bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Learner Participation in Online Discussion Forums in Massive Open Online Courses: The Role of Mandatory Participation
Authors: Du Zhao , Wang Fang , Wang Shan , Xiao Xiao
Published: April 2022

Online discussion forums are an essential and standard setup in online courses to facilitate interactions among learners. However, learners’ inadequate participation in online discussion forums is a long-standing challenge, which necessitates instructor intervention and the design consideration of online learning platforms. This research proposes and studies the role of mandatory participation, i.e., learners’ participation in online course forums by instructors’ requirements, in fostering their voluntary participation and boosting their learning performance. This novel effect link between mandatory participation and voluntary participation has not been assessed in previous research. An empirical study is conducted using a large-scale dataset of 27,767 learners from a leading massive open online course (MOOC) platform in China. The findings indicate that besides its direct effect on learning performance, learners’ mandatory participation has a significant positive effect on their voluntary participation in online course forums, enhancing learning performance. Moreover, the effect of mandatory participation on voluntary participation varies across learner groups, being more prominent for early registrants than late registrants and part-time learners than full-time learners. This research contributes to the online learning literature by introducing mandatory participation as a viable approach to foster voluntary participation and boost learning performance through enhanced voluntary participation. It provides evidence on the effectiveness of the novel design feature of MOOC platforms that enables and facilitates the mandatory participation mechanism in online learning.
Children and Adolescents’ Ingroup Biases and Developmental Differences in Evaluations of Peers Who Misinform
Authors: Farooq Aqsa , Ketzitzidou Argyri Eirini , Adlam Anna , Rutland Adam
Published: April 2022

Previous developmental research shows that young children display a preference for ingroup members when it comes to who they accept information from – even when that information is false. However, it is not clear how this ingroup bias develops into adolescence, and how it affects responses about peers who misinform in intergroup contexts, which is important to explore with growing numbers of young people on online platforms. Given that the developmental span from childhood to adolescence is when social groups and group norms are particularly important, the present study took a Social Reasoning Developmental Approach. This study explored whether children and adolescents respond differently to a misinformer spreading false claims about a peer breaking COVID-19 rules, depending on (a) the group membership of the misinformer and their target and (b) whether the ingroup had a “critical” norm that values questioning information before believing it. 354 United Kingdom-based children (8–11 years old) and adolescents (12–16 years old) read about an intergroup scenario in which a peer spreads misinformation on WhatsApp about a competitor. Participants first made moral evaluations, which asked them to judge and decide whether or not to include the misinformer, with follow-up “Why?” questions to capture their reasoning. This was followed by asking them to attribute intentions to the misinformer. Results showed that ingroup preferences emerged both when participants morally evaluated the misinformer, and when they justified those responses. Participants were more likely to evaluate an ingroup compared to an outgroup misinformer positively, and more likely to accuse an outgroup misinformer of dishonesty. Adolescents attributed more positive intentions to the misinformer compared with children, with children more likely to believe an outgroup misinformer was deliberately misinforming. The critical norm condition resulted in children making more positive intentionality attributions toward an ingroup misinformer, but not an outgroup misinformer. This study’s findings highlight the importance of shared group identity with a misinformer when morally evaluating and reasoning about their actions, and the key role age plays in intentionality attributions surrounding a misinformer when their intentions are ambiguous.
Entrepreneurial Institutional Environment and Entrepreneurial Orientation: The Mediating Role of Entrepreneurial Passion
Authors: Zhou Xue , Zhang Ling , Su Xiaoyun
Published: April 2022

The entrepreneurial institutional environment is the external factor that entrepreneurial enterprises rely on for survival. Our interest is in how entrepreneurs cultivate entrepreneurial orientation in response to the highly uncertain entrepreneurial situation. Based on the cognitive appraisal theory of emotion, we analyzed the impact of the entrepreneurial institutional environment on entrepreneurial orientation through entrepreneurial passion. This study applied stepwise regression analyses to test the hypotheses on a sample of 197 entrepreneurs from the co-creation space in China. The output of the study showed that the entrepreneurial institutional environment had a positive effect on entrepreneurial orientation and that entrepreneurial passion played a mediating role between the entrepreneurial institutional environment and entrepreneurial orientation.
Age Differences in Speech Perception in Noise and Sound Localization in Individuals With Subjective Normal Hearing
Authors: Weissgerber Tobias , Müller Carmen , Stöver Timo , Baumann Uwe
Published: April 2022

Hearing loss in old age, which often goes untreated, has far-reaching consequences. Furthermore, reduction of cognitive abilities and dementia can also occur, which also affects quality of life. The aim of this study was to investigate the hearing performance of seniors without hearing complaints with respect to speech perception in noise and the ability to localize sounds. Results were tested for correlations with age and cognitive performance. The study included 40 subjects aged between 60 and 90 years (mean age: 69.3 years) with not self-reported hearing problems. The subjects were screened for dementia. Audiological tests included pure-tone audiometry and speech perception in two types of background noise (continuous and amplitude-modulated noise) which was either co-located or spatially separated (multi-source noise field, MSNF) from the target speech. Sound localization ability was assessed and hearing performance was self-evaluated by a questionnaire. Speech in noise and sound localization was compared with young normal hearing adults. Although considering themselves as hearing normal, 17 subjects had at least a mild hearing loss. There was a significant negative correlation between hearing loss and dementia screening (DemTect) score. Speech perception in noise decreased significantly with age. There were significant negative correlations between speech perception in noise and DemTect score for both spatial configurations. Mean SRTs obtained in the co-located noise condition with amplitude-modulated noise were on average 3.1 dB better than with continuous noise. This gap-listening effect was severely diminished compared to a younger normal hearing subject group. In continuous noise, spatial separation of speech and noise led to better SRTs compared to the co-located masker condition. SRTs in MSNF deteriorated in modulated noise compared to continuous noise by 2.6 dB. Highest impact of age was found for speech perception scores using noise stimuli with temporal modulation in binaural test conditions. Mean localization error was in the range of young adults. Mean amount of front/back confusions was 11.5% higher than for young adults. Speech perception tests in the presence of temporally modulated noise can serve as a screening method for early detection of hearing disorders in older adults. This allows for early prescription of hearing aids.
The Impact of COVID-19 Pandemic on Corporate Social Responsibility and Job Embeddedness in China
Authors: Meirun Tang , Lockey Steven , Blenkinsopp John , Yueyong He , Ling Ling
Published: April 2022

This article aims to investigate the impact of employee perceptions of corporate social responsibility (CSR) on job embeddedness under the drastic circumstances of coronavirus disease 2019 (COVID-19). This study also investigated the role of organizational identification as a psychological mechanism linking employee perceptions of corporate social responsibility (CSR) to job embeddedness. Survey data were collected from 325 employees in banking industry of China and analyzed using partial least squares structural equation modeling (PLS-SEM). Results revealed that CSR to employees and organizational identification were positively and significantly related to job embeddedness, while CSR to customers, CSR to government, and CSR to society did not significantly predict job embeddedness. Organizational identification fully mediated the relationship between CSR to customers, CSR to government, CSR to society and job embeddedness, and partially mediated the relationship between CSR to employees and job embeddedness. The results suggest engaging in CSR activities can lead employees to identify themselves with the organization and enhance their embeddedness. The article concludes with several implications for practice and recommendations for future research.
To Quiz or to Shoot When Practicing Grammar? Catching and Holding the Interest of Child Learners: A Field Study
Authors: Brom Cyril , Kolek Lukáš , Lukavský Jiří , Děchtěrenko Filip , Volná Kristina
Published: April 2022

Learning grammar requires practice and practicing grammar can be boring. We examined whether an instructional game with intrinsically integrated game mechanics promotes this practice: compared to rote learning through a quiz. We did so “in the field.” Tens of thousands children visited, in their leisure time, a public website with tens of attractive online games for children during a 6-week-long period. Of these children, 11,949 picked voluntarily our grammar training intervention. Thereafter, unbeknown to them, they were assigned either to the game or the quiz condition. By means of learning analytics, we examined variables related to participants’ persistence and performance. The results showed large participant drop-out before completing the first level in both conditions (42.2%), confirming the boringness of the topic. More children completed at least one level in the game compared to the quiz (61.8 vs. 53.6%). However, more children completed the intervention (all six levels) with the quiz (6.0 vs. 4.3%). In the game, children answered fewer questions correctly (36.3 vs. 47.4) and made more errors compared to the quiz (16.1 vs. 13.1). These findings suggest that even if a game initially catches user attention, it may not hold it. Plus, even if it is a minimalistic game with intrinsic integration of learning and playing, it may be distractive. We conclude that persistence in practicing grammar may be driven by other means than by a game’s shooting mechanics; for instance, by a desire to learn the topic and a feeling of achievement or by quizzing mechanics.
RETRACTED: Mental Health Problems Among Front-Line Healthcare Workers Caring for COVID-19 Patients in Vietnam: A Mixed Methods Study
Authors: Nguyen Thu Kim , Tran Ngoc Kim , Bui Thuy Thanh , Tran Len Thi , Tran Nhi Tho , Do Mai Tuyet , Nguyen Tam Thanh , Tran Huong Thi Thanh
Published: April 2022

Aim

Healthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam.

Methods

A descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients to May 01, 2020.

Results

The results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19.

Conclusion

During the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam.
Reviews via Mobile: The Role of Mobile Cues and Typographical Errors in Online Review Adoption
Authors: Lim Young-shin , Maslowska Ewa
Published: April 2022

Online consumer reviews are increasingly being written on and posted from mobile devices such that some platforms have started to indicate when this is the case with cues such as “via mobile” (i.e., mobile cue). Reviews from mobile devices differ from those from non-mobile devices; for example, reviews from mobile devices are more likely to include typographical errors. For this study, a web-based experiment was conducted to investigate viewers’ evaluation and adoption of online reviews in regard to a mobile cue and typographical errors. The results indicate an interaction effect between the presence of a mobile cue and typographical errors. When a review did not include typographical errors, the presence of a mobile cue negatively affected the evaluation and adoption of information (i.e., the viewer’s attitude toward the reviewed restaurant). However, the effects of a mobile cue were not significant for a review with typographical errors. Further, the results suggest that the viewer’s perception of the review writing effort and the review’s information usefulness are sequential mediators explaining the information adoption mechanism. The findings provide interesting insights into consumers’ perceptions of online reviews in the current media landscape in which the large-scale adoption of mobile devices is a well-recognized phenomenon.
Musicdrops@work: Impact of Shared Listening to Short Live Music Interventions on Sense of Belonging and Subjective Wellbeing at Work
Authors: Güsewell Angelika , Gay-Balmaz Sarah , Imseng Catherine
Published: April 2022

Assuming live music can foster belonging in the workplace, this study linked companies in the secondary and tertiary sectors with the world of music performance. Specifically, students from a Swiss music university offered live mini-concerts (10 min of classical music) on the premises of three companies over a period of 3 months. To analyze the impact of these brief musical interventions on the sense of belonging of staff in these companies, a mixed methods approach was adopted using a standardized questionnaire (Barcelona Music Reward Questionnaire, a short online questionnaire on the appreciation of the music and the emotional state induced, and focus groups interviews at the end of the experiment). The short concerts were much appreciated. On the individual level, they led to a greater sense of pleasure and were perceived as a break, a possibility to connect to one’s emotions and above all, as a “moment for oneself.” On the group level, the short concerts allowed the members of teams to meet, prompted conversations and new ways of sharing, created links, and offered opportunities to get to know work colleagues differently and to discover them on a more personal level.
Sex Differences in Social Cognition and Association of Social Cognition and Neurocognition in Early Course Schizophrenia
Authors: Kubota Ryotaro , Okubo Ryo , Ikezawa Satoru , Matsui Makoto , Adachi Leona , Wada Ayumu , Fujimaki Chinatsu , Yamada Yuji , Saeki Koji , Sumiyoshi Chika , Kikuchi Akiko , Omachi Yoshie , Takeda Kazuyoshi , Hashimoto Ryota , Sumiyoshi Tomiki , Yoshimura Naoki
Published: April 2022

Background

Both impairment and sex differences in social cognition and neurocognition have been documented in schizophrenia. However, whether sex differences exist in the association between social cognition and neurocognition are not known. We aimed to investigate the contribution of areas of neurocognition to theory of mind (ToM) and hostility bias, representing social cognition, according to sex in early course schizophrenia.

Methods

In this cross-sectional study, we assessed neurocognition using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS) and assessed the ToM and hostility bias subdomains of social cognition using the Social Cognition Screening Questionnaire (SCSQ) in 131 participants (65 female, 66 male) diagnosed with schizophrenia within 5 years of onset. Sex differences were analyzed usingt-tests. The associations of neurocognitive subdomains with ToM and hostility bias according to sex were analyzed using multiple regression analysis. Results were adjusted by age, estimated premorbid intelligence quotient, and symptomatology.

Results

No sex differences were found in ToM (p= 0.071) or hostility bias (p= 0.057). Higher verbal fluency was significantly associated with higher ToM in females (p< 0.01), whereas higher executive function was significantly associated with higher ToM in males (p< 0.05). Higher verbal fluency was significantly associated with lower hostility bias in females (p< 0.05), whereas neurocognition and hostility bias were not significantly associated in males.

Conclusion

The results suggest that neurocognition associated with social cognition differ according to sex. These differences should be considered for more effective treatment of social cognition.
Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia?
Authors: Pinto Sabina M. , Cheung Jason P. Y. , Samartzis Dino , Karppinen Jaro , Zheng Yong-ping , Pang Marco Y. C. , Wong Arnold Y. L.
Published: April 2022

Introduction

Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP.

Objectives

This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders.

Methods

Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses.

Results

People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP.

Conclusion

More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
Dopamine Supersensitivity: A Novel Hypothesis of Opioid-Induced Neurobiological Mechanisms Underlying Opioid-Stimulant Co-use and Opioid Relapse
Authors: Strickland Justin C. , Gipson Cassandra D. , Dunn Kelly E.
Published: April 2022

Emergent harms presented by the co-use of opioids and methamphetamine highlight the broader public health challenge of preventing and treating opioid and stimulant co-use. Development of effective therapeutics requires an understanding of the physiological mechanisms that may be driving co-use patterns, specifically the underlying neurobiology of co-use and how they may facilitate (or be leveraged to prevent) continued use patterns. This narrative review summarizes largely preclinical data that demonstrate clinically-meaningful relationships between the dopamine and opioid systems with direct implications for opioid and stimulant co-use. Synthesized conclusions of this body of research include evidence that changes in the dopamine system occur only once physical dependence to opioids develops, that the chronicity of opioid exposure is associated with the severity of changes, and that withdrawal leaves the organism in a state of substantive dopamine deficit that persists long after the somatic or observed signs of opioid withdrawal appear to have resolved. Evidence also suggests that dopamine supersensitivity develops soon after opioid abstinence and results in increased response to dopamine agonists that increases in magnitude as the abstinence period continues and is evident several weeks into protracted withdrawal. Mechanistically, this supersensitivity appears to be mediated by changes in the sensitivity, not quantity, of dopamine D2 receptors. Here we propose a neural circuit mechanism unique to withdrawal from opioid use with implications for increased stimulant sensitivity in previously stimulant-naïve or inexperienced populations. These hypothesized effects collectively delineate a mechanism by which stimulants would be uniquely reinforcing to persons with opioid physical dependence, would contribute to the acute opioid withdrawal syndrome, and could manifest subjectively as craving and/or motivation to use that could prompt opioid relapse during acute and protracted withdrawal. Preclinical research is needed to directly test these hypothesized mechanisms. Human laboratory and clinical trial research is needed to explore these clinical predictions and to advance the goal of developing treatments for opioid-stimulant co-use and/or opioid relapse prevention and withdrawal remediation.
Epidemiological and Clinical Characteristics of Influenza Outbreaks Among Children in Chongqing, China
Authors: Meng Xuchen , Zhao Han , Ou Rong , Zeng Qing , Lv Huiqun , Zhu Hua , Ye Mengliang
Published: April 2022

Influenza is a global serious public health threat. Seasonal influenza among children in Chongqing has been a heavy health burden. To date, few studies have examined the spatial and temporal characteristics of influenza. This research sheds new light on correlating them with influenza outbreaks with data of over 5 years (2014–2018). All cluster outbreaks among preschool and school-age children reported in Chongqing were collected through the Public Health Emergency Management Information System. The demographical, epidemiological, and clinical data of the cases were analyzed. From 2014 to 2018, a total of 111 preschool- and school-based influenza-like illness outbreaks involving 3,549 cases were identified. Several clinical symptoms that were analyzed in this study showed significant contrast between influenza A and B. Spatial autocorrelation analysis over the 5-year data detected Xiushan district being the most likely cluster. The exploration of the spatial distribution and clinical characteristics of influenza cluster of children in Chongqing could help the effective implementation of health policies. Future studies should be conducted to monitor the outbreaks of influenza among children.
Association Between Dietary Inflammatory Index and Sex Hormone Binding Globulin and Sex Hormone in U.S. Adult Females
Authors: Liu Nuozhou , Feng Ying , Luo Xinyao , Ma Xue , Ma Fang
Published: April 2022

Context

It is still unknown whether the dietary inflammatory index (DII) is associated with sex hormones and sex hormone binding globulin (SHBG) in adult women.

Objective

This study examined the association between DII and sex hormones and SHBG in U.S. adult women.

Design and Participants

This was a cross-sectional study. A total of 2,092 female participants (age ≥ 20) from the 2013–2016 National Health and Nutrition Examination Survey were enrolled. Dietary inflammatory potential was assessed by DII based on 24-h dietary recall. SHBG was assessed using immuno-antibodies and chemo-luminescence, whereas sex hormones were measured by ID-LC–MS/MS.

Results

The average DII was 0.21 ± 1.68, ranging from −4.54 (most anti-inflammatory) to 4.28 (most pro-inflammatory). After adjusting all covariates, a per-unit DII increase in DII tertile 3 was related to an 8.05 nmol/L SHBG decrease compared to DII tertile 1 (P = 0.0366). Subgroup analysis stratified by perimenopausal period found that this negative association remained strong but only existed in women before (β = −3.71, 95% CI: −7.43, −0.12, P = 0.0423) the perimenopausal period. Interaction terms were added to both subgroup analyses and found no significant heterogeneity among different body mass index (BMI) or perimenopausal groups (P > 0.05). Treshold analyses showed that the association of age with SHBG was an inverted U-shaped curve (inflection point: age = 50 yrs).

Conclusion

A proinflammatory diet caused decreased SHBG. However, more well-designed studies are still needed to validate and verify the causal relationship between DII and sex hormones and SHBG.
Beliefs, Perceptions, and Behaviors Regarding Chronic Respiratory Diseases of Roma in Crete, Greece: A Qualitative FRESH AIR Study
Authors: Anastasaki Marilena , van Bree Egid M. , Brakema Evelyn A. , Tsiligianni Ioanna , Sifaki-Pistolla Dimitra , Chatzea Vasiliki E. , Crone Matty C. , Karelis Andreas , van der Kleij Rianne M. J. J. , Poot Charlotte C. , Reis Ria , Chavannes Niels H. , Lionis Christos
Published: April 2022

Background

The global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD.

Methods

For this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior.

Results

We conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator).

Conclusion

These five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations.
Artificial Intelligence Radiotherapy Planning: Automatic Segmentation of Human Organs in CT Images Based on a Modified Convolutional Neural Network
Authors: Shen Guosheng , Jin Xiaodong , Sun Chao , Li Qiang
Published: April 2022

Objective:

Precise segmentation of human organs and anatomic structures (especially organs at risk, OARs) is the basis and prerequisite for the treatment planning of radiation therapy. In order to ensure rapid and accurate design of radiotherapy treatment planning, an automatic organ segmentation technique was investigated based on deep learning convolutional neural network.

Method

A deep learning convolutional neural network (CNN) algorithm called BCDU-Net has been modified and developed further by us. Twenty two thousand CT images and the corresponding organ contours of 17 types delineated manually by experienced physicians from 329 patients were used to train and validate the algorithm. The CT images randomly selected were employed to test the modified BCDU-Net algorithm. The weight parameters of the algorithm model were acquired from the training of the convolutional neural network.

Result

The average Dice similarity coefficient (DSC) of the automatic segmentation and manual segmentation of the human organs of 17 types reached 0.8376, and the best coefficient reached up to 0.9676. It took 1.5–2 s and about 1 h to automatically segment the contours of an organ in an image of the CT dataset for a patient and the 17 organs for the CT dataset with the method developed by us, respectively.

Conclusion

The modified deep neural network algorithm could be used to automatically segment human organs of 17 types quickly and accurately. The accuracy and speed of the method meet the requirements of its application in radiotherapy.
Epidemiology, Drug Susceptibility, and Clinical Risk Factors in Patients With Invasive Aspergillosis
Authors: Wang Yuerong , Zhang Luwen , Zhou Longrong , Zhang Min , Xu Yuanhong
Published: April 2022

Background

This study aimed to investigate the Aspergillus species distribution, antifungal sensitivities, clinical characteristics, and risk factors of patients with invasive aspergillosis (IA) in a tertiary teaching hospital in Anhui Province.

Methods

In the present study, 156 Aspergillus isolates were collected from patients admitted to a 2,800-bed comprehensive hospital between January 2019 and April 2021. The epidemiology of Aspergillus species was well-examined, and its antifungal susceptibility was specifically measured by the microbroth dilution method. The risk factors of patients with IA were documented and analyzed intensively. In addition, gene sequencing was employed to determine gene mutations of cytochrome P450 14-α sterol demethylase-Aspergillus (cyp51A) associated with azole resistance among Aspergillus fumigatus.

Results

The Aspergillus species distribution was dominated by A. fumigatus (56.41%), Aspergillus flavus (20.51%), and Aspergillus niger (15.38%) locally. In particular, all Aspergillus species showed very low minimum inhibitory concentrations (MICs, ≤ 0.5 μg/ml) for azoles and echinocandins, slightly high MICs (1.66–2.91 μg/ml) for amphotericin B, and exceptionally high MICs (>64 μg/ml) for flucytosine. Azole-resistant rate of Aspergillus species in this local region reached up to 5.79%. Correlation analyses of multiple antifungals indicate a significant MIC relevance between isavuconazole and voriconazole (Pearson correlation coefficient was 0.81, P < 0.0001). The clinical risk factors for patients with IA were found primarily to be pulmonary diseases (P = 0.007) and patients' age (P < 0.001). Notably, three mutant loci (TR46/Y121F/T289A) of the cyp51A gene were identified in azole-resistant A. fumigatus.

Conclusions

The Aspergillus species emerged increasingly, of which A. fumigatus and A. flavus remained the main pathogens for invasive Aspergillus infections in the local region. The vast majority of Aspergillus species exhibited good susceptibility to all the antifungals, except flucytosine. The local occurrence of azole-resistant Aspergillus species grew gradually and needed monitoring in time. Pulmonary diseases and age were likely considered as highly associated risk factors for IA. To our knowledge, the clinically isolated azole-resistant A. fumigatus with TR46/Y121F/T289A mutations identified here were rarely reported in the area of China.
A Rapid Literature Review of Multi-Criteria Decision Support Methods in the Context of One Health for All-Hazards Threat Prioritization
Authors: Zhao Jiawei , Smith Tiffany , Lavigne Melissa , Aenishaenslin Cécile , Cox Ruth , Fazil Aamir , Johnson Ana , Sanchez Javier , Hermant Benoit
Published: April 2022

Background

Multi-Criteria Decision Analysis (MCDA) is a decision support tool that can be used in public health emergency management. The use of a One Health lens in MCDA can support the prioritization of threats and interventions which cut across the human, animal, and environmental domains. Previous literature reviews have focused on creating a snapshot of MCDA methodological trends. Our study provides an update to the MCDA methods literature with key considerations from a One Health perspective and addresses the application of MCDA in an all-hazards decision-making context.

Methods

We conducted a literature search on MEDLINE, EMBASE, SCOPUS, the CAB database, and a limited online gray literature search in partnership with a librarian from Health Canada. Articles were limited to those published in the year 2010 or later in a high-income setting (OECD member countries).

Results

Sixty-two articles were included for synthesis. Of these articles, most were Canadian studies (20%); and prioritized health risks, threats, and interventions in the human domain (69%). Six commonly used prioritization criteria were identified: threat, health, intervention, strategic, social, and economic impact. Stakeholders were engaged in 85% of studies and commonly consisted of government groups, non-governmental groups, subject matter experts, and the public. While most articles (65%) included elements of One Health based on our definition, only 5 studies (9%) explicitly acknowledged One Health as a guiding principle for the study. Forty seven percentage of studies noted that MCDA was beneficial in supporting the decision-making process.

Conclusion

Current literature on health prioritization presents some variability in the depth of integration of the One Health framework and on the use of various MCDA methodologies given prioritization objectives. Studies which applied a comprehensive One Health approach, prioritized disparate threats, or conducted cyclical prioritizations for governing bodies were broad in scope, but sparse. The results of our review indicate the need for better guidance on the integration of a One Health approach and the use of various MCDA methods given the main prioritization objectives.
Cost-Effectiveness Analysis of Five Systemic Treatments for Unresectable Hepatocellular Carcinoma in China: An Economic Evaluation Based on Network Meta-Analysis
Authors: Zhao Mingye , Pan Xingming , Yin Yue , Hu Hongfei , Wei Jifu , Bai Zhaoshi , Tang Wenxi
Published: April 2022

Background and Objective

Unresectable hepatocellular carcinoma (uHCC) is the main histological subtype of liver cancer and causes a great disease burden in China. We aimed to evaluate the cost-effectiveness of five first-line systemic treatments newly approved in the Chinese market for the treatment of uHCC, namely, sorafenib, lenvatinib, donafenib, sintilimab plus bevacizumab (D + A), and atezolizumab plus bevacizumab (T + A) from the perspective of China's healthcare system, to provide a basis for decision-making.

Methods

We constructed a network meta-analysis of 4 clinical trials and used fractional polynomial models to indirectly compare the effectiveness of treatments. The partitioned survival model was used for cost-effectiveness analysis. Primary model outcomes included the costs in US dollars and health outcomes in quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $33,521 (3 times the per capita gross domestic product in China) per QALY. We performed deterministic and probabilistic sensitivity analyses to investigate the robustness. To test the effect of active treatment duration on the conclusions, we performed a scenario analysis.

Results

Compared with sorafenib, lenvatinib, donafenib, D + A, and T + A regimens, it yielded an increase of 0.25, 0.30, 0.95, and 1.46 life-years, respectively. Correspondingly, these four therapies yielded an additional 0.16, 0.19, 0.51, and 0.86 QALYs and all four ICERs, $40,667.92/QALY gained, $27,630.63/QALY gained, $51,877.36/QALY gained, and $130,508.44/QALY gained, were higher than $33,521 except for donafenib. T + A was the most effective treatment and donafenib was the most economical option. Sensitivity and scenario analysis results showed that the base-case analysis was highly reliable.

Conclusion

Although combination therapy could greatly improve patients with uHCC survival benefits, under the current WTP, donafenib is still the most economical option.
A Window Into Mental Health: Developing and Pilot-Testing a Mental Health Promotion Intervention for Mexican Immigrants Through the Ventanilla de Salud Program
Authors: Martínez Rodríguez Delia Lilian , González Vázquez Tonatiuh , Márquez Serrano Margarita , Groot Mary de , Fernandez Alicia , Gonzalez Casanova Ines
Published: April 2022

Background

Mexican immigrants in the United States face mental health challenges, disparities, and limited access to healthcare; however, mental health promotion efforts specifically targeting this population have been insufficient. The objective of this study was to develop and test a mental health promotion intervention based on protective mental health factors and coping strategies for Mexican immigrants recruited through a free, consulate-based program in Atlanta.

Material and Methods

Working with the Ventanilla de Salud program, we conducted a longitudinal study in three phases: formative research and design, pre-intervention assessment and post-implementation evaluation. The intervention was designed based on the health promotion model and interviews with stakeholders. Qualitative information was collected by semi-structured interviews with participants before and after the intervention. Quantitative outcomes were knowledge about protective factors and coping mechanisms, and psychosocial distress. Differences were assessed using the Wilcoxon non-parametrical test. Intent-to-treat analysis was conducted with all participants who signed the informed consent (carrying last observation forward), and a complete case analysis was conducted with those who attended at least 70% of the sessions and completed the post- implementation evaluation.

Results

Twenty-five participants were enrolled in the intervention. Mean age was 38 years, and the majority were women. Only nine participants attended at least 70% of the sessions and completed the final evaluation. Men, those who did not complete high school, and workers in service or construction jobs were more likely to drop out. Knowledge about protective factors [pre- vs. post-intervention median (inter-quartile range) = 111 (100, 120) vs. 115 (100, 124)] and coping mechanisms [96 (85, 104) vs. 99 (90, 110)], as well as psychosocial distress [3 (2, 3) vs. 2 (2, 3)] improved after the intervention in both intent-to treat and complete case analyses (p < 0.05). Qualitative results also support improvements in targeted protective factors.

Discussion

The intervention was successful in improving psychological distress among Mexican immigrants. These results support the implementation of evidence-based mental health promotion interventions among Mexican immigrants via free and familiar programs. A limitation was the high attrition; future studies should explore approaches to improve retention in this population.
Spatial and Temporal Differences in the Health Expenditure Efficiency of China: Reflections Based on the Background of the COVID-19 Pandemic
Authors: Shi Yi , Xie Yufeng , Chen Huangxin , Zou Wenjie
Published: April 2022

The outbreak of the COVID-19 pandemic has brought several challenges to China's national health services, causing great risks and uncertainties to people's lives. Considering China's huge population and relatively small medical investment and its good performance in the COVID-19 pandemic, this research utilizes the hybrid meta-frontier model to analyze health expenditure efficiencies of 30 provinces in China from 1999 to 2018 and compares spatial and temporal differences of the efficiencies in regards to regional forward position and national common frontier. The results show an obvious difference in health expenditure efficiency in different provinces along the regional frontier, in which the efficiency gap in the eastern region is the largest. Moreover, the room for improvement in health expenditure efficiency varies from region to region. For the national common frontier, Beijing is the most efficient, while Guizhou is the least. The eastern region owns the most efficient technical level of health expenditure efficiency, and there is a large efficiency distance between it and the western region. The findings offer effective guidance for elevating the expenditure structure and spatial resource allocation of public health and for promoting the equalization of high quality basic medical services.
Cluster of Acute Appendicitis Among High School Tibetan Students in Nanchang, China: Investigation, Control, and Prevention
Authors: Guo Yitian , Ye Deqiang , Yang Guifang , Liu Guozhen , Cui Xiaochen , Tan Shiyun , Guo Yi
Published: April 2022

Objective

Infectious etiology of acute appendicitis is a current hot topic. The most of study on appendicitis came from sporadic patients and focused on clinical treatment rather than control and prevention of appendicitis in the population. The present study aims to investigate the epidemiological features of cluster of acute appendicitis, risk factors, and evaluate effectiveness of control and prevention in population.

Methods

We conducted longitudinal study on a cluster of acute appendicitis among Tibetan students at a high school in eastern China, which was divided into three stages: 1. We retrospectively collected epidemiological data and clinical data to explore risk factor and possible transmission route in August of 2005; 2. We conducted targeted measures from August of 2005 and analyzed incidence trend from 2000 to 2010; 3. Since no new patients occurred in 2011, we conducted surveillance from the beginning of 2012 until July 2018.

Results

Among 973 Tibetan students, there were 120 patients with more female patients (102 of 499, 20.4%) than male patients (18 of 474, 3.8%) from January of 2000 to December of 2010. The 4-year cumulative incidence rates in female students enrolled in 2001, 2002, 2003, 2004, 2005, 2006 were 26.8% (11 of 41), 27.1% (13 of 48), 44.7% (21 of 47), 42.4% (14 of 33), 23.1% (9 of 39), and 19.3% (11 of 57), respectively before their graduation. There was a clustering feature. Mutual contact with patients before the onset of symptoms was an important risk factor (Adjusted OR 4.89, 95% CI: 1.67–14.35). Transmission route may be fecal-oral infection. Before conducting targeted measures, the incidence rate increased from 2000 and peaked in 2005. After conducting targeted measures, the incidence rate decreased year by year until 2010. Under surveillance from January of 2012 to July of 2018, only four sporadic patients occurred at this school.

Conclusion

This cluster of acute appendicitis had features of an infectious disease in epidemiology, which can be controlled and prevented by targeted measures. Our study may also be used for prevention of sporadic patients and be generalized in general population as cluster of appendicitis occurred in many provinces of China.
Advanced MRI Protocols to Discriminate Glioma From Treatment Effects: State of the Art and Future Directions
Authors: Malik Dania G. , Rath Tanya J. , Urcuyo Acevedo Javier C. , Canoll Peter D. , Swanson Kristin R. , Boxerman Jerrold L. , Quarles C. Chad , Schmainda Kathleen M. , Burns Terry C. , Hu Leland S.
Published: April 2022

In the follow-up treatment of high-grade gliomas (HGGs), differentiating true tumor progression from treatment-related effects, such as pseudoprogression and radiation necrosis, presents an ongoing clinical challenge. Conventional MRI with and without intravenous contrast serves as the clinical benchmark for the posttreatment surveillance imaging of HGG. However, many advanced imaging techniques have shown promise in helping better delineate the findings in indeterminate scenarios, as posttreatment effects can often mimic true tumor progression on conventional imaging. These challenges are further confounded by the histologic admixture that can commonly occur between tumor growth and treatment-related effects within the posttreatment bed. This review discusses the current practices in the surveillance imaging of HGG and the role of advanced imaging techniques, including perfusion MRI and metabolic MRI.
A Protocol to Understand the Implementation and Experiences of an Online Community-Based Performance Arts Programme Through and Beyond the COVID-19 Pandemic, Brain Waves
Authors: Estevao Carolina , Taylor Elizabeth , Jarrett Lucinda , Fort Joseph , Murphy Kevin , Woods Anthony , Crane Nikki , Fancourt Daisy , Pariante Carmine M. , Jones Fiona
Published: April 2022

Introduction

Individuals living with acquired brain injury experience numerous psychological, physical, and social challenges. Since the COVID-19 pandemic, many have experienced additional isolation, mental health issues and have had limited access to social and physical activities otherwise available in the community.

Materials and Methods

Brain Waves is a 12-week online performance arts programme developed during the COVID-19 pandemic, for people with acquired brain injury (ABI). The research component of Brain Waves is a qualitative study, using Interpretative Phenomenological Analysis (IPA) and ethnographic methods (Observations and Interviews). The study will recruit two distinct populations: individuals living with acquired brain injury (including people who have experienced traumatic brain injury and stroke who are participating in the programme) and stakeholders (facilitators, involved in the delivery of Brain Waves). This paper presents the protocol for a project which aims to gain an understanding of the implementation and experiences of creating and participating in an online community-based performance arts programme.