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string | predicted_class
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Given the high aAD variability of each carabid species among the sample sites, two threshold levels (‘‘central” and ‘‘nuclear”) were introduced with the exclusive intent of facilitating the interpretation of the data table (S1 Table; see ), i.e. a species is central in the site where it shows the maximum aAD, while it is nuclear in the site(s) where it shows an aAD equal to, or greater than, the mean aAD among the sites .
|
study
| 100.0 |
This study was carried out on private lands (Terranova and part of the Arcavacata olive groves) with the permission of the owners, and on public lands explicitly devoted to agricultural researches (Mirto and part of the Arcavacata olive groves) managed by the Council for Agricultural Research and Analysis of Agricultural Economics, Research Centre for Olive, Citrus and Tree Fruit. Field studies did not involved endangered or protected species.
|
other
| 99.9 |
The observed species richness (62 species) and mean activity density (aAD = 13.9) are within confidence intervals for the expected values computed by means of bootstrapping (61–79, 9.2–18.8, respectively); hence, sampling intensities were adequate in the studied sites. We collected 10,189 individuals belonging to 62 species, of which 32 were in tilled olive groves, 21 were in half-cropland and 49 were in cover-cropped fields. The aAD of the collected species, their scientific names and authorities, has been presented in S1 Table, which shows that most of the species were scattered among the different sample sites, with 31% of the species captured in one site (singletons) and 21% on two sites (doubletons). Only two generalist predators, Pterostichus melas italicus and Calathus fuscipes, were collected from all sites, with values ranging between 0.56–9.89 and between 0.71–31.92 respectively. Five species, Pseudophonus rufipes, Calathus cinctus, Calathus montivagus, Carabus coriaceus mediterraneus and Laemostenus cimmerius, were found in more than 50% of the sampled sites.
|
study
| 100.0 |
The result of cluster analysis was the cross-classification of sites and species given in S1 Table, where the groups of sites A, B and C (Fig 2) and the groups of species 1, 2, 3, and 4 (Fig 3) were recognized. The similarity structure of the data was improved by highlighting central species in bold and nuclear species underlined. The sites belonging to groups A (three sites) and B (eight sites) are in the region of the deciduous forests, while the sites belonging to group C (six sites) are in the region of evergreen Mediterranean forests.
|
study
| 100.0 |
In the cross-classification of the group of sites A (Fig 2) with the group of species 4 (Fig 3) most of the species either have a central value in the sites of group A, showing no nuclear values in other sites, or were captured exclusively in such sites (see S1 Table). This is the only group in which the seed eater species are present in large numbers (24%), mainly tied to the REN5 site, which is characterized by cover-cropping. In the sites of group A there are scattered species automatically assigned (i.e., from the algorithm) to group 3 while reasonably belonging to group 4 (see S1 Table)
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study
| 100.0 |
The largest group of sites is B, whose sites are located in different geographic districts, i.e., REN sites are located in the western part of the region, while MIR and TER are located in the eastern part. Most of the species captured in the sites of the B group belong to groups 1 and 2 (clustered into the same supergroup; see Fig 3). However, they also show central values (as well as only a few nuclear values) mainly in the REN3, MIR1, MIR2 and MIR4 sites, showing a structure of similarity that is more homogeneous by subclustering into a subgroup (see Fig 2), as distinct from the REN4, REN6-7 and TER5 sites, where the species are scattered among the B group sites.
|
study
| 100.0 |
For analysing whether it was possible to characterize the clusters of sites on the basis of the dominances of the species traits, Table 2 was evaluated. It shows that the species traits were quite unevenly distributed among the several categories they were organized in. The most frequent body size was that of small species (i.e., size between 5mm and 10mm, s2 category in Table 2) within the whole sampled carabid fauna, where they accounted for the 53% of the species. The same s2 category was also the most frequent one in the group of sites A and B (53% and 51% respectively), while the s3 category was the most frequent (40%) in group C.
|
study
| 100.0 |
First column: in bold, the type of trait, under which, indented and in plain text, follows the list of the evaluated traits. Code: the code given to each species trait. For each trait the percentage of species bearing that trait was given on the basis of all sampled species in column "Species (total)", while the average percentage has been given for each group of sites, outlined by the cluster analysis of Fig 2, in columns "average A, B and C".
|
study
| 99.9 |
Among the four feeding strategies evaluated in Table 2, generalist predators were the most frequent species both within the whole sampled carabids (category G = 39%) and within each group of sites (category G never less than 53%), while polyphagy was the second most frequent feeding strategy.
|
study
| 99.94 |
Both the whole sampled carabid fauna and the sets of species within the three group of sites (A, B and C, Fig 2) can be considered as similar for what concerns the most frequent species traits, because all of them were characterized by the dominance of small species, macropterous species, generalist predators and autumn breeders, while they were quite homogeneous in respect to geographic distribution, as evaluated in Table 2.
|
study
| 99.94 |
To outline the species mainly related to olive plantations, among the several candidates, on the basis of their aAD, we highlighted that species with aAD values higher than average within each cluster of sites (see Fig 2 and S1 Table). After excluding the two forest species, i.e., Calathus montivagus and Pterostichus melas, it was possible to recognize 11 species, listed in Table 3, as characteristic of olive plantations. They showed a distribution range mainly around the Mediterranean region, and they are chiefly small species with a high dispersal power and an opportunistic diet (see Table 3).
|
study
| 99.94 |
The results of PCA showed that it is not possible to highlight one single factor (i.e. axis) mainly affecting data ordination, because 20% of data variability is distributed along the first axis of the space outlined by the principal components, while 18% and 14% is distributed along the second and third axes respectively, i.e., only half of the entire variability is explained by means of the three most meaningful principal components. Moreover, the sample sites were drawn close together and mainly around the axes’ origin, which is a probable symptom of the lack of preponderance among the several factors affecting species distribution.
|
study
| 100.0 |
The ordination of the sites along the first axis (Fig 4, S2 Table) mirrors the potential vegetation characterizing them, even though some exceptions are evident (i.e., REN6 and REN7 sites). On the left part of the axis, a set of sites characterized by evergreen Mediterranean vegetation has been projected, while the deciduous forest sites have been projected on the right.
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other
| 99.25 |
Along the second axis (Fig 4, S2 Table), the order of the sites mirrors the soil type. Going from down to top, it is possible to recognize a sequence from clay through sand clay to alluvial soil, i.e., from dry to damp soils, although sites REN5 and REN3 do not follow such ordination.
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other
| 99.9 |
The soil management is probably tied to the third axis (S2 Table), where it is possible to see a separation between the sites affected by man-originated disturbance (negative side of the third axis) and the sites characterized by cover-cropping (positive side), with the exception of REN2.
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other
| 99.94 |
The ordination of our data showed that (see Fig 4, quadrant II of the space generated by the PCA) in olive plantations that grow within a potential deciduous oak region over dry soils, and in which disturbance generated by man was limited to seasonal grass mowing, feeding strategies that exploit vegetal resources in an opportunistic (e.g., Amara sicula, Harpalus attenuates and Ophonus azureus; see Fig 5) or exclusive way (i.e., seed-eating species, such as Carterus rotundicollis and Ophonus ardosiacus) were positively selected. Meanwhile, when under the same potential vegetation, humid soil conditions, the disturbance by man is greater (PCA quadrant I; Fig 4), then seed eaters left room for opportunistic or predator feeding strategies (e.g., Anchomenus dorsalis, Pseudophonus rufipes and Brachinus sclopeta; see Fig 5).
|
study
| 100.0 |
The space has been identified in four quadrants (I—IV) to facilitate the interpretation of species vs. sites position. The name of the species has been coded by merging the first four letters of the genus with the first four letters of the species name (see S1 Table for species names).
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other
| 99.9 |
It is likely that the life strategies which were successful to survive in deciduous forest conditions, were positively selected for the bioclimatic Mediterranean belt too (PCA quadrant III; Fig 4), but only to some extent. Carabid populations colonizing olive plantations of the Mediterranean belt were characterized almost entirely by generalist zoophagous predators (e.g., Calathus fuscipes) and the lack of specialized predators, while the latter were present with a few species in deciduous forests. They were also characterized by a chorological spectrum dominated by Mediterranean species; and by low body size variability, mainly restricted to s3 category (a category size of 10-15mm).
|
study
| 99.94 |
Olive cultivation in Calabria is characterized by highly heterogeneous agricultural management practices, often affected by the interaction of microclimatic and soil features. Olive plantations were introduced in the hill landscape (49%) and in montane areas (42%) mainly, while only 9% were introduced in the lowlands , over a wide range of soil types, aspect, tillage type and potential climax forestation.
|
other
| 99.9 |
The distribution of carabid species living in the studied agricultural landscape is characterized by the high number of singletons (31%) and doubletons (21%), which account for more than half of the sampled fauna. The species distribution is probably due to the complexity of the interaction between semi-natural and artificial (i.e., man-originated) environmental factors.
|
other
| 94.75 |
On the basis of the classification, it was not possible to outline a clear species vs. site cluster structure. Instead it was found an evident trend of site-by-site species clustering, which was probably affected by the ecological factors characterizing every single sample site. This is the case, e.g., of the sites belonging to the A group, where the fact of belonging to the same geographical district may have influenced species distribution, while in the group C the natural and man-made disturbance is likely to be more critical than sharing the same geographical district.
|
study
| 99.94 |
After the classification of the sites, it was possible to characterize the groups of the sites on the basis of the potential vegetation they were located within, while other factors recorded in the sites did not mirror site clustering (see Table 1 and Fig 2).
|
study
| 99.94 |
Ordination showed that at least three factors affected the species distribution among the sampled sites, namely (in an apparent order of importance), potential vegetation, soil type and soil management, so that the outlining of a clear ecological gradient is probably hindered by the interaction among such factors. On the basis of the explained variability by the first three PCA axes (i.e., 50%), and the indirect gradient analysis arguable by the site distribution along the axes, it is indeed possible to hypothesize that, in our sites, each factor was slightly prevailing on the others at the local scale in an apparent random manner. Similar results have been found by where soil management was one among several factors affecting arthropods distribution in olive agroecosystem, and by , where groundcover vegetation played different roles at different geographical scales. It is not to be excluded that even in the studied sites the interaction of several factors, e.g. soil tillage, residue management and N fertilization rate, could affect soil biota diversity as found by .
|
study
| 100.0 |
An answer to our first question comes from the olive grove picture emerging from our work, and from the literature, which is that of an agroecosystem showing an uniform physiognomy, under which several local factors, either natural and man-induced, exerted a driving influence on the local composition of species assemblages. Different life strategies (i.e., species traits) eased to cope with the local driving factors, as Table 2 showed, but we found that each species trait was equally dominant in the sampled sites even though soil cultivation techniques were different.
|
study
| 100.0 |
The above confirms that the olive grove is a complex agroecological system, where natural resources, like carabids, are not linearly affected by the intensity of agricultural practices, i.e. soil cultivation technique is not the preponderant factor affecting specie distribution.
|
other
| 99.94 |
The second question of our paper is to be framed into an historical perspective. The sampled sites belonged to the same ecological landscape, and their agricultural dimension was developed by the same agricultural practices, so that they represent a sort of homogeneous unity, both under present anthropic factors and historical landscape modification point of view.
|
other
| 99.9 |
On the basis of the data heterogeneity and landscape features outlined above, we interpret the carabid distribution in olive plantations as stemming from two sets of species, one set originating from forest and the other from non-forest ecosystems. The two sets actually coexist in the studied sites, giving rise to several species groupings, depending on the ecological factors prevailing within each olive plot. A set of a few species originating from natural forest ecosystems (e.g., Pterostichus melas, Calathus montivagus, Laemostenus cimmerius) was able to resist man-induced land modifications (i.e., agriculture) by keeping viable populations in olive plantations. This was also thanks to a probable turnover from the surrounding forest environments, as observed for Lepidoptera . A set of species originating from non-forest ecosystems found in olive plantations a new environment, which was to be colonized (e.g., Calathus fuscipes and Pseudophonus rufipes), to be opportunistically exploited (e.g., Amara aenea, Brachinus sclopeta, B. italicus and Scybalicus oblongiusculus), or facilitated fitting microhabitat conditions (e.g., soil humidity for Bembidiinae).
|
study
| 100.0 |
It is also not to be excluded, and it should be further investigated, that the presence of higher-order interactions (HOIs in ) among carabid populations lead to the local formation of species groupings. Such local species groupings, filtered by the local diversity of the abiotic factors, actually would be facies of a higher level community, i.e. a sort of super-community.
|
other
| 99.8 |
Question ii) posed in the introduction remains partly open, because on the basis of cluster analysis and PCA, it is likely that many species characterized the different facets of olive plantation. Since we observed several species showing exclusive preference for only one of the several olive plantation facets, it was not possible to list a group of species as indicators of the olive agroecosystem, while it was possible to outline in Table 3 the species mainly related to the sampled olive groves.
|
study
| 99.94 |
This suggests that throughout the Mediterranean region it will be likely to find different species groups in relation to geographical factors (e.g., compare the results of ). Our third question concerns the relationship between the faunistic geographical variation by analysing the life strategies positively or negatively affected by soil cultivation.
|
other
| 99.8 |
The interpretation of carabid distribution on the basis of species traits (i.e., life strategies) shows that, after evident species diversity, uniform life strategies are dominant when the species had to cope with the ecological factors that characterize the different plantation facets.
|
other
| 99.9 |
The general dominance of autumn breeders is due to mowing and tillage, which are practised in spring, negatively selecting those species laying eggs in spring. It is possible to hypothesize that, as a rule within the agricultural landscape, the positive selection of a given seasonal breeding strategy mirrors seasonal soil management.
|
other
| 99.9 |
Macropterous species dominate the complex of species groupings because olive plantation, although it is a permanent tree agroecosystem, it is far from being a semi-natural environment, at least in Calabria, where a remarkable amount of artificial disturbance, mainly at soil level, is always present, and against which high dispersal power offers an adequately resilient strategy.
|
other
| 99.94 |
Under a perspective based on ecological gradient analysis, we found that the principal factors driving species distribution were the potential vegetation and soil type. Within the region of potential oak forests, on damped soils the omnivorous or the seed eating species found better conditions than the zoophagous species, which instead found better conditions on dry soils. Within the region of the potential Mediterranean vegetation, feeding strategy is more uniformly characterised by generalist predators species, with no apparent influence from the soil type.
|
study
| 99.94 |
The results from both taxonomic and biological analyses are congruent with similar studies in agroecosystems (and literature therein) and suggest that carabid beetles can be used as model organisms exemplifying the response of insects living on the ground of olive groves.
|
other
| 99.44 |
They may represent an ecosystem service for controlling pest insects that spend part of their biological cycle on the gro und. In particular, we suggest that Pterostichus melas and Calathus fuscipes, generalist predators and autumn breeders, could be potential natural resources against Bactrocera. oleae in autumn [68, 69]. Furthermore, they are the only species present in all the sampled sites showing wide ecological tolerance. The same role may be played by Pseudophonus rufipes, as demonstrated by against Ceratitis capitata.
|
study
| 92.25 |
Our work is the first attempt to describe carabid beetle communities in Mediterranean olive plantations on the basis of the classical approach of species-by-site sampling, which we have further improved by weighting the species traits (for other types of cultivation see [71–73]). We have demonstrated that an informative approach ought to take into account community parameters that are different from the richness and abundance of species, to highlight the effects of agricultural management on biodiversity. A combination of taxonomic and functional approaches provides extra information confirming that the analysis of species’ morpho-functional features is a promising and common approach to evaluate functional diversity [21, 47, 74].
|
study
| 99.94 |
Our work suggests that a functional approach can reveal the interactions between biocoenosis and the factors affecting agroecosystems, not only spatially but also temporally. Adequate agricultural management should stimulate the presence of ‘positive’ arthropods, which could be able to restrain pest population directly and/or indirectly in a natural fashion. Future research should be focused on the role of medium-sized carabids, autumn breeders, to controle the olive fly and possibly other crop pests. Moreover, as we have found that several factors affect almost to the same degree the species distribution, the complexity of the olive agroecosystem must be considered when planning to use carabids for providing ecosystem services.
|
study
| 99.94 |
According to World Health Organization estimation about 18 million people worldwide are suffering from Alzheimer's disease (AD) and figures would shoot up to 34 million by 2025 in aging population. The onset and propagation of AD is unrelenting from cellular to molecular levels, governed by multitude of factors leading to a continual decrease in cognitive abilities (Felsenstein et al., 2014). Recent advances in understanding the genetic factors that predispose to AD, as well as in biomarker development have brought with them the promise of earlier and more reliable diagnosis of this disease. However, treatment regime and strategies available, approved by US-FDA are limited by their scope to alter pharmacological targets that can provide symptomatic relief to the patient (Lannfelt et al., 2014). The present stock of drugs for AD consists of donepezil, galantamine, rivastigmine, and memantine. The primary mechanism of action for these drugs is to decrease the acetyl cholinesterase (AChE) levels thus altering acetylcholine level, while memantine is a low-affinity voltage-dependent uncompetitive antagonist at glutamatergic N-methyl d-aspartate receptor (NMDA) thereby blocking the activity of the neurotransmitter glutamate. All the existing treatments for AD are only symptomatic but non curative (Lannfelt et al., 2014). Under these circumstances a drug molecule with multiple pharmacological properties with intent to modify as well as reduce the risk factors contributing toward disease burden will be highly appreciated. Drugs that are aimed at disrupting AD disease progression by inhibition/degradation of the protein mis-folding of β-amyloid (Aβ) into neurotoxic oligomeric aggregates has been encouraged for AD (Scheff et al., 2007).
|
review
| 99.9 |
With the advent of new diagnostic tools various pathological conditions have been identified at different stages of AD. Accumulation of amyloid beta (Aβ) to form clumps known as neuritic or senile plaques is considered as hallmark of AD. The buildup of these plaques seems to be a crucial as they lead to oxidative stress coupled with mitochondrial dysfunction and barrage of inflammatory cascade causing neuronal cell death. Studies carried by Zhang et al. (2016) on L-3-n-butylphthalide (L-NBP) extracted from seeds of Chinese celery (Apium graveolens Linn) showed some promising results in animal models of AD. Interestingly treatment of L-NBP (15 mg/kg; oral, 3 months) to APP/PS1 mice resulted in amelioration of Aβ induced damage to synapse. Improvement in synaptic plasticity which is considered as an essential factor modulating cognitive functions in AD has also been observed after L-NBP. Pictorial results from electron microscopy revealed the significant increase in number of synapse and spines in hippocampus regions following treatment with L-NBP. It could be reasoned that multiple molecular events have been amended to bring about changes in synaptic strength. These changes might range from removal of synaptic plaques to anti oxidative and anti-inflammatory mechanisms. However, it is very hard to distinguish whether removal of synaptic plaques provides anti oxidative and anti-inflammatory relief or vice versa. In this study Zhang et al. (2016) explored pertinent proteins associated with synaptic plasticity in hippocampus to unveil the mechanism of neuroprotective effects of L-NBP and found upregulation in expression of PSD95, synaptophysin, β-catenin and GSK- 3β on treatment with L-NBP. PDS-95 is an abundant synaptic protein playing an important role in maintaining and regulating excitatory synapses and promoting synaptogenesis. β-catenin is a crucial factor for Wnt signaling pathway necessary for the maintenance of dendritic strength and density. An important issue remaining unanswered in these studies was involvement of adult neurogenesis following exposure to L-NBP. Since it affects multiple pharmacological targets it could be reasoned that L-NBP might alter stem cells in the hippocampal region to bring about changes in synaptic plasticity by involving the Wnt pathway. Whether the potential of L-NBP is limited to the degradation of Aβ or it might regulate proteins associated with adult neurogenesis via activation of stem cell markers in AD still remains elusive (Lei et al., 2014).
|
review
| 99.2 |
Interestingly, L-NBP influence on inflammatory responses during AD has been previously reported involving decreased expression of IBA-1 and inhibition of microglia activation in APP/PS1 mice. Furthermore, significant decrease in Aβ deposition linked with decreased gliosis has also been observed on after L-NBP exposure highlighting potential effects of the compound in ameliorating inflammation. Anti-inflammatory potential of L-NBP is well documented wherein it reduced neuro inflammation in lipopolysaccharide-treated C57BL/6 mice. The anti-inflammatory response could be beneficial in long term therapy in case of neurodegenerative disorders (Lei et al., 2014; Zhang et al., 2016).
|
study
| 99.6 |
Mitochondria are considered a target in neurodegenerative disorder since reactive oxygen species generated during ATP generation tip the balance toward neuronal damage and apoptosis (Figure 1). Elevated levels of mitochondrial ROS particularly in the neurons may target the lipid bilayers and cause neurochemical alterations. Further, compromised membrane potential could be associated with enhanced apoptosis due to activation of intrinsic apoptotic pathway. Amelioration of oxidative damage either through chelating ROS or promoting the expression of anti-oxidant enzymes is considered a potential mechanism through which L-NBP exerts its anti-oxidant effect (Peng et al., 2008, 2010).
|
study
| 99.94 |
Taken together, the findings suggest that the neurotherapeutic potential of L-NBP as a disease modifier in AD is due to its multiple pharmacological properties. It may be hypothesized from the experimental findings that the specific feature of this compound is the ability to reduce the load of Aβ and to exert anti-oxidant properties by lowering the levels of ROS, maintaining optimum MMP with reduction in inflammatory markers. For the first time Zhang et al. (2016) have demonstrated that this molecule could also repair synaptic damages via modulation of PSD95, synaptophysin (SYN), β-catenin, and GSK-3 β. L-NBP acts through various systems to impede progression of AD. Previous studies with L-NBP in patient with subcortical vascular cognitive impairment without dementia have demonstrated improved cognitive and global functioning and good safety (Jia et al., 2016). Another study by Xiang et al. (2014) also supported the neuroprotective role of L-BNP in an AD model by inhibiting oxidative injury, neuronal apoptosis and glial activation, regulating amyloid-beta protein precursor processing and reducing amyloid-beta formation. These studies substantiate the necessity of further evaluations of L-NBP for its potential beneficial effects in neurological diseases. However, the clinical efficacy of the molecule still requires to be evaluated. Bioavailability is considered as another major issue faced by natural compounds during clinical trials. Until disease-modifying therapies become available, further research is needed to develop new drug delivery strategies to ensure ease of administration and adequate pharmacokinetic properties, since no available treatments stop or reverse the progression of the disease. As of 2016, more than 1000 clinical trials have been or are being conducted to find ways to treat the disease, but it is unknown if any of the tested treatments will work.
|
review
| 99.9 |
Intimal hyperplasia is the universal response of vessels to a chronic structural change that occurs in denuded arteries, arterialized veins, and in the anastomoses of prostheses used as grafts for bypass; it is also defined as an abnormal migration and proliferation of smooth vascular muscle cells associated with the deposition of extracellular connective tissue matrix, which is then accompanied by remodeling of the new tissue.
|
other
| 99.9 |
There is a great need for ways to prevent or reverse intimal hyperplasia. The myointimal hyperplasia is reported to be reversible only in the first and second weeks after vascular injury, and it depends on the degree and duration of the causative injury.
|
other
| 99.9 |
On the basis of the studies available in the literature, we found that Allium sativum has beneficial effects such as anti-inflammatory, antioxidant, hypocholesterolemic, antitumoral, and anti-atherosclerotic actions, which prompted us to test its protective effect against myointimal hyperplasia. Our aim is to determine the mean difference of post-angioplasty myointimal hyperplasia in the external iliac artery of rabbits with induced atherosclerosis and treated with A. sativum compared with those treated with cilostazol, since the articles found in the literature demonstrate that cilostazol has effects of reducing the total cholesterol, triglyceride and phospholipids in serum, and moreover, the triglyceride content in the atherosclerotic arteries, so cilostazol significantly reduced the intimal atherosclerotic area.
|
study
| 99.94 |
This is an experimental study in laboratory animals for 35 days, including 30 adult female New Zealand rabbits (Oryctolagus cuniculus; > 4 months old, >2 kg body weight). The animals were equally divided into 3 groups: PS group (physiological saline solution, negative control), group C (cilostazol, positive control), and group A (A. sativum, study drug).
|
study
| 99.94 |
The selected rabbits comprised a nonprobability sample of convenience. The animals were grouped by using simple randomization with the help of a free research randomizer program (http://www.randomizer.org/form.htm), by using three blocks containing 10 numbers each. Each block corresponded to the drug used, and the numbers generated corresponded to the animals. Thus, each animal was assigned a letter and a number corresponding to the group and animal identification (e.g., C1=animal 1, cilostazol group; A2=animal 2, A. sativum group). This identification was written with indelible blue ink on the inside face of the base of the right ear of the animals.
|
study
| 99.9 |
We opted for closed animal handling, and the trial was performed in the animal house of origin, under a forced exhaust ventilation system, with periods of natural luminescence, mean temperature of 20ºC, minimum noise, and humidity of around 50%. The animals were kept in appropriate cages with an area of 0.64 m2; they had no contact with their natural secretions. The diet consisted of water and granulated commercial diet (Purina® for rabbits—15% crude protein, 2.5% ethereal extract, 16% fiber material, 10% ash, 2.5% calcium, 0.42% phosphorus, 13% humidity, 31.58% carbohydrates) given ad libitum before and during the experiment.
|
study
| 99.8 |
Law 6638, May 8, 1979—Standards for Educational and Scientific Practice of Animal Vivisection;Universal Declaration of Animal Rights, UNESCO, October 15, 1978;Law of environmental crimes (Law No. 9,605/1998);The guidelines from Directive 2010/63/EU of the European Parliament on the protection of animals used for scientific purposes;The rules of the Brazilian College of Animal Experimentation—COBEA, 1991, on the Ethical Principles in Animal Experimentation.
|
other
| 99.94 |
All groups were offered 20 mL sifted yolk of chicken egg daily, administered orally in the morning with the aid of a 20 mL syringe, for a period of 100 days. The diet was prepared daily, and proper hygiene was maintained to prevent contamination; the diet was given raw.
|
other
| 99.9 |
After 100 days of administration of the atherogenic diet, it was stopped and myointimal hyperplasia was induced by means of the following technique: rabbits were weighed and anesthetized with 10 mg.kg-1 xylazine and 40 mg.kg-1 ketamine, intramuscularly, on the proximal side to the right hindpaw, according to a technique described in the literature.
|
study
| 99.6 |
Anesthesia was verified by the absence of pain reflex in the direct interdigital hold in the right ear. After anesthetic induction, trichotomy was performed in the lower abdomen and right inguinal region, followed by proper cleaning of the area, under aseptic conditions and antisepsis with polyvinyl pyrrolidone iodine degerming solution with 10% active iodine.
|
clinical case
| 99.94 |
We collected 5 mL blood from the central ear vein with a syringe, to 6-mL tubes with a suitable preservative for biochemical analysis. After collection, the samples were sent for testing in the analysis laboratory of the Hospital University Lauro Wanderley at the Federal University of Paraíba (UFPB), where they were centrifuged and the low density lipoprotein (LDL), very low-density lipoprotein (VLDL), triglycerides, high density lipoprotein (HDL), and total cholesterol levels were analyzed. Subsequently, a 2–3-cm skin incision was made in the longitudinal direction in the inguinal fold with scalpel blade (#11) to expose the femoral artery, which was isolated with a 3-0 cotton thread. A small transverse arteriotomy was performed with a scalpel blade (#11) for the introduction of a 0.014-in metal guidewire and a semi-compliant catheter balloon (2.5 mm diameter and 20 mm long; balloon/artery ratio, 2.5:1), which was inserted in the lumen of the femoral right artery in the cranial direction and its position in the right external iliac artery was determined through visualization of the proximal balloon shoulder to the dissected inguinal ligament. The balloon catheter was inflated for 1 min until the rated burst pressure (RBP) of the angioplasty balloon (about 12 atm), leading to distension of the arterial wall. After balloon deflation and removal of all guidewire balloons, we performed ligation with a 3-0 cotton thread above and below the arteriotomy. Finally, the skin was sutured with a 4-0 nylon thread. Analgesics (10 mg.kg-1 ibuprofen orally, diluted in drinking water for 2 days) and antibiotics (20 mg.kg-1 ceftriaxone, intramuscular, single dose) were administered to all groups in the postoperative period, to prevent animal suffering. Twentyfour hours after surgery, the drug administration began in each group.
|
study
| 96.9 |
Group A (A. sativum) received 800 µkg-1.day-1 of A. sativum by garage (the garlic was crushed and mixed with drinking water to a total volume of 10 mL) for 5 weeks, the PS group (negative control) received 0.9% physiological saline by gavage 10 mL.day-1 for 5 weeks and group C (cilostazol) received cilostazol (ZHENJIANG Haisen, China) at a dose of 50 mg.day-1 for 5 weeks by gavage (cilostazol was diluted in 10 mL drinking water).
|
study
| 71.25 |
The drugs were administered during a 5-week period, ending when the animals were anesthetized by using the abovedescribed technique, and new blood samples were collected for post-dose drug lipid profile analysis. The animals were euthanized with a lethal dose of an anesthetic (150 mg.kg-1 pentobarbital. The right external iliac artery, which received balloon injury due to the surgical procedure, was collected transabdominally.
|
study
| 99.8 |
Arterial blocks were fixed in 10% formalin for at least 24 h and then prepared for routine light microscopy, as follows: gradual and increasing dehydration with 70% alcohol until absolute alcohol concentration was reached; diaphonization in xylene and liquid paraffin embedding at 60°C; and preparation of paraffin blocks. The paraffin blocks were cut with a microtome in a thickness of 3 µm, and the sections were mounted on extrafine glass slides (76´ 25 mm). Next, they were stained with hematoxylineosin for general morphology study; Verhoeff's stain for the evaluation of elastic fibers; and Masson's trichrome stain for general morphological study and characterization of elastic fibers, collagen, and muscle. Then, they were mounted with coverslips and natural resin. Also, immunohistochemistry assays were performed with the monoclonal HHF35 antibody (Kit DAKO Monoclonal Mouse anti-human Muscle Actin, clone HHF35) for determining the invasive reactions in the artery layers (smooth muscle), and C4d (Kit Spring Bioscience Rabbit Antihuman C4d Polyclonal antibody) to study the immune response in the vascular endothelium; in both immunohistochemistry tests, peroxidase was used as a developer. The slides were prepared and examined under magnifications of 2.5´, 10´, and 40´ by a duly accredited pathologist.
|
study
| 99.3 |
For morphometry, a Bioval® optical microscope was used, with the program ToupTekView® version ´86 3.7.2270 (copyright 2003–2013; http://www.touptek.com) and the Opticam® 14 MP digital camera. The percentage of myointimal area was calculated by using the ImageJ 64 program, where the image of the vessel was formatted as follows:
|
other
| 99.5 |
The area of the vessel adventitia was manually removed externally bypassing the muscle layer, which is easily visible. The automatic deletion was cutting structures of the muscle layer when some areas of adventitia had the same or similar color intensity that the middle layer (muscle);The remaining image was transformed into 8-bit;The rest of the image formed by the lumen of the vessel and myointimal layer was transformed into a mask, and the area in pixels was measured; this area was called the total area;Then, only the area of the vessel lumen was measured;The area of myointimal layer was calculated in pixels by subtracting the light area from the total area (area of the mean-intima layer with light);The percentage was then calculated by dividing the area of the myointimal layer by the total area.
|
study
| 99.94 |
The area of the vessel adventitia was manually removed externally bypassing the muscle layer, which is easily visible. The automatic deletion was cutting structures of the muscle layer when some areas of adventitia had the same or similar color intensity that the middle layer (muscle);
|
other
| 99.9 |
For stereoscopy of the immunohistochemical results (monoclonal antibody HHF35 and C4d), we took three random field photos by using the 40X objective of microscope, and with each histological slide of each animal in each group. These photos do not suffer any further increase in its size. Then, the 36-point test was used, in which the area of immunomarkers was calculated by using the formula:
|
study
| 99.9 |
A = Vv/2Qa µm2where Vv (volume density of the immunomarker) was estimated by counting the points (36-point test).Vv = Pp/Ptwhere Pp is the number of points that touch the immunomarkers, and Pt is the total number of points in the test area of 200 µm2, which in our case was 36 points.Qa (number density of nuclei area) was calculated by the formulaQa = N/Atwhere N is the number of nuclei counted in the test area and At is our test area, which was 200 µm2.
|
study
| 99.94 |
Masking for microscopy was performed by changing the letter and the initial marking number with another letter and number known only to the principal investigator. The new description was stored in an opaque and sealed envelope, which was only opened at the time of data analysis. The pathologists did not know which method was being used in the target vessel.
|
other
| 99.9 |
We also measured the sample size using the online calculator LEE (Epidemiology and Statistics Laboratory), available for free on the website: http://www.lee.dante.br/pesquisa/amostragem/di_1_pro_tes.html, which resulted in n = 9 (nine) for each group. To calculate the hypothesis test for a proportion the following parameters were used:
|
study
| 97.5 |
ANOVA tests were used (one-way and two-way) with confirmatory testing: Tukey (multicomparative) for quantitative data and the Chi-square test for qualitative data, both with two-tailed hypothesis. Where the two-way analysis of variance test was used for continuous temporal variables and the one-way test was used for transverse continuous variables. Furthermore, the Tukey test was used for quantitative data (continuous variables) because there was more than one group with different drugs, whereas the χ2 test was used for qualitative data (nominal categorical variables).
|
study
| 99.94 |
Considering the area of intrusion or modification of myointimal cells in the muscle layer, characterized by the immunohistochemical marker HHF35 monoclonal antibody both hyperplasia with invasion in the intima (Figure 3A), and, in and hyperplasia without muscle invasion in the intima (Figure 3B) were observed. The following results were obtained:
|
study
| 99.94 |
Fig. 3A: Image showing hyperplasia with invasion in the intima, yellow arrows show the internal elastic membrane, black arrows show foam cells and red arrows show positivity to HHF35 antibody in the intimal hyperplasia. Scale 5/100 mm, 10X. B: Image showing hyperplasia without muscle invasion in the intimal, blue arrows indicate hyperplasia without muscle invasion. HHF35 monoclonal, scale 5/100 mm, 10X).
|
clinical case
| 99.5 |
A: Image showing hyperplasia with invasion in the intima, yellow arrows show the internal elastic membrane, black arrows show foam cells and red arrows show positivity to HHF35 antibody in the intimal hyperplasia. Scale 5/100 mm, 10X. B: Image showing hyperplasia without muscle invasion in the intimal, blue arrows indicate hyperplasia without muscle invasion. HHF35 monoclonal, scale 5/100 mm, 10X).
|
clinical case
| 92.94 |
Negative control group, PS: mean, 8.35 µm2; 95% CI, 5.74–10.96 µm2;Positive control group, cilostazol: mean, 14.47 µm2; 95% CI, 8.06–20.88 µm2;Treated group, A. sativum: mean, 11.52 µm2; 95% CI, 7.09–15.96 µm2, with P=0.1387 and not significant in the Tukey test.
|
study
| 100.0 |
Considering the inflammatory area by complement and characterized in this study by the immunohistochemical marker C4d, hyperplasia with active inflammation in the intimal (Figure 4A) and hyperplasia without active inflammation in the intima (Figure 4B) were observed. The following results were obtained:
|
study
| 100.0 |
Fig. 4A: Image showing hyperplasia with active inflammation in the intimal indicated by red arrows – C4d positive, yellow arrows show the internal elastic membrane, red arrows show positivity to C4D polyclonal and blue arrows indicate hyperplasia, scale 5/100 mm, 10X. B: Image showing hyperplasia without active inflammation in the intima, yellow arrows show the internal elastic membrane and blue arrows indicate hyperplasia, scale 5/100 mm, 10X).
|
clinical case
| 99.3 |
A: Image showing hyperplasia with active inflammation in the intimal indicated by red arrows – C4d positive, yellow arrows show the internal elastic membrane, red arrows show positivity to C4D polyclonal and blue arrows indicate hyperplasia, scale 5/100 mm, 10X. B: Image showing hyperplasia without active inflammation in the intima, yellow arrows show the internal elastic membrane and blue arrows indicate hyperplasia, scale 5/100 mm, 10X).
|
clinical case
| 78.75 |
Negative control group, PS: mean, 3.50 µm2; 95% CI, varying from 2.11 to 4.89 µm2;Positive control group, cilostazol: mean, 3.98 µm2; 95% CI, varying from 2.83 to 5.14 µm2;Treated group, A. sativum: mean, 4.16 µm2; 95% CI, varying from 1.66 to 6.67 µm2;with P=0.8295 and not significant in the Tukey test.
|
study
| 100.0 |
From the morphological results, we observed that there was no standardization of myointimal hyperplasia, as in some animals, hyperplasia occurred only in the intimate layer characterized by its elevation with invasion to the vessel lumen and the presence of foam cells without muscle invasion and other animals with muscle invasion (Figure 5A). Some animals showed changes only in the muscle layer (middle), and the arterial intimal layer was spared; these changes were characterized by calcium deposition at different levels (Figure 5B). Considering the immunohistochemical analysis with the HHF35 monoclonal antibody for the muscle cells, there was also no myointimal hyperplasia pattern, because we observed that the animals had hyperplasia with muscle invasion or muscle metaplasia in the intimate vascular network (Figure 3A), as well as no muscle change (Figure 3B).
|
study
| 100.0 |
Fig. 5A: Isolated intimal hyperplasia. The blue arrows indicate hyperplasia, black arrows indicate the foam cells. Masson staining, 10X, scale 5/100 mm). B: Calcification in the middle layer. Blue arrows show the calcifications, green arrows indicate the normal muscle. Masson staining, 4X, scale 1/10 mm).
|
clinical case
| 98.06 |
A: Isolated intimal hyperplasia. The blue arrows indicate hyperplasia, black arrows indicate the foam cells. Masson staining, 10X, scale 5/100 mm). B: Calcification in the middle layer. Blue arrows show the calcifications, green arrows indicate the normal muscle. Masson staining, 4X, scale 1/10 mm).
|
other
| 97.5 |
By observing the immunohistochemical marker C4d (Figure 4), it was determined that there was no inflammatory standardization in the intima layer, considering that some animals had intimal hyperplasia without inflammatory reaction by the complement system and others with inflammation.
|
study
| 99.94 |
Concerning the mean difference of total cholesterol (Table 1) between the A. sativum and the 0.9% PS groups, we obtained 32.150 mg/dL with 95% CI varying from -41.384 to 105.684 mg/dL. The mean difference between the cilostazol and 0.9% PS groups was -26.750 mg/dL, with 95% CI varying from -100.284 to 46.784 mg/dL. However, between the cilostazol and A. sativum groups, the mean difference was -58.900 mg/dL with 95% CI from -132.434 to 14.634 mg/dL. From two-way ANOVA, we obtained P=0.0165; however, the results were not significant in the Tukey test. Thus, there was no difference between groups in total cholesterol.
|
study
| 100.0 |
The difference of HDL cholesterol mean between A. sativum and 0.9% PS was 4.325 mg/dL with 95% CI varying from -6.667 to 15.317 mg/dL. The mean difference between the cilostazol and 0.9% PS groups was 0.570 mg/dL, with 95% CI of -10.422 to 11.562 mg/dL. On the other hand, between the cilostazol and A. sativum groups, the mean difference was -3.755 mg/dL with 95% CI of 7.237 to -14.747 mg/dL. From two-way ANOVA, we obtained P=0.0199; however, in the Tukey test, there was no significant difference between the groups.
|
study
| 100.0 |
For VLDL, the mean differences between the A. sativum and 0.9% PS, cilostazol and 0.9% PS, and cilostazol and A. sativum groups were infinitely in two-way ANOVA (P=0.8107); thus, there was no difference between groups concerning VLDL cholesterol. The Tukey test was not done, given that the ANOVA result was not significant.
|
study
| 100.0 |
Nevertheless, the mean difference in triglycerides between the A. sativum and 0.9% PS groups was 21.600 mg/dL, with 95% CI varying from -58.974 to 102.174 mg/dL. Between the cilostazol and 0.9% PS groups, the mean difference was -34.950 mg/dL, with 95% CI varying from -115.524 to 45.624 mg/dL. Between the cilostazol and A. sativum groups, the mean difference was -56.550 mg/dL with 95% CI of -137.124 to 24.024 mg/dL. The calculation with two-way ANOVA obtained P=0.2013, and the Tukey test was not significant; thus, there was no difference between groups.
|
study
| 100.0 |
Concerning the effect on the liver of the tested substances, P=0.5853 was obtained for the presence of steatosis in all groups, with a mean of five animals for the 0.9% PS group, with 95% CI of -58.53 to 68.53; a mean of five rabbits for the cilostazol group, with 95% CI varying from -45.82 to 55.82; and a mean of five rabbits for the A. sativum group, with 95% CI of -45.82% to 55.82.
|
study
| 100.0 |
Cholangitis of the liver occurred in a mean of five animals for the 0.9% PS group, with 95% CI of -7.70 to 17.71; a mean of five animals for the cilostazol group, with 95% CI of 5; and a mean of five rabbits for the A. sativum group, with 95% CI varying from -20.41 to 30.41 (P=0.6592).
|
study
| 99.94 |
Portal infiltration of the liver was found in a mean five animals for the 0.9% PS group, with 95% CI of 3.59 to 6.41; a mean of five animals for the cilostazol group, with 95% CI of 0.76 to 9.24; and a mean of five rabbits for the A. sativum group, with 95% CI varying from 2.18 to 7.82 (P=0.6211).
|
study
| 100.0 |
We partially accepted hypothesis H1 because the results obtained in the experimental group (A. sativum) were similar to those obtained in the positive control (cilostazol), but differed from those obtained in the negative control (0.9% physiological saline solution). However, the tested drug had no effect on the inhibition of myointimal hyperplasia, since the result obtained was the same as the positive control.
|
study
| 100.0 |
A. sativum was chosen as the target drug in the study to inhibit myointimal hyperplasia because, according to Efendy et al., Campbell et al. and Yamaji et al., it has an anti-atherosclerotic effect. Moreover, according to Lau, A. sativum has a hypocholesterolemic effect; furthermore, Borek reported that it has antitumor, anti-inflammatory, and antioxidant effects. Hence, there was a great possibility that A. sativum would act favorably in the inhibition of myointimal hyperplasia. The dose of 800 µg.kg-1.day-1 was chosen as the test dose in the present study, as Efendy et al. reported that 800 µg.kg-1.day-1 of crude extract of garlic can inhibit the development of fat layers and the accumulation of cholesterol in the vessel walls, thus protecting them against the development of atherosclerosis. The use of A. sativum in its original form as based on the study by Borek, who found that allicin—a component of A. sativum — is unstable in solution, as it is a lipid-soluble, volatile organosulfur compound. Thus, it is essential that the maximum possible amount of the active substances of A. sativum is retained.
|
study
| 99.94 |
Rabbits were chosen for the study because, according to research performed by Ferrer et al., the rabbit is a valid atherogenic vascular injury model. Takagi et al. proved that the hyperplasia occurring in rabbits is similar to that occurring in human coronary arteries, besides Ylã-Herttuala et al. demonstrated that both rabbits and humans have a common pattern of inflammatory reactions in the complement system.
|
study
| 99.94 |
The immunohistochemical study of specimens was performed with monoclonal HHF35 and polyclonal C4d in an attempt to establish the mechanism of action of the drugs, given that the former is a marker for muscle cells and the C4d is a marker for the inflammatory process mediated by the complement system. Ylä-Herttuala et al. demonstrated the action of the complement system in atherosclerotic lesions and Tsai et al. identified the inhibitory activity of p38 by using cilostazol. Since the inhibition of p38 has been associated with possible therapeutic effects on autoimmune diseases and inflammatory processes, we chose to assess the effect of A. sativum on inflammation through the complement system; then we used the marker C4d. However, in all animals, no statistical difference was observed with regard to muscle invasion in the intima as well as the inflammatory process mediated by the complement system in the myointimal wall. Therefore, the study was not able to characterize the manner in which the inhibition or decrease of myointimal hyperplasia occurred, given that there was no statistically significant inhibition of muscle invasion or reduction of the inflammatory process, with the use of A. sativum or cilostazol.
|
study
| 100.0 |
In the morphometric analysis, there was no pattern of hyperplasia among the groups because some animals had hyperplasia of the muscle layer with breakdown of muscle cells and calcium deposition; others only had a change of intima such as stratification of the intimal layer and muscle invasion; and others showed change in two layers, suggesting that there are various mechanisms underlying the development of myointimal hyperplasia, even though there were only two induction mechanisms — the hypercholesterolemic diet and endothelial injury (balloon). However, these findings are in contrast with those from the literature, which states that the distribution of hyperplasia may be intimal, diffuse, focal, or within the body vessel. Furthermore, Van Craeyveld et al. found that the main changes of atherosclerosis and hyperplasia actually occur in the deep layers of the vessel (muscle) and not in the intima. The staining method of Verhoeff, which is used for elastic fibers, was performed to try to define the intima and the muscle of vessel to calculate only the intimal hyperplasia; however, it was not effective in this delimitation. Therefore, we studied the myointimal layer.
|
study
| 100.0 |
A. sativum and cilostazol were able to inhibit myointimal hyperplasia in 40.9% and 54.64% of animals, respectively, as compared to the negative control (0.9% physiological saline solution), demonstrating the effectiveness of both substances. Although the proportion of animals exhibiting myointimal hyperplasia inhibition was 13.74% higher with cilostazol than with A. sativum, the fact that cilostazol is a drug that is already the active ingredient should be considered. Thus, even though a plant in its original form was used, without isolation of the active principle, a statistically similar result was obtained.
|
study
| 100.0 |
A. sativum and cilostazol were not able to reduce the lipid levels, thus our results are consistent with the current findings and we did not observe a difference in the lipid levels following in the dose of 800 µg.kg-1.day-1 in rabbits. Others studies indicated that the hypolipidemic action of garlic was observed only after 2 to 6 months of continuous administration of A. sativum, thus suggesting that the time used to conduct this study (35 days) was not sufficient to observe such a hypolipidemic effect, which was also reported by Ried et al..
|
study
| 99.94 |
With regard to the safety of A. sativum, the use of this drug in animals for the inhibition of myointimal hyperplasia was successful, without any difference in the presence of steatosis, cholangitis, and portal infiltration between groups. A. sativum has a LD50 of 3034 mg.kg-1 and maximum dosage without side effects of 2200 mg.kg-1; moreover, it is not contraindicated in pregnant animals.
|
other
| 99.7 |
The research carried out in this study paves the way for a new drug against myointimal hyperplasia, which is the main cause of failure of both coronary as well as peripheral angioplasties that lead to reinfarctions and failure of vascular grafts, and consequently to the need for amputations in many people, particularly diabetic patients.
|
other
| 94.5 |
Another study to be performed using higher doses of A. sativum, as this study used only the plant and not even an extract, and still matched the protective effect of an expensive drug, which can be useful in the third world population.Further research to be conducted with crude extract, followed by fractionation of this extract to obtain its active ingredient.
|
other
| 99.6 |
Patient engagement (PE) has been defined as patients (and their families or representatives) and health professionals working in active partnership at various levels across the health care system to improve health and health care [1–3]. The definition recognizes that patients can be engaged at the organizational or system level to improve the design of health services. Examples include, but are not limited to, serving on hospital or government committees ‘to help with everything, from paint chips to policy’ or on panels that develop clinical practice guidelines . The definition also recognizes that patients can be engaged at the level of their own care, sometimes referred to as patient centred care, which is the focus of our study [1–3]. PE in their own care can vary according to patient circumstances and preferences from receiving information or education to being an active partner in the care team by setting goals and taking part in decisions . Methods or tools to implement or achieve PE in their own care include, but are not limited to lay summaries, pre-consultation question prompts, decision aids, shared decision-making and self-management programmes [1–3].
|
review
| 99.75 |
PE in their own health care is desirable because it can improve patient knowledge, relationship with providers, health service use, satisfaction with health care, adherence to recommended treatment and other desirable lifestyle behaviours, and clinical outcomes . However, numerous factors challenge PE. For example, patients may not be familiar or comfortable with PE , and physicians may experience role tension between PE and delivering clinical care . Consequently, many patients do not experience desired levels of PE , and experts have advocated for improved PE implementation [10, 11].
|
review
| 99.7 |
PE is particularly relevant when treatment-associated risks and outcomes are difficult to predict [1–3]. In such cases, decisions are ‘preference sensitive’ because patients informed of risks and benefits might change their treatment preference . The preference-sensitive concept is germane to the context of non-drug technologies where evidence of the safety and effectiveness of some implantable cardiovascular or orthopaedic medical devices is limited [13, 14], and they have been associated with morbidity and mortality [15, 16]. Medical devices have been defined as non-drug technologies or instruments vital to the prevention, diagnosis, cure or treatment of a disease or abnormal physical condition . Examples of lower risk devices are wheel chairs and endoscopes, and examples of higher risk devices are joint or cardiovascular implants that require invasive procedures.
|
review
| 99.9 |
Few patients appear to have been engaged in medical device decision-making. For example, among Medicare beneficiaries who underwent elective coronary artery stenting in 2008, few reported having discussed treatment options (10%), associated risks (19%) or their treatment preferences (16%) . Among 17 of 22 standardized patients, visits with American cardiologists did not address, or minimized quality-of-life issues and the risks of implantable cardioverter-defibrillator (ICD) placement . All respondents to a survey of American patients who had joint replacement said that benefits were discussed more than risks . In another study of patients undergoing knee arthroplasty in one Canadian centre, most had little knowledge of the risks and benefits of options for devices and surgical approaches, and desired more information .
|
study
| 99.9 |
Given the overall benefits of PE, and patient reports of little or no PE for decision-making about higher risk medical devices, further research is needed to explore PE for medical device decision-making. The feasibility of PE is thought to hinge on the effort or resources required from patients, physicians or the health care system . There is a paucity of research from the perspective of physicians on the effort or resources required to engage patients in decisions about medical devices. Such knowledge would provide useful insight on how to better implement PE in this unique context. The purpose of this study was to explore physicians’ views about the feasibility of PE in decisions about higher risk implantable medical devices.
|
study
| 99.94 |
A qualitative approach was chosen to explore physician views about PE in medical device decision-making . More specifically, the research design employed was based on what is referred to as basic descriptive qualitative research . This method does not generate theory as would other qualitative approaches such as grounded theory technique. Instead, the purpose of basic descriptive qualitative research is to describe factual information about phenomena directly conveyed by participants through semi-structured interviews. It is interpretive and, as we did, often employs a theoretical framework to analyse the findings once generated using methods of qualitative analysis. Rigour and transferability were optimized using standard strategies and reporting criteria [24, 25]. These included exploring responses inductively for emerging ideas, identifying deviant cases, comparison of independent thematic coding across two individuals and demonstrating responses from an array of respondents by including an anonymous identification code with exemplary quotes. Ethics approval for this study was granted by the University Health Network. Participants provided written informed consent prior to being interviewed, in which they were apprised of the research rationale and goals. There was no relationship among members of the research team and participants.
|
study
| 99.94 |
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