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Isailă OM, Drima E, Hostiuc S. An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders. Healthcare (Basel) 2023; 11:2585. [PMID: 37761783 PMCID: PMC10530757 DOI: 10.3390/healthcare11182585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.
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Affiliation(s)
- Oana-Maria Isailă
- Department of Legal Medicine and Bioethics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Eduard Drima
- Medical Clinical Department, Dunărea de Jos University, 800201 Galați, Romania
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Pavlidou A, Gorisse G, Banakou D, Walther S. Using virtual reality to assess gesture performance deficits in schizophrenia patients. Front Psychiatry 2023; 14:1191601. [PMID: 37363173 PMCID: PMC10288366 DOI: 10.3389/fpsyt.2023.1191601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls. Methods Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups. Discussion This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
| | | | - Domna Banakou
- Arts and Humanities Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
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Lopes-Rocha AC, de Paula Ramos WH, Argolo F, Gondim JM, Mota NB, Andrade JC, Jafet AF, de Medeiros MW, Serpa MH, Cecchi G, Ara A, Gattaz WF, Corcoran CM, Loch AA. Gesticulation in individuals with at risk mental states for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:30. [PMID: 37160916 PMCID: PMC10169854 DOI: 10.1038/s41537-023-00360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
Nonverbal communication (NVC) is a complex behavior that involves different modalities that are impaired in the schizophrenia spectrum, including gesticulation. However, there are few studies that evaluate it in individuals with at-risk mental states (ARMS) for psychosis, mostly in developed countries. Given our prior findings of reduced movement during speech seen in Brazilian individuals with ARMS, we now aim to determine if this can be accounted for by reduced gesticulation behavior. Fifty-six medication-naïve ARMS and 64 healthy controls were filmed during speech tasks. The frequency of specifically coded gestures across four categories (and self-stimulatory behaviors) were compared between groups and tested for correlations with prodromal symptoms of the Structured Interview for Prodromal Syndromes (SIPS) and with the variables previously published. ARMS individuals showed a reduction in one gesture category, but it did not survive Bonferroni's correction. Gesture frequency was negatively correlated with prodromal symptoms and positively correlated with the variables of the amount of movement previously analyzed. The lack of significant differences between ARMS and control contradicts literature findings in other cultural context, in which a reduction is usually seen in at-risk individuals. However, gesture frequency might be a visual proxy of prodromal symptoms, and of other movement abnormalities. Results show the importance of analyzing NVC in ARMS and of considering different cultural and sociodemographic contexts in the search for markers of these states.
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Affiliation(s)
- Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | | - Felipe Argolo
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - João Medrado Gondim
- Instituto de Computação, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Natalia Bezerra Mota
- Instituto de Psiquiatria (IPUB), Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Research department at Motrix Lab - Motrix, Rio de Janeiro, Brazil
| | - Julio Cesar Andrade
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Fontes Jafet
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Matheus Wanderley de Medeiros
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | | | - Anderson Ara
- Statistics Department, Federal University of Paraná, Curitiba, PR, Brazil
| | - Wagner Farid Gattaz
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Cheryl Mary Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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5
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Ridenour JM, Garrett M. Intent to Understand the Meaning of Psychotic Symptoms During Patient-Psychiatrist Interactions. Am J Psychother 2022:appipsychotherapy20220034. [DOI: 10.1176/appi.psychotherapy.20220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeremy M. Ridenour
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
| | - Michael Garrett
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
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Pavlidou A, Chapellier V, Maderthaner L, von Känel S, Walther S. Using dynamic point light display stimuli to assess gesture deficits in schizophrenia. Schizophr Res Cogn 2022; 28:100240. [PMID: 35242609 PMCID: PMC8866720 DOI: 10.1016/j.scog.2022.100240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 12/29/2022]
Abstract
Background Gesture deficits are ubiquitous in schizophrenia patients contributing to poor social communication and functional outcome. Given the dynamic nature of social communications, the current study aimed to explore the underlying socio-cognitive processes associated with point-light-displays (PLDs) of communicative gestures in the absence of any other confounding visual characteristics, and compare them to other well-established stimuli of gestures such as pictures by examining their association with symptom severity and motor-cognitive modalities. Methods We included 39-stable schizophrenia outpatients and 27-age-gender matched controls and assessed gesture processing using two tasks. The first task used static stimuli of pictures of a person performing a gesture. The limbs executing the gesture were missing and participants' task was to choose the correct gesture from three-options provided. The second task included videos of dynamic PLDs interacting with each other. One PLD performed communicative gestures, while the other PLD imitated/followed these performed gestures. Participants had to indicate, which of the two PLDs was imitating/following the other. Additionally, we evaluated symptom severity, as well as, motor and cognitive parameters. Results Patients underperformed in both gesture tasks compared to controls. Task performance for static stimuli was associated with blunted affect, motor coordination and sequencing domains, while PLD performance was associated with expressive gestures and sensory integration processes. Discussion Gesture representations of static and dynamic stimuli are associated with distinct processes contributing to poor social communication in schizophrenia, requiring novel therapeutic interventions. Such stimuli can easily be applied remotely for screening socio-cognitive deficits in schizophrenia.
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Affiliation(s)
- Anastasia Pavlidou
- Corresponding author at: Psychiatric Services University of Bern, University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, Bollingerstr. 111, CH-3000 Bern 60, Switzerland.
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Chapellier V, Pavlidou A, Mueller DR, Walther S. Brain Stimulation and Group Therapy to Improve Gesture and Social Skills in Schizophrenia-The Study Protocol of a Randomized, Sham-Controlled, Three-Arm, Double-Blind Trial. Front Psychiatry 2022; 13:909703. [PMID: 35873264 PMCID: PMC9301234 DOI: 10.3389/fpsyt.2022.909703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED An important component of nonverbal communication is gesture performance, which is strongly impaired in 2/3 of patients with schizophrenia. Gesture deficits in schizophrenia are linked to poor social functioning and reduced quality of life. Therefore, interventions that can help alleviate these deficits in schizophrenia are crucial. Here, we describe an ongoing randomized, double-blind 3-arm, sham-controlled trial that combines two interventions to reduce gesture deficits in schizophrenia patients. The combined interventions are continuous theta burst stimulation (cTBS) and social cognitive remediation therapy (SCRT). We will randomize 72 patients with schizophrenia spectrum disorders in three different groups of 24 patients. The first group will receive real cTBS and real SCRT, the second group will receive sham cTBS and real SCRT, and finally the third group will receive sham SCRT. Here, the sham treatments are, as per definition, inactive interventions that mimic as closely as possible the real treatments (similar to placebo). In addition, 24 age- and gender-matched controls with no interventions will be added for comparison. Measures of nonverbal communication, social cognition, and multimodal brain imaging will be applied at baseline and after intervention. The main research aim of this project will be to test whether the combination of cTBS and SCRT improves gesture performance and social functioning in schizophrenia patients more than standalone cTBS, SCRT or sham psychotherapy. We hypothesize that the patient group receiving the combined interventions will be superior in improving gesture performance. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT04106427].
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Affiliation(s)
- Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel R Mueller
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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8
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Zahid A, Best MW. Stigma towards individuals with schizophrenia: Examining the effects of negative symptoms and diagnosis awareness on preference for social distance. Psychiatry Res 2021; 297:113724. [PMID: 33486270 DOI: 10.1016/j.psychres.2021.113724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/11/2021] [Indexed: 12/26/2022]
Abstract
Social exclusion towards individuals with schizophrenia can occur as a result of stigmatizing attitudes towards the diagnosis or as a response to observing atypical behaviours resulting from symptoms. The present study examined social exclusion towards schizophrenia as a function of diagnosis awareness and presence of negative symptoms. 64 healthy participants watched four different videos of confederates who were either labelled / not labelled with schizophrenia and displayed / did not display negative symptoms. Participants ranked their preference for social interaction with individuals in ten different activities and were told that they would complete the activities based on their rankings. A significant interaction between label and symptoms was found as knowledge of diagnosis increased desire for social distance if symptoms were absent and decreased desire for social distance if symptoms were present. A main effect of symptom presence was also found as participants displayed greater desire to complete activities with individuals not displaying symptoms than participants displaying symptoms but there was no effect of diagnostic label. Social exclusion appears to be dependent on both presence of negative symptoms and knowledge of diagnosis. It may be useful to focus on increasing public acceptance of specific symptom presentations in public mental health campaigns.
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Affiliation(s)
- Aqsa Zahid
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada; Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON, Canada M1C 1A4
| | - Michael W Best
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada; Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON, Canada M1C 1A4.
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Pavlidou A, Walther S. Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia. Front Psychol 2021; 11:607312. [PMID: 33488466 PMCID: PMC7817610 DOI: 10.3389/fpsyg.2020.607312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.
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Affiliation(s)
- Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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10
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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Santangelo A, Monteleone AM, Casarrubea M, Cassioli E, Castellini G, Crescimanno G, Aiello S, Ruzzi V, Cascino G, Marciello F, Ricca V. Recurring sequences of multimodal non-verbal and verbal communication during a human psycho-social stress test: A temporal pattern analysis. Physiol Behav 2020; 221:112907. [PMID: 32275912 DOI: 10.1016/j.physbeh.2020.112907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Trier Social Stress Test (TSST) is a widely used protocol to study human psycho-social stress responses. Quantitative reports of non-verbal behaviors have been carried out by means of the Ethological Coding System for Interviews (ECSI). However, no data have described whether and how non-verbal and verbal behaviors take part in the composition of multimodal sequences of communication during the test. METHOD Five non-verbal ECSI categories and four verbal behaviors related with communication were included in the Ethogram. A focal sampling was employed to ensure a high temporal resolution of the behavioral annotation. T-Pattern Analysis was employed to detect statistically-grounded behavioral sequences. RESULTS As a first step, frequency, overall duration and mean time length were reported for each component of the Ethogram. Besides, T-Pattern Analysis revealed that communication during TSST is organized according to a complex temporal patterning. We found 51 different sequences (T-patterns): 8 T-patterns included exclusively non-verbal behaviors; 17 T-patterns included verbal behaviors and 26 T-patterns encompassed mixed non-verbal and verbal behaviors. T-patterns were discussed depending on their putative functional meaning since non-verbal behaviors almost did not overlap within patterns. CONCLUSIONS The implementation of an Ethogram including non-verbal and verbal components highlights the multimodal human communication in TSST. T-Pattern Analysis unveils the real-time interplay among these components. In this study results are discussed according to Jakobson's six constitutive factors of communication.
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Affiliation(s)
- Andrea Santangelo
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | | | - Maurizio Casarrubea
- Laboratory of Behavioural Physiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Human Physiology Section "Giuseppe Pagano", University of Palermo, Palermo, Italy.
| | - Emanuele Cassioli
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Giuseppe Crescimanno
- Laboratory of Behavioural Physiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Human Physiology Section "Giuseppe Pagano", University of Palermo, Palermo, Italy.
| | - Stefania Aiello
- Laboratory of Behavioural Physiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Human Physiology Section "Giuseppe Pagano", University of Palermo, Palermo, Italy.
| | - Valeria Ruzzi
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valdo Ricca
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 PMCID: PMC8061300 DOI: 10.1017/s2045796019000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
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Vietz E, März E, Lottspeich C, Wölfel T, Fischer MR, Schmidmaier R. Ward round competences in surgery and psychiatry - a comparative multidisciplinary interview study. BMC MEDICAL EDUCATION 2019; 19:137. [PMID: 31068159 PMCID: PMC6506958 DOI: 10.1186/s12909-019-1554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The ward round is a key element in everyday hospital inpatient care irrespective of the medical speciality. The underperformance in conducting ward rounds of junior clinicians has already been described. Therefore, necessary skills and competences of clinicians need to be defined, taught and delivered for curricular instruction. In addition to published data on ward round competences in internal medicine this study aims to determine the common competences for surgical and psychiatric ward rounds in order to find differences depending on the speciality. METHODS Semi-structured interviews with surgical (N = 30) and psychiatric ward staff (N = 30) of a university hospital and five community hospitals were conducted. Competences necessary for performing ward rounds as well as structural aspects were identified by systematic content analysis and frequency analysis, supported by adequate statistics. RESULTS Relevant competences for both fields are: collaborative clinical reasoning, communication with the patient and the team, organization, teamwork, management of difficult situations, self-management, error-management, teaching, empathy, nonverbal communication, patient-management and professionalism. Clinical skills were mentioned more often in surgical interviews, while nonverbal communication was described more often in psychiatric interviews. Empathy and communication with the team were more frequently attributed to psychiatric residents. CONCLUSION The competences which were identified as necessary for conducting a ward round in surgery and psychiatry are similar and correspond to previously reported competences in internal medicine. Clinical skills are of greater importance in surgery than in psychiatry. Concerning empathy and nonverbal communication, further research is needed to determine whether they are of minor importance in surgery or whether there is a lack of awareness of these competences.
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Affiliation(s)
- Elisa Vietz
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Esther März
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Christian Lottspeich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Ziemssenstrasse 1, 80336 Munich, Germany
| | - Teresa Wölfel
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Martin R. Fischer
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Ralf Schmidmaier
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Ziemssenstrasse 1, 80336 Munich, Germany
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Fiquer JT, Moreno RA, Brunoni AR, Barros VB, Fernandes F, Gorenstein C. What is the nonverbal communication of depression? Assessing expressive differences between depressive patients and healthy volunteers during clinical interviews. J Affect Disord 2018; 238:636-644. [PMID: 29957481 DOI: 10.1016/j.jad.2018.05.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/05/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is unclear if individuals with Major Depressive Disorder (MDD) present different nonverbal behavior (NVB) compared with healthy individuals, and also if depression treatments affect NVB. In this study, we compared the NVB of MDD subjects and healthy controls. We also verified how MDD subjects' NVB is affected by depression severity and acute treatments. METHODS We evaluated 100 MDD outpatients and 83 controls. We used a 21-category ethogram to assess the frequency of positive and negative NVB at baseline. MDD subjects were also assessed after eight weeks of treatment (pharmacotherapy or neuromodulation). We used the Wilcoxon signed-rank test to compare the NVB of MDD subjects and controls; beta regression models to verify associations between MDD severity and NVB; the Shapiro-Wilk test to verify changes in NVB after treatment; and logistic regression models to verify NVB associated with treatment response according to the Hamilton depression rating scale. RESULTS Compared with controls, MDD subjects presented higher levels of six negative NVB (shrug, head and lips down, adaptive hand gestures, frown and cry) and lower levels of two positive NVB (eye contact and smile). MDD subjects' NVB was not associated with depression severity, and did not significantly change after depression treatment. Treatment responders showed more interpersonal proximity at baseline than non-responders. LIMITATIONS Our ethogram had no measure of behavior duration, and we had a short follow-up period. CONCLUSIONS MDD subjects have more negative and less positive social NVB than controls. Their nonverbal behavior remained stable after clinical response to acute depression treatments.
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Affiliation(s)
- Juliana Teixeira Fiquer
- Laboratory of Medical Investigation (LIM 23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Ricardo Alberto Moreno
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Vivian Boschesi Barros
- University of São Paulo School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Clarice Gorenstein
- Laboratory of Medical Investigation (LIM 23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
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15
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Granziol U, Spoto A, Vidotto G. The assessment of nonverbal behavior in schizophrenia through the Formal Psychological Assessment. Int J Methods Psychiatr Res 2018; 27:e1595. [PMID: 29098743 PMCID: PMC6877208 DOI: 10.1002/mpr.1595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 12/16/2022] Open
Abstract
The nonverbal behavior (NVB) of people diagnosed with schizophrenia consistently interacts with their symptoms during the assessment. Previous studies frequently observed such an interaction when a prevalence of negative symptoms occurred. Nonetheless, a list of NVBs linked to negative symptoms needs to be defined. Furthermore, a list of items that can exhaustively assess such NVBs is still needed. The present study aims to introduce both lists by using the Formal Psychological Assessment. A deep analysis was performed on both the scientific literature and the DSM-5 for constructing the set of nonverbal behaviors; similarly, an initial list of 138 items investigating the behaviors was obtained from instruments used to assess schizophrenia. The Formal Psychological Assessment was then applied to reduce the preliminary list. A final list of 23 items necessary and sufficient to investigate the NVBs emerged. The list also allowed us to analyze specific relations among items. The present study shows how it is possible to deepen a patient's negative symptomatology, starting with the relations between items and the NVBs they investigate. Finally, this study examines the advantages and clinical implications of defining an assessment tool based on the found list of items.
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Affiliation(s)
- Umberto Granziol
- Department of General Psychology, University of Padua, Padova, Italy
| | - Andrea Spoto
- Department of General Psychology, University of Padua, Padova, Italy
| | - Giulio Vidotto
- Department of General Psychology, University of Padua, Padova, Italy
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16
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Psychopathological dimensions and the clinician's subjective experience. Psychiatry Res 2017; 258:407-414. [PMID: 28870646 DOI: 10.1016/j.psychres.2017.08.079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/11/2017] [Accepted: 08/27/2017] [Indexed: 11/20/2022]
Abstract
Classical psychopathology highly valued the interaction between clinician and patient, and recent findings have provided preliminary evidence of an association between categorical psychiatric diagnosis and the clinician's subjective experience during the first clinical assessment. To extend these findings, the present study examined the relationship between psychopathological dimensions and clinicians' subjective experiences. The study involved 45 clinicians and 783 patients in several psychiatric inpatient and outpatient units. When they saw a new patient, the clinicians completed the Assessment of Clinician's Subjective Experience questionnaire (ACSE) and the 24-item Brief Psychiatric Rating Scale (BPRS). Scores on five core psychopathological dimensions supported by meta-analytic evidence (Affect, Positive Symptoms, Negative Symptoms, Activation, Disorganization) were derived from the BPRS. Multivariate analysis revealed that each psychopathological dimension was characterized by a distinct pattern of independent associations with certain aspects of Clinician's Subjective Experience, as measured by the ACSE. This study provided preliminary evidence of significant and theoretically consistent relationships between major psychopathological dimensions and the psychiatrist's subjective experience during the first clinical evaluation. Improving the understanding of intersubjective processes may have important implications for theory, practice, research, and training.
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17
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Riehle M, Lincoln TM. Social consequences of subclinical negative symptoms: An EMG study of facial expressions within a social interaction. J Behav Ther Exp Psychiatry 2017; 55:90-98. [PMID: 28092781 DOI: 10.1016/j.jbtep.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The negative symptoms of schizophrenia are related to lower social functioning even in non-clinical samples, but little is known about the distinct social consequences of motivational and expressive negative symptoms. In this study we focused on expressive negative symptoms and examined how these symptoms and varying degrees of pro-social facial expressiveness (smiling and mimicry of smiling) relate to the social evaluations by face-to-face interaction partners and to social support. METHODS We examined 30 dyadic interactions within a sample of non-clinical participants (N = 60) who were rated on motivational and expressive negative symptoms with the Clinical Assessment Interview for Negative Symptoms (CAINS). We collected data on both interaction partners' smiling-muscle (zygomaticus major) activation simultaneously with electromyography and assessed the general amount of smiling and the synchrony of smiling muscle activations between interaction partners (mimicry of smiling). Interaction partners rated their willingness for future interactions with each other after the interactions. RESULTS Interaction partners of participants scoring higher on expressive negative symptoms expressed less willingness for future interactions with these participants (r = -0.37; p = 0.01). Smiling behavior was negatively related to expressive negative symptoms but also explained by motivational negative symptoms. Mimicry of smiling and both negative symptom domains were also associated with participants' satisfaction with their social support network. LIMITATIONS Non-clinical sample with (relatively) low levels of symptoms. CONCLUSIONS Expressive negative symptoms have tangible negative interpersonal consequences and directly relate to diminished pro-social behavior and social support, even in non-clinical samples.
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Affiliation(s)
- Marcel Riehle
- Universität Hamburg, Department of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Universität Hamburg, Department of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
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18
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Ruchlewska A, Kamperman AM, van der Gaag M, Wierdsma AI, Mulder NCL. Working Alliance in Patients with Severe Mental Illness Who Need a Crisis Intervention Plan. Community Ment Health J 2016; 52:102-8. [PMID: 25701077 PMCID: PMC4710646 DOI: 10.1007/s10597-015-9839-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022]
Abstract
Working alliance has been characterized as an important predictor of positive treatment outcomes. We examined whether illness insight, psychosocial functioning, social support and locus of control were associated with working alliance as perceived by both patient and clinician. We assessed 195 outpatients with psychotic or bipolar disorders. Our findings indicated that patients rated the alliance more positively when they experienced a greater need for treatment, fewer behavioral and social problems, and more psychiatric symptoms. Clinicians rated the alliance more positively in patients who reported fewer social problems and better illness insight. Patients' demographic characteristics, including being female and married, were also positively related to the clinician-rated alliance. Our results suggest that patients and clinicians have divergent perceptions of the alliance. Clinicians may need help developing awareness of the goals and tasks of patients with certain characteristics, i.e., singles, men, those with poor illness insight and those who report poor social functioning.
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Affiliation(s)
- Asia Ruchlewska
- Department of Psychiatry, ESPRi Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Astrid M Kamperman
- Department of Psychiatry, ESPRi Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - André I Wierdsma
- Department of Psychiatry, ESPRi Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Niels C L Mulder
- Department of Psychiatry, ESPRi Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- BavoEuropoort, Rotterdam, The Netherlands
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What's in an item? Predicting social outcomes in schizophrenia spectrum disorders from the PANSS item "Poor Rapport". Schizophr Res 2015; 168:593-4. [PMID: 26362734 DOI: 10.1016/j.schres.2015.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/23/2022]
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