Choice Points:Creating Clinical Qualitative Research Studies

Today, more psychotherapists are seeing the utility of studying their own and others\u27 therapeutic work. With the growing popularity and acceptance of qualitative methods, the research process takes on special significance for the clinician/researcher. Using qualitative methodologies, therapists can conduct studies that are immediately relevant to their therapeutic work. In this paper, I discuss eight decisions or choice points clinician/researchers face when conducting clinical qualitative research studies. The choices I discuss are not all inclusive, yet they are representative of the choices most clinical qualitative projects required

Sensemaking in Clinical Qualitative Research

When therapists research clinical populations or situations from a qualitative research perspective, their task is different from when researchers conduct their own clinical qualitative studies. With researchers, the study at hand may be their first time in the field. For researchers in this situation it is easier to use qualitative methods such as grounded theory (Glaser & Strauss, 1967) because there is a tabula rasa quality to this initial foray into the unknown as a theory from observations is constructed anew. In the case of the therapists-as-qualitative-researchers, clinicians already have made some sort of sense of the other by virtue of their previous experiences or exposures with the population or situation in question. Instead of constructing theories like their researcher colleagues, researching clinicians must face their previous constructions (i.e., sensemaking from experience), create methods which allow for deconstruction (i.e., sensemaking challenged), and then work towards building reconstructions (i.e., sensemaking remade) (Dervin, 1992; Duffy, 1995; Shields & Dervin, 1993; Weick, 1995). In this manner, the confidence that therapist-researchers have in their observations can be both rigorously challenged and bolstered. We present ways of undertaking this triadic approach to inquiry and sensemaking along with a conceptual tool from the presenters\u27 work, The Y of the How, will be offered as one way this approach to clinical research can be accomplished

Molecular mechanism of tanshinone IIA and cryptotanshinone in platelet anti-aggregating effects: an integrated study of pharmacology and computational analysis.

Tanshinone IIA and cryptotanshinone are two pharmacologically active diterpenoids extracted from the roots of Salvia milthiorriza Bunge, a plant used in Chinese traditional medicine for the treatment of some cardiovascular and cerebrovascular disease. Until now, the molecular mechanisms of action of these two diterpenoids on platelets are partially known. To clarify this aspect, here we utilized an integrated study of pharmacology and computational analysis. Our results demonstrate that cryptotanshinone is able to inhibit in a concentration dependent manner the rat platelet aggregation and also is endowed of Gi-coupled P2Y12 receptor antagonist as demonstrated by docking studies. This computational method was also performed for tanshinone IIA demonstrating even for this diterpenoid an interaction with the same receptor. The findings from our study enable a better understanding of tanshinone IIA and cryptotanshinone biological properties, which could ultimately lead to the development of novel pharmaceutical strategies for the treatment and/or prevention of some cardiovascular disease

Antinociceptive effects of tetrazole inhibitors of endocannabinoid inactivation: Cannabinoid and non-cannabinoid receptor-mediated mechanisms

Background and purpose: Tetrazoles were recently developed as inhibitors of the cellular uptake of the endocannabinoid anandamide or of its hydrolysis by fatty acid amide hydrolase (FAAH), but were proposed to act also on non-endocannabinoid-related serine hydrolases. Experimental approach: We tested, in a model of inflammatory pain induced in mice by formalin, five chemically similar inhibitors: (i) OMDM119 and OMDM122, two potent carbamoyl tetrazole FAAH inhibitors with no effect on anandamide uptake; (ii) LY2183240, a carbamoyl tetrazole with activity as both FAAH and uptake inhibitor; (iii) OMDM132, a non-carbamoyl tetrazole with activity only as uptake inhibitor and iv) OMDM133, a non-carbamoyl tetrazole with no activity at either FAAH or uptake. Results: All compounds (2.5-10 mg kg -1, i.p.) inhibited the second phase of the nocifensive response induced by intraplantar injection of formalin. The effects of OMDM119, OMDM122 and OMDM133 were not antagonized by pretreatment with cannabinoid CB 1 receptor antagonists, such as rimonabant or AM251 (1-3 mg kg -1, i.p.). The effects of LY2183240 and OMDM132 were fully or partially antagonized by rimonabant, respectively, and the latter compound was also partly antagonized by the CB 2 receptor antagonist, AM630. Conclusions and implications: (i) non-FAAH hydrolases might be entirely responsible for the antinociceptive activity of some, but not all, tetrazole FAAH inhibitors, (ii) the presence of a carbamoylating group is neither necessary nor sufficient for such compounds to act through targets other than FAAH and (iii) inhibition of anandamide uptake is responsible for part of this antinociceptive activity, independently of effects on FAAH. © 2008 Macmillan Publishers Limited All rights reserved

Isolation and characterization of cardiac mesenchymal stromal cells from endomyocardial bioptic samples of arrhythmogenic cardiomyopathy patients

A normal adult heart is composed of several different cell types, among which cardiac mesenchymal stromal cells represent an abundant population. The isolation of these cells offers the possibility of studying their involvement in cardiac diseases, and, in addition, provides a useful primary cell model to investigate biological mechanisms. Here, the method for the isolation of C-MSC from arrhythmogenic cardiomyopathy patients\u2019 bioptic samples is described. The endomyocardial biopsy sampling is guided in the right ventricular areas adjacent to the scar visualized by electro-anatomical mapping. The digestion of the biopsies in collagenase and their plating on a plastic dish in culture medium to allow C-MSC growth is described. The isolated cells can be expanded in culture for several passages. To confirm their mesenchymal phenotype, the description of immuno-phenotypical characterization is provided. C-MSC are able to differentiate into several cell types like adipocytes, chondrocytes, and osteoblasts: in the context of ACM, characterized by adipocyte deposits in patients\u2019 hearts, the protocols for the adipogenic differentiation of C-MSC and the characterization of lipid droplet accumulation are described

MIRA: a Multiphysics Approach to Designing a Fusion Power Plant

Fusion systems codes (SCs) are deployed to produce the baseline of the European fusion power reactor (DEMO) within its conceptual design. A DEMO baseline is mostly defined by a radial/vertical reactor sketch and major reactor parameters, such as fusion and net electric power, magnetic fields, and plasma burn time. A baseline shall also meet a set of prescribed reactor requirements, constraints, and architectural features. According to the conceptual design workflow implemented within the EU-DEMO programme, the output from the SC is transferred to the detailed physics and engineering design codes. Presently-available fusion SCs rely on rather basic physics and engineering models (mostly at zero or one-dimensional level). The design codes, instead, are very detailed but run on much longer computing times. To fill the gap between systems and design codes, the multi-fidelity systems/design tool modular integrated reactor analysis (MIRA)—has been recently developed. MIRA incorporates the physics and the engineering insights of the utmost domains of tokamak reactors and relies on a higher spatial resolution, spanning from 1D up to 3D modelling frames. The MIRA approach has been applied to the DEMO 2017 baseline, generated by the EU reference SC PROCESS and used as input to MIRA. In the paper, the architectural and mathematical insights of the MIRA package are described, along with an EU-DEMO 2017 baseline analysis

The membranotropic peptide gh625 to combat mixed candida albicans/klebsiella pneumoniae biofilm: Correlation between in vitro anti-biofilm activity and in vivo antimicrobial protection

The antibiofilm activity of a gH625 analogue was investigated to determine the in vitro inhibition and eradication of a dual-species biofilm of Candida albicans and Klebsiella pneumoniae, two leading opportunistic pathogens responsible for several resistant infections. The possibility of effectively exploiting this peptide as an alternative anti-biofilm strategy in vivo was assessed by the investigation of its efficacy on the Galleria mellonella larvae model. Results on larvae survival demonstrate a prophylactic efficacy of the peptide towards the infection of each single microorganism but mainly towards the co-infection. The expression of biofilm-related genes in vivo showed a possible synergy in virulence when these two species co-exist in the host, which was effectively prevented by the peptide. These findings provide novel insights into the treatment of medically relevant bacterial–fungal interaction

High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome

Objective: Age is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. This opportunity opens the unsolved question about the most appropriate HGG treatment in elderly patients. The aim of this study is to analyze if HGG maximal safe resection guided by an intraoperative multimodal imaging protocol coupled with neuromonitoring is associated with differences in outcome in elderly patients versus younger ones. Methods: We reviewed 100 patients, 53 (53%) males and 47 (47%) females, with median (IQR) age of 64 (57; 72) years. Eight patients were diagnosed with Anaplastic Astrocytoma (AA), 92 with Glioblastoma (GBM). Surgery was aimed to achieve safe maximal resection. An intraoperative multimodal imaging protocol, including neuronavigation, neurophysiological monitoring, 5-ALA fluorescence, 11C MET-PET, navigated i-US system and i-CT, was used, and its impact on EOTR and clinical outcome in elderly patients was analyzed. We divided patients in two groups according to their age: 65 years, and surgical and clinical results (EOTR, post-operative KPS, OS and PFS) were compared. Yet, to better understand age-related differences, the same patient cohort was also divided into 70 years and all the above data reanalyzed. Results: In the first cohort division, we did not found KPS difference over time and survival analysis did not show significant difference between the two groups (p = 0.36 for OS and p = 0.49 for PFS). Same results were obtained increasing the age cut-off for age up to 70 years (p = 0.52 for OS and p = 0.92 for PFS). Conclusions: Our data demonstrate that there is not statistically significant difference in post-operative EOTR, KPS, OS, and PFS between younger and elderly patients treated with extensive tumor resection aided by a intraoperative multimodal protocol