Review of Qualitative Research Methods in Health Information System Studies.

OBJECTIVES: The aim of this study was to review hospital-based health information system (HIS) studies that used qualitative research methods and evaluate their methodological contexts and implications. In addition, we propose practical guidelines for HIS researchers who plan to use qualitative research methods. METHODS: We collected papers published from 2012 to 2022 by searching the PubMed and CINAHL databases. As search keywords, we used specific system terms related to HISs, such as "electronic medical records" and "clinical decision support systems," linked with their operational terms, such as "implementation" and "adaptation," and qualitative methodological terms such as "observation" and "in-depth interview." We finally selected 74 studies that met this review's inclusion criteria and conducted an analytical review of the selected studies. RESULTS: We analyzed the selected articles according to the following four points: the general characteristics of the selected articles; research design; participant sampling, identification, and recruitment; and data collection, processing, and analysis. This review found methodologically problematic issues regarding researchers' reflections, participant sampling methods and research accessibility, and data management. CONCLUSIONS: Reports on the qualitative research process should include descriptions of researchers' reflections and ethical considerations, which are meaningful for strengthening the rigor and credibility of qualitative research. Based on these discussions, we suggest guidance for conducting ethical, feasible, and reliable qualitative research on HISs in hospital settings.

Comparison on removal performance of virus, antibiotic-resistant bacteria, cell-associated and cell-free antibiotic resistance genes, and indicator chemicals by ozone in the filtrated secondary effluent of a sewage treatment plant.

Due to the widespread appearance of viruses, antibiotic-resistant bacteria (ARBs), and antibiotic resistance genes (ARGs) in the aquatic environment, more powerful oxidation processes such as ozonation are needed to enhance the efficiency of their inactivation and removal during wastewater treatment. However, information is lacking on the elimination rates of viruses, ARBs, cell-associated ARGs (ca-ARGs), and cell-free ARGs (cf-ARGs) during ozonation. This study examined the kinetics and dose-dependent inactivation of a virus (MS2 coliphage) and an ARB (Ampicillin-resistant [AmpR] E. coli) and the removal of ca- and cf-ARGs (plasmid-encoded blaTEM) by ozonation in a filtered secondary effluent (SE) of a municipal sewage treatment plant (STP). In addition, the ozonation kinetics of carbamazepine (CBZ) and metoprolol (MTP)-ubiquitous organic micropollutants with different removal rate constants-were also investigated in order to monitor their effectiveness as indicators for the abovementioned biological risk factors. Our results showed that ozonation was an efficient way to remove MS2, AmpRE. coli, ARGs, CBZ, and MTP. We investigated the kinetics of their inactivation/removal with respect to exposure in terms of CT (dissolved ozone concentration C and contact time T) value, and found their inactivation/removal constants were in the following order: MS2 (8.66 ×103 M-1s-1) ≈ AmpRE. coli (8.19 ×103 M-1s-1) > cf-ARG (3.95 ×103 M-1s-1) > CBZ (3.21 ×103 M-1s-1) > ca-ARG (2.48×103 M-1s-1) > MTP (8.35 ×102 M-1s-1). In terms of specific ozone dose, > 5-log inactivation of MS2 was observed at > 0.30 mg O3/mg DOC, while > 5-log inactivation of AmpRE. coli was confirmed at 1.61-2.35 mg O3/mg DOC. Moreover, there was almost no removal of ca-ARG when the specific ozone dose was < 0.68 mg O3/mg DOC. However, 2.86-3.42-log removal of ca-ARG was observed at 1.27-1.31 mg O3/mg DOC, while 1.14-1.36-log removal of cf-ARG was confirmed at 3.60-4.30 mg O3/mg DOC. As alternative indicators, > 4-log removal of CBZ was observed at > 1.00 mg O3/mg DOC, while > 2-log removal of MTP was confirmed at > 2.00 mg O3/mg DOC. Thus, it was observed that inactivation of E. coli needs a greater ozone dose to achieve the same level of inactivation of AmpRE. coli; for ARGs, cf-ARG can persist longer than ca-ARG if low dosages of ozone are applied in the filtrated SE, CBZ might act as an indicator with which to monitor the inactivation of viruses and ARBs, while MTP might act as an indicator with which to monitor removal of ARGs. Moreover, cf-ARG cannot be neglected even after ozonation due to the possibility that ca-ARGs can become cf-ARGs during ozonation and be discharged with the final effluent, posing a potential risk to the receiving environment.

Transillumination facilitates coccygeal arterial cannulation in anaesthetised small-breed dogs.

BACKGROUND: Arterial access in small-breed dogs is challenging, but arterial visualisation may facilitate the procedure, as evidenced in human medicine. This prospective, randomised study investigated the result of using transillumination to guide coccygeal artery cannulation in small-breed dogs. METHODS: Coccygeal artery cannulation was attempted in dogs anaesthetised with butorphanol, midazolam, propofol and sevoflurane. In 70 dogs (standard technique group [STECHNIQUE group]), arterial cannulation was performed using pulse palpation. In 71 dogs (transilluminating-standard technique group [TSTECHNIQUE group]), a transilluminating device was utilised. The device was placed on the dorsal tail, and the cannula was advanced towards the dark line visible against the bright background. If the artery was not well visualised due to pigmentation, pulse palpation was used. The success rate of arterial cannulation was compared between the groups using the chi-squared test. RESULTS: Arterial cannulation was significantly more successful (p < 0.001) in the TSTECHNIQUE group (63/71 [88.7%]) than in the STECHNIQUE group (43/70 [61.4%]). LIMITATIONS: The number of punctures attempted and the time to cannulation were not assessed, and the procedure was only performed by veterinarians experienced in arterial cannulation. CONCLUSIONS: The transillumination allows for a more accurate approach to the coccygeal artery, improving the success of arterial cannulation when combined with pulse palpation.

Mechanical Behavior of Fine Recycled Concrete Aggregate Concrete with the Mineral Admixtures.

The paper describes the mechanical behavior of fine recycled concrete aggregate (FRCA) concrete according to the mineral admixtures. Three types of the mineral admixtures, i.e., fly ash (FA), ground-granulated blast-furnace slag (GGBS), and silica fume (SF), are used and the replacement ratios of FRCA are 50% and 100%. The dosages of the admixtures of FA, GGBS, and SF are determined with the normal dosage (30%, 40%, and 5.0%, respectively) based on the ACI committee reports (No. 232, 233, and 234) and half-normal dosage. The mechanical performance is investigated with the compressive and splitting tensile strength, and elastic modulus. Additionally, the total porosity is measured in natural fine aggregate (NFA) and FRCA 100% replaced specimens by mercury intrusion porosimetry (MIP) for investigating the relationship with the compressive strength. Based on the experimental test results, the mineral admixtures improve the mechanical performance of FRCA concrete. The effective dosages of FA, GGBS, and SF for FRCA concrete are investigated according to the replacement ratio of the FRCA. In particular, FRCA 100% replaced concrete may be possible to be used for the structural concrete members with the specific dosage of the mineral admixtures. The prediction of the splitting tensile strength and the elastic modulus by the codes or previous formulas exhibits underestimated and overestimated results, respectively. The relationship between the total porosity and the compressive strength of the FRCA concrete should be modified with more experimental tests.

Punching Shear Behavior of Two-Way Concrete Slabs Reinforced with Glass-Fiber-Reinforced Polymer (GFRP) Bars.

This study investigated the punching shear behavior of full-scale, two-way concrete slabs reinforced with glass fiber reinforced polymer (GFRP) bars, which are known as noncorrosive reinforcement. The relatively low modulus of elasticity of GFRP bars affects the large deflection of flexural members, however, applying these to two-way concrete slabs can compensate the weakness of the flexural stiffness due to an arching action with supporting girders. The test results demonstrated that the two-way concrete slabs with GFRP bars satisfied the allowable deflection and crack width under the service load specified by the design specification even in the state of the minimum reinforcement ratio. Previous predicting equations and design equations largely overestimated the measured punching shear strength when the slab was supported by reinforced concrete (RC) girders. The strength difference can be explained by the fact that the flexural behavior of the supporting RC beam girders reduces the punching shear strength because of the additional deflection of RC beam girders. Therefore, for more realistic estimations of the punching shear strength of two-way concrete slabs with GFRP bars, the boundary conditions of the concrete slabs should be carefully considered. This is because the stiffness degradation of supporting RC beam girders may influence the punching shear strength.

Adjusted color probability codes for peripapillary retinal nerve fiber layer thickness in healthy Koreans.

BACKGROUND: Though a newly developed spectral domain optical coherence tomography (OCT) is at the center of interests for many ophthalmologic researchers and clinicians, its own characteristics are not fully evaluated yet. The main purpose of this study was to establish the adjusted color probability codes for peripapillary retinal nerve fiber layer (RNFL) thickness in healthy Koreans and to compare them with original color codes provided by spectral domain OCT. METHODS: Two hundred ninety-five healthy Korean eyes were enrolled and their peripapillary RNFL thickness was measured by Cirrus OCT. For each decade of age, the normal thickness reference was determined on the basis of z-scores and the adjusted color probability codes were established. Then the agreements between adjusted and original color codes were calculated using weighted Kappa (Kw) coefficient. RESULTS: On the basis of Kw coefficient, the overall agreement between the adjusted and original probability color codes was not excellent (Kw range of 0.500 to 0.806). If the adjusted probability codes were assumed as a standard of comparison, the original color codes showed the false-negative in 11% of eyes and the false-positive in 0.3% of eyes for average RNFL thickness. CONCLUSIONS: Adjusted color probability codes judged by the Korean normative data showed a discrepancy with original codes. It implies that normal reference and adjusted probability codes for each ethnicity might be needed to determine whether a certain RNFL thickness is within normal range or not.

Effect of confining pressure due to external jacket of steel plate or shape memory alloy wire on bond behavior between concrete and steel reinforcing bars.

For external jackets of reinforced concrete columns, shape memory alloy (SMA) wires are easy to install, and they provide active and passive confining pressure; steel plates, on the other hand, only provide passive confining pressure, and their installation on concrete is not convenient because of the requirement of a special device. To investigate how SMA wires distinctly impact bond behavior compared with steel plates, this study conducted push-out bond tests of steel reinforcing bars embedded in concrete confined by SMA wires or steel plates. For this purpose, concrete cylinders were prepared with dimensions of 100 mm x 200 mm, and D-22 reinforcing bars were embedded at the center of the concrete cylinders. External jackets of 1.0 mm and 1.5 mm thickness steel plates were used to wrap the concrete cylinders. Additionally, NiTiNb SMA wire with a diameter of 1.0 mm was wound around the concrete cylinders. Slip of the reinforcing bars due to pushing force was measured by using a displacement transducer, while the circumferential deformation of specimens was obtained by using an extensometer. The circumferential deformation was used to calculate the circumferential strains of the specimens. This study assessed the radial confining pressure due to the external jackets on the reinforcing bars at bond strength from bond stress-slip curves and bond stress-circumferential strain curves. Then, the effects of the radial confining pressure on the bond behavior of concrete are investigated, and an equation is suggested to estimate bond strength using the radial confining pressure. Finally, this study focused on how active confining pressure due to recovery stress of the SMA wires influences bond behavior.

Role of heat shock protein 47 in transdifferentiation of human tenon's fibroblasts to myofibroblasts.

BACKGROUND: Heat shock protein 47 (Hsp47) is a well-known molecular chaperone in collagen synthesis and maturation. The aim of this study is to investigate its putative role in the transdifferentiation of Tenon's fibroblasts to myofibroblasts. METHODS: Primary cultured human Tenon's fibroblasts were exposed to transforming growth factor-ß1 (TGF-ß1) for up to 48 hours. The mRNA levels of Hsp47 and α smooth muscle actin (αSMA) were determined by quantitative real time RT-PCR. After delivery of small interfering RNA (siRNA) molecules targeting Hsp47 into the cells, the expression of Hsp47 and αSMA proteins was determined by western immunoblotting. RESULTS: TGF-ß1 increased the mRNA expressions of both Hsp47 and αSMA in human Tenon's fibroblasts, as determined by quantitative real time RT-PCR. However, it induced the protein expression of only αSMA but not Hsp47, as determined by western immunoblots. When siRNAs specific for Hsp47 were introduced into those cells, the TGF-ß1-induced expression of αSMA was significantly attenuated on western immunoblots; after 48 hours of exposure to TGF-ß1, the relative densities of immunobands were 11.58 for the TGF-ß1 only group and 2.75 for the siRNA treatment group, compared with the no treatment control group (p < 0.001). CONCLUSIONS: Our data suggest that Hsp47 may be related to the TGF-ß1-induced transdifferentiation of human Tenon's fibroblasts to myofibroblasts.

Processing of SiO2 protective layer using HMDS precursor by combustion CVD.

Hexamethyldisilazane (HMDS, [(CH3)3Si]2NH) was used as a precursor to form SiO2 protective coatings on IN738LC alloys by combustion chemical vapor deposition (CCVD). SEM and XPS showed that the processed coatings were composed mainly of SiO2. The amount of HMDS had the largest effect on the size of the SiO2 agglomerates and the thickness of the deposited coatings. The specimens coated with SiO2 using the 0.05 mol/l HMDS solution showed a significantly higher temperature oxidation resistance than those deposited under other conditions.

Inadvertent scleral perforation after strabismus surgery: incidence and association with refractive error.

BACKGROUND: Inadvertent scleral perforation is a rare but serious complication of extraocular muscle surgery for strabismus. We evaluated the incidence of unwanted scleral penetration after strabismus surgery and its association with refractive error. METHODS: This cross-sectional noncomparative case series comprised 453 eyes from 236 patients who underwent strabismus surgery. After dilation, each patient had fundus examination using indirect binocular ophthalmoscope. Chorioretinal scars around the suture area, which presumed the previous scleral perforation, were detected. We assessed whether the presence of these scars was related to the degree of preoperative refractive error. RESULTS: Mean postoperative follow-up was 52.44 (SD 30.07) months. Overall incidence of inadvertent penetration of the sclera was 1.77%. A total of 8 eyes (6 patients) showed chorioretinal scars, and all were myopic. Of these, 3 eyes were classified as mild myopia, 3 as moderate myopia, and the other 2 as severe myopia. The relationship between inadvertent scleral penetration and degrees of refractive error was weak but statistically significant (p = 0.001). INTERPRETATION: Inadvertent scleral perforation after strabismus surgery seems to be associated with myopic refractive error.

Agmatine inhibits hypoxia-induced TNF-alpha release from cultured retinal ganglion cells.

The effect of hypoxia on the release of tumor necrosis factor-alpha (TNF-alpha) in transformed rat retinal ganglion cells (RGCs) and the effect of agmatine on the hypoxia-induced production of TNF-alpha in RGCs were evaluated. RGCs were cultured under hypoxic conditions with 5% oxygen, with or without 100 microM agmatine. The expression levels of TNF-alpha and its receptor-1 (TNF-R1) were investigated by Western blot analysis. After 6 hours of hypoxia, we noted an increase in TNF-alpha production in RGCs. Agmatine significantly reduced TNF-alpha level after 12 hours of hypoxic treatment. The expression of TNF-R1 was not affected by the hypoxia or agmatine treatment. Our results show that agmatine inhibits the TNF-alpha production of RGCs in hypoxic condition. These results demonstrate a possible neuroprotective mechanism for agmatine against hypoxic damage in RGCs.

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma.

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

Structural studies of porcine myeloid antibacterial peptide PMAP-23 and its analogues in DPC micelles by NMR spectroscopy.

PMAP-23 is a cathelicidin-derived antimicrobial peptide identified from porcine leukocytes. PMAP-23 was reported to show potent antimicrobial activity against Gram-negative and Gram-positive bacteria without hemolytic activity. To study the structure-antibiotic activity relationships of PMAP-23, two analogues by replacing Trp with Ala were synthesized and their tertiary structures bound to DPC micelles have been studied by NMR spectroscopy. PMAP-23 has two alpha-helices, one from Arg1 to Arg10 in the N-terminal region and the other from Phe18 to Arg23 in the C-terminal region. PMAP-1 (Trp(7)-->Ala) shows similar structure to PMAP-23, while PMAP-2 (Trp(21)-->Ala) has a random structure in the C-terminus. PMAP-2 was found to show less antibacterial and vesicle-disrupting activities than PMAP-23 and PMAP-1 [J. H. Kang, S. Y. Shin, S. Y. Jang, K. L. Kim, and K.-S. Hahm (1999) Biochem. Biophys. Res. Commun. 264, 281-286]. Trp(21) in PMAP-23 which induces an alpha-helical structure in the second alpha-helix is essential for the antibacterial activity of PMAP-23. Also, the fluorescence data proved that Trp(21) at the second alpha-helix is buried deep into the phospholipid in the membrane. Therefore, it implies that Trp(21) in the second alpha-helix at the C-terminus of PMAP-23 may play an important role on the interactions with the membrane and the flexible region including two proline residues may allow this alpha-helix to span the lipid bilayer.