bluuebunny/crossref_metadata_2025_split huggingface dataset:
Grading Reflective Essays: The Construct Validity and Reliability of a Newly Developed Tool- GRE-9
Authors: Makarem Nisrine N , Rahme Diana V , Brome Dayana , Saab Bassem R 
Published: September 2023

Abstract
Background
The main objective of this study is to assess the construct validity and reliability of the Grading Reflective Essays-9 (GRE-9).
Methods
This study took place in a major tertiary academic medical center in Beirut, Lebanon. 104 reflective essays written by years 1–3 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 2 trained raters who independently scored the essays using GRE-9. GRE-9 scores were then correlated with scores on communication skills OSCE stations and in-training examinations to investigate, respectively, convergent and divergent validity. One of the 2 raters scored the essays twice one month apart to assess the reliability of the GRE-9 using intra rater reliability and internal consistency.
Results
There was a weak, non-significant correlation between GRE-9 score and In training examination (ITE) score (r = − .213, p = .395). There was a moderate, non-significant correlation between GRE-9 scores and the Objective structured clinical examination (OSCE) communication station scores (r = − .412 p = .162). The correlation coefficient between trails 1 and 2 was significant (r = .832, p = .000). Intra class correlation coefficient (ICC) analysis demonstrated almost perfect intra-rater agreement (0.819; 95% CI: 0.741–0.875) of the test ratings over time.
Conclusions
GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial intra-rater reliability and evidence of divergent validity. The study found non-significant correlations between reflective writing scores OSCE communication scores demonstrating a lack of relationship between reflective writing and this measure of performance.
WeChat mini program in laboratory biosafety education among medical students at Guangzhou Medical University: a mixed method study of feasibility and usability
Authors: Li QianJun , Zhao JingJing , Yan RuiChao , Gao QiJian , Yao Zhen , Li Xue , Liang Ying , Wen ShiHao , Yang LiJuan 
Published: September 2023

Abstract
Background
Laboratory biosafety should be a priority in all healthcare institutions. An engaging and tailored training program will ensure that students are prepared for their careers as professionals so that they can perform their duties in a safe and effective manner. As the most popular social application in China, WeChat has become a powerful tool for delivering interventions and can be used for health education. The objective of the present study was to assess the feasibility and usability of a WeChat mini program in laboratory biosafety education for medical laboratory students at Guangzhou Medical University (GMU).
Methods
The WeChat mini program "WeMed" was developed and extensively evaluated using a mixed method approach. A convergent design was undertaken to assess feasibility and usability among second-year undergraduate students at GMU between November 2022 and June 2023. In the quantitative strand, two evaluations were conducted via online surveys from students (n = 67) after a four-week study period. The System Usability Scale (SUS) was used to evaluate usability, while self-developed questions were used to assess feasibility. In the qualitative strand, fourteen semi-structured interviews were conducted to confirm the findings. A reflexive thematic analysis was utilized to analyze the qualitative data.
Results
An adequate SUS score (M = 68.17, SD = 14.39) was obtained in the quantitative strand. Based on the results, the acceptability of the WeMed program is in the marginal high range, and the grade scale is in class D. This finding was further supported by the positive experiences shared by students highlighting the usability and feasibility of the WeMed program in the qualitative strand.
Conclusion
The WeMed program proves to be a valuable supplementary learning strategy for medical laboratory students, empowering them with essential knowledge and skills in laboratory biosafety. WeMed's emphasis on laboratory biosafety contributes to a culture of safety and compliance in medical laboratories. Medical laboratory students could better prepared to adhere to safety protocols and guidelines, contributing to a safer working environment for themselves and others.
The mediating and moderating role of rumination and cognitive reappraisal between perceived stress and prenatal depression: a multicenter cross-sectional study in southeast China
Authors: Wang Yuying , Fang Fan , Yang Yuan , Liu Wenting , Gao Yaqin , Chen Yuqi , Liu Haiyan , Huang Fanyan , Chen Yu 
Published: September 2023

Abstract
Background
Prenatal depression is one of the most prevalent psychiatric disorders among maternal. Perceived stress plays an important role in the onset of prenatal depression, however, the underlying mechanisms between them are not well understood. We aimed to explore the mechanisms from rumination(risk factors) and cognitive reappraisal(protective factors) perspectives, which may be used to design interventions to improve prenatal depression.
Methods
A multicenter cross-sectional survey of 1055 maternal were enrolled using a convenience sampling method from June 2020 to January 2021 and was conducted in five hospitals in Guangzhou, southeastern China. A moderated mediation model was performed to examine the role of rumination(Ruminative Responses Scale, RRS), and cognitive reappraisal(Emotional Regulation Questionnaire, ERQ) in the relationship between perceived stress(Perceived Stress Scale 10, PSS-10) and prenatal depression(Edinburgh Postpartum Depression Scale, EPDS).
Results
The prevalence of prenatal depression was 37.53%. There was a significant correlation among perceived stress, rumination, cognitive reappraisal, and prenatal depression(all P < 0.001). Rumination played a partial mediating role in the relationship between perceived stress and prenatal depression, accounting for 58.92% of the total effect. Moreover, the indirect effect of rumination in this link was moderated by cognitive reappraisal. This mediation effect was stronger for pregnant women with lower levels of cognitive reappraisal(P < 0.001).
Conclusions
The study provides powerful evidences through a large maternal sample for the mediating role of rumination and the moderating role of cognitive reappraisal between perceived stress and prenatal depression. Ongoing clinical care and targeted interventions may need to carry out from the perspective of rumination according to the different cognitive levels of maternal.
The role of vitamin D status on treatment outcome among HIV- infected children receiving care in Kisumu County, Kenya
Authors: Asamuka Maurice Songoreh , Ogonda Lilian , Onyango Calleb George , Guyah Bernard 
Published: September 2023

Abstract

Background: Kenya has a paediatric HIV burden of nearly 140,000 children, of which only 48% of those on antiretroviral therapy (ART) have achieved the desired viral suppression possibly due to vitamin D deficiency. We explored the influence of vitamin D levels on treatment outcome.
Method: We performed a cross-sectional study of 196 participants aged 3 – 14 years; among them 98 HIV infected who received treatment between 2019 - 2020 in Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya. The exposure was vitamin D levels, including deficient (<20 ng/ml), insufficient (≥20 - <30 ng/ml), and sufficient (30 – 50ng/ml). The outcome was optimal immune recovery (CD4 ≥ 500 cells/mm3) and optimal viral suppression (viral load ≤ 200 copies/ml). We compared difference in means for each vitamin D category between HIV infected and uninfected using independent t-test, multiple comparisons of vitamin D levels among age categories using ANOVA and post hoc test and Pearson correlation to correlate vitamin D levels, CD4 and viral load of HIV infected children.
Results: Compared with HIV uninfected, HIV infected recorded mean age ± standard deviation of10.65±2.17 years with 39(39.8%) males vs. 6.68±2.81 years with 52(53.1%) males p<0.001; and the difference in vitamin D mean levels was statistically significant [28.21 ± 6.39 infected vs.30.88 ± 6.62 uninfected] t = 2.94, df =194, p = 0.004, 95%CI (0.90 – 4.59). Among age categories, mean vitamin D varied significantly F (2,193) = 10.68, p =0.001; with higher levels observed between 1-4 years category {mean difference 4.64ng/ml, p = 0.02, [95%CI 1.49 – 7.78]} and 5-9 years category {mean difference 4.33ng/ml, p = 0.001, [95%CI 1.89 – 6.38]} as compared to 10 – 14 years respectively.
Additionally, children with optimal immune recovery recorded higher proportion of vitamin D deficiency and insufficiency (12.24% and 42.86%) as compared with sub optimally recovered 1.02% and 4.08%); while children with optimal viral suppression recorded higher proportion of vitamin D deficiency and insufficiency (8.16% and 30.61%) as compared with sub optimally suppressed (5.1% and 16.3%).
Conclusion: Infections with HIV suppresses levels of vitamin D, but this has no influence on CD4 counts and viral load status in children receiving ART.
Quality Indicators for Enhanced Recovery After Surgery (ERAS) Nursing in Cervical Cancer Patients: A Qualitative Study from the Perspectives of Patients and Nurses
Authors: Luo Yanxia , Ye Minshan , Chen Yiteng , Wang Xindi , Lin Huahong , Ruan Weiqing 
Published: September 2023

Abstract
Background
The quality of nursing of cervical cancer Enhanced Recovery After Surgery care (ERAS) is closely associated with cervical cancer patients and gynaecological nursing staff. However, there is limited previous research on the opinions and views of these two groups regarding the quality indicators. This study aimed to explore the standards and requirements of nursing quality in cervical cancer ERAS care from the perspectives of cervical cancer patients and nursing staff.
Methods
A descriptive qualitative study was conducted using one-on-one semi-structured interviews between January 2023 and April 2023 with seven cervical cancer patients and twelve gynaecological nursing staff from a tertiary hospital in Guangzhou, China. The interviews were audio-recorded and analysed using thematic analysis.
Results
Using the structure-process-outcome model as a reference, seven themes were identified, namely: (1) Optimisation and allocation of human resources; (2) Equipment and environmental support; (3) Improvement of the ERAS institutional system; (4) Enhancement of team expertise and professional ethics; (5) Improvement of health education efficiency; (6) Patients’ psychological state and care; (7) Patients’ outcome reporting and auditing.
Conclusion
This study reveals nursing measures valued by patients and nursing staff in cervical cancer ERAS care, which can be used to assess and enhance the nursing quality of cervical cancer ERAS care.
Experiences of returning to work in schizophrenic patients after treatment: a longitudinal qualitative study
Authors: Song Jin , Zhang Yu-xin , Qin Meng-nan , Ren Jia-xin , Jia Yan-nan , Yu Hong , Zhou Yu-qiu 
Published: September 2023

Abstract
Background: Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia, which plays a positive role in improving the quality of life and mental symptoms of patients with schizophrenia.The existing studies on RTW in schizophrenic patients are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in schizophrenic patients.
Method: A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within one month post-discharge, and (3) six months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis.
Results：A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of schizophrenic patients reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase：the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2 expectation of assistance pre-work. And four themes in the third phase: (1）tremendous pressure of RTW; (2）lack of medical and social support; (3) social status and interpersonal relationships change; (4) high level of financial pressure.
Conclusion: The experience of RTW is a dynamic process with great challenges in each phase，schizophrenic patients have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care，and follow-up mental health services and disease information should be accessible to support schizophrenic patients to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for people with schizophrenia, and take certain measures to change the current situation.
Feed intake and in vitro dry matter digestibility in dairy cows fed different levels of dried Moringa oleifera leaves and Medicago sativa hay as a supplement to Chloris gayana hay
Authors: Alarape Omolara Latifat , Migwi Perminus K. , Ondiek James O. 
Published: September 2023

Abstract
The effect of supplementing Rhodes grass hay with different levels of dried Moringa (Moringa oleifera) leaves and Lucerne hay on feed intake and in vitro digestibility were studied using lactating dairy cows. Nine lactating Holstein-Friesian cows with initial body weight of 444 ± 39.7 kg were randomly assigned to three experimental treatments using a Randomised Complete Block Design (RCBD). Rhodes grass hay was fed ad libitum while Moringa leaves and Lucerne hay were supplemented at the ratio 0:10 in T1, 5:5 in T2 and 10:0 in T3 respectively. Moringa supplementation increased (p˂0.05) the DM intake of the basal diet (13.7 kg DM/day) and the total DM intake (15.3 kg DM/day). The Moringa-supplemented treatment (T3) produced the highest gas (8.93 ml/200mg DM) at 24 hr, has the highest SCFA (0.19 ml/200mg DM) and ME (6.86 MJ/kg DM) but the least organic matter digestibility (20.7%) when compared to the control. The results showed that the use of dried Moringa leaves as a protein supplement to low quality diets improved the DM intake and the digestibility of the diet which can lead to an increase in dairy productivity.
Interprofessional Identity Development: Awareness as the Beginning of Change
Authors: Cantaert Gabriël Rafaël , Lauwerier Emelien , Reinders Jan-Jaap , Goyvaerts Silke , Vaes Lena , d’Hooghe Yorinde , Mertens Fien , Slaghmuylder Yaël , Oosterwijck Jessica Van , Pype Peter 
Published: September 2023

Abstract
Background: Developing an interprofessional identity (IPI) generates an intrinsic motivation for interprofessional collaboration owing to pro-diversity beliefs that mitigate identity threat within dynamic teams. However, personal experiences and contextual changes such as the transition into practice may decrease this openness and, as such, disrupt the complementarity between an individual’s professional and IPI. This study explores the construct of readiness-to-change as a missing link in strengthening IPI by revisiting the contested Readiness for Interprofessional Learning Scale (RIPLS).
Methods: A pragmatic constructionist stance combining quantitative and qualitative approaches was adopted to determine the meaning and utility of a translated Dutch version of the RIPLS in an undergraduate university context. The validity and reliability were evaluated by analyzing cross-disciplinary data obtained from a cross-sectional (n=3311) and two prepost studies (n=330/n=89). In addition, a content analysis was performed by means of a coding frame and on the basis of interviews with teachers (n=2) and trainees (n=6) in health sciences.
Results: Exploratory factor analysis, informed by the content analysis, led to a hypothesized one-factor model comprising 8 items with factor loadings between .512 and .697 and explaining 35.35% of the total variance (eigenvalue=3.463), which was relabeled the Awareness of Interprofessional Learning Scale (AIPLS). Confirmatory factor analysis with posttest data (n=456) showed excellent model fit (SRMR=.018, RMSEA=.068, CFI=.969, TLI=.957) and factor loadings (.62-.77), while both the unidimensional and 4-dimensional RIPLS’ structure showed very poor (SRMS=.071/RMSEA=.083) to reasonable (SRMS=.059/RMSEA=.067) model fit. Additionally, the AIPLS has a high coefficient omega (.81), moderate stability (ICC=.725) and confirmed convergent validity.
Conclusions: The comprehensive approach adopted in this study led us to reject the RIPLS as a multidimensional instrument as the subscales showed considerable overlap and did not reflect the construct of readiness. Instead, the AIPLS measures interprofessional awareness, which is vital in the first stages in developing readiness, allowing us to reinterpret past research and to revisit the scale’s applicability in a theory-driven way. Moreover, we consider interprofessional awareness to be the beginning of change because it is a precursor of self-efficacy, openness and commitment, which may prove to be missing links to leverage in the delivery of interprofessional education.
PD-1 inhibitors combined with paclitaxel and cisplatin in first-line treatment of esophageal squamous cell carcinoma (ESCC): a network meta-analysis
Authors: Zhao Jia , Zhang Simeng , Guo Xiaoyu , li Ce , Yang Bowen , Qu Xiujuan , Wang Shuo 
Published: September 2023

Abstract
Background
The combination of PD-1 inhibitors with paclitaxel/cisplatinum (PD-1 + TP) and fluoropyrimidine/cisplatinum (PD-1 + FP) both have been shown to improve overall survival (OS) and progression-free survival (PFS) in patients with previously untreated, advanced esophageal squamous cell carcinoma (ESCC). However, there is no consensus on which chemotherapy regimen combined with PD-1 has better efficacy. To address this important issue in the first-line treatment of patients with esophageal squamous cell carcinoma, we conducted a network meta-analysis.
Methods
Data were collected from eligible studies searched in Medline, Web of Science, Pubmed, the Cochrane Library and Embase. Pooled Hazard Ratio (HR) for OS, and PFS, Odds Ratio (OR) for objective response rate (ORR) and ≥ 3grade treatment-related adverse events (≥ 3TRAEs) were estimated to evaluate the efficacy of PD-1 inhibitors combined with TP or FP.
Results
Five RCTs and one retrospective study involving 3685 patients and evaluating 4 treatments were included in this network meta-analysis. Compared to other treatments, PD-1 + TP was better. For PFS, the HRs for PD-1 + TP compared to PD-1 + FP, TP and FP were 0.59 (0.44, 0.80), 0.56 (0.51, 0.61) and 0.45 (0.37, 0.56) respectively. For OS, PD-1 + TP was also a better treatment compared to other treatments, the HRs were 0.74 (0.56, 0.96), 0.64 (0.57, 0.71), 0.53 (0.43, 0.67) respectively. For ORR, there was no significant difference between PD-1 + TP and PD-1 + FP, ORs were 1.2 (0.69, 2.11). Compare with TP and FP, PD-1 + TP has a obvious advantage, ORs were 2.5 (2.04, 3.04) and 2.95 (1.91, 4.63). For ≥ 3TRAEs, PD-1 + TP compared to other treatments, OR were 1.34 (0.74, 2.46) and 1.13 (0.92, 1.38) and 2.23 (1.35, 3.69).
Conclusion
PD-1 + TP significantly improved both PFS and OS compared to PD-1 + FP. Taking into account both efficacy and safety, PD-1 + TP may be a superior first-line treatment option for esophageal squamous cell carcinoma.
The unintended consequences of decarbonizing the China Southern Power Grid
Authors: Galelli Stefano , Jin Xiaoyu , Chowdhury Kamal , Cheng Chuntian 
Published: September 2023

Abstract
Decarbonizing the electricity sector requires massive investments in generation and transmission infrastructures that may impact both water and land resources. Characterizing these effects is key to ensure a sustainable energy transition. Here, we identify and quantify the unintended consequences of decarbonizing the China Southern Power Grid, China’s second-largest grid. We show that reaching carbon neutrality by 2060 is feasible; yet, doing so requires converting 40,000 km2 of land to support solar and wind as well as tapping on rivers to build 32 GW of hydropower. The impact of wind and solar development would span across multiple sectors, since crop and grassland constitute 90% of the identified sites. The construction of new dams would carry major externalities and trickle down to nearby countries, as most dams are located in transboundary rivers. Curbing the international footprint of this decarbonization effort would require additional investments (12 billion USD) in carbon capture technologies.
Natural disasters and technological upgrading measured by changes in demand for ICT labour: Estimating the impacts with text
Authors: Campos-González Jorge 
Published: September 2023

Abstract

Extensive literature has studied the economic impact of natural disasters. However, specific impacts on labour markets have received less attention. Using a massive earthquake (> 8.0 Mw) that struck Chile in 2010 and proprietary data from a Chilean online job board (4,136 job postings published between 2008 and 2012), we examine changes in demand for Information and Communications Technologies, ICT, related labour as a proxy for technological upgrading, by assuming that ICT and related technologies drive much of the technical change in production. We implement a structural topic model to discover and estimate the difference in the prevalence of ICT and Construction labour. Our results show that ICT labour does not change. In contrast, Construction labour significantly differed after the disaster, suggesting that reconstruction activities led to employment differences. Our results suggest that there was no substantive technological replacement following the earthquake.
JEL Classification: J20, Q54, O33
Facile Assembly of Flexible Symmetric Micro-Supercapacitors with Wide Working Voltage Window
Authors: Li Min , Han Xiangguang , Zhao Libo , Jia Chen , Li Zhikang , Xie Jiaqi , Luo Guoxi , Yang Ping , Boukherroub Rabah , Türker Yurdanur , Özkaynak Mert , Dönmez Koray , Jiang Zhuangde 
Published: September 2023

Abstract
With the upcoming flourishing development of intelligent robots and wearable electronics, demands for high-performance flexible energy storage devices are increasing. In this study, flexible symmetric micro-supercapacitors (MSCs) that could work in wide working voltage window were demonstrated by combining laser-direct-writing graphene (LG) electrodes with phosphoric acid-non-ionic surfactant liquid crystal (PA-NI LC) gel electrolyte. To increase the flexibility and enhance the conformal ability with anisotropic surfaces of the MSC devices, after the interdigitated LG formation on polyimide (PI) film surface, they were further transferred onto a flexible, stretchable and transparent polydimethylsiloxane (PDMS) substrate, which displayed favorable flexibility and mechanical characteristics in the bending test. Furthermore, the electrochemical performance of symmetric MSCs with various electrode widths (300, 400, 500 and 600 μm) was appraised. The findings disclosed that the symmetric MSC devices could be conducted in a large voltage range (0-1.5 V), and the one with 300-μm electrode width (MSC-300) exhibited the largest areal capacitance of 2.3 mF×cm-2 at 0.07 mA×cm-2 and areal (volumetric) energy density of 0.72 μWh×cm-2 (35.9 mWh×cm-3) at 55.07 μW×cm-2 (2753.5 mW×cm-3), along with favorable mechanical and cycling stability. After charging for ~20 s, two MSC-300 devices connected in series could supply energy to a calculator to operate for ~130 s, suggesting the practical application potential as energy storage device.