used in this research, and the results showed that street mothers were satisfied with their current lives. Some of the reasons for their satisfaction include having a place to stay, gathering with their family every day, having a job, having independent earning, supporting children's education, and meeting their family's needs. This study also found that life satisfaction was associated with feeling satisfied with the self, family life, health, job, and community environment. Furthermore, participants expressed positive affect in the form of happiness when their job and earnings were good when gathering with the family or neighbors when the family is in harmony. The children are obedient when they can meet the needs of the children when they receive unexpected rewards. In contrast, the participants experienced negative affect in the form of guilt when they were unable to make the family happy, and disappointed when daily earnings were small. They were sad when children were not obedient, angry, and disappointed about living conditions and worried, anxious, and afraid about the workplace conditions.
The health beliefs of patient with type 2 diabetes mellitus who use herbs as a complement to self-care
Authors: Joeliantina Anita , Anugrahini Hepta Nur , Proboningsih Jujuk
Published: March 2021

Diabetes mellitus type 2 patients who have a tendency to use herbs, are based on the patient's health belief that herbal medicine is a natural ingredient that has efficacy and is safe. This study aimed to explore health beliefs as predictors of herbal use as a complement to diabetes self-care. A cross-sectional study was conducted on 230 patients with type 2 diabetes mellitus who had been clinically diagnosed, received medical treatment and used herbs. The data was collected using a questionnaire at seven community health centers (Puskesmas) in Surabaya City. Data analysis using Partial Least Square. The indicator of health belief variables has a loading factor value>0.5: perceived vulnerability and severity (0.820), perceived benefits (0.739), perceived barriers (0.822), sense of self-efficacy (0.695). Health beliefs have a significant effect on the use of herbs as a complement to diabetes self-care, the value of T>1.97 (T>10.07). Health beliefs consisting of perceived vulnerability and severity, perceived benefits, perceived inhibition, and perceived self-efficacy were strong predictors associated with the use of herbs as a complement to diabetes self-care. Nurses as part of health workers must pay attention to patient health beliefs in providing education to patients.
Midterm Prognosis of Patients With Pulmonary Embolism Receiving Catheter‐Directed Thrombolysis or Systemic Thrombolysis: A Nationwide Population‐Based Study
Authors: Lin Donna Shu‐Han , Lin Yu‐Sheng , Wu Cho‐Kai , Lin Heng‐Hsu , Lee Jen‐Kuang
Published: March 2021

Background

This study compared the efficacy and safety between catheter‐directed thrombolysis (CDT) and systemic thrombolysis for patients with acute pulmonary embolism (PE) with midterm follow‐up.

Methods and Results

We conducted a prospective open cohort study by using data from the Taiwan National Health Insurance Research Database for 2001 to 2013. Patients who were first admitted for PE and were treated by either systemic thrombolysis or CDT were included and compared. Inverse probability of treatment weighting, based on the propensity score, was used to mitigate possible selection bias. A total of 145 CDT‐treated and 1158 systemic thrombolysis–treated patients with PE were included. The in‐hospital mortality rate was significantly lower in the CDT group (12.7% versus 21.4%; odds ratio, 0.49; 95% CI, 0.36–0.67) after inverse probability of treatment weighting. No significant differences between the groups were observed for the safety (bleeding) outcomes. In patients who survived the index PE admission, the 1‐year all‐cause mortality rate was significantly lower in the CDT group after inverse probability of treatment weighting (12.2% versus 13.2%; hazard ratio [HR], 0.73; 95% CI, 0.56–0.94). Treatment with CDT was also associated with lower risks of recurrent PE (9.3% versus 17.5%; subdistribution HR, 0.52; 95% CI, 0.41–0.66). The difference remained through the last follow‐up.

Conclusions

Among patients with PE requiring reperfusion therapy, those accepting CDT had lower all‐cause mortality and recurrent PE over both short‐term and midterm follow‐up periods than those receiving systemic thrombolysis. The bleeding risk was similar for both groups. These findings should be cautiously validated in future randomized trials.
Psychophysiological Markers of Performance and Learning during Simulated Marksmanship in Immersive Virtual Reality
Authors: Liu Sicong , Clements Jillian M. , Kirsch Elayna P. , Rao Hrishikesh M. , Zielinski David J. , Lu Yvonne , Mainsah Boyla O. , Potter Nicholas D. , Sommer Marc A. , Kopper Regis , Appelbaum Lawrence G.
Published: March 2021

The fusion of immersive virtual reality, kinematic movement tracking, and EEG offers a powerful test bed for naturalistic neuroscience research. Here, we combined these elements to investigate the neuro-behavioral mechanisms underlying precision visual–motor control as 20 participants completed a three-visit, visual–motor, coincidence-anticipation task, modeled after Olympic Trap Shooting and performed in immersive and interactive virtual reality. Analyses of the kinematic metrics demonstrated learning of more efficient movements with significantly faster hand RTs, earlier trigger response times, and higher spatial precision, leading to an average of 13% improvement in shot scores across the visits. As revealed through spectral and time-locked analyses of the EEG beta band (13–30 Hz), power measured prior to target launch and visual-evoked potential amplitudes measured immediately after the target launch correlated with subsequent reactive kinematic performance in the shooting task. Moreover, both launch-locked and shot/feedback-locked visual-evoked potentials became earlier and more negative with practice, pointing to neural mechanisms that may contribute to the development of visual–motor proficiency. Collectively, these findings illustrate EEG and kinematic biomarkers of precision motor control and changes in the neurophysiological substrates that may underlie motor learning.
Tracking the Contents of Spatial Working Memory during an Acute Bout of Aerobic Exercise
Authors: Garrett Jordan , Bullock Tom , Giesbrecht Barry
Published: March 2021

Recent studies have reported enhanced visual responses during acute bouts of physical exercise, suggesting that sensory systems may become more sensitive during active exploration of the environment. This raises the possibility that exercise may also modulate brain activity associated with other cognitive functions, like visual working memory, that rely on patterns of activity that persist beyond the initial sensory evoked response. Here, we investigated whether the neural coding of an object location held in memory is modulated by an acute bout of aerobic exercise. Participants performed a spatial change detection task while seated on a stationary bike at rest and during low-intensity cycling (∼50 watts/50 RPM). Brain activity was measured with EEG. An inverted encoding modeling technique was employed to estimate location-selective channel response functions from topographical patterns of alpha-band (8–12 Hz) activity. There was strong evidence of robust spatially selective responses during stimulus presentation and retention periods both at rest and during exercise. During retention, the spatial selectivity of these responses decreased in the exercise condition relative to rest. A temporal generalization analysis indicated that models trained on one time period could be used to reconstruct the remembered locations at other time periods, however, generalization was degraded during exercise. Together, these results demonstrate that it is possible to reconstruct the contents of working memory at rest and during exercise, but that exercise can result in degraded responses, which contrasts with the enhancements observed in early sensory processing.
Behavioral Induction of a High Beta State in Sensorimotor Cortex Leads to Movement Slowing
Authors: Muralidharan Vignesh , Aron Adam R.
Published: March 2021

The sensorimotor beta rhythm (∼13–30 Hz) is commonly seen in relation to movement. It is important to understand its functional/behavioral significance in both health and disease. Sorting out competing theories of sensorimotor beta is hampered by a paucity of experimental protocols in humans that manipulate/induce beta oscillations and test their putative effects on concurrent behavior. Here, we developed a novel behavioral paradigm to generate beta and then test its functional relevance. In two human experiments with scalp EEG (n = 11 and 15), we show that a movement instruction generates a high beta state (postmovement beta rebound), which then slows down subsequent movements required during that state. We also show that this high initial beta rebound related to reduced mu–beta desynchronization for the subsequent movement and, further, that the temporal features of the beta state, that is, the beta bursts, related to the degree of slowing. These results suggest that increased sensorimotor beta in the postmovement period corresponds to an inhibitory state—insofar as it retards subsequent movement. By demonstrating a behavioral method by which people can proactively create a high beta state, our paradigm provides opportunities to test the effect of this state on sensations and affordances. It also suggests related experiments using motor imagery rather than actual movement, and this could later be clinically relevant, for example, in tic disorder.
Aiming High, No Matter What?
Authors: Rudolphi Frida , Salikutluk Zerrin
Published: March 2021

The authors examine cross-national variation in the ethnic gradient in aspirations among 14-year-olds in England, Germany, the Netherlands and Sweden by using data from the Children of Immigrants Longitudinal Survey in Four European Countries, collected in 2009/2010. Results show that most ethnic minority groups are more likely to have university aspirations than ethnic majority youth. The most consistent minority advantage is found in England and Sweden, consistent with the interpretation that the ample scope for choice in progression through these school systems allows high ambitions of minorities to play out well. However, minority advantage of some groups is also present in the Netherlands and Germany, where transitions are more heavily conditional on previous performance. The pattern for immigrant generational status varies across countries and ethnic origins. There is no consistent empirical evidence indicating that aspiration differences between ethnic minority and majority youth will diminish due to assimilation processes across the generations.
The Point of Reality and the Circle of Appearance
Authors: Meisami Sayeh
Published: March 2021

This article explains three major Sufi themes of Maḥmūd Shabistarī’s Gulshan-i rāz as connected by the point-circle metaphor that captures the illusory state of a circle formed by the fast motion of a point. Inspired by Ibn ʿArabī, Shabistarī employs this metaphor in his poetic presentation of the unity of being, the existential state of the human soul, and the bifurcation of religious knowledge and practice into exoteric and esoteric with its implications for the relation between prophethood and sainthood. The article explains these themes mostly in light of Shams al-Dīn Lāhījī’s renowned commentary, Mafātīḥ al-iʿjāz. The analysis of some key verses on the above themes in Shabistarī’s Gulshan-i rāz and the corresponding comments from Lāhījī demonstrates the significance of Akbarian Sufi philosophy in the intellectual and literary life of Persians since late medieval times.
The Right to Freedom of Thought in the European Convention on Human Rights
Authors: O’Callaghan Patrick , Shiner Bethany
Published: March 2021

This paper examines the right to freedom of thought in the European Convention on Human Rights against the background of technological developments in neuroscience and algorithmic processes. Article 9 echr provides an absolute right to freedom of thought when the integrity of our inner life or forum internum is at stake. In all other cases, where thoughts have been manifested in some way in the forum externum, the right to freedom of thought is treated as a qualified right. While Article 9 echr is a core focus of this paper, we argue that freedom of thought is further supported by Articles 8, 10 and 11 echr. This complex of rights carves out breathing space for the individual’s personal development and therefore supports the enjoyment of freedom of thought in its fullest sense. Charged with ‘maintaining and promoting the ideals and values of a democratic society’ as well as ensuring that individual human rights are given ‘practical and effective protection’, this paper predicts that the European Court of Human Rights will make greater use of the right to freedom of thought in the face of the emerging challenges of the Fourth Industrial Revolution.
Marasmius tricystidiatus sp. nov. (Agaricales, Marasmiaceae) and its morphological and phylogenetic relationship with Marasmius jalapensis

Authors: RAMÍREZ NATALIA A. , NIVEIRO NICOLÁS , SALVADOR-MONTOYA CARLOS A. , PIRIS DA MOTTA FÁTIMA , PÉREZ M. LAURA , POPOFF ORLANDO F.
Published: March 2021

Morphological and phylogenetic analyses were performed on recently collected Marasmius specimens including specimens previously determined as Marasmius jalapensis in northern Argentina and Paraguay. A description of a new species for northern Argentina and Colombia and a new morphological delimitation of M. jalapensis with a more restricted distribution range are proposed. Marasmius tricystidiatus sp. nov. is characterised by its yellowish and slightly sulcate pileus, medium-sized basidiomata, setae in all tissues and cheilocystidia of three types, viz., Siccus-type broom cells, cheilosetae, and transitional elements; M. jalapensis, the closest species, is similar in pileus coloration and presence of setoid cystidia in all tissues, but mainly differs in having only cheilosetae and broader basidiospores on average. Both species are closely related and belong to sect. Globulares subsect. Leonini, but the relationships within the latter still must be resolved.
Folic Acid Functionalized Chlorin e6-Superparamagnetic Iron Oxide Nanocarriers as a Theranostic Agent for MRI-Guided Photodynamic Therapy
Authors: Sun Zhenbo , Luo Mingfang , Li Jia , Wang Ailing , Sun Xucheng , Wu Qiong , Li Kaiyue , Ma Ying , Yang Caixia , Li Xianglin
Published: March 2021

Imaging-guided cancer theranostic is a promising strategy for cancer diagnostic and therapeutic. Photodynamic therapy (PDT), as an approved treatment modality, is limited by the poor solubility and dispersion of photosensitizers (PS) in biological fluids. Herein, it is demonstrated
that superparamagnetic iron oxide (SPIO)-based nanoparticles (SCFs), prepared by conjugated with Chlorin e6 (Ce6) and modified with folic acid (FA) on the surface, can be used as versatile drug delivery vehicles for effective PDT. The nanoparticles are great carriers for photosensitizer Ce6
with an extremely high loading efficiency. In vitro fluorescence imaging and in vivo magnetic resonance imaging (MRI) results indicated that SCFs selectively accumulated in tumor cells. Under near-infrared laser irradiation, SCFs were confirmed to be capable of inducing low cell
viability of RM-1 cells In vitro and displaying efficient tumor ablation with negligible side effects in tumor-bearing mice models.
Transient Response of the Southern Ocean to Idealized Wind and Thermal Forcing across Different Model Resolutions
Authors: Li Qian , England Matthew H. , McC. Hogg Andrew
Published: March 2021

The Southern Ocean has undergone significant climate-related changes over recent decades, including intensified westerly winds and increased radiative heating. The interplay between wind-driven cooling and radiative warming of the ocean is complex and remains unresolved. In this study, idealized wind and thermal perturbations are analyzed in a global ocean–sea ice model at two horizontal resolutions: nominally, 1° and 0.1°. The sea surface temperature (SST) response shows a clear transition from a wind-driven cooling phase to a warming phase. This warming transition is largely attributed to meridional and vertical Ekman heat advection, which are both sensitive to model resolution due to the model-dependent components of temperature gradients. At higher model resolution, due to a more accurate representation of near-surface vertical temperature inversion and upward Ekman heat advection around Antarctica, the anomalous SST warming is stronger and develops earlier. The mixed layer depth at midlatitudes initially increases due to a wind-driven increase in Ekman transport of cold dense surface water northward, but then decreases when the thermal forcing drives enhanced surface stratification; both responses are more sensitive at lower model resolution. With the wind intensification, the residual overturning circulation increases less in the 0.1° case because of the adequately resolved eddy compensation. Ocean heat subduction penetrates along more tilted isopycnals in the 1° case, but it orients to follow isopycnal layers in the 0.1° case. These findings have implications for understanding the ocean response to the combined effects of Southern Hemisphere westerly wind changes and anthropogenic warming.