Structural, mechanical and swelling characteristics of 3D scaffolds from chitosan-agarose blends

This study aimed to explore the correlation between mechanical and structural properties of chitosan-agarose blend (Ch-Agrs) scaffolds. Porosity of Ch-Agrs scaffolds was constant at 93%, whilst pore sizes varied between 150 and 550 μm. Pore sizes of the blend scaffolds (150 - 300 μm) were significantly smaller than for either agarose or chitosan scaffolds alone (ca. 500 μm). Ch50-Agrs50 blend scaffold showed the highest compressive modulus and strength values (4.5 ± 0.4 and 0.35 ± 0.03 MPa) due to reduction in the pore size. The presence of agarose improved the stability of the blends in aqueous media. The increase in compressive properties and residual weight after the TGA test, combined with the reduction in the swelling percentage of the blend scaffolds suggested an interaction between chitosan and agarose via hydrogen bonding which was confirmed using FTIR analysis. All wet blend scaffolds exhibited instant recovery after full compression. This study shows the potential of Ch-Agrs scaffolds for repairing soft tissue

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways