bluuebunny/crossref_metadata_2025 huggingface dataset:
Inter-Brain Synchronization During Sandplay Therapy: Individual Analyses
Authors: Akimoto Michiko , Tanaka Takuma , Ito Junko , Kubota Yasutaka , Seiyama Akitoshi
Published: November 2021

Interactions between the client (Cl) and therapist (Th) evolve therapeutic relationships in psychotherapy. An interpersonal link or therapeutic space is implicitly developed, wherein certain important elements are expressed and shared. However, neural basis of psychotherapy, especially of non-verbal modalities, have scarcely been explored. Therefore, we examined the neural backgrounds of such therapeutic alliances during sandplay, a powerful art/play therapy technique. Real-time and simultaneous measurement of hemodynamics was conducted in the prefrontal cortex (PFC) of Cl-Th pairs participating in sandplay and subsequent interview sessions through multichannel near-infrared spectroscopy. As sandplay is highly individualized, and no two sessions and products (sandtrays) are the same, we expected variation in interactive patterns in the Cl–Th pairs. Nevertheless, we observed a statistically significant correlation between the spatio-temporal patterns in signals produced by the homologous regions of the brains. During the sandplay condition, significant correlations were obtained in the lateral PFC and frontopolar (FP) regions in the real Cl-Th pairs. Furthermore, a significant correlation was observed in the FP region for the interview condition. The correlations found in our study were explained as a “remote” synchronization (i.e., unconnected peripheral oscillators synchronizing through a hub maintaining free desynchronized dynamics) between two subjects in a pair, possibly representing the neural foundation of empathy, which arises commonly in sandplay therapy (ST).
Social and Professional Impact of Learning Communities Within the Alliances for Graduate Education and the Professoriate Program at Michigan State University
Authors: Thomas Steven D. , Ali Abdifatah , Alcover Karl , Augustin Dukernse , Wilson Neco
Published: November 2021

At Michigan State University (MSU), the AGEP learning community features the participation of over 70% of the African-American, Latinx, and Native-American under-represented minorities (URM), also referred to as Black, Indigenous, and People of Color (BIPOC) doctoral students in fields sponsored by the National Science Foundation (NSF). Monthly learning community (LC) meetings allow AGEP participants to create dialogues across disciplines through informal oral presentations about current research. The learning communities also offer opportunities to share key information regarding graduate school success and experience; thus providing a social network that extends beyond the academic setting. At MSU, AGEP also provides an interdisciplinary and multigenerational environment that includes graduate students, faculty members, post-docs and prospective graduate students. Using monthly surveys over a 4-year period, we evaluated the impact of this AGEP initiative focusing on the utility of the program, perceptions of departmental climate, career plans and institutional support. Findings indicate that AGEP participants consider their experiences in the program as vital elements in the development of their professional identity, psychological safety, and career readiness. Experiences that were identified included networking across departments, focus on career placement, involvement in minority recruitment and professional development opportunities. Additionally, AGEP community participants resonated with the “sense of community” that is at the core of the MSU AGEP program legacy. In this article, we proposed a variation of Tomlinson’s Graduate Student Capital model to describe the AGEP participants’ perceptions and experiences in MSU AGEP. Within this 4-year period, we report over 70% graduation rate (completing with advanced degrees). More than half of Ph.D. students and almost 30% of master’s degree students decided to pursue academia as their careers. In addition, we found a high satisfaction rate of AGEP among the participants. Our analysis on graduate student capital helped us identify motivating capital development by years spent at MSU and as an AGEP member. These findings may provide some insight into which capitals may be deemed important for students relative to their experiences at MSU and in AGEP and how their priorities change as they transition toward graduation.
Emerging School Readiness Profiles: Motor Skills Matter for Cognitive- and Non-cognitive First Grade School Outcomes
Authors: Kamphorst Erica , Cantell Marja , Van Der Veer Gerda , Minnaert Alexander , Houwen Suzanne
Published: November 2021

A promising approach for studying school readiness involves a person-centered approach, aimed at exploring how functioning in diverse developmental domains conjointly affects children’s school outcomes. Currently, however, a systematic understanding lacks of how motor skills, in conjunction with other school readiness skills, affect a child’s school outcomes. Additionally, little is known about longitudinal associations of school readiness with non-academic (e.g., socioemotional) school outcomes. Therefore, we examined the school readiness skills of a sample of Dutch children (N = 91) with a mean age of 3 years and 4 months (46% girls). We used a multi-informant test battery to assess children’s school readiness in terms of executive functions (EFs), language and emergent literacy, motor skills, and socioemotional behavior. During the spring term of a child’s first grade year, we collected academic and non-academic (i.e., EFs, motor skills, socioemotional- and classroom behavior, and creative thinking) school outcomes. A latent profile analysis revealed four distinct profiles. Children in the “Parent Positive” (29%) profile were rated positively by their parents, and performed variably on motor and language/emergent literacy skills tests. The second profile–“Multiple Strengths” (13%)–consisted of children showing strengths in multiple domains, especially with respect to motor skills. Children from the third profile–“Average Performers” (50%)–did not show any distinct strengths or weaknesses, rather displayed school readiness skill levels close to, or just below the sample mean. Finally, the “Parental Concern” (8%) profile was characterized by high levels of parental concerns, while displaying slightly above average performance on specific motor and language skills. Motor skills clearly distinguished between profiles, next to parent-rated EFs and socioemotional behavior, and to a lesser extent emergent literacy skills. School readiness profiles were found to differ in mean scores on first grade academic achievement, parent- and teacher-rated EFs, motor skills, parent-rated socioemotional functioning, and pre-requisite learning skills. The pattern of mean differences was complex, suggesting that profiles could not be ranked from low to high in terms of school outcomes. Longitudinal studies are needed to disentangle the interaction between emerging school readiness of the child and the surrounding context.
Cross-Format Integration of Auditory Number Words and Visual-Arabic Digits: An ERP Study
Authors: Finke Sabrina , Kemény Ferenc , Clayton Francina J. , Banfi Chiara , Steiner Anna F. , Perchtold-Stefan Corinna M. , Papousek Ilona , Göbel Silke M. , Landerl Karin
Published: November 2021

Converting visual-Arabic digits to auditory number words and vice versa is seemingly effortless for adults. However, it is still unclear whether this process takes place automatically and whether accessing the underlying magnitude representation is necessary during this process. In two event-related potential (ERP) experiments, adults were presented with identical (e.g., “one” and 1) or non-identical (e.g., “one” and 9) number pairs, either unimodally (two visual-Arabic digits) or cross-format (an auditory number word and a visual-Arabic digit). In Experiment 1 (N=17), active task demands required numerical judgments, whereas this was not the case in Experiment 2 (N=19). We found pronounced early ERP markers of numerical identity unimodally in both experiments. In the cross-format conditions, however, we only observed late neural correlates of identity and only if the task required semantic number processing (Experiment 1). These findings suggest that unimodal pairs of digits are automatically integrated, whereas cross-format integration of numerical information occurs more slowly and involves semantic access.
Understanding and Enhancing Chinese TEFL Teachers’ Motivation for Continuing Professional Development Through the Lens of Self-Determination Theory
Authors: Yang Jie
Published: November 2021

Teachers’ continuing professional development (CPD) is a dynamic process that coordinates teachers’ external behavior and internal states. Most teachers participate in varied forms of CPD activities either voluntarily or contractually. The more motivated teachers are to engage in CPD, the more likely they achieve professional and personal growth. Against this backdrop, the current study, adopting the framework of self-determination theory (SDT), sought to investigate the types and levels of Chinese college TEFL (Teaching English as a Foreign Language, hereafter TEFL) teachers’ motivation toward CPD. The questionnaire survey was administered to 402 academics who taught the English language in diverse universities in China. The quantitative analysis showed that teachers exhibited stronger identified regulation and intrinsic motivation than external regulation. Specifically, the exploratory factor analysis identified five motivational orientations: inner-directed academic improvement and cognitive interest, academic self-fulfillment and obligation, academic and social responsibility, social recognition and promotion, lacking the intention for CPD, which corresponded to the SDT motivation continuum. To triangulate, further interviews were conducted with 12 TEFL teachers. The findings of the qualitative analysis—the thematic analysis through Nvivo (Version 12) on the open-ended question and the interviews, revealed that teachers’ struggles in CPD were mainly concerned with the school-related, CPD-related, and teacher-related problems. Moreover, a big gap between teachers’ needs and contextual support was found to be bridged. Based on the findings, this study proposed that social conditions should support teachers’ basic psychological needs in order to sustain and enhance TEFL teachers’ motivation for CPD.
The Impact of Calling on Employee Creativity: Evidence From Internet Companies
Authors: Lv Jia , Chen Wanming , Ruan Yufang
Published: November 2021

With the rapid development of technology and increasingly fierce competition in the global market, innovation has become the most important competitive advantage for enterprises. Employee creativity is widely considered the source of organizational innovation. This study explores the antecedents of employee creativity from the perspective of career development in the context of high-technology industry. Specifically, we examine the effects of calling on employee creativity through the mediation of career commitment and the moderation of responsible leadership. With data collected from a sample of 218 respondents from internet companies, a series of regression analyses was conducted to test the proposed hypotheses. In addition, a moderated mediation model was further examined. Discussion, implications, and limitations are presented.
Emotional Responses Toward a New Research Policy Among Academics in a Chinese University
Authors: Lu Hua , Zhang Xiaorong
Published: November 2021

Teacher emotion has received prominent attention in the field of education as they are closely related to teacher identity and teachers’ well-being. While many previous studies have taken teachers’ emotions in teaching as their research focuses, this study investigated university English as a foreign language (EFL) teacher-researchers’ emotions and emotion regulation strategies in research in the context of a new research policy. One-on-one semi-structured interviews were conducted with seven EFL teacher-researchers at a Chinese university which implemented China’s new research policy of breaking the “five-only,” supplemented by the analysis of narrative frames and the institutional research documents. The data revealed that university EFL teacher-researchers experienced wide-ranging and diverse emotions at the micro-level, meso-level, and macro-level of research, with different attitudes toward the new research policy. They also employed multiple strategies of antecedent-focused and response-focused approaches to regulate emotions in research. This study helps unpack the complexity of emotions experienced by university teachers in research, and also calls for the attention of stakeholders to pay to the emotions and well-being of university EFL teachers.
The Ethical Use of Fit Indices in Structural Equation Modeling: Recommendations for Psychologists
Authors: Stone Bryant M.
Published: November 2021

Fit indices provide helpful information for researchers to assess the fit of their structural equation models to their data. However, like many statistics and methods, researchers can misuse fit indices, which suggest the potential for questionable research practices that might arise during the analytic and interpretative processes. In the current paper, the author highlights two critical ethical dilemmas regarding the use of fit indices, which are (1) the selective reporting of fit indices and (2) using fit indices to justify poorly-fitting models. The author highlights the dilemmas and provides potential solutions for researchers and journals to follow to reduce these questionable research practices.
Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer
Authors: Koranyi Susan , Hinz Andreas , Hufeld Julia M. , Hartung Tim J. , Quintero Garzón Leonhard , Fendel Uta , Letsch Anne , Rose Matthias , Esser Peter , Mehnert-Theuerkauf Anja
Published: November 2021

Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale-II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer.

Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach‘s Alpha (α). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatment-related variables were examined with ANOVAs.

Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with α = 0.93 for the DS-II total scale, α = 0.90 for the Meaning and Purpose subscale, and α = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).

Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.
Global Inequality in Service Sector Development: Trend and Convergence
Authors: Ma Ning , Shum Wai Yan , Han Tingting , Cheong Tsun Se
Published: November 2021

The COVID-19 pandemic has caused a huge impact on global service sector. In the pandemic background, to understand the disparity in service sector outputs at the global level is crucial for assessing the effectiveness of development policies in different countries. This study investigate the global service sector and it aims to investigate the transitional dynamics of the output from the service sector by adopting stochastic kernel analyses. Distribution dynamics analyses are carried out for all the countries in the world. The data are then divided into different regional and income groups to evaluate the impacts of geographical location and income on the development of the service sector. The results show that the Global North will continue to make greater strides, while the output capacity in many Global South countries struggles to reach the global average. Moreover, it is shown that countries with higher per capita income will perform better in the development of their service sector than those with low per capita income, thereby highlighting the persistence of global inequality. Finally, this study shows that the Sub-Saharan Africa region and the South Asia region both are very important in the alleviation of global inequality.
Psychological Benefits and Challenges of Ph.D. Entrance Exam Virtual Interviews During COVID-19 Pandemic: Does Gender Play a Role?
Authors: Ebadi Saman , Bashiri Saba
Published: November 2021

This study aimed to investigate the reflections of Iranian students on Ph.D. entrance exam interviews held virtually nationwide during the Pandemic. Two hundred thirty-one Ph.D. applicants were invited to fill out an anonymous online survey designed in Google Forms, 36 out of whom volunteered to participate in follow-up semi-structured interviews. Two ANOVA measures were used to investigate the possible influences of gender and prior virtual interview experience on the applicants’ perceptions. Thematic analysis was also adopted to explore the participants’ attitudes and perceptions toward virtual interviews (VI). Quantitative findings showed that Iranian Ph.D. applicants perceived VI as a flexible and helpful procedure that provided them with satisfactory interpersonal treatment. Still, they did not favor the procedure’s perceived behavioral control and ability to communicate information to perform procedural justice. Moreover, neither their gender nor their prior experience of the virtual interview was a predictor of their perspectives’ discrepancies. The thematic analysis of the qualitative data revealed that despite having some cognitive, personal, and financial benefits, VI posed some technical, communicative, and personal challenges. This study provides implications for universities and applicants who will use VI for different purposes in higher education.
An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression
Authors: Muscat Sherry-Anne , Hartelius Glenn , Crouch Courtenay Richards , Morin Kevin W.
Published: November 2021

Research over the last two decades has established ketamine as a safe, effective, fast-acting, and sustained antidepressant that significantly reduces adverse symptoms associated with depression, even in patients who are treatment resistant. Much of this research has evolved within the framework of several independent branches of scientific inquiry: in addition to the study of ketamine is a non-selective NMDAR antagonist with rapid antidepressant effects, it has also been found effective as a psychoplastogen that stimulates synaptogenesis and increases neuroplasticity, as a powerful anti-inflammatory that may improve inflammation-related depressive symptoms, as a substance that induces beneficial high entropy brain states, and as a subjectively impactful psychedelic agent. Each branch of inquiry has generated independent evidence of ketamine's efficacy but has advanced without substantive coordination or communication with other lines of inquiry. Integrative research that considers these branches of research together may lead toward a better understanding of ketamine's effects and improved treatment protocols and clinical outcomes. Such an overview can inform more comprehensive patient care through: (a) informed patient psychoeducation that encompasses all of ketamine's mechanisms of action; (b) calibration of optimal dosage to ensure induction and maintenance of high entropy brain states during each ketamine session utilizing EEG measurement; (c) Improved management of emergence side effects through proper care for set and setting; (d) inclusion of pre-selected appropriate music to enhance the emotional experience; (e) increased monitoring of ketamine effects on cortical activity, inter-hemispheric imbalance, and inflammation-related levels of cytokines to further improvements in ketamine protocols; and (f) appropriate timing of any adjunctive psychotherapy sessions to coincide with peak neurogenesis at 24–48 h post ketamine treatment.
Exploring Influences on Theory of Mind Impairment in Opioid Dependent Patients
Authors: Eidenmueller Katharina , Grimm Franz , Hermann Derik , Frischknecht Ulrich , Montag Christiane , Dziobek Isabel , Kiefer Falk , Bekier Nina Kim
Published: November 2021

Theory of mind (ToM) is an aspect of social cognition impaired in different addictive disorders, including opioid addiction. This study aimed at replicating ToM deficits in opioid dependent patients undergoing opioid maintenance treatment (OMT) and exploring the influence of substance use related variables, executive functions and childhood maltreatment on ToM in opioid dependent patients. 66 opioid dependent patients were tested using the Movie for Assessment of Social Cognition (MASC) and compared with the data of healthy controls. Furthermore, the opioid dependent patients underwent testing for executive functions and filled in the Childhood Trauma Questionnaire (CTQ). Performance on the MASC was significantly poorer in the opioid dependence group than in the control group, even when recent additional drug use and psychiatric comorbidities were controlled for. No correlations were found between ToM and substance use related factors. Aspects of ToM performance in opioid dependent patients correlated significantly with different EF domains. ToM correlated significantly with the CTQ scales for physical maltreatment. The results confirm impaired ToM in opioid dependent patients and highlight executive functions and childhood maltreatment as influential factors. The lack of associations between ToM and substance use related variables and the association with childhood maltreatment suggest that ToM impairments might be a risk factor predating substance abuse.
Introduction and Psychometric Validation of the Resilience and Strain Questionnaire (ResQ-Care)— A Scale on the Ratio of Informal Caregivers' Resilience and Stress Factors
Authors: Wuttke-Linnemann Alexandra , Palm Svenja , Scholz Lea , Geschke Katharina , Fellgiebel Andreas
Published: November 2021

Background: Informal caregivers are a particularly vulnerable population at risk for adverse health outcomes. Likewise, there are many scales available assessing individual caregiver burden and stress. Recently, resilience in caregivers gained increasing interest and scales started to assess resilience factors as well. Drawing on a homeostatic model, we developed a scale assessing both caregivers' stress and resilience factors. We propose four scales, two covering stress and two covering resilience factors, in addition to a sociodemographic basic scale. Based on the stress:resilience ratio, the individual risk of adverse health outcomes and suggestions for interventions can be derived.

Methods: A total of 291 informal caregivers filled in the ResQ-Care as part of a survey study conducted during the second wave of the COVID-19 pandemic in Germany. Exploratory factor analysis was performed. Validity analyses were examined by correlations with the Brief Resilience Scale (BRS), the Perceived Stress Scale (PSS-4) and the Geriatric Depression Scale (GDS-15).

Results: The data fitted our proposed four-factor solution well, explaining 43.3% of the variance. Reliability of each scale was at least acceptable with Cronbach's α ≥0.67 and MacDonald's ω ≥0.68 for all scales. The two strain scales weighed more than the resilience scales and explained 65.6% of the variance. Convergent and discriminant validity was confirmed for the BRS and PSS-4, whereas the GDS-15 correlation pattern was counterintuitive.

Conclusion: The factor structure of the ResQ-Care scale was confirmed, with good indications of reliability and validity. Inconsistent correlations of the scales with the GDS-15 might be due to a reduced validity of GDS-15 assessment during the COVID-19 lockdown.
Implementing an Exercise Physiology Clinic for Consumers Within a Community Mental Health Service: A Real-World Evaluation
Authors: Fibbins Hamish , Edwards Law , Morell Rachel , Lederman Oscar , Ward Philip , Curtis Jackie
Published: November 2021

Background: Physical activity significantly improves mental illness symptoms and physical health for people living with mental illness. Mental health services do not routinely provide their consumers with access to exercise professionals for physical activity engagement. Barriers exist to integrating physical activity as part of standard care including staff culture, finance, and resources. This study examines the feasibility of newly established exercise physiology clinic within a mental health service in Sydney, Australia.

Methods: A single site, open trial was conducted in a community centre within a large mental health district. A meeting room was converted into a part-time exercise physiology clinic where individualised physical activity interventions were delivered by an accredited exercise physiologist. Outcome measures including BMI, cardiovascular fitness, and self-reported physical activity were collected.

Results: A total of 84 mental health consumers (17% of eligible consumers within the mental health service) participated in the clinic on average for one exercise session weekly. Moderate-to-vigorous physical activity significantly increased and sedentary time significantly decreased (p < 0.001).

Conclusions: Exercise physiology clinics are feasible within mental health services and should be incorporated as part of standard care.
Health-Promoting Behaviors, Risk Perceptions, and Attention to COVID-19-Related Information: Comparing People's Responses to the COVID-19 Pandemic Across Times of Chinese New Year and Summer 2020 in Hong Kong
Authors: Xu Yue , Chen Hui-Fang , Yeung Wai Keung Jerf , Hsieh Chih-Wei , Yuan Hsiang-Yu , Chang Lennon Yao-Chung
Published: November 2021

Background: Since the start of the COVID-19 pandemic, individuals have been encouraged to engage in health-promoting behaviors, namely actions taken to prevent infection and keep themselves healthy, such as maintaining social distancing. However, other factors, such as risk perception and feelings of fear, also might influence whether an individual takes such measures. This study compared people's responses to the pandemic in terms of their adoption of COVID-19 health-promoting behaviors, COVID-19 risk perceptions, and attention to COVID-19-related information during two periods: the 2020 Chinese New Year (CNY) in Hong Kong (HK), i.e., the very beginning of the COVID-19 outbreak (Time 1, T1), and summer 2020, i.e., before and during the third wave of COVID-19 infections in HK (Time 2, T2).

Methods: Data were extracted from 180 HK participants, who were asked to recall and report their health-promoting behaviors, emotional and cognitive COVID-19 risk perceptions, and attention to COVID-19-related information during T1 and T2. A repeated-measures ANOVA series was conducted to investigate differences in public responses between the two aforementioned time points.

Main Findings: After controlling for the effects from gender, age, and education levels, the participants reported practicing more infection-prevention behaviors, experiencing a lower level of fear as a psychological response, and paying less attention to COVID-19-related information during T2 than T1.

Conclusions: This study addressed the need to monitor public responses to the COVID-19 pandemic, including changes in people's behaviors and psychological responses across time. The results also suggest that the HK public was steered toward striking a balance between strengthening their infection-prevention behaviors and reducing their fear of COVID-19 infection.
Pacing Forward in the Face of Fragility: Lessons From African Institutions and Governments' Response to Public Health Emergencies
Authors: Bitanihirwe Byron , Ssewanyana Derrick , Ddumba-Nyanzi Ismael
Published: November 2021

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of “unfortunate realties” ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013–2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.
A Systematic Survey of Physicians' Insights Into Lipohypertrophy
Authors: Shen Min , Shi Yun , Zheng Shuai , Fan Hongqi , Xu Jingjing , Yang Tao
Published: November 2021

Background: It is important that physicians be aware of LH. We designed a questionnaire to determine physician awareness, knowledge, and behaviors regarding LH in clinical practice.

Participants: A total of 499 questionnaires were completed by physicians in hospitals from 13 cities in Jiangsu Province, China.

Key Results: Compared with physicians at tertiary hospitals, significantly fewer physicians at primary hospitals reported awareness of LH and its screening methods. The proportion of resident physicians aware of LH was significantly lower than the proportion of senior physicians. The proportion of physicians who could identify all LH risk factors among the low-GDP group was significantly higher than the high-GDP group. Only 38.7% of doctors could successfully identify all the hazards associated with LH, but more doctors in tertiary hospitals were able to do so compared to those in secondary and primary hospitals. Compared with tertiary hospitals, the proportions of primary and secondary hospitals with management processes were significantly lower. The proportion of doctors who educated patients regarding LH prevention and treatment in primary hospitals was markedly lower than in tertiary hospitals.

Conclusions: Overall, physicians have an inadequate understanding of LH, especially in primary hospitals.
Application of Rough Set Theory to Improve Outpatient Medical Service Quality in Public Hospitals Based on the Patient Perspective
Authors: Du Man-Li , Tung Tao-Hsin , Tao Ping , Chien Ching-Wen , Chuang Yen-Ching
Published: November 2021

Purpose: To analyze the key factors and decision-making behaviors affecting overall satisfaction based on perceptual data of outpatients.

Methods: The official satisfaction questionnaire developed by the National Health Commission of the People's Republic of China was used. Rough set theory was used to identify the perception patterns between condition attributes (i.e., service factors) and a decision attribute (i.e., overall service level) and to express them in rule form (i.e., if-then).

Results: The four minimal-coverage rules, with strength exceeding 10% in the good class, and six crucial condition attributes were obtained: “Ease of registration (C1),” “Respected by registered staff (C2),” “Registered staff's listening (C3),” “Respected by doctor (C9),” “Signpost (C12),” and “Privacy (C16).” In addition, the average hit rate for 5-fold cross-validation was 90.86%.

Conclusions: A series of decision rules could help decision-makers easily understand outpatients' situations and propose more suitable programs for improving hospital service quality because these decision rules are based on actual outpatient experiences.
Epidemiological Characteristics of COVID-19 Resurgence in Areas Initially Under Control
Authors: Li Yazhen , Yang Kai , Zha Shanshan , Wang Lingwei , Chen Rongchang
Published: November 2021

Objectives: To investigate the epidemiological characteristics and infection routes of new cases in order to provide information for preventing COVID-19 resurgence in areas initially under control.

Methods: The information of new symptomatic and asymptomatic patients in Chinese mainland was collected. The location distribution, epidemic course, infection routes and patients' characteristics of outbreaks were described and analyzed.

Results: There were 43 new outbreaks with 3,795 symptomatic patients in Chinese mainland from March 21, 2020 to June 13, 2021. These outbreaks mainly occurred in central, border and coastal port cities. The main infection route of first generation indigenous patients was contact with imported cases and contaminated goods or environments. The infection routes of secondary generation patients mainly included family transmission, indoor social gathering infection, nosocomial infection and other infection routes. Family transmission was the most common infection route, and indoor social gathering was the most important reason for the large-scale outbreaks.

Conclusions: Strengthen the management of imported patients and staff in high-risk posts was the key point to avoid the first generation indigenous patients. Adequate family isolation, prompt management policies for indoor public place and monitor of population at risk of infection were key strategies for preventing COVID-19 resurgence in areas initially under control.
Influence of the First Wave of the COVID-19 Pandemic on Cancer Care in a German Comprehensive Cancer Center
Authors: Kirchberg Johanna , Rentsch Anke , Klimova Anna , Vovk Vasyl , Hempel Sebastian , Folprecht Gunnar , Krause Mechthild , Plodeck Verena , Welsch Thilo , Weitz Jürgen , Fritzmann Johannes
Published: November 2021

Introduction: During the first wave of the COVID-19 pandemic in 2020, the German government implemented legal restrictions to avoid the overloading of intensive care units by patients with COVID-19. The influence of these effects on diagnosis and treatment of cancer in Germany is largely unknown.

Methods: To evaluate the effect of the first wave of the COVID-19 pandemic on tumor board presentations in a high-volume tertiary referral center (the German Comprehensive Cancer Center NCT/UCC Dresden), we compared the number of presentations of gastrointestinal tumors stratified by tumor entity, tumor stage, and treatment intention during the pandemic to the respective data from previous years.

Results: The number of presentations decreased by 3.2% (95% CI −8.8, 2.7) during the COVID year 2020 compared with the pre-COVID year 2019. During the first shutdown, March–May 2020, the total number of presentations was 9.4% (−18.7, 1) less than during March–May 2019. This decrease was significant for curable cases of esophageal cancer [N = 37, 25.5% (−41.8, −4.4)] and colon cancer [N = 36, 17.5% (−32.6, 1.1)] as well as for all cases of biliary tract cancer [N = 26, 50% (−69.9, −15)] during the first shutdown from March 2020 to May 2020.

Conclusion: The impact of the COVID-19 pandemic on the presentation of oncological patients in a CCC in Germany was considerable and should be taken into account when making decisions regarding future pandemics.
Predictors of Seronegative Conversion After Centralized Management of Syphilis Patients in Shenzhen, China
Authors: Luo Zhenzhou , Ding Yi , Yuan Jun , Wu Qiuhong , Tian Lishan , Zhang Li , Li Bo , Mou Jinsong
Published: November 2021

Objective: The aim of this study was to explore the seronegative conversion status of syphilis patients after centralized management and to analyze potential determinants.

Materials and Methods: A retrospective population-based cohort study was conducted, and data for individuals who had been diagnosed with syphilis between 2011 and 2019 were retrieved from the Shenzhen Nanshan Center for Chronic Disease Control. Seroconversion statuses were summarized as percentages. Univariable and multiple Cox proportional hazard regression models were used to analyze the factors associated with seronegative conversion among syphilis patients.

Results: During the study period, 1,545 patients with syphilis participated in the syphilis convergence case management program on a voluntary basis, of whom 290 were excluded due to missing follow-up data. A total of 27.6% (346/1255) of patients with syphilis showed seronegative conversion. Multivariable analysis revealed that the following significantly determined syphilis seroconversion from positive to negative: younger age (15–19 years vs. ≥30 years: HR = 2.18), male gender (HR = 1.45), lower baseline toluidine red unheated serum test (TRUST) titer of ≤ 1:8 (HR = 2.23), and different disease stages, including latent syphilis (HR = 1.98), primary syphilis (HR = 7.67), and secondary syphilis (HR = 4.83).

Conclusions: Few patients with syphilis tested negative after treatment at the end of the study. Seronegative conversion in the patients was associated with age, sex, baseline TRUST titer, and syphilis stage.
Combining Repetitive Transcranial Magnetic Stimulation and Video Game-Based Training to Improve Dexterity in Parkinson's Disease: Study Protocol of a Randomized Controlled Trial
Authors: Pastore-Wapp Manuela , Lehnick Dirk , Nef Tobias , Bohlhalter Stephan , Vanbellingen Tim
Published: November 2021

Introduction: Patients with Parkinson's disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL) due to dysfunctional supplementary motor area (SMA). The aim of this clinical trial protocol work is to describe how the effectiveness of a combined repetitive transcranial magnetic stimulation (rTMS) over SMA and video-game-based skill training (VBT) in PD will be evaluated. The short and long-term benefits are assessed.

Methods and analysis: A single-blind (patients) stratified (based on Hoehn & Yahr) parallel randomized sham-controlled rTMS-VBT study with a baseline and two follow-up measurements (3 and 12 weeks) is being conducted. These measurements include the dexterity questionnaire 24 (DextQ-24) as a primary outcome, and nine hole peg test and coin rotation task as main secondary dexterity outcomes. Further secondary outcomes will be the subscale II of the movement disorders society unified PD rating scale (MDS-UPDRS) to assess improvements on overall ADL and the Parkinson's Disease Questionnaire-39 to assess quality of life. Thirty-six outpatients (from one neurorehabilitation center) with PD (diagnosis based on brain bank criteria) will be recruited who report difficulties with dexterity in performing ADL. All PD patients will receive a 45-min VBT three times a week for 3 weeks. The PD patients randomized in the experimental group will receive VBT preceded by real rTMS, being intermittent theta burst (iTBS) stimulation sessions. The PD patients randomized to the control group receive a VBT with sham rTMS.

Discussion: The study will provide evidence to determine whether a combined iTBS and VBT skill intervention is more effective than a VBT intervention alone to improve dexterity in PD.

Ethics and dissemination: The study was approved by the Ethics Committee for Northwest and Central Switzerland (EKNZ), Switzerland 2019–00433. The study will be conducted in accordance with the Helsinki Declaration and the Guidelines of Good Clinical Practice. Informed consent will be signed prior to subject enrolment. Dissemination will include submission to international peer-reviewed professional journals and presentation at international congresses.

The study protocol has been registered in the clinicaltrials.gov registry with the identification code: NCT04699149.
Level and Predictors of Knowledge of Reproductive Rights Among Haramaya University Students, Eastern Ethiopia: A Cross-Sectional Study
Authors: Yuya Mohammed , Adem Hassen Abdi , Assefa Nega , Alemu Addisu , Umer Abdurezak Adem , Oljira Lemessa
Published: November 2021

Background: Globally, two-thirds of pre-mature deaths and one-third of the total disease burden in adults are associated with problems that began in adolescent and youth. Global and national acting educational and health policies, strategies, and programs designed to promote, implement, and improve adolescent and youth sexual and reproductive health services utilization should be responsive, consider the knowledge of reproductive rights and risk factors. This study assessed the level and predictors of knowledge of reproductive rights among Haramaya University students in Ethiopia.

Methods: An institution-based cross-sectional study was conducted among randomly selected Haramaya University students from March 1 to 24, 2018. A self-administered pre-tested structured questionnaire was used to collect data from participants. Data were entered using EpiData version 3.1 and analyzed using SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with knowledge of reproductive rights. Adjusted odds ratio (AOR) with 95% CI was used to report association and significance was declared at P-value < 0.05.

Results: Of 822 total students invited to the study, 812 (98.8%) respondents participated in the study. A total of 424 students (52.2%, 95% CI: 48.8, 55.4%) had an above-average level of knowledge on reproductive rights. Participants who were in the fourth and above year of the study [AOR = 2.37 (1.58, 3.54)], whose father's had higher education [AOR = 1.89 (1.27, 2.80)], who came from rich families [AOR = 1.54 (1.07, 2.21)], in the health faculty [AOR = 3.37 (2.17, 5.23)], utilized reproductive health services [AOR = 2.81 (2.21, 4.98)] and participated in reproductive health club [AOR = 1.77 (1.27, 2.47)] were significantly associated with knowledge of reproductive rights.

Conclusion: Around half of the participants knew reproductive rights. In this study, lack of awareness (information) on reproductive health issues and absence of reproductive health services utilization were strong independent predictors of knowledge of reproductive rights.
“Claim vs. Reality”—A German Case Study on Modes and Functions of Sports-Pedagogical Communication
Authors: Jaitner David , Koerner Swen , Serwe-Pandrick Esther
Published: November 2021

Academic sports pedagogy continuously assures itself of its disciplinary foundations and determines its position in the structure of modern sciences. While communication is based on differences, the distinction between claim and reality plays a crucial role in sports pedagogy. However, the forms and functions in which the distinction appears have not been more closely investigated in sports pedagogic. This article starts with this in mind, exemplarily focusing on academic sports pedagogy in Germany. While analyzing 212 scientific texts of sports-pedagogical provenance, three central variations of the distinction could be identified, which persist until today and are present in the discipline's central discussion lines: (1) hierarchical demarcation, (2) unsystematic approach, (3) direct synthesis. From a functional point of view, the distinction between claim and reality continuously (re)organizes the relationship of sports pedagogy to other scientific disciplines, educational policy guidelines, and school practice expectations, thus proving to be a supporting pillar of disciplinary identity work.
Positive Influence of Certification on the Financial Performance of Cocoa Production Models in Cameroon
Authors: Lescuyer Guillaume , Bassanaga Simon
Published: November 2021

Cameroon plans to double its cocoa production in the coming decade in line with international requirements for sustainable and deforestation-free cocoa. Private certification, which has developed considerably in recent years, should help achieve this objective. Based on a literature review and 63 individual interviews with farmers, we identified four archetypes of cocoa production using the criteria of plantation size, degree of shade, and support from public or private extension services. We analyzed the average operating accounts of the four archetypes. Our findings show that the net profit rates obtained by small-scale certified producers are 14% (in the savannah zone) and 24% (in the forest zone). These rates are much higher than for the other two production models. Certification schemes provide technical and financial support, which has a positive influence on the practices of many small-scale producers and compensates for the lack of public services, which are now almost non-existent. A hybrid governance of the cocoa sector in Cameroon could clarify and improve the organization of the interactions between public regulation and private certification systems.
A Consensus Meeting on Expert Recommendations on Operating Specifications for Laparoscopic Radical Resection of Hilar Cholangiocarcinoma
Authors: Xiong Yongfu , Jingdong Li , Zhaohui Tang , Lau Joseph
Published: November 2021

Background: With advances in techniques and technologies, laparoscopic radical resection of hilar cholangiocarcinoma (HCCA) has gradually been carried out in major medical centers in China. Its feasibility and safety have been accepted by a group of Chinese surgical experts.

Methods: To standardize perioperative management of HCCA by using laparoscopic resectional approach, to ensure safety of the patient with standardized management, improve prognosis of the patient, and enable proper application and refinement of this surgical approach, the expert group on specifications for laparoscopic radical resection of HCCA in China organized a consensus meeting.

Results: Laparoscopic radical resection of HCCA is difficult and associated with high risks. Appropriate patients should be carefully selected and this surgical approach should be promoted gradually. The experts met and arrived at 16 recommendations on perioperative management of HCCA by using laparoscopic surgery. There were three recommendations on preoperative diagnosis and evaluation; one recommendation on surgical principles of treatment; one recommendation on indications and contraindications; one recommendation on credentialing, staffing, and equipment; nine recommendations on laparoscopic techniques in different stages of operation; and one recommendation on indications for conversion to open surgery.

Conclusion: Laparoscopic surgery for HCCA is still in the early phase of development. This consensus provides a clinical reference with the aim to promote and to facilitate its further development.