The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. We outline rigorous criteria applied to a qualitative study ...assessing perceptions and experiences of staff working in Australian emergency departments.
We used an integrated mixed-methodology framework to identify different perspectives and experiences of emergency department staff during the implementation of a time target government policy. The qualitative study comprised interviews from 119 participants across 16 hospitals. The interviews were conducted in 2015-2016 and the data were managed using NVivo version 11. We conducted the analysis in three stages, namely: conceptual framework, comparison and contrast and hypothesis development. We concluded with the implementation of the four-dimension criteria (credibility, dependability, confirmability and transferability) to assess the robustness of the study, RESULTS: We adapted four-dimension criteria to assess the rigour of a large-scale qualitative research in the emergency department context. The criteria comprised strategies such as building the research team; preparing data collection guidelines; defining and obtaining adequate participation; reaching data saturation and ensuring high levels of consistency and inter-coder agreement.
Based on the findings, the proposed framework satisfied the four-dimension criteria and generated potential qualitative research applications to emergency medicine research. We have added a methodological contribution to the ongoing debate about rigour in qualitative research which we hope will guide future studies in this topic in emergency care research. It also provided recommendations for conducting future mixed-methods studies. Future papers on this series will use the results from qualitative data and the empirical findings from longitudinal data linkage to further identify factors associated with ED performance; they will be reported separately.
The use of antibiotics with or without prescription is increasing worldwide. With certain limitations, metronidazole (MTZ) is extensively used as an antibacterial and antiparasitic drug. Derivatives ...of 1,2,4-oxadiazole (ODZ) are used to modify the chemical structure of drugs. The present study aimed to synthesize new MTZ-ODZ derivatives that could potentially lead to new medications.
The reaction of MTZ with ethyl chloroacetate and potassium carbonate anhydrous was used to produce compound 7. This compound was treated with hydrazine hydrate in methanol to obtain compound 8. Carbon disulfide and potassium hydroxide were then added to obtain compound 9, which was then mixed with various α-haloketones to obtain compounds 10a to 10f. Subsequently, the structures of the new MTZ-ODZ derivatives were determined.
All new compounds exhibited excellent activity against all tested organisms. The synthesized compounds showed a significant radical scavenging activity. The IC
value for compounds 10a, 10b, 10c, 10d, 10e, and 10f was 70.42±0.15, 70.52±0.54, 85.21±0.85, 80.10±0.46, 82.52±0.13, and 70.45±0.12 g/mL, respectively. In terms of antigiardial activity, the IC
value for compounds 10a,10b, 10c, and 10d ranged from 1.31±0.11 µM to 2.26±0.49 µM. In contrast, the IC
for MTZ was 3.71±0.27 µM. Compound 10f showed the highest antigiardial activity with an IC
value of 0.88±0.52 µM.
Most of the MTZ-ODZ derivatives showed high radical scavenging activity in the benzene ring due to the activation of certain groups, such as OCH
, NO
, and OH. The results suggest that the newly synthesized compounds could be used as an antiparasitic drug.
5-fluorouracil (5-FU) is a specific anti-cancer agent that is generally used to treat gastrointestinal, colorectal, and breast cancer. In this work, chitosan (CS) was extracted from local fish scales ...using an established method. 5-FU was then converted to 1-acetic acid-5-fluorouracil (FUAC) and reacted with this CS to prepare chitosan-1-acetic acid-5-fluorouracil (CS-FUAC) conjugates as a colon-specific prodrug. All compounds were characterized by Proton nuclear magnetic resonance (¹H-NMR), Fourier-transform infrared (FTIR), and UV-visible spectroscopy. The synthesized compound was subjected to a chemical stability study in phosphate buffer (0.2 M, pH 7.4) and in KCl/HCl buffer (0.2 M, pH 1.2) at different time intervals (0-240 min) and incubation at 37 °C. This revealed a significantly greater stability and a longer half-life for the CS-FUAC than for FUAC. Hemolytic activity results indicated a much lower toxicity for CS-FUAC than for 5-FU and supported consideration of CS-FUAC for further biological screening and application trials. The percentage of FUAC in the conjugates was determined by subjecting the prodrug to treatment in basic media to hydrolyze the amide bond, followed by absorbency measurements at 273 nm. The cytotoxicity studies of the conjugates were also evaluated on human colorectal cancer cell line (HT-29), which showed that the conjugates are more cytotoxic than the free drug. Therefore, CS-FUAC conjugates can be considered to represent potential colon-specific drug delivery agents, with minimal undesirable side effects, for colon cancer therapy.
Recently,
chemical modifications of chitosan (CS) have attracted
the attention of scientific researchers due to its wide range of applications.
In this research, chitin (CH) was extracted from the ...scales of
Cyprinus carpio
fish and converted to CS by three chemical
steps: (i) demineralization, (ii) deprotonation, and (iii) deacetylation.
The degree (measured as a percentage) of deacetylation (DD %) was
calculated utilizing the acid–base titration method. The structure
of CS was characterized by Fourier transform infrared (FT-IR) spectroscopy
and thermogravimetric analysis (TGA). Three new CS Schiff bases (CSSBs)
(CS-P1, CS-P2, and CS-P3) were synthesized via coupling of CS with
2-chloroquinoline-3-carbaldehyde, quinazoline-6-carbaldehyde, and
oxazole-4-carbaldehyde, respectively. The newly prepared derivatives
were verified, structurally, by nuclear magnetic resonance (
1
H and
13
C NMR) and FT-IR spectroscopy. Antimicrobial activity
was evaluated for the prepared compounds against both “Gram-negative”
and “Gram-positive” bacteria, namely,
Escherichia coli
,
Klebsiella pneumonia
,
Staphylococcus aureus
, and
Streptococcus mutans
, in addition to two kinds of
fungi,
Candida albicans
and
Aspergillus fumigates
. Cytotoxicity of the synthesized
CSSBs was evaluated via a MTT screening test. The results indicated
a critical activity increase of the synthesized compound rather than
CS generally tested bacteria and fungi and the absence of cytotoxic
activity. These findings suggested that these new CSSBs are novel
biomaterial candidates with enhanced antibacterial and nontoxic characteristics
for applications in areas of both biology and medicine.
Selective laser melting (SLM) is extensively used, as one of the additive manufacturing (AM) technologies, for fabricating metallic products. This advanced method allows to produce various parts with ...intricate geometries in high three-dimensional (3D) accuracy from fusion powders in a layer-by-layer style. Hence, different engineering materials and applications can be achieved by SLM. Titanium (Ti) and its alloys are essential materials for biomedical applications due to their excellent characteristics such as biocompatibility, mechanical strength and electrochemical behavior. The high engineering value of Ti materials in medicine promotes the researchers and specialists to carry out extensive researches and investigations on SLM of this kind of non-ferrous biomaterial. This article reviews some of the significant mechanical properties of biomedical Ti materials fabricated throughout SLM. The correlation between the mechanical characteristics and the micro-structural features, of SLM-Ti is presented with a great endeavor to increase the knowledge about SLM and its effect on the mechanical performance of Ti in medicine.
Optogenetics is an advanced neural stimulation technique with high spatiotemporal precision. Various stimulation devices have been developed using microfabrication techniques to deliver light to ...specific population of neurons. However, traditional microfabrication techniques rely on clean room facilities, making the overall manufacturing process long and cumbersome. In this paper, we present an optical neural stimulator using an optical fiber coupled with a micro-sized light-emitting diode (<inline-formula> <tex-math notation="LaTeX">\mu </tex-math></inline-formula>LED) for neuromodulation. The proposed system utilizes a 3D-printed mount to hold and couple the optical fiber with the <inline-formula> <tex-math notation="LaTeX">\mu </tex-math></inline-formula>LED which is also placed on a 3D-printed substrate with micrometer-sized conductive wires for electrical connection. As such, the proposed device fabrication and assembly steps are simple but efficient without using any semiconductor fabrication processes. In addition, the stimulation depth can be easily customized from the depth for the cortex to that of deep brain structures by simply cleaving the fiber with the desired length and integrating it with the mount. Electrical, optical, and thermal properties of the fabricated device are evaluated experimentally. The validation shows that the device can generate enough intensity light on the tip under a low-temperature change for the safety of the brain tissue. For validation of the device's efficacy, the stimulator is implanted in the motor cortex of mice and is used to modulate the subject's motor behaviors. The experiments show that there is an increase in the velocity of mice's movement during the optical stimulation of the motor cortex. These results prove that the proposed device can successfully modulate the target neurons in the cortex.
Coating of stainless steel (SS) plays a crucial role in improving the properties required for various biomedical applications. These characteristics include biocompatibility, mechanical along with ...corrosion and wear performances. In this respect, this study developed uniform pure hydroxyapatite (HA) and HA/ titania (TiO2) composite films applied on the surface of SS using the sol-gel technique. The morphology and chemical composition of investigated surfaces were analyzed using a scanning electron microscope (SEM) and energy dispersive spectroscopy (EDS), respectively. Moreover, uncoated and coated SS substrates' surface roughness, micro-hardness, and wear characteristics were evaluated. The results displayed that a homogeneous nano-scale surface with higher values of micro-hardness and wear resistance is obtained for coated SS substrates, especially for HA/TiO2 composite coating.
Abstract Background Evaluating outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. Mehods We retrospectively identified patients aged over 70 years ...with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records. Results There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group ( p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts ( n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group – 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke ( p = 0.80) or permanent pacemaker ( p = 0.33) between the groups. Conclusions Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation. Clinical trial registration Not required.
This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms ...and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience.
We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale CDRS). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up.
Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings.
The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.
To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS).
This retrospective study was performed on ...hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022.
The mean age of patients was 19.4 ± 11.9 (range, 3–70) years 335 (57.6 %) females and 247 (42.4 %) males (P < .001). DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia.
This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.
PDF
