Internationalization of medical education in China: An investigation of medical graduates' global competence and its influencing factors

AIM

Global competence has become an important competence for medical graduates in the globalized world. However, research on it is scarce. This study was built upon the scholarship published in the field to measure medical graduates' global competence.

MATERIALS AND METHODS

A questionnaire was administered to China's medical graduates sampled from four institutions of medical education. Descriptive statistics were made to analyze the level of medical graduates GC. Influencing factors were investigated using multiple linear regression. Multiple levels of regression analysis were used to identify the influence of different independent variables on the dependent variable.

RESULTS

The sample had a relatively good level of global competence in general, but lacked skills in cross-cultural communication and international academic communication. "Internationalization Concept and System" and "International Development of Teachers" in the school dimension and "Taking International Courses", "International Publication" and "Participation in International Conference" in the dimension of individual international involvement had a significant positive impact on the cultivation of global competence.

CONCLUSIONS

The universities should aim for the construction of an effective institutional mechanism for internationalization to help improve students' global competence.

Privacy Concerns About Sharing General and Specific Health Information on Twitter: Quantitative Study

BACKGROUND

Twitter is a common platform for people to share opinions, discuss health-related topics, and engage in conversations with a wide audience. Twitter users frequently share health information related to chronic diseases, mental health, and general wellness topics. However, sharing health information on Twitter raises privacy concerns as it involves sharing personal and sensitive data on a web-based platform.

OBJECTIVE

This study aims to adopt an interactive approach and develop a model consisting of privacy concerns related to web-based vendors and web-based peers. The research model integrates the 4 dimensions of concern for information privacy that express concerns related to the practices of companies and the 4 dimensions of peer privacy concern that reflect concerns related to web-based interactions with peers. This study examined how this interaction may affect individuals' information-sharing behavior on Twitter.

METHODS

Data were collected from 329 Twitter users in the United States using a web-based survey.

RESULTS

Results suggest that privacy concerns related to company practices might not significantly influence the sharing of general health information, such as details about hospitals and medications. However, privacy concerns related to companies and third parties can negatively shape the disclosure of specific health information, such as personal medical issues (β=-.43; P<.001). Findings show that peer-related privacy concerns significantly predict sharing patterns associated with general (β=-.38; P<.001) and specific health information (β=-.72; P<.001). In addition, results suggest that people may disclose more general health information than specific health information owing to peer-related privacy concerns (t165=4.72; P<.001). The model explains 41% of the variance in general health information disclosure and 67% in specific health information sharing on Twitter.

CONCLUSIONS

The results can contribute to privacy research and propose some practical implications. The findings provide insights for developers, policy makers, and health communication professionals about mitigating privacy concerns in web-based health information sharing. It particularly underlines the importance of addressing peer-related privacy concerns. The study underscores the need to build a secure and trustworthy web-based environment, emphasizing the significance of peer interactions and highlighting the need for improved regulations, clear data handling policies, and users' control over their own data.

Sociodemographic Factors Predict Incident Mild Cognitive Impairment: A Brief Review and Empirical Study

OBJECTIVES

Mild cognitive impairment (MCI) is a transitional stage between normal cognitive aging and dementia that increases the risk of progressive cognitive decline. Early prediction of MCI could be beneficial for identifying vulnerable individuals in the community and planning primary and secondary prevention to reduce the incidence of MCI.

DESIGN

A narrative review and cohort study.

SETTING AND PARTICIPANTS

We review the MCI prediction based on the assessment of sociodemographic factors. We included participants from 3 surveys: 8915 from wave 2011/2012 of the China Health and Retirement Longitudinal Study (CHARLS), 9765 from the 2011 Chinese Longitudinal Healthy Longevity Survey (CLHLS), and 1823 from the 2014 Rugao Longevity and Ageing Study (RuLAS).

METHODS

We searched in PubMed, Embase, and Web of Science Core Collection between January 1, 2019, and December 30, 2022. To construct the composite risk score, a multivariate Cox proportional hazards regression model was used. The performance of the score was assessed using receiver operating characteristic (ROC) curves. Furthermore, the composite risk score was validated in 2 longitudinal cohorts, CLHLS and RuLAS.

RESULTS

We concluded on 20 articles from 892 available. The results suggested that the previous models suffered from several defects, including overreliance on cross-sectional data, low predictive utility, inconvenient measurement, and inapplicability to developing countries. Our empirical work suggested that the area under the curve for a 5-year MCI prediction was 0.861 in CHARLS, 0.797 in CLHLS, and 0.823 in RuLAS. We designed a publicly available online tool for this composite risk score.

CONCLUSIONS AND IMPLICATIONS

Attention to these sociodemographic factors related to the incidence of MCI can be beneficially incorporated into the current work, which will set the stage for better early prediction of MCI before its incidence and for reducing the burden of the disease.

Relationship between Racial Diversity in Medical Staff and Hospital Operational Efficiency: An Empirical Study of 3870 U.S. Hospitals

Demand for foreign nurses and medical staff is rapidly increasing due to the severe labor shortage in U.S. hospitals triggered by the COVID-19 pandemic. However, empirical studies on the effect of the racial diversity of medical staff on hospital operations are still lacking. This research gap is thus investigated based on the foreign medical staff working in 3870 U.S. hospitals. Results show that workforce racial diversity has a significantly positive relationship with hospital operational efficiency regarding occupancy rate, manpower productivity, capacity productivity, and case mix index. Notably, this study empirically supports that increasing the ratio of foreign nurses positively affects the overall operational efficiency of hospitals. In addition, the study results also indicate that the hospital location, size, ownership, and teaching status act as significant control variables for the relationship between racial diversity and hospital efficiency. These results imply that hospitals with these specific operating conditions need to pay more attention to racial diversity in the workplace, as they are structurally more sensitive to the relationship between racial diversity and operational efficiency. In short, the findings of this study suggest that hospital efficiency can be operationally improved by implementing workforce ethnic diversity. For this reason, hospital stakeholders and healthcare policymakers are expected to benefit from this study's findings. Above all, the results of this study imply that if an organization adapts to extreme external environmental changes (e.g., the COVID-19 pandemic) through appropriate organizational restructuring (i.e., expanding the workforce racial diversity by hiring foreign medical staff), the organization can gain a competitive advantage, a claim that is supported by contingency theory. Further, investors are increasingly interested in ESG, especially companies that embody ethical and socially conscious workplaces, including a diverse and inclusive workforce. Thereby, seeking racial diversity in the workforce is now seen as a fundamental benchmark for organizational behavior that predicts successful ESG business practices, a claim that is supported by stakeholder theory. Therefore, in conclusion, the findings of this study suggest that workforce racial diversity is no longer an optional consideration but should be considered as one of the essential determinants of competitive advantage in organizations, particularly in the healthcare sector.

Missing data matter: an empirical evaluation of the impacts of missing EHR data in comparative effectiveness research

OBJECTIVES

The impacts of missing data in comparative effectiveness research (CER) using electronic health records (EHRs) may vary depending on the type and pattern of missing data. In this study, we aimed to quantify these impacts and compare the performance of different imputation methods.

MATERIALS AND METHODS

We conducted an empirical (simulation) study to quantify the bias and power loss in estimating treatment effects in CER using EHR data. We considered various missing scenarios and used the propensity scores to control for confounding. We compared the performance of the multiple imputation and spline smoothing methods to handle missing data.

RESULTS

When missing data depended on the stochastic progression of disease and medical practice patterns, the spline smoothing method produced results that were close to those obtained when there were no missing data. Compared to multiple imputation, the spline smoothing generally performed similarly or better, with smaller estimation bias and less power loss. The multiple imputation can still reduce study bias and power loss in some restrictive scenarios, eg, when missing data did not depend on the stochastic process of disease progression.

DISCUSSION AND CONCLUSION

Missing data in EHRs could lead to biased estimates of treatment effects and false negative findings in CER even after missing data were imputed. It is important to leverage the temporal information of disease trajectory to impute missing values when using EHRs as a data resource for CER and to consider the missing rate and the effect size when choosing an imputation method.

Empirical Study of Surface Deterioration Analysis Based on Random Fields for Reinforced Concrete Structures in Marine Environment

Corrosion-induced deterioration of the in-service marine reinforced concrete (RC) structures may result in unsatisfactory serviceability or insufficient safety. Surface deterioration analysis based on random fields can provide information regarding the future development of the surface damage of the in-service RC members, but its accuracy needs to be verified in order to broaden its applications in durability assessment. This paper performs an empirical study to verify the accuracy of the surface deterioration analysis based on random fields. The batch-casting effect is considered to establish the "step-shaped" random fields for stochastic parameters in order to better coordinate their actual spatial distributions. Inspection data from a 23-year-old high-pile wharf is obtained and analyzed in this study. The simulation results of the RC panel members' surface deterioration are compared with the in-situ inspection results with respect to the steel cross-section loss, cracking proportion, maximum crack width, and surface damage grades. It shows that the simulation results coordinate well with the inspection results. On this basis, four maintenance options are established and compared in terms of the total amounts of RC panel members needing restoration and the total economic costs. It provides a comparative tool to aid the owners in selecting the optimal maintenance action given the inspection results, to minimize the lifecycle cost and guarantee the sufficient serviceability and safety of the structures.

Exploring the importance of a usable and emotional product design from the user's perspective

Usability and emotionality are important components of user experience. However, an equal consideration of both constructs in product design is not always possible due to sometimes competitive objectives. In order to foster a user-oriented design decision in such conflicting situations, this paper examines the general importance of both constructs and their dimensions from the user's perspective while taking into account socio-demographic variables. Examination was realised by conducting a product independent anonymous online survey (n = 130). The findings confirm that both constructs are important, yet in a direct comparison, usability is perceived as more important than emotionality. Taking selected dimensions of both constructs into account, an intuitive, easy and learnable usage, suitability for the user's task and freedom from impairment are particularly important in terms of usability. An aesthetic and pleasurable product design as well as originality is essential in terms of emotionality.Practitioner summary: This paper aims for supporting user-oriented design decisions in the context of conflicting objectives occurring in the consideration of usability and emotionality in product design. The conducted survey (n = 130) revealed usability as perceived more important than emotionality. Usability may thus be prioritised within conflicting design decisions.Abbreviations: DFG: German Research Foundation; e.g.: for example; GESIS: Leibniz Institute for the Social Sciences; m: metric; M: Mean; n: number of participants; n: nominal; o: ordinal; p level: level of statistical significance; RQ: Research question; r: correlation coefficient; V: Cramer's V; χ²: Chi-square.

Are Health Information Systems Ready for the Digital Transformation in Portugal? Challenges and Future Perspectives

PURPOSE

This study aimed to reflect on the challenges of Health Information Systems in Portugal at a time when technologies enable the creation of new approaches and models for care provision, as well as to identify scenarios that may characterize this practice in the future.

DESIGN/METHODOLOGY/APPROACH

A guiding research model was created based on an empirical study that was conducted using a qualitative method that integrated content analysis of strategic documents and semi-structured interviews with a sample of fourteen key actors in the health sector.

FINDINGS

Results pointed to the existence of emerging technologies that may promote the development of Health Information Systems oriented to "health and well-being" in a preventive model logic and reinforce the social and management implications.

ORIGINALITY/VALUE

The originality of this work resided in the empirical study carried out, which allowed us to analyze how the various actors look at the present and the future of Health Information Systems. There is also a lack of studies addressing this subject.

RESEARCH LIMITATIONS/IMPLICATIONS

The main limitations resulted from a low, although representative, number of interviews and the fact that the interviews took place before the pandemic, so the digital transformation that was promoted was not reflected. Managerial implications and social implications: The study highlighted the need for greater commitment from decision makers, managers, healthcare providers, and citizens toward achieving improved digital literacy and health. Decision makers and managers must also agree on strategies to accelerate existing strategic plans and avoid their implementation at different paces.

Assessing Factors That Influence Womenpreneurs' Intention to Use Technology: A Structural Equation Modeling Approach

The growth of financial literacy is significant nowadays. Because of this, more people are becoming increasingly responsible in their financial planning, investments, and living expenses. In developing new technology, it is necessary to know the technological acceptance of the prospective users of the technology itself. This study aims to identify the primary factors influencing the technology acceptance levels of lower-middle socio-economic users for a digital financial literacy application. The proposed model in this research was developed based on UTAUT, TAM, and Usability model, and it consists of six primary constructs: (1) Performance Expectancy; (2) Effort Expectancy; (3) Social Influence; (4) Resources and Cost; (5) Satisfaction; (6) Behavior Intention. All the hypotheses used in this study were statistically measured using SmartPLS tools. This study found that because many lower-middle socio-economic users lack sufficient understanding of technology to properly utilize it, that a digital platform is not the right tool to teach them financial literacy.

An empirical study on cultural identity measurement and its influence mechanism among heritage tourists

In the effort to integrate culture and tourism, an important strategy for the prosperity and sustainability of tourism, it is necessary to factor in tourists' cultural identity and emotional interaction with cultural heritage to keep pace with the trends of cultural heritage tourism. Drawing on in-depth interviews and software such as Nvivo and Smart-PLS, this study aims to develop and verify cultural identity measures for cultural heritage tourists, construct a theoretical model of cultural identity, travel experience, place attachment, satisfaction, and revisit intention, and verify the theoretical relationship between these dimensions in the Archaeological Ruins of Liangzhu City. The results show that cultural identity is positively associated with travel experience and place attachment but not significantly associated with satisfaction; travel experience is positively associated with place attachment and revisit intention; place attachment is positively associated with satisfaction; place attachment is positively associated with revisit intention; satisfaction is positively associated with revisit intention. This qualitative and quantitative research enriches the theoretical achievements concerning cultural identity among cultural heritage tourists and proposes recommendations for management practice accordingly.

An Empirical Study of the Contribution of Total Quality Management to Occupational Safety and Health Performance in Saudi Organizations

Working to ensure a safe and secure work environment for workers and employees has become an essential component of achieving organizational excellence in modern organizations. Occupational safety and health (OSH) programs help in attracting and retaining the workforce and human competencies, thus improving the operational and organizational performance of these organizations. Total quality management (TQM) is a management philosophy adopted by successful organizations to achieve sustainable business performance. This study aims to assess the level of implementation of total quality management and occupational safety and health in Saudi organizations and investigates the relationship between total quality management practices and occupational safety and health performance. Data were collected from a number of random organizations during the period November to December 2021. Based on a sample of 99 valid responses, empirical results were obtained through descriptive and advanced statistical analysis, indicating that TQM practices and OHS are highly implemented in Saudi organizations. The statistical results also showed that TQM practices have a significant positive impact on OSH performance in the surveyed organizations. The seven TQM fundamental pillars and the five OSH program components can be considered as essential success factors and fundamental pillars for TQM implementation in organizations and for OSH performance improvement.

[Approach and evidence-based study of provincial-level eco-economic development planning]

The development of ecological economy is one of the core elements of the ecological civilization system and an essential means to optimize the social-ecological systems. The key to developing ecological economy lies in preparing the development plan to realize concrete implementation. Given the objective and realistic demand for the development of ecological economy, it is critically needed to propose the approach of eco-economic planning and conduct empirical research. We sorted out the connotation of ecological economy, proposed the general idea of "object identification-resource evaluation-principal construction-target setting-task content-mechanism guarantee", and proposed three work modules, including "preliminary preparation, content design, review & approval", and finally built a technical system for the preparation of provincial-scale ecological economy planning. We outlined the 14th Five-Year Plan for Eco-Economic Development of Liaoning Province, and discussed critical issues such as the connotation definition and index system establishment for eco-economic development plan. This work provides ideas for the scientific and standardized preparation of ecological economy development plan at the provincial level in China.

The Effect of the KDL Active School Plan on Children and Adolescents' Physical Fitness in China

The development of physical fitness among Chinese children and adolescents is not fundamentally improving, and an exploration of effective ways to promote it is an urgent need. Research into physical fitness promotion in schools is increasingly deepening worldwide. However, the implementation and verification of intervention programs with local characteristics in accordance with China's national conditions are relatively weak. This study conducted a randomized controlled trial to examine the effects of the KDL (Know it, Do it, Love it) Active School Plan (KDL-ASP) on children and adolescents' physical fitness. A total of 596 students from level two (2nd-grade students) to five (11th-grade students) in China were assessed in terms of their physical fitness. Of these, 308 students were randomly selected to participate in the KDL-ASP, which uses a combination of indoor and outdoor sports activities in which teachers, parents, and students participate together. The remaining 288 students performed conventional physical activities. After one school year of intervention with the KDL-ASP, the physical fitness of the children and adolescents improved. The improvements in the speed of level two girls, the strength of level four boys, and the lung capacity of level five boys were the most obvious. These results demonstrate the viability of indigenized intervention in schools to improve physical fitness and suggest that KDL-ASP needs to be considered throughout the whole progress of physical education learning for children and adolescents.

Off-Time Work-Related Smartphone Use and Bedtime Procrastination of Public Employees: A Cross-Cultural Study

While previous studies have examined the negative effects of work-related smartphone use after hours, little is known about whether and how it influences employees’ unhealthy sleep behavior (i.e., bedtime procrastination). Drawing on the ego depletion theory, this study explored the effects of work-related smartphone use after hours on bedtime procrastination. To further uncover potential cross-cultural differences, a sample of 210 public employees from the United States and 205 public employees from China were used. Results via path analysis revealed that off-time work-related smartphone use positively influenced bedtime procrastination via the mediating role of self-control depletion. These findings were consistent between the United States and Chinese sample; however, off-time work-related smartphone use after hours increased the likelihood of self-control depletion more strongly in the United States than in China. The implications of our findings for both theory and practice were discussed.

How to Improve Entrepreneurship Education in "Double High-Level Plan" Higher Vocational Colleges in China

Entrepreneurship education complements vocational education in helping students develop their career prospects. This empirical study comprehensively analyzed sample data of 13,885 students from 40 “Double High-level Plan” higher vocational colleges in China using robust standard error regression analysis and other methods. The results showed that Entrepreneurship Practice (EP), Entrepreneurship Curriculum (EC), and Integration of Entrepreneurship Education and Professional Education (IEEPE) have a significant positive effect on Entrepreneurship Education Performance (EEP), with EP being the most important factor. Furthermore, ascribed factors (gender, household registration, only child or not, whether parents have entrepreneurial experience) and self-achieved factors (double high-level type, school area, subject major, whether to accept social entrepreneurship education) were found to affect students' perception of investment in entrepreneurship education. The study summarizes the existing problems of entrepreneurship education in “Double High-level Plan” higher vocational colleges and proposes four suggestions: pursue the integrated development of entrepreneurship education and “Double High-level” construction, advance both theoretical education and practical education, promote digital reform of the “three teaches” (teachers, teaching materials, and teaching methods), and develop entrepreneurship education in a comprehensive and balanced manner. This has certain theoretical and practical significance for the improvement of entrepreneurship education in other developing countries.

Understanding the Factors Influencing the Leisure Tourism Behavior of Visually Impaired Travelers: An Empirical Study in China

This study looks at the real-world problems which vision impaired individuals face when they travel. More specifically, this study aims to explore the main factors influencing the leisure tourism behavior of visually impaired individuals. Based on in-depth semi-structured interviews with 26 visually impaired respondents, this study identifies six main factors impacting on the leisure tourism behavior of visually impaired individuals including: tourism products and services, personal psychological factors, social support, community support, personal socio-economic factors, and barrier-free environments. Findings show that visually impaired travelers have strong requirements for auditory, tactile, and physical participation. Support factors such as travel companions/escorts, tour organizers specifically targeting their experiential offerings at the visually impaired, and an accessible environment are important considerations for visually impaired travelers. Findings also show that visually impaired individuals participate in leisure tourism to enhance their own abilities, relieve pressures on their families, break stereotypes associated with the visually impaired, and promote the need for greater tourism development specifically targeting visually impaired travelers. This study also proposes a theoretical model outlining the factors influencing leisure tourism of visually impaired people.

What Influences the Perceived Trust of a Voice-Enabled Smart Home System: An Empirical Study

Contemporarily, almost all the global IT giants have aimed at the smart home industry and made an active strategic business layout. As the early-stage and entry-level product of the voice-enabled smart home industry, the smart speakers have been going through rapid development and rising fierce market competition globally in recent years. China, one of the most populous and largest markets in the world, has tremendous business potential in the smart home industry. The market sales of smart speakers in China have gone through rapid growth in the past three years. However, the market penetration rate of related smart home devices and equipment still stays extremely low and far from mass adoption. Moreover, the market sales of smart speakers have also entered a significant slowdown and adjustment period since 2020. Chinese consumers have moved from early impulsive consumption to a rational consumption phase about this early-stage smart home product. Trust in the marketing field is considered an indispensable component of all business transactions, which plays a crucial role in adopting new technologies. This study explores the influencing factors of Chinese users’ perceived trust in the voice-enabled smart home systems, uses structural equation modeling (SEM) to analyze the interaction mechanism between different variables, and establishes a perceived trust model through 475 valid samples. The model includes six variables: system quality, familiarity, subjective norm, technology optimism, perceived enjoyment, and perceived trust. The result shows that system quality is the essential influence factor that impacts all other variables and could significantly affect the perceived trust. Perceived enjoyment is the most direct influence variable affected by system quality, subjective norm, and technology optimism, and it positively affects the perceived trust in the end. The subjective norm is one of the most distinguishing variables for Chinese users, since China has a collectivist consumption culture. People always expect their behavior to meet social expectations and standards to avoid criticism and acquire social integration. Therefore, policy guidance, authoritative opinions, and people with important reference roles will significantly affect consumers’ perceived trust and purchase intention. Familiarity and technology optimism are important influential factors that will have an indirect impact on the perceived trust. The related results of this study can help designers, practitioners, and researchers of the smart home industry produce products and services with higher perceived trust to improve consumers’ adoption and acceptance so that the market penetration rate of related products and enterprises could be increased, and the maturity and development of the voice-enabled smart home industry could be promoted.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people's recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people's RW and RPA. The results showed that two main factors affecting older people's RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

The Role of Entrepreneurship Policy in College Students' Entrepreneurial Intention: The Intermediary Role of Entrepreneurial Practice and Entrepreneurial Spirit

Entrepreneurship is a sustainable development tool that supports the alleviation of poverty and unemployment. Focusing on the promotion of entrepreneurial intention (EI) under the background of entrepreneurship education (EE), this study used a structural equation model to examine the role of entrepreneurship policy (EPo), entrepreneurial practice (EPr), and entrepreneurial spirit (ES) on the EI of 384 college students from 22 universities in Guangdong Province. The test results show that there are significant positive correlations between EPo and EI; EPo and EPr; EPo and ES; and EPr and EI. They also support the hypothesis that EPr enhances the positive effect that EPo has on EI. This study puts forth measures to improve EI and makes contributions to future research on EE.

Health Privacy Information Self-Disclosure in Online Health Community

The scarcity of medical resources is a fundamental problem worldwide; the development of information technology and the Internet has given birth to online health care, which has alleviated the above problem. The survival and sustainable development of the online health community requires users to continuously disclose their health and privacy. Therefore, it is a great practical significance to find out the factors and mechanisms that promote users' self-disclosure in the online health community. From the perspective of individual and situation interaction, this study constructed influencing factors model of health privacy information self-disclosure. Finally, we collected 264 valid samples from the online health community through online and offline questionnaire surveys and then use the SPSS20.0 and AMOS21.0 to conduct exploratory factor analysis, confirmatory factor analysis, scale reliability and validity analysis, and structural equation model analysis. The main findings are as follows: trust in websites and trust in doctors reduce the privacy concern. The privacy trade-off will not occur when trust is enough to offset the privacy concerns caused by personalized services, reciprocity norms, and other factors. Second, reciprocity norms are inevitably compulsive, which will increase privacy concerns. However, based on voluntariness, reciprocity norms can enhance user trust. Third, service quality caused by personalized services not only enhance the social rewards of users but also eliminate the privacy concern. Fourth, users' health privacy attention and information sensitivity are too high to decrease the influence of user' privacy concerns on personal health privacy information disclosure. The conclusions of this paper will help us to supplement privacy calculus theory and the application scope of the attention-based view. The proposed strategy of this article can be used to stimulate the information contribution behavior of users and improve the medical service capabilities in online health community.

Current Perspectives on Augmented Reality in Medical Education: Applications, Affordances and Limitations

This systematic review has been developed against a background of rapid developments in augmented reality (AR) technology and its application in medical education. The objectives are to provide a critical synthesis of current trends in the field and to highlight areas for further research. The data sources used for the study were the PubMed, Web of Science and Discover databases. Sources included in the study comprised peer reviewed journal articles published between 2015 and 2020. Inclusion criteria included empirical research findings related to learning outcomes and the populations for the selected studies were medical students. Studies were appraised in terms of to what extent the use of AR contributed to learning gains in knowledge and/or skill. Twenty-one studies were included in the analysis, and the dates of these suggested an increasing trend of publications in this area. The uses of AR in each selected study were analyzed through a lens of affordance, to identify which specific affordances of AR appear to be most effective in this domain. Results of the study indicated that AR seems to be more effective in supporting skill development rather than knowledge gain when compared to other techniques. Some key affordances of AR in medical education are identified as developing practical skills in a spatial context, device portability across locations and situated learning in context. It is suggested that a focus on relevant affordances when designing AR systems for medical education may lead to better learning outcomes. It is noted that the majority of AR systems reported in the selected studies are concentrated in the areas of anatomy and surgery, but that are also other areas of practice being explored, and these may provide opportunities for new types of AR learning systems to be developed for medical education.

Comparison Study of Perceived Neighborhood-Built Environment and Elderly Leisure-Time Physical Activity between Hangzhou and Wenzhou, China

Physical activity and health are of significant importance for the rapid aging population in China. Built environment has been suggested to be associated with elderly physical activity and health. However, the association differences between cities remain unclear. Perceived built environment scores and elderly leisure-time physical activity (LTPA) of 308 elderly in Hangzhou and 304 elderly in Wenzhou were collected using Neighborhood Environment Walkability Scale and International Physical Activity Questionnaire, respectively. A multivariate linear regression method and T-test were used to analyze of the associations between elderly LTPA and built environment and the differences between the two cities, respectively. The results showed that LTPA was positively associated with walking/cycling facilities and crime safety in both cities. LTPA was positively correlated with residential density, aesthetics, pedestrian/traffic safety in Wenzhou and negatively correlated with access to services in Hangzhou. The perceived scores of aesthetics (2.71 vs. 2.45) and pedestrian/traffic safety (2.11 vs. 1.71) in Hangzhou were significantly higher than those in Wenzhou. The results suggested that built environment elements like higher walking/cycling facilities and crime safety may motivate elderly engaging LTPA in both cities. However, LTPA was affected by different factors in these two cities. In the urban redevelopment, survey conducted in its own city would provide meaningful information and cannot be neglected.

Hedonic and Utilitarian Motivations of Home Motion-Sensing Game Play Behavior in China: An Empirical Study

As an important branch of video games and the integration of emerging motion-sensing technology, home motion-sensing games cannot only bring hedonic entertainment but also promote utilitarian benefits including exercise and social interaction for people to improve their physical and psychological health. As one of the most populous countries in the world, China has the largest number of households in the world but quite a low home game penetration rate due to the 13 year game industry winter for international enterprises. Whether Chinese customers have the intention of using motion-sensing games to improve their health status in the home environment will directly determine the commercial potential of the relevant industry in the Chinese market. In order to understand the motives of users and explore the market possibility and prospects of the game industry, this study adopts empirical research and structural equation modeling to construct a motivation model of Chinese consumers toward motion-sensing gameplay behavior in the household environment. We distributed 515 questionnaires to conduct a survey; 427 valid responses have been received, and 203 data, which meet the inclusion criteria of the required game experience, have been analyzed by SPSS25.0 and AMOS25.0. A structural equation model for the gameplay motivation has been constructed. The result shows that the three functional motivators, exercise (Path efficient = 0.40, p < 0.01), entertainment (Path efficient = 0.27, p < 0.01), and social interaction (Path efficient = 0.36, p < 0.01) of home motion-sensing games have a significantly positive impact on the user's intention to play. Furthermore, the diversity and the time-and-place flexibility variables exert an important positive influence on the users' gameplay behavior through their effects on the three main functional motive variables. To sum up, (1) exercise, (2) entertainment, and (3) social interaction are the main functional motivations of the Chinese consumers' gameplay behaviors; (4) diversity and (5) time-and-place flexibility are the two main attribute motivators. The acceptance of Chinese users for home motion-sensing games remains positive and high. The motion-sensing game industry has broad market prospects in China through its potential in promoting consumer's wellness and health in the home environment.

Are the Teachers and Students Satisfied: Sustainable Development Mode of Entrepreneurship Education in Chinese Universities?

Entrepreneurship education plays an important role in sustainable development. Chinese governmental agencies are making all-out efforts to promote schoolwide entrepreneurship education from top to bottom to achieve sustainable economic and social development. This is a phenomenon worth studying and summarizing. Improving the satisfaction degree of teachers and students of entrepreneurship education in universities for sustainable development becomes a typical mode of entrepreneurship education in Chinese universities. The data are derived from 12,269 valid questionnaires in student volume and 1,241 valid questionnaires in teacher volume from top universities in China, and regression and variance analyses were applied. The results show that the overall satisfaction of teachers and students is higher than the national average. There are significant differences in the overall satisfaction of different types of teachers and students. Teachers are most satisfied with the organizational leadership measures of the universities in entrepreneurship education and least satisfied with the lack of professional human resource management strategies for entrepreneurship education teachers. Students are most satisfied with entrepreneurship policy and least satisfied with entrepreneurship learning, especially that entrepreneurship theory learning and practice learning are closely combined with students’ majors. The overall satisfaction of students of entrepreneurship education mainly comes from the influence of “entrepreneurship policy dividend,” entrepreneurship learning, and entrepreneurship competition and entrepreneurship practice, which go hand in hand. The overall satisfaction of teachers is most affected by the satisfaction of organizational leadership, followed by the satisfaction of mechanism guarantee and teaching management. This study introduces the sustainable development model of entrepreneurship education in top Chinese universities through the improvement of satisfaction of entrepreneurship education and has certain reference significance for managers and teachers of entrepreneurship education practice in other developing countries.

Inpatient Flow Distribution Patterns at Shanghai Hospitals

Empirical studies based on patient flow data are needed to provide more materials to summarize the general pattern of patient distribution models. This study takes Shanghai as an example and tries to demonstrate the inpatient flow distribution model for different levels and specialties of medical institutions. Power, negative exponential, Gaussian, and log-logistic models were used to fit the distributions of inpatients, and a model of inpatient distribution patterns in Shanghai was derived, based on these four models. Then, the adjusted coefficient of determination (R²) and Akaike information criterion (AIC) values were used to assess the model fitting effect. The log-logistic function model has a good simulation effect and the strongest applicability in most hospitals. The estimated value of the distance-decay parameter β in the log-logistic function model is 1.67 for all patients, 1.89 for regional hospital inpatients, 1.40 for tertiary hospital inpatients, 1.64 for traditional Chinese medicine hospital inpatients, and 0.85 for mental hospital inpatients. However, the simulations at the tumor, children’s and maternity hospitals, were not satisfactory. Based on the results of empirical analysis, the four attenuation coefficient models are valid in Shanghai, and the log-logistic model of the inpatient distributions at most hospitals have good simulation effects. However, further in-depth analysis combined with the characteristics of specific specialties is needed to obtain the inpatient model in line with the characteristics of these specialties.

Minimum sample sizes for invasion genomics: Empirical investigation in an invasive whitefly

Analysis of population genetics provides insights into the evolutionary processes, among which the sample size choice is per se a crucial issue in the analysis. Genome-wide high-throughput techniques based on RADseq have been increasingly used in studies on the population genomics of invasive species. However, there is little information available regarding optimal sample sizes for analyzing population genomics of invasive species. In this study, we first use type IIB endonucleases restriction site-associated DNA (2b-RAD) to mine thousands of single nucleotide polymorphisms (SNPs) for native and introduced populations in Q1 clade (SPB and 17JN) and Q2 clade (ISQ and UAS0601) of the whitefly, Bemisia tabaci (Gennadius) MED (also known as B. tabaci biotype Q). Then, we used resampling techniques to create simulated populations with a random subset of individuals and 3,000 SNPs to determine how many individuals should be sampled for accurate estimates of intra- and interpopulation genetic diversity. We calculated the intrapopulation genetic diversity parameters (unbiased expected heterozygosity, observed heterozygosity, and the number of effect alleles) and pairwise genetic differentiation F ST; finally, an ad hoc statistic, ΔK, was used to determine the optimal value. Our results showed that a sample size greater than four individuals (n ≥ 4) has little impact on estimates of genetic diversity within whitefly populations; moreover, precise estimate of F ST can be easily achieved at a very small simple size (n = 3 or 4). Our results will provide in-depth understanding of the optimization of sampling schemes in population genomics of invasive species.

Do Researchers in Empirical Ethics Studies Have a Duty to Act Upon their Findings? Case Study in End-of-Life Decision Making

The outlined empirical study on the decision-making process concerning the limitation of life-prolonging treatment (DLT) in patients with advanced cancer at a University hospital setting triggered some new questions for research ethics with respect to studies using empirical methods in medical ethics. The analyzed data of the study showed that less than half of the patients were involved in DLT. Deciding against CPR (cardiopulmonary resuscitation) and transferal to the ICU (intensive care unit) without informing and explaining it to the perfectly competent patient can be regarded as a violation of the ethical principle of respect for autonomy. This is what the embedded researcher witnessed throughout the study recruitment and data acquisition, as the noninvolvement of patients was not just a result of the final data analysis. The ethical question raised in this situation was as follows: Does the embedded researcher has a moral duty to intervene when she witnesses that ethical standards are not upheld?

The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety

Patient safety is defined as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several reports and research studies reflect the high incidence and subsequent high cost of patient harm in general and within intensive care units. Against this background, this study tests a theoretical framework addressing relationships among patient safety climate dimensions and their impact on safety performance. The dimensions refer to safety in terms of procedure suitability and information flow, managerial safety practices, and priority of safety. A retrospective cross-sectional analytical research study was conducted. The target population was recruited from the three intensive care units in the main tertiary level hospital in Malta. A sample of 215 healthcare professionals, who fit the eligibility criteria, participated in this research study, achieving a response rate of 82.7%. The “Survey on Patient Safety Climate” was utilized. Findings support the following hypotheses: the higher the extent to which safety procedures are perceived as suitable to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = −0.269, p ≤ 0.01) and the higher the extent to which safety information flow is perceived as clear and unambiguous to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = −0.295, p ≤ 0.01). Findings also support the following hypotheses: managerial safety practices mediate the relationship between safety procedure suitability/safety information flow and clinical incidents (p = 0.009, p = 0.014, respectively) and priority of safety mediates the relationship between safety procedure suitability/safety information flow/managerial safety practices and clinical incidents (p = 0.002, p = 0.002, p = 0.042, respectively). Health service managers must ensure employees perceive safety procedures as suitable and safety information as clear and unambiguous, emphasize the manager's role as a safety referent and safety change agent and create an organization that prioritizes safety over work pace, workload and pressure for production. Essentially, health service managers need to create safety leaders to drive the organization to patient safety.

Judging homicide defendants by their brains: an empirical study on the use of neuroscience in homicide trials in Slovenia

This paper presents a study that analyses all available homicide trials in Slovenia between 1991 and 2015 for neuro-evidence. Almost every fifth case discusses neuroscience. The most prevalent type of neuro-evidence is neuro-psychological testing, less common are structural neuroimaging and electroencephalography, while we discovered no use of functional neuroimaging. The two largest categories of neurological conditions suffered by defendants are traumatic brain injury and brain damage due to long-term alcohol and drug abuse. When presented, neuro-evidence affected courts' decisions in 85% of trials (15% of all tried homicide cases) and had an impact on the criminal sentence or another outcome of the trial in 79% of cases. By far most often neuro-evidence affects decisions regarding criminal capacity, ie insanity and (substantially) diminished capacity, which, in turn, strongly reflects in criminal sanctions. Neuroscience information is typically used to mitigate or even reduce the sentence, but never as an aggravating circumstance. It is also frequently utilized to support decisions about medical security measures (compulsory psychiatric treatment). This study further suggests that the double-edged sword of neuroscience is an elusive concept and that the mechanism by which neuroscience affects courts' decisions in civil-law systems is different from the one in common-law jurisdictions.

Signaling trustworthiness: The effect of leader humor on feedback-seeking behavior

Given its capacity to cultivate a range of positive outcomes in the workplace, humor has been recognized as a valuable tool for leadership purposes. However, the theoretical understanding of leader humor remains relatively limited and the mechanism through which it influences follower outcomes has not been clearly identified. Drawing on signaling theory, we developed and empirically tested a model which delineates the relationship between leader humor and a specific follower behavior - proactive feedback seeking. We collected data from 304 employees and their respective leaders working in a large Canadian retail organization. Results of our analyses indicate that leader humor can impact subordinate feedback-seeking behavior via its influence on subordinates' affect-based and cognition-based trust in the leader.

Missing binary data extraction challenges from Cochrane reviews in mental health and Campbell reviews with implications for empirical research

OBJECTIVES

Tο report challenges encountered during the extraction process from Cochrane reviews in mental health and Campbell reviews and to indicate their implications on the empirical performance of different methods to handle missingness.

METHODS

We used a collection of meta-analyses on binary outcomes collated from a previous work on missing outcome data. To evaluate the accuracy of their extraction, we developed specific criteria pertaining to the reporting of missing outcome data in systematic reviews. Using the most popular methods to handle missing binary outcome data, we investigated the implications of the accuracy of the extracted meta-analysis on the random-effects meta-analysis results.

RESULTS

Of 113 meta-analyses from Cochrane reviews, 60 (53%) were judged as "unclearly" extracted (ie, no information on the outcome of completers but available information on how missing participants were handled) and 42 (37%) as "unacceptably" extracted (ie, no information on the outcome of completers as well as no information on how missing participants were handled). For the remaining meta-analyses, it was judged that data were "acceptably" extracted (ie, information on the completers' outcome was provided for all trials). Overall, "unclear" extraction overestimated the magnitude of the summary odds ratio and the between-study variance and additionally inflated the uncertainty of both meta-analytical parameters. The only eligible Campbell review was judged as "unclear."

CONCLUSIONS

Depending on the extent of missingness, the reporting quality of the systematic reviews can greatly affect the accuracy of the extracted meta-analyses and by extent, the empirical performance of different methods to handle missingness.

The Holistic Impact of Classroom Spaces on Learning in Specific Subjects

The Holistic Evidence and Design (HEAD) study of U.K. primary schools sought to isolate the impact of the physical design of classrooms on the learning progress of pupils aged from 5 to 11 years (U.S. kindergarten to fifth grade). One hundred fifty-three classrooms were assessed and links made to the learning of the 3,766 pupils in them. Through multilevel modeling, the role of physical design was isolated from the influences of the pupils' characteristics. This article presents analyses for the three main subjects assessed, namely, reading, writing, and math. Variations in the importance of the physical design parameters are revealed for the learning of each subject. In addition to some common factors, such as lighting, a heavy salience for Individualization in relation to math becomes apparent and the importance emerges of Connection for reading and of Links to Nature for writing. Possible explanations are suggested. These results provide a stimulus for additional finesse in practice and for further investigation by researchers.

Growing an ethics consultation service: A longitudinal study examining two decades of practice

BACKGROUND

Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time.

METHODS

This study examines data collected from a busy ethics consultation service over a period of more than two decades.

RESULTS

We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity.

CONCLUSIONS

We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores.

Empirical Study on Designing of Gaze Tracking Camera Based on the Information of User's Head Movement

Gaze tracking is the technology that identifies a region in space that a user is looking at. Most previous non-wearable gaze tracking systems use a near-infrared (NIR) light camera with an NIR illuminator. Based on the kind of camera lens used, the viewing angle and depth-of-field (DOF) of a gaze tracking camera can be different, which affects the performance of the gaze tracking system. Nevertheless, to our best knowledge, most previous researches implemented gaze tracking cameras without ground truth information for determining the optimal viewing angle and DOF of the camera lens. Eye-tracker manufacturers might also use ground truth information, but they do not provide this in public. Therefore, researchers and developers of gaze tracking systems cannot refer to such information for implementing gaze tracking system. We address this problem providing an empirical study in which we design an optimal gaze tracking camera based on experimental measurements of the amount and velocity of user’s head movements. Based on our results and analyses, researchers and developers might be able to more easily implement an optimal gaze tracking system. Experimental results show that our gaze tracking system shows high performance in terms of accuracy, user convenience and interest.

Long-term psychosocial and behavioral adjustment in individuals receiving genetic test results in Lynch syndrome

A cross-sectional study of 155 participants who underwent genetic testing for Lynch syndrome (LS) examined long-term psychosocial and behavioral outcomes. Participants completed standardized measures of perceived risk, psychosocial functioning, knowledge, and a questionnaire of screening activities. Participants were on average 47.3 years and had undergone testing a mean of 5.5 years prior. Eighty four (54%) tested positive for a LS mutation and 71 (46%) negative. For unaffected carriers, perceived lifetime risk of colorectal cancer was 68%, and surprisingly, 40% among those testing negative. Most individuals demonstrated normative levels of psychosocial functioning. However, 25% of those testing negative had moderate depressive symptoms, as measured by the Center for Epidemiologic Studies for Depression Scale, and 31% elevated state anxiety on the State-Trait Anxiety Inventory. Being female and a stronger escape - avoidant coping style were predictive of depressive symptoms. For state anxiety, similar patterns were observed. Quality of life and social support were significantly associated with lower anxiety. Carriers maintained higher knowledge compared to those testing negative, and were more engaged in screening. In summary, most individuals adapt to genetic test results over the long term and continue to engage in screening. A subgroup, including some non-carriers, may require added psychosocial support.

Criminal defense in Chinese courtrooms: an empirical inquiry

Scholars in the field of Chinese criminal procedure law study have long decried the meager legal protection afforded to criminal defendants on trial and the hapless status of Chinese criminal defense attorneys in the courtroom. Unfortunately, very little empirical evidence was available to shed light on how criminal defense was carried out in Chinese courtrooms. Based on observations of 325 actual criminal trials from 55 District People's Courts in J province, this study provides an opportunity to understand the mundane work performed by Chinese criminal defense attorneys. In particular, this study describes how criminal defense attorneys prepare and present their cases (as measured in terms of bail request, overall trial preparation, examination of defendants and witnesses, presentation of evidence, and overall defense strategy), and analyzes the outcomes of their performance. In addition, this study examines the discernible impact of criminal defense work due to types of legal representation utilized (legal aid vs. privately retained attorneys), numbers of attorneys representing the client, and the gender composition of the attorneys.

Inducing craving for alcohol in the laboratory

Research on the mechanisms of craving often involves inducing craving in subjects in controlled settings. This article describes techniques that have been used to induce craving for alcohol, including (1) exposing subjects to actual alcoholic beverages, (2) exposing subjects to visual representations of alcoholic beverages, (3) manipulating the subjects' mood states, and (4) controlling environmental settings. The intensity of craving can be rated by the subjects themselves or can be assessed by clinicians through behavioral observations or the measurement of certain physiological responses. Success in inducing craving in the laboratory, however, has been inconsistent. Ultimately, researchers may need to monitor subjects' craving responses in actual environmental settings.