Developing a Questionnaire for Iranian Women's Attitude on Medical Ethics in Vaginal Childbirth

Background: Vaginal delivery is one of the challenging issues in medical ethics. It is important to use an appropriate instrument to assess medical ethics attitudes in normal delivery, but the lack of tool for this purpose is clear. Objectives: The aim of this study was to develop and validate a questionnaire for the assessment of women’s attitude on medical ethics application in normal vaginal delivery. Patients and Methods: This methodological study was carried out in Iran in 2013 - 2014. Medical ethics attitude in vaginal delivery questionnaire (MEAVDQ) was developed using the findings of a qualitative data obtained from a grounded theory research conducted on 20 women who had vaginal childbirth, in the first phase. Then, the validation criteria of this tool were tested by content and face validity in the second phase. Exploratory factor analysis was used for construct validity and reliability was also tested by Cronbach’s alpha coefficient in the third phase of this study. SPSS version 13 was used in this study. The sample size for construct validity was 250 females who had normal vaginal childbirth. Results: In the first phase of this study (tool development), by the use of four obtained categories and nine subcategories from grounded theory and literature review, three parts (98-items) of this tool were obtained (A, B and J). Part A explained the first principle of medical ethics, part B pointed to the second and third principles of medical ethics, and part J explained the fourth principle of medical ethics. After evaluating and confirming its face and content validity, 75 items remained in the questionnaire. In construct validity, by the employment of exploratory factor analysis, in parts A, B and J, 3, 7 and 3 factors were formed, respectively; and 62.8%, 64% and 51% of the total variances were explained by the obtained factors in parts A, B and J, respectively. The names of these factors in the three parts were achieved by consideration of the loading factor and medical ethics principles. The subscales of MEAVDQ showed significant reliability. In parts A, B and J, Cronbach’s alpha coefficients were 0.76, 0.72 and 0.68, respectively and for the total questionnaire, it was 0.72. The results of the test–retest were satisfactory for all the items (ICC = 0.60 - 0.95). Conclusions: The present study showed that the 59-item MEAVDQ was a valid and reliable questionnaire for the assessment of women’s attitudes toward medical ethics application in vaginal childbirth. This tool might assist specialists in making a judgment and plan appropriate for women in vaginal delivery management

Treatment Outcome and Skin Complications in Tumor Bed Boost Radiotherapy Using Photons or Electrons in Breast Cancer Patients after Breast-Conserving Surgery

Background and Objective: In patients with breast cancer, the administration of an additional dose of radiotherapy to the tumor bed after breast treatment is associated with a decrease in local recurrence. Electron source is mainly used due to proper dose distribution and lack of skin irradiation. Nevertheless, access to electrons is not possible in all medical centers. Therefore, continuing treatment using smaller photon fields may be a reasonable option. The aim of this study is to investigate and compare the outcome of treatment and skin complications in tumor bed boost radiotherapy using photons or electrons in breast cancer patients after breast-conserving surgery. Methods: In this retrospective cohort, 280 patients with non-metastatic breast cancer who underwent breast-conserving surgery and adjuvant radiotherapy were included in the study. After whole breast radiotherapy with conventional regimen (50 Gy in 25 sessions), the patients underwent tumor bed boost with electrons or photons (with a dose of 10 Gy in 5 sessions) (electron: 145 people, photon: 135 people). Survival values, cosmetic results (Harvard Harris criteria) and skin toxicity (5th edition of General Toxicity Criteria and Adverse Effects) were compared between the two groups during the follow-up of patients. Findings: Recurrence-free survival in the same breast was not significantly different in two groups (recurrence-free survival in photon boost 95% (with a 95% confidence interval between 9% and 97%) and electron boost 93% (with a 95% confidence interval between 79% and 97) (p=0.69). There was no difference between radiotherapy-induced dermatitis and subcutaneous toxicity at the end of the treatment between the two treatment groups. However, one month after the end of the treatment, the cases of severe radiotherapy-induced dermatitis were higher in the photon treatment group (88% vs. 65.5%, p=0.007). However, the subcutaneous toxicity 2 months after the end of treatment was significantly higher in the electron boost group (0% vs. 7.5%, p<0.05). Mild pain in the same breast 6 months after the end of the treatment was higher in the photon treatment group (0% vs. 8.9%, p<0.001). Conclusion: Based on the results of the present study, using an electron or photon source to boost the dose to the tumor bed following whole breast radiotherapy in breast cancer patients undergoing breast-conserving surgery is associated with similar treatment results in terms of recurrence in the same breast. Of course, the toxicity profile, especially the skin toxicity, is different between the two approaches

Petrology, petrogenesis, and geochronology review of the Cenozoic adakitic rocks of northeast Iran: Implications for evolution of the northern branch of Neo‐Tethys

Cenozoic adakitic rocks of the northern part of the Central Iran Structural Zone (CISZ) are among the notable geological features of the terrains in northeast Iran, so a comprehensive comparison of several of these adakitic sequences is presented. This lithogeochemical analysis is constrained to examining adakitic magmatism of the three magmatic belts within the CISZ, which from southeast to northeast and from oldest to youngest are as follows: (a) south of Shahrood-Damghan, (b) north-northwest of Sabzevar-Neyshabour, and (c) south of Qouchan and west of Esfarayen. Radiogenic isotope analysis using Rb–Sr and Sm–Nd methods show that the adakitic rocks associated with Qouchan-Esfarayen magmatism have 0.512581 to 0.51288 initial 143Nd/144Nd and 0.703903 to 0.705627 initial 87Sr/86Sr, with εNd −0.86 to 4.98. Adakitic rocks in south to southeast Shahrood have 0.512775 to 0.512893 initial 143Nd/144Nd and 0.703746 to 0.705314 initial 87Sr/88Sr, with εNd 3.69 to 6.0, and adakites emplaced into the Sabzevar ophiolite have 0.512846 to 0.512911 initial 143Nd/144Nd and 0.70379 to 0.705019 initial 87Sr/86Sr contents with εNd of 5.26 to 6.54. Isotopic initial ratios of Nd and Sr support an origin involving partial melting of the subducting oceanic lithosphere of the northern branch of Neo-Tethys and the associated suprasubduction mantle wedge in producing these adakitic rocks

Keratins extracted from Merino wool and Brown Alpaca fibres: Thermal, mechanical and biological properties of PLLA based biocomposites

: Keratins extracted from Merino wool (KM) and Brown Alpaca fibres (KA) by sulphitolysis and commercial hydrolyzed keratins (KH) were used as fillers in poly(l-lactic) acid based biocomposites processed by solvent casting in chloroform. Different contents (1 wt.% and 5 wt.%) of keratins were considered and the morphological, thermal, mechanical, chemical and biological behaviours of the developed PLLA biocomposites were investigated. The results confirmed that surface morphologies of biocomposites revealed specific round-like surface topography function of different microsized keratin particles in different weight contents, such as the analysis of bulk morphologies which confirmed a phase adhesion strictly dependent by the keratin source. Transparency and thermal responses were deeply affected by the presence of the different keratins and their interaction with the PLLA matrix. Tensile test results underlined the possibility to modulate the mechanical behaviour of PLLA selecting the keratin type and content in order to influence positively the elastic and/or plastic response. It was demonstrated that surface characteristics of PLLA/KA systems also influenced the bovine serum albumin adsorption, moreover PLLA and PLLA biocomposites based on different kinds of keratins supported the culture of human bone-marrow mesenchymal stem cells, indicating that these biocomposites could be useful materials for medical applications