Development and application of a nitrogen oxides analyzer based on the cavity attenuated phase shift technique.

Nitrogen oxides (NOx) are crucial in tropospheric photochemical ozone (O3) production and oxidation capacity. Currently, the widely used NOx measurement technique is chemiluminescence (CL) (CL-NOx), which tends to overestimate NO2 due to atmospheric oxidation products of NOx (i.e., NOz). We developed and characterized a NOx measurement system using the cavity attenuated phase shift (CAPS) technique (CAPS-NOx), which is free from interferences with nitrogen-containing species. The NOx measured by the CAPS-NOx and CL-NOx analyzers were compared. Results show that both analyzers showed consistent measurement results for NO, but the NO2 measured by the CAPS-NOx analyzer (NO2_CAPS) was mostly lower than that measured by the CL-NOx analyzer (NO2_CL), which led to the deviations in O3 formation sensitivity regime and Ox (= O3 + NO2) sources (i.e., regional background and photochemically produced Ox) determined by the ozone production efficiencies (OPE) calculated from NO2_CL and NO2_CAPS. Overall, OPE_CL exceeded OPE_CAPS by 18.9%, which shifted 3 out of 13 observation days from the VOCs-limited to the transition regime when judging using OPE_CL, as compared to calculations using OPE_CAPS. During the observation period, days dominated by regional background Ox accounted for 46% and 62% when determined using NO2_CL and NO2_CAPS, respectively. These findings suggest that the use of the CL-NOx analyzer tends to underestimate both the VOCs-limited regime and the regional background Ox dominated days. The newly built CAPS-NOx analyzer here can promote the accurate measurement of NO2, which is meaningful for diagnosing O3 formation regimes and Ox sources.

Design and Implementation of a Desorption Electro-flow Focusing Sprayer on an Orbitrap Mass Spectrometer for DESI Mass Spectrometry Imaging at High Spatial Resolution and at High Speed.

Since desorption electrospray ionization mass spectrometry (DESI-MS) was first presented in 2004, the fundamental design of the sprayer has undergone relatively minor modifications. This changed in 2022 when Takats and co-workers implemented the desorption electro-flow focusing (DEFFI) sprayer design by modifying the sprayer from a commercial DESI system, leading to significantly improved spatial resolution and robustness compared with the traditional DESI-MSI sprayer design. Here, we present the design of a new DEFFI sprayer that can be built from standard fittings and connectors in combination with an aluminum spray head that can be machined in most mechanic workshops. The new design represents a cost-efficient approach to improved DESI-MSI on mass spectrometers from all vendors, including high-resolution instruments such as Orbitraps and FT-ICR. The new DEFFI sprayer is demonstrated on a QExactive Orbitrap mass spectrometer, resulting in a massively improved ion yield compared with the classic DESI sprayer. The improved ion yield enables DESI-MSI at ion injection times down to 5 ms, allowing for DESI-MSI at a potentially very high speed. More importantly, the DEFFI sprayer delivers a more robust and focused spray, which is easier to use and requires less optimization. It provides high spatial resolution with limited effort compared with previous modifications of the traditional DESI design. Imaging of rat testis was performed at pixel sizes down to 12 µm, suggesting a spatial resolution of approximately 30 µm, which may have potential for further improvement.

Development of theoretical framework and digital competence assessment checklist (DCAC) for nursing students.

Background: The rapid development of digital technology impacts all aspects, including nursing education. Nursing programs are tasked with equipping graduates with both clinical skills and digital competence. However, inconsistencies in the conceptual understanding of digital competence in nursing literature, underscore the need to refine the concept. Design: This study involved two phases including a modified Delphi approach and psychometric testing. In Phase 1, the panel of experts in nursing was invited to evaluate the theoretical framework, domain, and item of assessment checklist. In Phase 2, the psychometric properties of the assessment checklist were tested using a quantitative survey. Setting: The study was conducted in Taiwan, Indonesia, and Vietnam. Participant: Participants included 12 nursing experts from Taiwan, Indonesia, and Vietnam during the development phase and 417 nursing students from these countries in the validation phase. Methods: Phase 1 utilized a modified Delphi approach establishing a theoretical framework and assessment checklist. Experts provided feedback on a Likert scale, aiming for consensus. Phase 2 involved a quantitative survey where graduate nursing students rated the DCAC. The analysis process following the recommendation of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Results: The theoretical framework defined digital competence across four domains. In the first Delphi round, all items were rated above the consensus threshold. After two rounds, the CVI ranged from .8 to 1.0, suggesting strong agreement among experts. The second phase revealed high discriminant validity among survey items, with Cronbach's alpha indicating high internal consistency. The refined 22-item DCAC showed improved fit indices, confirming the assessment checklist's structure. Conclusion: The developed 22-item DCAC is a valid and reliable tool for measuring digital competence among nursing students. Integration of digital competence into nursing education is essential for preparing students to excel in the healthcare environment.

Refinement and Evaluation of the Critical Thinking Self-Assessment Scale.

Background and Purpose: Critical thinking (CT) skills are necessary tools for enhancing patient care. The Critical Thinking Self-Assessment Scale (CTSAS) was based on Facione et al.'s (1990) schema of 6 CT skills and 16 subskills. Although early results indicated a strong instrument, it was lengthy at 115 items. The study purpose was to statistically reduce the number of items in the instrument. Methods: Using a sample of 712 undergraduate nursing students, item analysis and confirmatory factor analysis were used to determine items to retain and delete. The scale was validated by comparing to the Need for Cognition Scale. Results: Items were reduced to 46 and spread over the 16 subskills. Conclusions: The revised CTSAS is a valid, reliable tool that is greatly reduced in length without compromising its psychometric properties. Faculty could use the measure as a reflection of students' levels on these skills and design learning activities to target problem areas.

Development and Testing of an Instrument to Measure Professionalism in Nursing.

Background and Purpose: Evaluation of professionalism in nursing has proven challenging as no objective measurement tool exists. The purpose of this study was to develop and test the Professionalism in Nursing Scale (PNS) for reliability and validity, which will facilitate evaluation of the constructs of professionalism in nursing. Participants were senior nursing students and registered nurses with at least a baccalaureate degree and a minimum of 3 years of experience working either in academia at an accredited university or in a practice setting in a Magnet hospital. Methods: Methodological research was used to design an instrument that measures professionalism in nursing. Phase 1 included item development, scaling, and evaluation of the content validity index, using 10 content experts. Phase 2 included pilot and field testing using participants meeting the inclusion criteria. Questionnaires were sent electronically to evaluate the relevance of each attribute of professionalism using a Likert scale. Phase 3 was scale evaluation, including reliability and validity of the PNS. Results: Final results of exploratory factor analysis supported a 33-item five-factor model. The factors were named Ethics and Interprofessional Collaboration, Excellence, Professional Engagement, Caring, and Self-Awareness. The overall reliability rate of the PNS was 0.97. Findings demonstrated the reliability and validity of the PNS for measuring professionalism in academic and clinician nurses and nursing students. Conclusions: Measuring professionalism in nursing can assist driving improvement of patient care, accountability, and team collaboration. A discussion of the PNS within the context of academia and clinical practice, along with implications for research, practice, education, and policy will be presented.

The Study on the Chinese Environmental Audit Tool (C-EAT) for Long-Term Care Facilities.

Objective: The aim of this study was to translate the Australian Environmental Assessment Tool (EAT) into Chinese and identify culturally specific characteristics in the Chinese context for adaptation. Background: In the context of dementia-specific care, the design of the environment is considered an influential factor in supporting and maintaining skills. However, despite the increasing number of individuals with dementia in China, there is currently no valid instrument available to systematically assess the quality of the physical environment in long-term care facilities (LTCFs). Methods: This study utilized a mixed-method procedure consisting of seven steps, including translation and adaptation. The study involved focus groups comprising an expert panel (n = 17) and potential users (n = 64) of the newly developed tool. Cross-cultural adaptation was performed through Chinese literature review and literature quality appraisal, field study, and expert committee review. Results: The final version of the China Environmental Assessment Tool (C-EAT) consisted of 10 key design principles and 64 items. The C-EAT was tested in four LTCFs in China and underwent two rounds of review by an expert panel. Conclusions: The C-EAT was deemed a suitable tool for assessing the environment and enhancing the living environments for individuals with dementia in LTCFs in China. In future research, field tests will be conducted to validate the C-EAT scale and modify the EAT-HC to enhance its applicability in China.

Cross-cultural adaptation of the awareness and beliefs about cancer measure for Hispanics/Latinos living in the United States.

Introduction: The purpose of this study is to culturally adapt the Awareness and Beliefs about Cancer (ABC) measure for use in the Hispanic/Latino population living in the United States (US). Methods: In accordance with Patient Reported Outcomes (PRO) Consortium guidelines for cross-cultural adaptation of measures for content and linguistic validity, we conducted: two forward-translations, reconciliation, two back-translations, revision and harmonization, six cognitive interviews, revision, external expert review, and finalization of the version. We used a mixed methods approach, conducting cognitive interviews with Hispanic/Latino community members while also convening an expert panel of six clinicians, health professionals, and community representatives and including the in the entire process. After cross-culturally adapting the ABC measure, we assessed the psychometric properties of the instrument using item response theory analysis. Item parameters, discrimination and category thresholds, and standard errors were calculated. For each of the adapted subdomains, we used item information curves to report the graphical profile of item effectiveness. Results: Twenty-two Hispanic/Latino community members were enrolled in cognitive interviews, and Hispanics/Latinos fluent in Spanish completed the measure to assess its psychometric properties. Cognitive interviews revealed opportunities to improve items. Key changes from the original measure include the inclusion of gender inclusive language and an inquiry into e-cigarette use on items related to smoking habits. Psychometric property analyses revealed that the anticipated delay in seeking medical help, general cancer beliefs, and cancer screening beliefs and behaviors subdomains had some slope parameters that were < 1; this implies that those items were not able to adequately discriminate the latent trait and had poor performance. Discussion: The adapted ABC measure for US Hispanics/Latinos meets content and linguistic validity standards, with construct validity confirmed for cancer symptom recognition and barriers to symptomatic presentation subdomains, but revisions are necessary for others, highlighting the need for ongoing refinement to ensure the cultural appropriateness of instruments.

A novel self-rating instrument designed for long-term, app-based monitoring of ADHD symptoms: A mixed-methods development and validation study.

Background: Regular outcome monitoring is essential for effective attention deficit hyperactivity disorder (ADHD) treatment, yet routine care often limits long-term contacts to annual visits. Smartphone apps can complement current practice by offering low-threshold, long-term sustainable monitoring capabilities. However, special considerations apply for such measurement which should be anchored in stakeholder preferences. Methods: This mixed-methods study engaged 13 experienced clinicians from Region Stockholm in iterative qualitative interviews to inform development of an instrument for app-based ADHD monitoring: the mHealth scale for Continuous ADHD Symptom Self-monitoring (mCASS). A subsequent survey, including the mCASS and addressing app-based monitoring preferences, was administered to 397 individuals with self-reported ADHD. Psychometric properties of the mCASS were explored through exploratory factor analysis and examinations of internal consistency. Concurrent validity was calculated between the mCASS and the Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1). Additional quantitative analyses included summary statistics and repeated-measures ANOVAs. Results: Clinicians identified properties influencing willingness to use and adherence including content validity, clinical relevance, respondent burden, tone, wording and preferences for in-app results presentation. The final 12-item mCASS version demonstrated four factors covering everyday tasks, productivity, rest and recovery and interactions with others, explaining 47.4% of variance. Preliminary psychometric assessment indicated satisfactory concurrent validity (r = .595) and internal consistency (α = .826). Conclusions: The mCASS, informed by clinician and patient experiences, appears to be valid for app-based assessment of ADHD symptoms. Furthermore, insights are presented regarding important considerations when developing mobile health (mHealth) instruments for ADHD individuals. These can be of value for future, similar endeavours.

Faculty Online Teaching Effectiveness Scale (FOTES): Instrument development and content validation.

This study aimed to develop and psychometrically test the Faculty Online Teaching Effectiveness Scale (FOTES) based upon both student and faculty perspectives of online teaching and learning in higher education. Online teaching effectiveness is a crucial component of quality education, but it has not been well-defined conceptually, and few studies have been conducted, using relevant domains, to accurately measure online teaching effectiveness. The impact of online course delivery on teaching effectiveness remains unclear. An exploratory sequential mixed methods design was employed with three phases of instrument development and psychometric testing. The FOTES comprises 50 items in seven domains: teaching philosophy, self-efficacy, relationships, course content, learning activities, teaching practices, and satisfaction. The instrument underwent initial testing, yielding positive expert appraisals with good-excellent psychometrics. All domains of the scale were significantly correlated, except for teaching philosophy. The preliminary results of the FOTES provide the empirical evidence to advance additional psychometric validation. This newly developed instrument has the potential to enhance faculty capacity and skill in self-evaluating their teaching effectiveness in online courses, providing a valid and reliable measure. The resulting instrument is poised to promote outcome evaluation and strengthen teaching and learning processes.

Construction of the discomfort assessment scale for immobilized trauma victims (DASITV).

BACKGROUND: Immobilization is an intervention widely administered to trauma victims and aims to reduce the victim's movements, ensuring the alignment of anatomical structures suspected of being injured. Despite the benefits of immobilization, it is responsible for the occurrence of pressure injuries, increases in intercranial pressure, pain, and discomfort. AIM: To develop an instrument to assess the discomfort caused by immobilization in trauma victims - Discomfort Assessment Scale for Immobilized Trauma Victims (DASITV). METHODS: A sequential mixed-methods design was used, divided into three distinct but complementary phases: (1) Conceptualization Phase - Construction of the DASITV; (2) Focus Group with a Panel of ten Technical Experts in the care of immobilized trauma victims to approve the DASITV proposal; (3) Acceptance of the scale proposal using a modified e-Delphi technique with 30 pre-hospital health professionals. RESULTS: The first phase led to the construction of a scale made up of two sub-scales. The Numerical Discomfort Scale assesses the level of discomfort the person reports from 0 to 10, with 0 being no discomfort and 10 being maximum discomfort. The second evaluation parameter gives the level of pressure in mmHg that the body exerts on the surface where it is immobilized. The combined interpretation of these two sub-scales leads to 4 different possibilities - ordered by level of severity. The Focus Group made it possible to improve the scale, with input from the group of experts and, using the modified e-Delphi technique, a wider group of professionals showed agreement with the DASITV. CONCLUSION: This study allowed us to propose a preliminary scale to assess the discomfort felt by victims of trauma caused by immobilization.

Patient-Reported Outcome Measure Development and Validation: A Primer for Clinicians.

A comprehensive definition of health includes the assessment of patient experiences of a disease and its treatment. These patient experiences are best captured by standardized patient-reported outcome (PRO) instruments. A PRO is reported directly by the patient (or caregiver) and provides the patient's perspective into how a disease and its treatment impact their lives. PRO instruments are typically standardized, validated questionnaires with items that are scaled and can be combined to represent an underlying health-related construct such as physical, social, and role functioning, psychological well-being, symptoms, pain, and quality of life. Over the past few decades, PROs have become increasingly used in clinical trials as endpoints to better understand treatment benefits from the patient's perspective and in clinical practice to identify unmet needs of patients, health risk surveillance, and monitor outcomes of care. In this paper, we describe the process for developing standardized PRO instruments, from conceptual model development through instrument validation.

Validity and Reliability of a Newly Developed Instrument to Measure Nursing Workarounds During Medication Administration.

Background and Purpose: According to patient safety literature, workarounds are used when processes are not clear and may not match the intended workflows. There is no available quantitative instrument to measure the type and frequency of workarounds when nurses administer medications. The purpose of this study was to assess the psychometric properties of a newly developed instrument that measured the type and frequency of workarounds when nurses administer medications to patients. Methods: Items for the newly developed instrument were derived based on the concept analysis of workarounds, and the psychometric evaluation included content validity, face validity, item analysis, dimensionality, reliability, and construct validity testing. The instrument was administered to registered nurses in an acute care hospital in Northern Virginia. Results: Psychometric evaluation of the newly developed instrument demonstrated adequate content and face validity. Based on exploratory factor analysis using principal axis factoring of the 18 items, 12 items were retained comprising three subscales: (a) defining characteristics, (b) type of workarounds, and (c) frequency of workarounds. Cronbach's alpha ranged from .83 to .92 for the three subscales. As hypothesized, convergent validity was supported by Spearman Rho correlations ranging from .27 to .47 among the Halbesleben, Rathert, and Bennett total and two subscales. Divergent validity was supported with Spearman Rho correlations ranging from -.09 to .15 with two other Halbesleben, Rathert, and Bennett subscales. Conclusions: The findings provided beginning evidence for the reliability and validity of the newly developed Savage Barcode-Assisted Medication Administration Workarounds Tool comprised of three subscales-defining characteristics, types of workarounds, and frequencies of workarounds.

The Development and Content Validation of a Clinical Screening Scale to Identify Attention-Deficit Hyperactivity Disorder Cases Based on the Gender Perspective: An e-Delphi Study.

BACKGROUND: Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD. OBJECTIVE: The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD. METHODS: The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content. RESULTS: A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls. CONCLUSIONS: To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study.

AIM: The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association. DESIGN: A cross-sectional survey was conducted between October 2020 and January 2021. METHODS: The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data. RESULTS: A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective. CONCLUSION: This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams. IMPACT: Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Emergency department triage decision-making by registered nurses: An instrument development study.

AIM: To develop and psychometrically test the triage decision-making instrument, a tool to measure Emergency Department Registered Nurses decision-making. DESIGN: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. METHODS: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision-making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4-point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. RESULTS: The triage decision-making instrument is a 22-item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty-nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser-Meyer-Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of .596 factor 1, .690 factor 2, .749 factor 3 and .822 for factor 4. CONCLUSION: The triage decision-making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. IMPACT: The instrument is a first step in quantifying triage decision-making in real-world clinical environments. The triage decision-making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. STATISTICAL SUPPORT: Dr. Tak Fung who is a member of the research team is a statistician. STATISTICAL METHODS: Development, validation and assessment of instruments/scales. Descriptive statistics. REPORTING METHOD: STROBE cross-sectional checklist. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The TDI makes the complexity of triage decision-making visible. Identifying the influence of decision-making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety.

The Childbearing sense of coherence scale (CSOC-scale): development and validation.

BACKGROUND: the salutogenic theory is essential to explain an individual's ability to maintain health during the perinatal period. While previous studies mainly focused on the perspectives from a family-level orientation and a global orientation, the purpose of the present study was to develop and validate a scale, the childbearing sense of coherence scale (CSOC-scale) from the individual's perceptions of the stresses, resources, and meaningfulness of childbearing. METHODS: A total of 3 separate studies contributed to the development of the CSOC-scale between July 2022 and February 2023. In study 1, the initial item pool based on the conceptual framework of the childbearing sense of coherence and the salutogenic theory was developed. Delphi expert consultation was conducted to revise and improve items. Studies 2 and 3 were cross-sectional studies. In study 2, item analysis and explore factor analysis (EFA) (N = 351 for women, N = 256 for men) were used to screen items. In study 3, confirmatory factor analysis (CFA) and reliability analysis (N = 366 for women, N = 308 for men) were used to test the fit indices and reliability of the final scale. RESULTS: final analysis suggested the CSOC-scale includes three factors, consisting of 13 items. Confirmatory factor analysis demonstrated good model fit (χ2 = 157.448, df = 62, χ2/ df = 2.539, RMSEA = 0.065, CFI = 0.974, TLI = 0.968, SRMR = 0.029 for women; χ2 = 181.363, df = 62, χ2/ df = 2.925, RMSEA = 0.079, CFI = 0.968, TLI = 0.960, SRMR = 0.033 for men) and high factor loadings (from 0.751 to 0.929 for women; from 0.746 to 0.947 for men). Internal consistency (Cronbach's α ranging from 0.895 to 0.933 for women and 0.881 to 0.945 for men in three dimensions; Cronbach's α was 0.919 for women and 0.821 for men in the entire instrument) and split-half reliability (Spearman-Brown coefficients ranging from 0.876 to 0.921 for women and 0.841 to 0.937 for men in three dimensions; Spearman-Brown coefficient was 0.744 for women and 0.785 for men in the entire instrument) were excellent. CONCLUSIONS: the CSOC-scale has robust psychometric properties. It is reliable and valid in evaluating the childbearing sense of coherence in women and men during pregnancy. Utilisation of this scale can help healthcare professionals understand the health maintenance competencies of couples during the transition of parenthood and provide health promotion services from a salutogenic perspective.

The Home-Based Experiences of Palliative and Hospice Care for Children and Caregivers (EXPERIENCE) Measure: Evaluation of Psychometric Properties.

CONTEXT: Home-based pediatric palliative and hospice care (PPHC) supports the hundreds of thousands of children with serious illness and complex care needs and their families in the home setting. Considerable variation, however, exists in the provision and quality of home-based PPHC in the U.S. Ensuring equitable, high-quality home-based PPHC for all children requires the evaluation of families' care experiences and assessment of whether these experiences are aligned with their needs and priorities. OBJECTIVES: To evaluate the psychometric properties of the previously developed 23-item home-based PPHC EXPERIENCE Measure for use with families of children receiving home-based PPHC in the United States. METHODS: Participants included families recruited from the Children's Hospital of Philadelphia, Courageous Parents Network, and several other hospital- and community-based PPHC programs across the U.S. who provide home-based PPHC services. Participants completed the EXPERIENCE Measure at baseline and again at retest. We evaluated the factor structure of the EXPERIENCE Measure, as well as evidence regarding score reliability and validity. RESULTS: Eighty-two family participants completed the baseline and 53 completed the retest questionnaire from 15 states across the U.S. We found evidence for the score reliability and validity of a four-domain EXPERIENCE measure. CONCLUSION: The EXPERIENCE Measure is a tool with evidence for reliable and valid scores to evaluate family-reported home-based PPHC experiences at the time care is being received. Future work will evaluate the usability (i.e., acceptability, feasibility, and clinical actionability) of EXPERIENCE, including the sensitivity of the instrument to change over time and its impact on real-time clinical actions.

Adapting and testing measures of organizational context in primary care clinics in KwaZulu-Natal, South Africa.

BACKGROUND: Implementation science frameworks situate intervention implementation and sustainment within the context of the implementing organization and system. Aspects of organizational context such as leadership have been defined and measured largely within US health care settings characterized by decentralization and individual autonomy. The relevance of these constructs in other settings may be limited by differences like collectivist orientation, resource constraints, and hierarchical power structures. We aimed to adapt measures of organizational context in South African primary care clinics. METHODS: We convened a panel of South African experts in social science and HIV care delivery and presented implementation domains informed by existing frameworks and prior work in South Africa. Based on panel input, we selected contextual domains and adapted candidate items. We conducted cognitive interviews with 25 providers in KwaZulu-Natal Province to refine measures. We then conducted a cross-sectional survey of 16 clinics with 5-20 providers per clinic (N = 186). We assessed reliability using Cronbach's alpha and calculated interrater agreement (awg) and intraclass correlation coefficient (ICC) at the clinic level. Within clinics with moderate agreement, we calculated correlation of clinic-level measures with each other and with hypothesized predictors - staff continuity and infrastructure - and a clinical outcome, patient retention on antiretroviral therapy. RESULTS: Panelists emphasized contextual factors; we therefore focused on elements of clinic leadership, stress, cohesion, and collective problem solving (critical consciousness). Cognitive interviews confirmed salience of the domains and improved item clarity. After excluding items related to leaders' coordination abilities due to missingness and low agreement, all other scales demonstrated individual-level reliability and at least moderate interrater agreement in most facilities. ICC was low for most leadership measures and moderate for others. Measures tended to correlate within facility, and higher stress was significantly correlated with lower staff continuity. Organizational context was generally more positively rated in facilities that showed consistent agreement. CONCLUSIONS: As theorized, organizational context is important in understanding program implementation within the South African health system. Most adapted measures show good reliability at individual and clinic levels. Additional revision of existing frameworks to suit this context and further testing in high and low performing clinics is warranted.

[Development and characteristics of a moxa floss shaping and spreading device].

This paper introduces a moxa floss shaping and spreading device for governor vessel moxibustion. This device is consisted of a storage unit and a propulsion unit, capable of automatically shaping moxa sticks for governor vessel moxibustion. The device allows for the flexible adjustment of moxa stick length, better conforming to the physiological curvature of the spine, and avoiding potential burns associated with governor vessel moxibustion. It simplifies the operational procedures for healthcare professionals, offering the advantages of ease of use, safety, and efficiency.

Translation and initial cross-cultural adaptation of the tool for support-gradual return-to-work for persons with chronic musculoskeletal pain to the Swedish setting.

BACKGROUND: A well-defined and clear procedure is a key factor supporting return-to-work and enhancing collaboration and understanding between employers and employees. The adaptation of the Tool for Support-Gradual Return to Work, TS-GRTW, addresses relevant cultural aspects valuable for wider adoption. OBJECTIVE: develop a Swedish version, the GRTWswe, for implementation and integration into the Swedish labor market's RTW process. This involved translating, culturally adapting, and assessing the appropriateness and utility. METHODS: In the initial step, a double back translation was performed to create an initial translated version. This version was then utilized in individual consultations, accompanied by an agreement questionnaire. For the subsequent step, group consultations were held to refine and customize the tool to suit the Swedish context. Ten occupational therapists completed the questionnaires, with mean agreement scores surpassing three on a four-point scale. Out of these, nine participated in group consultations. RESULTS: The findings suggest the requirement for specific modifications to the GRTWswe. These adaptations are essential because of cultural differences in organizational structures and reference frameworks. Moreover, participants unanimously agreed to broaden the scope of target groups, encompassing employees without regard for diagnosis and expanding the range of professions that can utilize this tool. This step aims to enhance the tool's applicability and usefulness. CONCLUSIONS: The study found strong alignment between questionnaire responses and group consultations outcomes, affirming the adapted tool's suitability for use in a Swedish context. The tool benefits employers and employees by enhancing communication, encouraging collaboration, and structuring processes, promising lasting improvements to work conditions.