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  • Öğe
    The need for a regional framework for marine scientific research in the Black Sea and Mediterranean Sea
    (Elsevier Science Bv, 2014) Oral, Nilufer
    One of the important contributions of the 1982 United Nations Law of the Sea Convention (UNCLOS) is Part XIII on Marine Scientific Research (MSR). UNCLOS recognizes the general rule that all states have the right to conduct MSR subject to rights and duties of other states under the convention and in addition, the obligation to promote and facilitate MSR. (C) 2014 Elsevier B.V. All rights reserved.
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    The Determination of Patient Learning Needs After Day Surgery: A Cross- Sectional Study
    (Elsevier Science Inc, 2023) Ustundag, Hulya; Gul, Asiye; Ozkaya, Birgul
    Purpose: This study was conducted to investigate the care perception and learning needs of patients undergo-ing day surgery. Design: A descriptive and cross-sectional model was used. Methods: The study was conducted with 234 patients who underwent day surgery in a general surgery clinic of a university hospital. Data were collected using a sociodemographic characteristics form, the Patient Perception of Hospital Experience with Nursing Scale (PPHEN) and the Patient Learning Needs Scale (PLNS). Findings: The PPHEN mean score was 67.99 +/- 11.98 and the PLNS total score was 211.15 +/- 38.49. The sub-scales showed that the highest scores were 38.47 +/- 6.93 for activities of life, while the lowest score was 20.60 +/- 4.23 for feelings related to condition. There was a statistically significant negative correlation in the PPHEN and PLNS subscales in terms of medications, activities of living, treatment, and complications. There was no statistically significant relationship between the demographic data of the patients (age, gender, and educational status). Conclusions: This study demonstrated that patients had high information needs and greater concerns, partic-ularly about activities of life. Nurses should be aware of the importance of identifying high learning needs to increase the level of satisfaction with nursing care in day surgery patients. (c) 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
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    Is B-Flow USG superior to Color Doppler USG for evaluating blood flow patterns in ovarian torsion?
    (W B Saunders Co-Elsevier Inc, 2015) Hancerliogullari, Kadir Oymen; Soyer, Tutku; Tosun, Alptekin; Hancerliogullari, Gulsah
    Objective: Ovarian torsion is an uncommon gynecological emergency that most often affects women of reproductive age. Its signs and symptoms are similar to those of other abdominal conditions, which make its differential diagnosis challenging. Color Doppler (Doppler USG) and B-flow ultrasonography (B-flow USG) are used for the differential diagnosis of ovarian torsion, and in this study, we aimed to evaluate these two techniques, validate B-flow USG as the gold standard non invasive diagnostic tool in the early phase of an ovarian torsion, and show that the B-flow USG is superior to the color Doppler USG. Materials and methods: Sixteen rabbits of the same age and weight were separated into 2 subgroups of 8. In Group I (shamgroup), right ovaries were fixated, and in Group II (torsion group), right ovaries underwent 720 degrees torsion in a counterclockwise direction. At 1 h and 2 h of ischemia, both ovaries were measured by the two techniques, and an additional measurement was taken at 24 h to determine any changes in the left ovary due to the right ovary ischemia. Volume flow, peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) measurements were taken both with color Doppler USG (using a 12 MHz linear probe, General Electric Medical Systems Logic 7, Milwaukee, USA) and with B-flow USG. Results: The right Doppler RI and PI values at 1 h were significantly higher than the right B-flow values (p < 0.05). The difference between the left B-flow RI and PI values and the left Doppler values at 1 h was not significant (p > 0.05), nor was the difference between the right B-flow RI value at 2 h and the right Doppler RI value at 2 h (p > 0.05). The right B-flow PI value at 2 h was statistically different from the right Doppler PI value at 2 h (p < 0.05), although the differences between the left B-flow RI and PI values at 1 h and 2 h and the left Doppler RI and PI values were not (p > 0.05). However, there was a significant difference between the RI values at 24 h (p < 0.05). Conclusions: In this study, the decrease in blood reperfusion at 1 h measured by B-flow USG was apparently higher than that measured by Doppler USG. However, by the end of 2 h, the measurements were equal (see Fig. 3 and 4). In conclusion, B-flow USG reveals the decrease in the blood flow more distinctly in the early phase. Moreover, B-flow Doppler USG is more reliable and advantageous than color Doppler USG because it provides a more accurate preoperative evaluation of the unilateral and contralateral preoperative adnexial structures, and allows for a better assessment of blood flow in the ovarian torsion. (C) 2015 Elsevier Inc. All rights reserved.
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    The impact of a poor quality embryo on the implantation chance of a good quality one when transferred together: A study on double blastocyst transfers
    (Elsevier Masson, Corp Off, 2021) Demirel, Cem; Celik, Hale Goksever; Tulek, Firat; Tuysuz, Gulsum; Donmez, Ersan; Ergin, Tolga; Buyru, Faruk
    Objective: Embryo quality assessment with morphological evaluation remains the first-line method of assessment to select the best embryo for transfer. We aimed to determine if an effect of poor quality embryos on good quality ones exists, whether by a paracrine effect or an adverse endometrial influence, when they are transferred together. Materials and methods: We included 412 couples, who underwent intracytoplasmic sperm injection (ICSI) cycles in a tertiary IVF center. Single embryo transfer with a good quality embryo and double embryo transfers with a good + poor quality embryo were evaluated. Overall pregnancy (PR) and live birth rates (LBR) were our main outcome measures. Results: When PR and LBR are compared, there was no statistical significance between single embryo transfer (SET) and double embryo transfer (DET) groups (51.7 % vs 53.7 %, p = 0.620 and 47 % vs 43.1 %, p = 0.117). When the PR and LBRs were compared between SET from poor cohort and DET group, the outcomes were better in DET group (22.1 % vs 53.7 %, p < 0.001 and 22.1 % vs 43.1 %, p < 0.001). The PR and LBRs of SET from good cohort were significantly better than those of DET (64.4 % vs 53.7 %, p < 0.001 and 57.7 % vs 43.1, p < 0.001). When the PR and LBRs of SET from good cohort and SET from poor cohort were compared, better results were obtained in SET from good cohort. Conclusion: The addition of poor quality embryo even is of benefit to the LBR, in the setting of when there is only one good quality blastocyst available for the transfer. (C) 2020 Elsevier Masson SAS. All rights reserved.
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    Isokinetic Strength Profiles of Thigh Muscles of Modern Dancers in Relation to Their Experience Level
    (Science & Medicine Inc, 2013) Agopyan, Ani; Tekin, Demet; Unal, Mehmet; Kurtel, Hizir; Turan, Gullu; Ersoz, Ayrin
    The aim of this study was to determine maximal voluntary peak torque (PT), PT% body weight (PT%BW), total work (TW), and hamstring/quadriceps ratio (HQR) for bilateral and unilateral thigh muscle strength during isokinetic muscle contractions in modern dancers in relation to their experience level. METHODS: Twenty-two female dancers were divided into two groups: intermediate dancers (ID, n=11) and advanced dancers (AD, n=11). Strength tests were performed using the Biodex System-III Pro Multijoint System isokinetic dynamometer to determine three joint angular velocities (60, 180, 300 degrees/s). RESULTS: During extension, ADs exhibited higher ratios in the HQR (p=0.016) on right leg at 300 degrees/s, IDs generated greater TW (p=0.042), and within groups, there was a significant left-to-right difference in the HQR at 300 degrees/s for ADs (p=0.042). During flexion, within groups, the ADs exhibited significant differences between legs for both PT (p=0.026) and PT%BW (p=0.022) at 300 degrees/s. CONCLUSION: For both groups, the average HQR in all angular velocities was not within the recommended range, which is required to prevent injuries; at the same time, unilateral muscular imbalances existed. Lower extremities of ADs exhibited asymmetric strength patterns at a certain level. Further research should be done to confirm the findings of this pilot study.
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    The effect of multifocal and multicentric tumours on local recurrence and survival outcomes in breast cancer
    (Imprimatur Publications, 2021) Ozturk, Alper; Ilgun, Serkan; Ucuncu, Muhammed; Gachayev, Firuz; Ordu, Cetin; Alco, Gul; Elbuken, Filiz
    Purpose: The purpose of this study was to compare the multifocal (MF)/multicentric (MC) breast cancers with unifocal (UF) breast cancers in terms of tumour characteristics, treatment methods, loco-regional recurrence and survival rates. Methods: Patients who were treated with a diagnosis of early-stage breast cancer (stage I,II) and had regular follow-up were included in the study. MF tumours were defined as having more than one tumour focus in the same quadrant, whereas MC tumours refered to the presence of more than one tumour focus in different quadrants. Results: In total, 1865 patients with invasive breast cancer were evaluated, 1493 (80.1%) of whom had UF cancer, 330 (17.7%) had MF cancer, and 42 (2.3%) had MC cancer. After comparing the groups with each other, it was seen that MF and MC breast cancers occurred more often at early ages and that lymph node invasion (LNI) was greater. No differences were seen between the 3 groups in terms of local recurrence-free survival (RFS) and overall survival (OS) rates. In multivariate analysis, it was found that MF and MC tumours had no impact on local recurrence and OS. In multivariate analysis, it was understood that HER2 positivity and triple-negative breast cancer (TNBC) had an impact on local recurrence, and age, lymphovascular invasion (LVI), T3 tumour, lymph node positivity and TNBC subtype had an impact on OS. Conclusion: Although MC and MF tumours show aggressive features such as high lymph node positivity and LVI, they have similar loco-regional recurrence and survival rates to UF tumours.
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    Effectiveness of Repetitive Transcranial Magnetic Stimulation in Patients With Failed Back Surgery Syndrome: A Double-Blind Randomized Placebo-Controlled Study
    (Am Soc Interventional Pain Physicians, 2021) Bursali, Canan; Ozkan, Feyza Unlu; Kaysin, Meryem Yilmaz; Dortcan, Nimet; Aktas, Ilknur; Kulcu, Duygu Geler
    Background: Failed back surgery syndrome (FBSS) is the term of persistent back and/or leg pain after lumbar surgery. Repetitive transcranial magnetic stimulation (r-TMS) is a technique that allows noninvasive and relatively painless stimulation of cerebral cortex. It can reduce the experience of chronic pain by producing the small electrical currents in the cortex via magnetic field. Objectives: The aim of this study is to determine the effectiveness of r-TMS treatment on patients with FBSS. Study Design: A double-blind, randomized, placebo-controlled trial. Setting: The Physical Medicine and Rehabilitation Clinic of Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. Methods: In this double-blinded, randomized, placebo-controlled trial, 20 patients (aged 3465 years) clinically diagnosed as FBSS who had a history of surgery for lumbar disc herniation with persistent back and leg pain were reviewed. Only patients with no root compression and/or spinal stenosis in postoperative magnetic resonance imaging of lumbar spine were included. Patients were randomly assigned to r-TMS (n:10) and sham (n:10) groups. Patients in the r-TMS group received 5 Hz of r-TMS as a 20-minute (1,000 pulses) daily session, 5 days per week, for a total of 10 sessions. r-TMS was applied with MagVenture device (MagPro X100, Denmark, 2009) and figure 8 coil (MMC 140 parabolic, MagVenture). Control group received sham r-TMS with the same protocol. Each patient was evaluated at baseline, days 5 and 10 of treatment, and 1 and 3 months after treatment. Visual Analog Scale (VAS), DN4 (Douleur Neuropathique en 4 Questions), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI) were used for evaluation. Results: There were no statistically significant differences between the groups for age, gender, number of surgeries, pain duration, working status, and drug usage. Significant improvements were achieved in DN4, ODI, BDI, and PSQI scores in the r-TMS group in comparison to the sham group. Both groups displayed improvements in VAS scores, whereas improvement in the sham group was limited to the first month. Achieved improvements in the r-TMS group in terms of VAS, DN4, ODI, BDI, and PSQI scores were sustained at the third month. Limitations: The limited number of patients and the short follow-up periods are the main limitations of our study. Further placebo-controlled studies with longer follow-up periods and greater number of cases would be beneficial for examining r-TMS application as a new treatment option in patients with FBSS. Conclusions: r-TMS might be an effective alternative treatment in patients with FBSS, further studies with larger groups are needed.
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    Impact of body weight-based dosing of palonosetron and ondansetron on postoperative nausea and vomiting following laparoscopic sleeve gastrectomy: a randomized, double-blind study
    (Taylor & Francis Ltd, 2024) Burcu, Buesra; Hacim, Nadir Adnan; Caliskan, Ozan; Demirgan, Serdar; Aktokmakyan, Talar Vartanoglu; Meric, Serhat; Duymaz, Tomris
    Background Postoperative nausea and vomiting (PONV) is a frequent adverse effect following laparoscopic sleeve gastrectomy. Palonosetron with a standard dosing (75 mu g) schedule has been questioned due to its low efficiency in obese patients. This study aimed to investigate the effectiveness and safety of the body weight-based dosing of palonosetron in managing PONV following laparoscopic sleeve gastrectomy. Methods A single-center, prospective, double-blinded randomized study was conducted between August 2021 and December 2021. Patients who underwent laparoscopic sleeve gastrectomy were prospectively recruited in the study. One hundred patients were randomly divided into palonosetron (Group P) and ondansetron (Group O). The demographic and clinical variables were recorded. The primary outcome of the study was the incidence of PONV between the two groups during the hospitalization. The secondary outcomes were the number of rescue anti-emetic and analgesic medications and the Functional Living Index-Emesis scores. Results There were 50 patients in each group (Group P and Group O). There were significant differences in the scores of POVN, nausea, and vomiting favoring Group P. In Group P, the rate of patients using rescue anti-emetics was significantly lower. The incidence of complete response and proportion of patients with higher Functional Living Index-Emesis scores were significantly higher in patients using palonosetron. Conclusions The use of palonosetron significantly reduced the incidence of PONV following laparoscopic sleeve gastrectomy. There was a significant improvement in the scores of Functional Living Index-Emesis in patients using palonosetron.
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    Time-dependent re-organization of biological processes by the analysis of the dynamic transcriptional response of yeast cells to doxorubicin
    (Royal Soc Chemistry, 2021) Karabekmez, Muhammed Erkan; Taymaz-Nikerel, Hilal; Eraslan, Serpil; Kirdar, Betul
    Doxorubicin is an efficient chemotherapeutic reagent in the treatment of a variety of cancers. However, its underlying molecular mechanism is not fully understood and several severe side effects limit its application. In this study, the dynamic transcriptomic response of Saccharomyces cerevisiae cells to a doxorubicin pulse in a chemostat system was investigated to reveal the underlying molecular mechanism of this drug. The clustering of differentially and significantly expressed genes (DEGs) indicated that the response of yeast cells to doxorubicin is time dependent and may be classified as short-term, mid-term and long-term responses. The cells have started to reorganize their response after the first minute following the injection of the pulse. A modified version of Weighted Gene Co-expression Network Analysis (WGCNA) was used to cluster the positively correlated co-expression profiles, and functional enrichment analysis of these clusters was carried out. DNA replication and DNA repair processes were significantly affected and induced 60 minutes after exposure to doxorubicin. The response to oxidative stress was not identified as a significant term. A transcriptional re-organization of the metabolic pathways seems to be an early event and persists afterwards. The present study reveals for the first time that the RNA surveillance pathway, which is a post-transcriptional regulatory pathway, may be implicated in the short-term reaction of yeast cells to doxorubicin. Integration with regulome revealed the dynamic re-organization of the transcriptomic landscape. Fhl1p, Mbp1p, and Mcm1p were identified as primary regulatory factors responsible for tuning the differentially expressed genes.
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    Integration of fluxome and transcriptome data in Saccharomyces cerevisiae offers unique features of doxorubicin and imatinib
    (Royal Soc Chemistry, 2021) Taymaz-Nikerel, Hilal
    Improving the efficacy of drugs and developing new drugs are required to compensate for drug resistance. Therefore, it is critical to unveil the mode of action, which can be studied through the cellular response at genome-scale, of the existing drugs. Here, system-level response of Saccharomyces cerevisiae, a eukaryotic model microorganism, to two chemotherapy drugs doxorubicin and imatinib used against cancer are analysed. While doxorubicin is mainly known to interact with DNA through intercalation and imatinib is known to inhibit the activity of the tyrosine kinase enzyme, the exact mechanisms of action for both drugs have not been determined. The response of S. cerevisiae cells to long-term stress by these drugs under controlled aerobic conditions was investigated and analyzed by the genome-wide transcriptome and genome-wide fluxes. The classification of adverse and similar responses of a certain gene at a transcriptional versus flux level indicated the possible regulatory mechanisms under these different stress conditions. Most of the biochemical reactions were found to be regulated at a post-transcriptional or metabolic level, whereas fewer were regulated at a transcriptional level for both stress cases. Furthermore, disparately induced and repressed pathways in the metabolic network under doxorubicin and imatinib stress were identified. The glycolytic and pentose phosphate pathways responded similarly, whereas the purine-histidine metabolic pathways responded differently. Then, a comparison of differential fluxes and differentially co-expressed genes under doxorubicin and imatinib stress provided the potential common and unique features of these drugs. Analyzing such regulatory differences helps in resolving drug mechanisms and suggesting new drug targets.
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    Mitochondrial estrogen receptors alter mitochondrial priming and response to endocrine therapy in breast cancer cells
    (Springernature, 2021) Karakas, Bahriye; Aka, Yeliz; Giray, Asli; Temel, Sehime Gulsun; Acikbas, Ufuk; Basaga, Huveyda; Gul, Ozgur
    Breast cancer is the most common cancer with a high rate of mortality and morbidity among women worldwide. Estrogen receptor status is an important prognostic factor and endocrine therapy is the choice of first-line treatment in ER-positive breast cancer. However, most tumors develop resistance to endocrine therapy. Here we demonstrate that BH3 profiling technology, in particular, dynamic BH3 profiling can predict the response to endocrine therapy agents as well as the development of acquired resistance in breast cancer cells independent of estrogen receptor status. Immunofluorescence analysis and subcellular fractionation experiments revealed distinct ER-alpha and ER-beta subcellular localization patterns in breast cancer cells, including mitochondrial localization of both receptor subtypes. shRNA-mediated depletion of ER-beta in breast cancer cells led to resistance to endocrine therapy agents and selective reconstitution of ER-beta in mitochondria restored sensitivity. Notably, mitochondria-targeted ER-alpha did not restore sensitivity, even conferred further resistance to endocrine therapy agents. In addition, expressing mitochondria-targeted ER-beta in breast cancer cells resulted in decreased mitochondrial respiration alongside increased total ROS and mitochondrial superoxide production. Furthermore, our data demonstrated that mitochondrial ER-beta can be successfully targeted by the selective ER-beta agonist Erteberel. Thus, our findings provide novel findings on mitochondrial estrogen signaling in breast cancer cells and suggest the implementation of the dynamic BH3 technique as a tool to predict acquired endocrine therapy resistance.
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    Dynamic Relations Between Mentalization Techniques and Therapeutic Alliance in Psychodynamic Child Therapy: An Evidence-Based Case Study
    (Amer Psychological Assoc, Div Psychotherapy, 2023) Guvenc, Dilara; Halfon, Sibel
    Therapeutic alliance and mentalization are common factors inherent to all effective treatments. Mentalization-based interventions have the potential to create a safe relationship, which makes further mentalizing interventions possible. However, to date, no study has examined the bidirectional relationship between these variables in child psychotherapy. In an evidence-based case study design, psychodynamic therapy processes of two Turkish children (age: 9 and 10 years) who presented with social withdrawal problems were compared. All their sessions (34 sessions from Case No. 1 and 31 from Case No. 2) were coded using the Therapy Process Observational Coding System-Alliance Scale and Mentalization-Based Treatment for Children Adherence Scale. Outcome scales pertaining to symptoms, attachment, and mentalization were administered at baseline and at termination. Time-series Granger Causality tests revealed that in the case with clinically significant outcome, mentalization techniques predicted therapeutic alliance in the subsequent sessions, which predicted the use of further mentalization interventions. However, this relationship was not supported in the case with no significant improvement. Selected sessions were clinically analyzed with verbatim session vignettes. Our findings indicate that mentalization techniques in child therapy are closely related to the therapeutic relationship.
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    Parental Reflective Function and Children's Attachment-Based Mental State Talk as Predictors of Outcome in Psychodynamic Child Psychotherapy
    (Amer Psychological Assoc, Div Psychotherapy, 2021) Halfon, Sibel; Besiroglu, Burcu
    Mentalization, operationalized as reflective function, is defined as the capacity to understand behavior in terms of mental states. Mentalization can be self-focused (i.e., mentalizing that focuses on one's own thoughts and feelings) or other-focused (i.e., mentalizing that focuses on others' thoughts and feelings). Some studies in adult psychotherapy show the importance of patients' mentalization capacity for treatment outcome; however, this has not yet been investigated in psychodynamic child psychotherapy. This study aimed to investigate whether baseline parental reflective function (PRF) and children's mental state talk (MST) predicted changes in emotional and behavioral problems in psychodynamic child psychotherapy. The sample included 60 Turkish school-age children (M-age = 7.90, SD = 1.35, 43.3% girls) with internalizing (18.3%), externalizing (5%), and comorbid (56.7%) problems, and 20% of the children were in the nonclinical range. The mothers were interviewed using the Parent Development Interview, which was coded for PRF (self- and child-focused). Children were administered an attachment-based story stem task, coded for MST (self- and other-focused). The Brief Problem Monitor was administered every month over the course of treatment for a total of 366 sessions. Multilevel modeling analyses indicated that mothers' child-focused PRF and children's self-focused MST predicted changes in problem behaviors. Parents' mentalization about their children and children's mentalization about their own internal states could be predictors of treatment response in psychodynamic child psychotherapy.
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    Mentalization, Session-to-Session Negative Emotion Expression, Symbolic Play, and Affect Regulation in Psychodynamic Child Psychotherapy
    (Amer Psychological Assoc, Div Psychotherapy, 2019) Halfon, Sibel; Yilmaz, Meltem; Cavdar, Alev
    Internalizing and externalizing problems have been related to negative emotionality, and affect regulation deficits in several studies. Certain psychodynamic models of treatment use children's symbolic play activity as a medium to mentalize negative emotions in order to develop children's affect regulation. However, the complex associations among these constructs and their associations with outcome have not been examined. This study aimed to investigate, first. whether average mentalization practices in treatment, as well as session-to-session expression of negative emotions and symbolic play predict gains in affect regulation and. second, whether changes in these variables are associated with clinically significant change in symptoms and global function. The sample included 40 outpatient children, who underwent long-term psychodynamic treatment. Nine hundred seventy-five sessions were coded for children's symbolic play, affect expression (anger and dysphoric affect). and affect regulation characteristics, and each treatment was scored for average adherence to mentalizing principles. Time Series Panel Analyses (TSPA) indicated session-to session use of symbolic play predicted gains in affect regulation. A significant 2-way interaction indicated that dysphoric affect expression in high mentalization adherent treatments was associated with higher affect regulation than in low adherent treatments. Partial correlation analyses indicated that mentalization adherence in treatment was associated with symptomatic improvement at trend level of significance, and changes in affect regulation and symbolic play were significantly associated with gains in global function. Findings point to the importance of use of symbolic play, and dysphoric affect expression in the context of mentalization practices for gains in affect regulation and outcome.
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    Side effect prediction based on drug-induced gene expression profiles and random forest with iterative feature selection
    (Springernature, 2021) Cakir, Arzu; Tuncer, Melisa; Taymaz-Nikerel, Hilal; Ulucan, Ozlem
    One in every ten drug candidates fail in clinical trials mainly due to efficacy and safety related issues, despite in-depth preclinical testing. Even some of the approved drugs such as chemotherapeutics are notorious for their side effects that are burdensome on patients. In order to pave the way for new therapeutics with more tolerable side effects, the mechanisms underlying side effects need to be fully elucidated. In this work, we addressed the common side effects of chemotherapeutics, namely alopecia, diarrhea and edema. A strategy based on Random Forest algorithm unveiled an expression signature involving 40 genes that predicted these side effects with an accuracy of 89%. We further characterized the resulting signature and its association with the side effects using functional enrichment analysis and protein-protein interaction networks. This work contributes to the ongoing efforts in drug development for early identification of side effects to use the resources more effectively.
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    Psychodynamic Technique and Therapeutic Alliance in Prediction of Outcome in Psychodynamic Child Psychotherapy
    (Amer Psychological Assoc, 2021) Halfon, Sibel
    Objective: This study is the first to investigate the effect of psychodynamic technique (PT), therapeutic alliance, and their interactions with outcome in psychodynamic child psychotherapy. Method: The sample comprised 79 Turkish children (mean age = 6.86 years, 38% girls) with discrete internalizing (22%), discrete externalizing (11%) and comorbid internalizing and externalizing (67%) problems. Independent raters coded 359 sessions from different phases of treatment using the Child Psychotherapy Process Q-Sort for PT and Therapy Process Observational Coding System-Alliance Scale. Problem-assessment measures were collected at intake and every 10th session in treatment using the Children's Behavior Checklist and Brief Problem Monitor. Results: Multilevel modeling analyses indicated that the PT and therapeutic alliance interacted such that more use of the PT in the context of high therapeutic affiance predicted less problem behaviors, whereas in the context of low therapeutic alliance PT predicted more problem behaviors. This relationship was moderated by problem comorbidity such that for children with comorbid problems, though a strong therapeutic alliance was indicated, an increase in PT use did not have a significant effect. Conclusion: Findings suggest that the use of psychodynamic interventions is indicated in the context of a strong therapeutic affiance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic affiance is not established. For children with comorbid problems, keeping the relationship strong is important.
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    Therapeutic Alliance Trajectories and Associations With Outcome in Psychodynamic Child Psychotherapy
    (Amer Psychological Assoc, 2019) Halfon, Sibel; Ozsoy, Deniz; Cavdar, Alev
    Objective: This study investigated therapeutic alliance (TA) trajectories, their demographic and symptomatic predictors, and associations with outcome in psychodynamic child psychotherapy. Method: The sample included 89 Turkish children (M-age = 6.87, SD = 2.11. 46% girls) with internalizing (37.11%), externalizing (21.14%). and comorbid (38.20%) problems; 12% of the children were in the nonclinical range. Independent raters coded 328 sessions from different phases of treatment using the Therapy Process Observational Coding System-Alliance Scale. Outcome measures were collected at intake and termination (Children's Behavior Checklist and Teacher Rating Form). Results: Multilevel growth curve modeling indicated that TA showed a quadratic trend (high-low-high) over the course of treatment. The shape-of-change methodology indicated three subgroups following a stable pattern, a slow and an accelerated quadratic TA trajectory. Externalizing problems (teacher report) negatively predicted average TA strength. Boys and children with internalizing problems showed a declining TA trajectory, whereas children with externalizing problems (teacher report) showed an upward TA trajectory. Multivariate multiple regression analyses showed that the average TA (i.e., intercept) and the positive quadratic slope (the high-low-high pattern) positively predicted changes in internalizing and externalizing problems (teacher report). Discussion: This study was the first to show the course of TA development in psychodynamic child psychotherapy, identify a number of child characteristics that facilitate and impede TA. Investigating both the strength and patterns of TA development when examining associations with outcome is important.
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    People Respond With Different Moral Emotions to Violations in Different Relational Models: A Cross-Cultural Comparison
    (Amer Psychological Assoc, 2021) Sunar, Diane; Cesur, Sevim; Piyale, Zeynep Ecem; Tepe, Beyza; Biten, Ali Furkan; Hill, Charles T.; Koc, Yasin
    Consonant with a functional view of moral emotions, we argue that morality is best analyzed within relationships rather than in individuals, and use Fiske's (1992) theory of relational models (RMs: communal sharing [CS], authority ranking [AR]. equality matching [EM], and market pricing [MP]) to predict that violations in different RMs will arouse different intensities of other-blaming emotions (anger, contempt and disgust) in both observers and victims, together with different intensities of self-blaming emotions (shame and guilt) in perpetrators, and to predict that these patterns of emotion will show similarity across both individuals and cultures. Three studies, using vignettes portraying moral violations in all RMs in different experimental designs. supported these expectations. while also producing some unexpected results. The intensity of shame and guilt varied markedly across RMs, but with little difference between the two emotions. The intensity of all 3 other-blaming emotions also varied across RMs. Anger was the most intense emotional response to violation in all RMs, whereas disgust and contempt were stronger in CS than in other RMs. Disgust and shame were linked more strongly in CS than in other RMs, and anger and guilt were more strongly linked than other emotion pairs in EM. Moral emotions in RMs involving hierarchy (AR and MP) differed widely depending on the perpetrator's dominant or subordinate status. Both Turkish (TR) and English-speaking (EN) samples showed similar patterns of all moral emotions across RMs. Understanding the functions of moral emotions in relationships using relational models can help to clarify multiple aspects of moral psychology.
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    Pathways to a more peaceful and sustainable world: The transformative power of children in families
    (Cambridge Univ Press, 2021) Britto, Pia R.; Hanoz-Penney, Suna; Ponguta, Liliana Angelica; Sunar, Diane; Issa, Ghassan; Hein, Sascha D.; do Rosario, Maria Conceicao
    This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
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    Effect of sex and dyad composition on speech and gesture development of singleton and twin children
    (Cambridge Univ Press, 2021) Ozturk, Sumeyra; Pinar, Ebru; Ketrez, F. Nihan; Ozcaliskan, Seyda
    Children's early vocabulary shows sex differences - with boys having smaller vocabularies than age-comparable girls - a pattern that becomes evident in both singletons and twins. Twins also use fewer words than their singleton peers. However, we know relatively less about sex differences in early gesturing in singletons or twins, and also how singletons and twins might differ in their early gesture use. We examine the patterns of speech and gesture production of singleton and twin children, ages 0;10-to-3;4, during structured parent-child play. Boys and girls - singleton or twin - were similar in speech and gesture production, but singletons used a greater amount and diversity of speech and gestures than twins. There was no effect of twin dyad type (boy-boy, girl-girl, boy-girl) on either speech or gesture production. These results confirm earlier research showing close integration between gesture and speech in singletons in early language development, and further extend these patterns to twin children.