bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anesthesiologists’ conceptions of learning anesthesia in the context of their specialty training program: a phenomenographic study
Authors: Chin Hanna , Ingerman Åke , Hergès Helena Odenstedt 
Published: August 2023

Abstract
Background
Training anesthesiologists poses challenges and complexities, particularly in defining and teaching excellence in anesthesia. Existing anesthesia curricula primarily emphasize the acquisition of knowledge, practical skills, and professional competencies, often neglecting the development of intangible skills like tacit knowledge. Despite efforts to establish learning goals through carefully describing competencies, there is a risk of oversimplifying the intricate aspects of professional anesthesia practice. Therefore, the objective of this study is to gain a deeper understanding of the genuine curriculum of a specialty training program in anesthesia. This will be achieved by exploring the perceptions of learners with different levels of experience within the program.

Methods
This study employs a phenomenographic research approach to explore the conceptions of anesthesiology trainees and specialists, specifically from a student’s perspective, regarding what constitutes an excellent anesthesiologist i.e., what to learn, and the learning process associated with it.

Results
This study identified three different conceptions of learning anesthesia within the context of a specialty training program: “Learning Competencies of Anesthesia,“ “Learning Work as an Anesthesiologist” and “Learning Being an Anesthesiology Professional.“ These conceptions ranged from a relatively instrumental view of education and self-responsibility for learning to a perspective of continuous personal reflection and development integrated with professional interaction. The three conceptions can be described in six dimensions describing the variation in approach to learning and the conceptualization of an anesthesiologist. Relationships between the conceptions and the dimensions were represented in a descriptive framework, showing the hierarchy of increasing understanding.

Conclusion
This study has uncovered diverse learner perspectives among anesthesiologists at various experience levels concerning their understanding of the role of an anesthesiologist and the associated learning process. These distinct understandings can be categorized into different groups and presented in a descriptive framework that encapsulates the fundamental elements and important educational aspects of an anesthesiologist’s progression through a specialty training program in anesthesia. By recognizing and integrating these diverse perspectives, anesthesia education can be enhanced, ultimately resulting in improved preparation of future anesthesia curriculum, teaching and assessments.
Adaptation and validation of the Evidence-based Practice Profile Questionnaire (EBP2Q) for clinical postgraduates in a Chinese context
Authors: Jia Yitong , Zhuang Xinqi , Zhang Yao , Meng Ge , Qin Shijia , Shi Wen-Xin , Wu Xiaojian , Zhang Yin-Ping 
Published: August 2023

AbstractBackgroundEvidence-based practice (EBP) is an essential approach of optimizing patient outcomes and driving progress in clinical practice. As an important reserve talent of medical staff and researchers, the clinical postgraduates are expected to become the backbones of supporting the implementation of EBP in clinical units after graduation. The assessment of their EBP learning outcomes is an important issue, yet few tools have been developed specifically in Mainland China. The purpose of this study is to adapt the Evidence-Based Practice Profile Questionnaire (EBP2Q) to Mainland China’s cultural context and to evaluate the psychometric properties of the Chinese EBP2Q in clinical postgraduates.MethodsCross-cultural modification, including translating the original EBP2Q into Chinese was implemented according to established guidelines. A pilot study was carried out in Mainland China among 30 clinical postgraduates. A subsequent validation study was conducted among 633 clinical postgraduates majoring in clinical medicine, stomatology and nursing from Mainland China. Construct validity was assessed by exploratory factor analysis (n = 313), together with confirmatory factor analysis (n = 320). Reliability was determined by internal consistency and test-retest reliability.ResultsThe Chinese EBP2Q consisted of 40 items. The content validity index of the Chinese EBP2Q achieved 0.938 at an acceptable level. Principal component analysis resulted in a four-factor structure explaining 61.586% of the total variance. All fitting indices satisfied the standard based upon confirmatory factor analyses, indicating that the four-factor structure contributed to an ideal model fit. The internal consistency appeared high for the Chinese EBP2Q, reaching a Cronbach’s alpha value of 0.926. Test–retest reliability was 0.868 and the split-half coefficient was 0.925.ConclusionChinese version of EBP2Q possesses adequate validity, test-retest reliability and internal consistency. It is a promising questionnaire to be adopted by Chinese medical educators in designing their course and curriculum, or by clinical postgraduates for self-assessment of EBP learning.
The missing voices in the conscientious objection debate: British service users’ experiences of conscientious objection to abortion
Authors: Self Becky , Maxwell Clare , Fleming Valerie 
Published: August 2023

Abstract
Background
The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes.

Method
Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection.

Findings
The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated.

Conclusions
Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care.
Effective communication of COVID-19 vaccine information to recently-arrived culturally and linguistically diverse communities from the perspective of community engagement and partnership organisations: a qualitative study
Authors: Dickson Kara , Aboltins Craig , Pelly Janet , Jessup Rebecca Leigh 
Published: August 2023

Abstract
Background
In many high-income countries, COVID-19 has disproportionately impacted Culturally and Linguistically Diverse (CALD) communities. Barriers to engaging with essential health messaging has contributed to difficulties in following public health advice and exacerbated existing inequity in Australia. Research suggests that recently-arrived CALD populations are particularly vulnerable to misinformation and are more likely to experience vaccine hesitancy. The aim of this study was to explore the barriers and enablers to COVID-19 vaccination among recently-arrived CALD communities in Melbourne’s outer north and identify strategies to reduce hesitancy in this population.

Methods
Semi-structured interviews were conducted with representatives from community organisations working with recently-arrived CALD communities in Melbourne’s north. This included a mix of peer (from the community) and health care workers.

Results
Fifteen participants from community organisations participated in interviews. Thematic analysis identified four themes; (1) trusted sources, (2) accurate and culturally sensitive information, (3) supported pathways and (4) enablers to vaccination.

Conclusions
Participants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities’ strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities.
Developing a combined framework for priority setting in integrated health and social care systems
Authors: Collins Marissa , Mazzei Micaela , Baker Rachel , Morton Alec , Frith Lucy , Syrett Keith , Leak Paul , Donaldson Cam 
Published: August 2023

Abstract
Background
There is an international move towards greater integration of health and social care to cope with the increasing demand on services.. In Scotland, legislation was passed in 2014 to integrate adult health and social care services resulting in the formation of 31 Health and Social Care Partnerships (HSCPs). Greater integration does not eliminate resource scarcity and the requirement to make (resource) allocation decisions to meet the needs of local populations. There are different perspectives on how to facilitate and improve priority setting in health and social care organisations with limited resources, but structured processes at the local level are still not widely implemented. This paper reports on work with new HSCPs in Scotland to develop a combined multi-disciplinary priority setting and resource allocation framework.

Methods
To develop the combined framework, a scoping review of the literature was conducted to determine the key principles and approaches to priority setting from economics, decision-analysis, ethics and law, and attempts to combine such approaches. Co-production of the combined framework involved a multi-disciplinary workshop including local, and national-level stakeholders and academics to discuss and gather their views.

Results
The key findings from the literature review and the stakeholder workshop were taken to produce a final combined framework for priority setting and resource allocation. This is underpinned by principles from economics (opportunity cost), decision science (good decisions), ethics (justice) and law (fair procedures). It outlines key stages in the priority setting process, including: framing the question, looking at current use of resources, defining options and criteria, evaluating options and criteria, and reviewing each stage. Each of these has further sub-stages and includes a focus on how the combined framework interacts with the consultation and involvement of patients, public and the wider staff.

Conclusions
The integration agenda for health and social care is an opportunity to develop and implement a combined framework for setting priorities and allocating resources fairly to meet the needs of the population. A key aim of both integration and the combined framework is to facilitate the shifting of resources from acute services to the community.
Exosomal miRNA-mediated intercellular communications and immunomodulatory effects in tumor microenvironments
Authors: Nail Howida M. , Chiu Chien-Chih , Leung Chung-Hang , Ahmed Mahmoud M. M. , Wang Hui-Min David 
Published: August 2023

AbstractExtracellular communication, in other words, crosstalk between cells, has a pivotal role in the survival of an organism. This communication occurs by different methods, one of which is extracellular vesicles. Exosomes, which are small lipid extracellular vesicles, have recently been discovered to have a role in signal transduction between cells inside the body. These vesicles contain important bioactive molecules including lipids, proteins, DNA, mRNA, and noncoding RNAs such as microRNAs (miRNAs). Exosomes are secreted by all cells including immune cells (macrophages, lymphocytes, granulocytes, dendritic cells, mast cells) and tumor cells. The tumor microenvironment (TME) represents a complex network that supports the growth of tumor cells. This microenvironment encompasses tumor cells themselves, the extracellular matrix, fibroblasts, endothelial cells, blood vessels, immune cells, and non-cellular components such as exosomes and cytokines. This review aims to provide insights into the latest discoveries concerning how the immune system communicates internally and with other cell types, with a specific focus on research involving exosomal miRNAs in macrophages, dendritic cells, B lymphocytes, and T lymphocytes. Additionally, we will explore the role of exosomal miRNA in the TME and the immunomodulatory effect.
Emerging environmental health risks associated with the land application of biosolids: a scoping review
Authors: Pozzebon Elizabeth A. , Seifert Lars 
Published: August 2023

Abstract
Background
Over 40% of the six million dry metric tons of sewage sludge, often referred to as biosolids, produced annually in the United States is land applied. Biosolids serve as a sink for emerging pollutants which can be toxic and persist in the environment, yet their fate after land application and their impacts on human health have not been well studied. These gaps in our understanding are exacerbated by the absence of systematic monitoring programs and defined standards for human health protection.

Methods
The purpose of this paper is to call critical attention to the knowledge gaps that currently exist regarding emerging pollutants in biosolids and to underscore the need for evidence-based testing standards and regulatory frameworks for human health protection when biosolids are land applied. A scoping review methodology was used to identify research conducted within the last decade, current regulatory standards, and government publications regarding emerging pollutants in land applied biosolids.

Results
Current research indicates that persistent organic compounds, or emerging pollutants, found in pharmaceuticals and personal care products, microplastics, and per- and polyfluoroalkyl substances (PFAS) have the potential to contaminate ground and surface water, and the uptake of these substances from soil amended by the land application of biosolids can result in contamination of food sources. Advanced technologies to remove these contaminants from wastewater treatment plant influent, effluent, and biosolids destined for land application along with tools to detect and quantify emerging pollutants are critical for human health protection.

Conclusions
To address these current risks, there needs to be a significant investment in ongoing research and infrastructure support for advancements in wastewater treatment; expanded manufacture and use of sustainable products; increased public communication of the risks associated with overuse of pharmaceuticals and plastics; and development and implementation of regulations that are protective of health and the environment.
Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa
Authors: Rautenberg Tamlyn A. , Ng Shu Kay , George Gavin , Moosa Mahomed-Yunus S. , McCluskey Suzanne M. , Gilbert Rebecca F. , Pillay Selvan , Aturinda Isaac , Ard Kevin L. , Muyindike Winnie R. , Musinguzi Nicholas , Masette Godfrey , Pillay Melendhran , Moodley Pravi , Brijkumar Jaysingh , Gandhi Rajesh T. , Johnson Brent , Sunpath Henry , Bwana Mwebesa B. , Marconi Vincent C. , Siedner Mark J. 
Published: August 2023

Abstract
Background
Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa.

Methods
We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression.

Results
In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL.

Conclusion
Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure.

Trial registration
ClinicalTrials.gov: NCT02787499.
Validity and reliability of the Dutch translation of the OPUS’ client satisfaction with device module in chronic users of hand orthoses
Authors: Oud Tanja , Tuijtelaars Jana , Schenk Jimmy , Nollet Frans , Brehm Merel-Anne 
Published: August 2023

Abstract
Background
Orthosis satisfaction is an important outcome in assessing quality of care. However, no measurement specifically assessing orthosis satisfaction is available in the Dutch language. Therefore, the aim of this study was to translate the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users’ Survey (OPUS) into Dutch, and to assess its content validity, structural validity and reliability in persons with chronic hand conditions.

Methods
The CSD was translated and cross-cultural adapted according to respective guidelines. To determine content validity, 10 chronic hand orthotic users and two professionals judged the relevance, comprehensibility, and comprehensiveness of the Dutch CSD (D-CSD). Thereafter, in a cross-sectional study, 76 persons were asked to complete the D-CSD twice, with a 2-week interval. Dimensionality of the D-CSD was examined by principal component analysis (PCA), and factor model fit was assessed by confirmatory factor analysis (CFA). Reliability was assessed as internal consistency and test-retest reliability, including the 95% limits of agreement (LoA), the standard error of measurement (SEM) and smallest detectable change (SDC).

Results
The D-CSD items and response options were deemed relevant and comprehensible. After adding an item on cleaning the orthosis, content validity was judged sufficient. PCA indicated a one-factor model, which was confirmed by CFA. We found good internal consistency (Cronbach’s alpha = 0.82; 95%CI 0.75–0.87), and moderate to good test-retest reliability (ICC = 0.81; 95%CI 0.71–0.87). There was no difference between the mean D-CSD score at test (26.8 points) and retest (25.9 points) (mean (SD) difference: 0.86 points (4.00); 95%CI -0.06-1.79; p = 0.07). The 95% LoA were −6.99 to 8.71, and the SEM and SDC were 2.88 and 7.98 points, respectively.

Conclusions
Based on sufficient content and structural validity, and good reliability, we consider the D-CSD a useful tool to evaluate orthosis satisfaction in persons with chronic hand conditions on group level. Because of a relatively high SDC, sensitivity to detect changes over time on individual level is limited.

Study registration number
NCT05320211.
Doctors’ alertness, contentedness and calmness before and after night shifts: a latent profile analysis
Authors: Debets Maarten P. M. , Tummers Fokkedien H. M. P. , Silkens Milou E. W. M. , Huizinga Coen R. H. , Lombarts Kiki M. J. M. H. , van der Bogt Koen E. A. 
Published: August 2023

Abstract
Background
While night shifts are crucial for patient care, they threaten doctors’ well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors’ feelings surrounding night shift by: identifying profiles based on doctors’ alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors’ pre- and post-shift profiles change (RQ2); and determining associations of doctors’ demographics and shift circumstances with alertness, contentedness and calmness change (RQ3).

Methods
Latent Profile Analysis using doctors’ pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3).

Results
In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes.

Conclusions
The results provided nuanced insight into doctors’ feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.