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Objective: This study aimed to explore the perceptions of women who have undergone unsuccessful in vitro fertilization (IVF) in Hangzhou, Zhejiang Province, China, and to explore how treatment failure has impacted their lives and relationships, thereby enabling the public to understand the unique experiences of these women. Design: A descriptive qualitative approach was employed, with purposive sampling used to recruit participants from the gynecological department of a traditional Chinese medicine clinic at a large tertiary hospital in Zhejiang province. Twelve women undergoing IVF treatment was involved in the study. Data were collected through face-to-face semi-structured interviews, which were transcribed verbatim. Conventional content analysis methods were used to analyze the data. Results: Following analysis, three main categories emerged: 1) The Psychological Experience of Initial Miscarriage from IVF Treatment, 2) The Psychological Experience of Repeated Treatment Failure, and 3) Interpersonal experiences and challenges. Women experiencing initial failure from IVF treatment reported emotions such as surprise, doubt, sadness, disappointment, and embarrassment. They perceived the process as harder than expected, leading to unexpected daily life challenges and difficulties in achieving success. As unsuccessful attempts persisted, they endured psychological suffering and lived in the shadow of repeated treatment failures. Doubts, perplexity, and anxiety grew, making reproduction seem like an insurmountable obstacle in their lives. In their interpersonal experience, women often felt guilt toward family, faced social isolation, and found it challenging to discuss IVF openly everywhere. They encountered a lack of understanding from others but also found mutual sympathy and support among people who shared similar experiences. Conclusions: The study provided an insight into the suffering of Chinese women undergoing IVF treatment, highlighting the challenges of overcoming treatment failures. The findings not only inform Chinese infertile women considering IVF treatment but also contribute to the development of more effective support services by healthcare providers. [ABSTRACT FROM AUTHOR]

Background: kangaroo care (KC), endorsed by the World Health Organization, is an evidence-based intervention that plays a pivotal role in mitigating preterm infant mortality and morbidity. However, this intervention has not been fully integrated into healthcare systems in China. This study aimed to gain insight into parents' perceptions and experiences of KC for preterm infants to contribute to the KC implementation on a larger scale. Methods: This study employed a descriptive qualitative design, using face-to-face, semi-structured, in-depth interviews. Fifteen parents participating in KC for preterm infants in the neonatal intensive care units (NICUs) were purposively sampled from four hospitals across four cities in Zhejiang Province, China. Thematic analysis was employed to analyze the data. Results: Four themes and twelve subthemes regarding the parents' perceptions and experiences about KC were identified. The four themes included: (1) Low motivation upon initial engagement with KC, (2) Dynamic fluctuations of emotional states during KC, (3) Unexpected gains, and (4) Barriers to participation. Conclusions: Parents' perceptions and experiences of KC was a staged process, with parents exhibiting distinct cognitive patterns and unique experiences at each stage. Overall, as KC progresses, parents' experiences tended to become increasingly positive, despite potential obstacles encountered along the way. To enhance the implementation of KC, healthcare providers could utilize prenatal and postnatal education programs. These programs aim to enhance the understanding of KC among parents of preterm infants, fostering sustained engagement in KC practices. [ABSTRACT FROM AUTHOR]

Aims: To longitudinally explore the symptom experience of Chinese patients with Crohn's disease within the first year following their diagnosis. Design: A longitudinal qualitative study. Method: Eighteen newly diagnosed Chinese patients with Crohn's disease were recruited through purposive sampling. Semi‐structured interviews were conducted at four time points: soon after diagnosis, 3, 6 and 12 months post‐diagnosis. Data were collected between January 2021 and February 2022. Conventional content analysis was used for data analysis of each time point. Afterwards, the data of each time point were compared longitudinally. COREQ checklist was followed. Results: Three themes and eight sub‐themes were formed through analysis: feelings towards symptoms (symptoms make me feel uneasy, symptoms make me feel inferior and symptoms make me feel helpless); acceptability of symptoms (difficult to accept, have to accept, be able to accept); functions of symptoms (assessing disease conditions and treatment effects, warning of disease management). Conclusions: Overall, the negative emotions related to symptoms gradually decreased over time, and the patient's acceptance of symptoms increased within the first year following diagnosis. In addition, when the disease was in remission after treatment, the warning function of symptoms gradually weakened. Impact: The process of how patients accept their symptoms found in this study provides a basis for nurses to improve patients' acceptance of symptoms and reduce their symptom‐related negative emotions. This study also emphasizes the phenomenon that patients gradually ignore some symptoms with their increased acceptance level, which warrants additional health education to strengthen their awareness of self‐management. Patient or public contribution: No patient or public contribution was required to design or undertake this study. Patients contributed only to the data collection and member checking. [ABSTRACT FROM AUTHOR]

Crohn's disease is a chronic condition causing inflammation of the lining of the digestive system. Individuals suffering from this illness encounter various challenges and problems, but studies investigating the illness experiences of patients with Crohn's disease in East Asian countries are scarce. The objective of this study was to explore the illness experiences of patients with Crohn's disease in China and construct an interpretive understanding of these experiences from the perspective of the patients. A constructivist grounded theory approach was used to develop a theoretical understanding of illness experiences. This study included participants from the following four provincial capital cities in China: Hangzhou, Nanjing, Guangzhou, and Wuhan. Purposive sampling and theoretical sampling were used to select Chinese patients living with Crohn's disease. Between February 2015 and January 2018, audio-recorded interviews were conducted. The data analysis included initial coding, focused coding, and theoretical coding using the constant comparative method and memo writing. Thirty-one participants were included in the study. "Regaining normality" was identified as the core category. The following four categories were conceptualized: comparing, struggling, reflecting, and realizing. Comparing refers to distinguishing the similarities and differences or evaluating the superiority and inferiority of similar things. Comparisons could occur between patients with Crohn's disease and healthy individuals or between patients and people in similar or more unfortunate situations. Struggling reflects the dilemmas experienced by patients with Crohn's disease in acknowledging their patient identity and informing others of this identity. Reflecting refers to the consideration of the values and life attitudes held by patients before and after the diagnosis of Crohn's disease. Realizing involves patients gaining a deeper understanding of the suffering associated with Crohn's disease after experiencing the illness. This study offers an interpretive understanding of the illness experiences of patients with Crohn's disease. Regaining normality represents the basic social psychological process. Regaining normality is related to reassessing and reconstructing the self after receiving a Crohn's disease diagnosis. This paper provides new insight into patients' lives and describes the strategies patients use to cope with the challenges and problems caused by the illness. These study findings can be used to develop future complex interventions and studies. [ABSTRACT FROM AUTHOR]

Background: The research on posttraumatic growth (PTG) promotion programmes, particularly narrative therapy (NT), for patients with inflammatory bowel disease (IBD) remains limited. This pilot study aims to develop an NT programme to promote PTG and evaluate its feasibility, preliminary effectiveness, participants' experiences and improvement suggestions. Methods: The NT programme was initially developed through literature review, interviews with IBD patients and expert panel discussions. A randomized controlled pilot trial was conducted to assess the feasibility and preliminary effectiveness of the programme. Participants in the NT group received five consecutive weekly sessions of the programme, while the control group received standard care. Outcomes including PTG, anxiety, depression and quality of life were measured. Qualitative interviews were conducted to explore participants' experiences and suggestions for programme modifications. Results: The NT programme was developed with scientific rigour. The recruitment rate and retention rate were 62.5% and 96.7%, respectively. A significant reduction in anxiety levels was observed, and manifestations of PTG were reported in the NT group. Suggestions for improvement of the NT programme were received from the participants. Conclusion: The NT programme was constructed to promote PTG in IBD patients in this study, further offering preliminary evidence for its feasibility and potential positive psychological change. However, large‐scale research is needed to validate its effectiveness for broader applications. [ABSTRACT FROM AUTHOR]

Background: The development and implementation of the transition from pediatric to adult healthcare systems for adolescents with inflammatory bowel disease (IBD) should consider stakeholders' perceptions. This study aimed to explore the factors influencing the transition of Chinese adolescents with IBD from the perspectives of patients, parents, and healthcare providers. Methods: A descriptive qualitative research was conducted. Purposive sampling was used to recruit 36 participants, including 13 patients, 13 parents, and 10 providers, from a tertiary pediatric IBD center, a tertiary adult IBD center, and the China Crohn's & Colitis Foundation in Zhejiang Province, China. Individual semi-structured interviews were used to collect data on facilitators and barriers to the transition process. Conventional content analysis was used to analyze the interview transcripts. Results: Nine primary themes were identified. Patients with young age, prolonged disease duration, severe disease, academic pressures such as the Gaokao, low level of disease acceptance, limited transition consciousness, low self-efficacy, poor transition communication, and inadequate medical transition system serve as barriers. While patients with the mentality of guilt towards their parents; parents with low education levels and intensive work schedules, high levels of disease acceptance, and situations of parent-child separation; stakeholders with high transition consciousness, high transition self-efficacy, and effective transition communication act as facilitators. Furthermore, community support and hospital guide services were also contributing factors during the transition. Conclusions: This study offers comprehensive insights into the factors affecting the transition of Chinese adolescent IBD patients. The process is continuously influenced by stakeholders, community, and healthcare environments and policies. Identifying these factors provides healthcare providers with a reference for developing and implementing targeted transition interventions. [ABSTRACT FROM AUTHOR]

Background Despite the fact that there are more and more Chinese nurses living and working in Australia, relatively little is known about the decisions to emigrate made by these nurses. Objectives To explore factors influencing China-educated nurses to emigrate to Australia. Design This was a secondary analysis of 46 semi-structured interviews with 28 China-educated nurses working in Australia. Conventional content analysis was used, and the results are presented thematically. Results The nurses emigrated for a wide variety of reasons: (a) personal factors (to improve English, to see more of the world and cultures, to seek novelty and adventure); (b) work-related factors (better work environment and more career choices); (c) social factors (better living environment and lifestyle); (d) cultural factors (positive perceptions in China of those who emigrate or have overseas experiences), and (e) economic factors (higher salaries and greater purchasing power). Conclusions Confirming findings from similar studies, China-educated nurses’ decisions to migrate are complex and not based solely on economic expectations. Personal and cultural factors play vital roles in nurses’ migration decisions. [ABSTRACT FROM AUTHOR]

Background: High levels of disease acceptance are important predictors of improved psychological well-being, treatment outcomes, and enhanced quality of life. Relatively few studies have focused on the process of disease acceptance in patients with Crohn's disease (CD), particularly those who are newly diagnosed.Purpose: To explore the disease acceptance process in newly diagnosed CD patients.Patients and Methods: A descriptive qualitative approach was employed. Sixteen CD patients from 2 tertiary hospitals in Hangzhou, Zhejiang were recruited through purposive sampling using a maximum variation strategy. Semi-structured interviews were conducted. The interviews were transcribed verbatim and analysed using conventional content analysis.Results: Five phases of the psychosocial process of the "acceptance journey" of newly diagnosed CD patients emerged from the data analysis: (1) praying for the illness to not be CD; (2) not being able to accept CD; (3) having to accept CD; (4) knowing that CD should be acceptable; and (5) starting to accept CD. Patients at the stage of "starting to accept CD" are more proactive and motivated to face the disease, and their overall acceptance of the disease is higher than that of the previous stages. However, by the end of the interview, 2 patients remained at the stage of "having to accept CD", and 3 patients remained at the stage of "knowing that CD should be acceptable". Two patients entered the stage of "starting to accept CD" and then reverted back to one of the previous stages.Conclusion: The "acceptance journey" of newly diagnosed CD patients is dynamic, individual and reversible. Traditional Chinese cultural values such as respect for authority, the philosophy of wu-wei and family responsibility contribute to the acceptance of CD in Chinese patients. Hence, there is a need to provide early and culturally tailored psychological support or interventions according to the stages of acceptance. [ABSTRACT FROM AUTHOR]

Background and Purpose: Transnational nurse migration is a growing phenomenon. This study explored the experiences of China-educated nurses working in Australia. Design: Using a constructivist grounded theory method, 46 in-depth interviews were conducted with 28 China-educated nurses in two major cities in Australia. Results: The core category emerged was “reconciling different realities”. Three phases of reconciling were conceptualised: realising, struggling, and reflecting. Realising refers to an awareness of the discrepancies between different realities. Struggling reflects the dilemma of the “middle position” and how being situated as “the other” is experienced. Reflecting is the process of making sense of the experience and rationalising the gains and losses associated with immigration. Conclusions: This study produced a theoretical understanding of the experience of China-educated nurses working in Australia. The findings not only inform Chinese nurses who wish to migrate but contribute to the implementation of more effective support services for immigrant nurses. [ABSTRACT FROM AUTHOR]

Background: Automated hematology analyzers are used to perform cell counts in body fluids. However, little is known about how the results compare between different analyzers. Methods: A single batch of serous fluid samples was used to evaluate the cell counting performance of 3 hematology analyzers: CD 3700, XE 2100, and LH 750. Two hundred and seventy four serous fluid samples were used to evaluate the accuracy of the analyzers and to compare the results between different analyzers. Results: The precision and linearity of the 3 analyzers were acceptable for both white blood cell counts and red blood cell counts with a low carryover rate. The limits of detection for white blood cells with the CD 3700, XE 2100, and LH 750 analyzers were 0.033×109/l, 0.07×109/l, and 0.20×109/l, respectively. Performing background counts had no influence on cell counts for any of the analyzers. For those samples over the limit of detection, there was agreement between the automated and manual counting methods. There were also reasonably comparable cell count results between the 3 analyzers. Conclusions: When the serous fluid cell counts are over the limit of detection, the analyzers produce accurate test results. Additionally, the results are comparable between the 3 hematology analyzers. [ABSTRACT FROM AUTHOR]

Context: As a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient. Objective: To investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies. Methods: Eleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome. Results: All test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome. Conclusions: Patient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value. [ABSTRACT FROM AUTHOR]

Abstract: Background: The migration of registered nurses as a response to a global nurse shortage has seen a growth in research interest in this area. Much of the research focuses on differences in language and culture which are posed as the attributes of the immigrant nurse. Objectives: In reporting on an analysis of data drawn from China-educated nurses working in the Australian health care system, this paper explores the social construction of difference and the related intersection of difference and racialisation. Design: A symbolic interactionist approach informed 46 in-depth interviews with 28 China-educated nurses. The method of analysis was initial and focused coding and constant comparison of data. The focus of interpretation was on human action and interaction as contextual and thus structural factors were critical to the analysis. Results: Two levels of meaning were depicted in this study: difference as “you are you and I am I” and difference as “incompetence”. Negative meanings were ascribed to difference which in turn legitimised inequality and held the potential to perpetuate racism. Conclusions: We argue that it is problematic to conceptualise difference as individual attributes. Difference needs to be contextualised and thus explored as a complex and socially constructed concept that in its application has social and political implications for immigrant nurses in Australia and elsewhere. [Copyright &y& Elsevier]

Coal gangue is the main solid waste produced in coal mining, and the resource utilization of coal gangue has become a popular topic in the industry. It is gradually applied that coal gangue concrete (CGC) prepared by replacing crushed stone with coal gangue in a certain proportion. Further, adding fly ash (FA) to CGC improves not only the performance of CGC, but also the resource utilization rate of coal-based solid waste, and this helps meet low carbon and environmental protection requirements. The effect of FA on the macro performance of CGCs has been investigated extensively; however, only few studies have examined microinterface structure changes, interface transition zone (ITZ) characteristics, and mortar microcharacteristics, which are closely related to the macro performance of concrete. Therefore, exploring the effect of FA on the microstructure performance of CGC has great scientific value and engineering significance. In this study, concrete with a 40% replacement rate of coal gangue, which is widely used in engineering practice, is considered the research object. The effect of 0%, 10%, 20%, 30%, and 40% FA on ITZ thickness, mortar pore structure, and micromorphology of CGC aggregates and the relationship between the microstructure parameters and mechanical properties of concrete are analyzed using microhardness tests, mercury intrusion porosimetry, and scanning electron microscopy. The research results indicate that, (1) with an increase in FA content, the decreasing range of the ITZ thickness of gangue concrete first increases and then decreases, and the total porosity of the mortar area increases, but the proportion of serious damage pores decreases; (2) the thickness of the coal gangue ITZ is smaller than that of crushed stone ITZ, which is attributed to the refinement of FA and the filling of ITZ pores; and (3) FA has a dual improvement effect on the ITZ performance of the gangue concrete and the pore structure of the mortar area. These research results provide a reference for further research on the influence of mineral admixtures on concrete ITZ and theoretical guidance for the modification methods of CGC. [ABSTRACT FROM AUTHOR]

• Discussing the frost resistance of gangue concrete under different replacement rates. • Proposing the freeze–thaw damage evolution model of coal gangue concrete with different gangue replacement rate. • Investigating the relationship of freeze–thaw damage value of coal gangue concrete and the change of relative peak strain under different replacement rates. • Establishing the coal gangue concrete freeze–thaw damage constitutive model. This paper aims to solve one of the main problems in the application of coal gangue concrete (CGC), that is, whether its mechanical properties can meet the requirements of norms and actual engineering practice in the freeze–thaw environment. In this work, the CGC with coal gangue coarse aggregate replacement rates of 0%, 20%, 40%, and 60% were subjected to freeze–thaw cycle. The frost resistance of CGC was comprehensively analyzed and evaluated from its appearance, relative mass, compressive strength and relative dynamic elastic modulus. Based on the regular pattern of relative dynamic elastic modulus of CGC, the evolution model of freeze–thaw damage of CGC was established to analyze the development of freeze–thaw damage. The CGC specimens after 0, 25, 50, 75, and 100 freeze–thaw cycles were measured by uniaxial compression constitutive test and acoustic emission test. The mechanical properties of CGC under freeze–thaw environment were analyzed through the whole stress–strain curve and the variation of parameters with freeze–thaw cycles. Finally, based on the acoustic emission characteristics of CGC in compression failure process, a load damage evolution model of CGC was established. Combined with the freeze–thaw damage evolution model, the freeze–thaw damage constitutive relationship of CGC was established, which can consider both freeze–thaw damage and load damage. The results suggest that the replacement rate of gangue for the CGC structure that requires frost resistance should be less than 40%; The freeze–thaw damage evolution model of CGC established in this paper can truly and effectively reflect the development of freeze–thaw damage of CGC under freeze–thaw environment; The CGC freeze–thaw damage constitutive model established in this paper can accurately reflect the overall process damage characteristics of CGC under freeze–thaw and load damage. It can provide a theoretical basis for the durability evaluation and life prediction of CGC structure in cold regions. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing number of Crohn's disease patients self-administering nasogastric feeding as enteral nutrition support therapy, no studies have reported the experiences of self-administering nasogastric feeding from the perspective of these patients. Objectives: To explore the initial trigger factors for the self-administration of nasogastric feeding by Crohn’s disease patients and to understand the experiences of self-administration of nasogastric feeding, its effects on various aspects of life and work, and relevant challenges and coping mechanisms encountered during this therapy in order to improve the understanding of this group of patients among medical staff and the public. Design: This study adopted a descriptive qualitative method. Crohn's disease patients from several tertiary hospitals in Hangzhou, Zhejiang, were recruited to participate through purposive sampling combined with maximum variation and the snowballing technique. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method. Results: A total of 11 Crohn's disease patients were interviewed. Four themes and eight subthemes emerged from the analysis: rejecting the self-administration of nasogastric feeding (being afraid of inserting the nasogastric tube, having concerns about nasogastric feeding), accepting the reality of nasogastric feeding (health being the most important, followed by having sources of support), nasogastric feeding as a double-edged sword (the disturbances and efficacies of nasogastric feeding), and nasogastric feeding as a part of life (becoming accustomed to tube insertion and taking nasogastric feeding for granted). Conclusions: Apart from suffering from physical discomfort, diet and body image disturbances, and inconveniences in daily life, Crohn's disease patients who self-administered nasogastric feeding faced many psychological challenges. Many of these patients eventually adjusted to a life with nasogastric feeding, but not everyone achieved this state. Therefore, health care providers, including physicians and nurses, and the general public should collaborate to help these patients adapt to their “new lives” as soon as possible. [ABSTRACT FROM AUTHOR]

• Coal gangue concrete (CGC) with 30% fly ash (FA) content has the best workability and strength. • The modification effect of FA on the working properties and strength of CGC is determined. • FA modifies CGC via physical and chemical changes in pores and ITZ structure. • Appropriate FA content enhances the effect of average gel pore size on the properties. Fly ash (FA) and gangue are common solid wastes. In this study, coarse aggregates were replaced with coal gangue at a constant substitution rate of 40% to promote the application of coal gangue in concrete production. The modification effect of FA content on the working and mechanical properties of coal gangue concrete (CGC) and its modification mechanism were revealed. At the macro level, the compression, splitting tensile, and flexural strengths were tested by using a pressure tester. From the microscopic aspect, the pore structure of the CGC was analyzed by nuclear magnetic resonance technique. The chemical products of the mortar and the micromorphology of the interfacial transition zone (ITZ) were characterized via scanning electron microscopy and energy dispersive spectroscopy. Results showed that the working and mechanical properties of the CGC can be significantly improved by adding an appropriate FA content. From a physical aspect, the modification mechanism is that fine FA particles fill the pores of the CGC during early cement hydration and contribute to the strength as microaggregates. Chemically, the secondary hydration of the FA particles changes the microstructure of the mortar and the ITZ. On the basis of grey relational analysis, the gel pore volume has the highest correlation with the concrete strength and the average gel pore size presents a linear relationship with the mechanical strength. Furthermore, appropriate addition of FA can significantly improve the average gel pore size. [ABSTRACT FROM AUTHOR]