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Background: Although many healthcare settings have since returned to pre‐pandemic levels of operation, long‐term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre‐pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over‐dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non‐dually enrolled residents. Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre‐pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. Conclusions: In 2022, emergency department and hospital utilization rates among long‐term residents were lower than pre‐pandemic levels and mortality rates were higher than pre‐pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs). STUDY DESIGN: Retrospective observational study using 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare. METHODS: We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating). RESULTS: We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95% CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02). CONCLUSIONS: BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks. [ABSTRACT FROM AUTHOR]

Background: Vascular anomalies (VAs) are rare congenital disorders that can cause pain, disfigurement, coagulopathy, asymmetric growth, and disability. Patients with complex VAs experience multiple barriers to accessing expert care. It is imperative to understand which factors support these patients' ability to navigate the healthcare system. Results: We surveyed adult patients with VAs using previously validated measures, recruiting participants from five patient advocacy groups and multidisciplinary VA clinics. The primary outcome was self-reported ability to access needed medical care, using the "Navigating the Healthcare System" subscale of the Health Literacy Questionnaire. We evaluated factors associated with the ability to navigate the healthcare system using multivariate linear regression (n = 136). We also performed an exploratory model that included the primary care doctor's knowledge of VAs for the subset of participants with a primary care doctor (n = 114). Participants were predominantly women (n = 90, 66%), White and non-Hispanic (n = 109, 73%), and college-educated (n = 101, 73%). Most participants had PIK3CA-Related Overgrowth Spectrum (n = 107, 78%). Most participants reported that navigating the healthcare system was "sometimes" or "usually difficult" (mean score 16.4/30, standard deviation 5.6). In multivariate linear regression, ability to navigate the healthcare system was associated positively with quality of information exchange (β = 0.38, 95% Confidence Interval (CI) 0.22 to 0.55, p <.001) and whether patients had VA specialists (β = 2.31, 95% CI 0.35 to 4.28, p =.021), but not associated with patient self-advocacy, anxiety, education, age, race and ethnicity, gender, or having a primary care doctor. In exploratory analysis of participants with primary care doctors, ability to navigate the healthcare system was positively associated with quality of information exchange (β = 0.27, 95% CI 0.09 to 0.45, p =.004), having a VA specialist (β = 2.31, 95% CI 0.22 to 4.39, p =.031), and primary care doctors' VA knowledge (β = 0.27, 95% CI 0.04 to 0.50, p =.023). Conclusion: Patients with VAs struggle to navigate the healthcare system. High-quality information from clinicians and more knowledgeable primary care doctors might help patients to access needed care. Relying on patient self-advocacy is insufficient. Future efforts should focus on patient-directed and clinician-directed educational interventions. Additionally, future work should assess the structural barriers that impede healthcare access for these patients. [ABSTRACT FROM AUTHOR]

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but have not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations ("deficiencies") issued during license inspections. Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural and environmental characteristics associated with the number of deficiencies. Results Most (79%) inspections resulted in at least one deficiency. The most common deficiencies concerned medications and treatments (57%), change of condition and monitoring (48%), and resident health services (45%). Structural characteristics associated with higher odds of receiving one or more deficiencies included larger size, memory care designation, shorter administrative tenure, and for-profit status. Environmental characteristics associated with higher odds of receiving one or more deficiencies included rural location, lower unemployment, and market concentration. The number and likelihood of a given community receiving a deficiency decreased over time. Discussion and Implications Resource dependency theory constitutes a useful framework to consider the role of structural and environmental factors that affect AL/RC quality, including resident needs, institutional knowledge, resource availability, and market pressure. License inspection data are a viable option for assessing the quality of AL/RC communities. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various topics within the issue, including health information technology (HIT), virtual medicine, and artificial intelligence (AI).

Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, we examined the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15. While there was no association between out-of-network specialty care and ACO spending, each percentage-point increase in receipt of out-of-network primary care was associated with an increase of $10.79 in quarterly total ACO spending per beneficiary. When we broke down total spending by place of service, we found that out-of-network primary care was associated with higher spending in outpatient, skilled nursing facility, and emergency department settings, but not inpatient settings. Our findings suggest an opportunity for the Medicare program to realize substantial savings, if policy makers developed explicit incentives for beneficiaries to seek more of their primary care within network. [ABSTRACT FROM AUTHOR]

Substantial policy effort has been directed at improving patients' ability to access and use electronic health records. Using nationwide data from 2,410 hospitals for the period 2014-16, we examined associations between patient- and hospital-level characteristics and access to and use of electronic health record data among discharged patients. On average, hospitals gave 95 percent of discharged patients access to view, download, and transmit their information, but only about 10 percent of those with access used it--levels that were stagnant during the study period. Access rates were highest among system-member, teaching, and for-profit hospitals. In contrast, access rates were lower for hospitals in the highest quartile for disproportionate share hospital status and for hospitals located in counties with high proportions of residents who were dually eligible for Medicare and Medicaid; use rates were lower for hospitals in counties with a high proportion of residents who were dually eligible, lacked computer or internet access, or were Hispanic. Overall, our findings suggest that policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the "digital divide" that accompanies health care disparities. Additional--possibly targeted--policy incentives, as well as higher thresholds for meeting the requirements of the Promoting Interoperability Program, merit policy makers' consideration. [ABSTRACT FROM AUTHOR]

Abstract Many studies have shown that some game motives help to identify the risk for the development of problematic Internet use, especially advancement, escapism and socializing. Previous researchers have investigated multiple risky motives in each study but treated them as individual variables with less concern about their interplay. However, in many studies, the results showed that all gaming motives were correlated, implying the possibility that gamers might endorse multiple motives simultaneously. This study thus adopted a person-centered approach that was capable of distinguishing people with apparent combinations of gaming motives. The first aim of this study was to examine the co-occurrence of three different gaming motives, using latent profile analysis. The second aim of this study was to examine whether there were differences among gamer profiles in their characteristics, problematic Internet use, depression, and other well-being indicators across five time points. Panel data were collected from the same college student sample every six months for 2 years, from 2012 to 2014. At time point 1, a total of 387 freshmen (female = 109; male = 278) were recruited in Taiwan. Four reliable clusters of gamers were identified: high-engagement, medium-engagement, low-engagement, and healthy-engagement. The validated analysis results showed that the high-engagement gamers were risky and had higher depression and problematic Internet use scores than the other gamer clusters from time 1 to time 5. Academic performances had no significant effect on the 4 gamer clusters from time 1 to time 5. When the high-engagement cluster was compared to the healthy-engagement cluster, the major difference was seen in the level of escapism motives and the consequent risk of developing negative psychological symptoms. However, when the healthy-engagement cluster was compared to the low-engagement cluster, there were no significant differences in their level of escapism motive or psychological outcomes in depression and problematic Internet use (PIU) scores. Taken together, these findings imply that the endorsement of the escapism motive might be a risky inner factor for depression, PIU, and other well-being indicators in college gamers. Based on our findings, the person-centered study may provide further insights to help gamers with functional impairment. In addition, intervention programs can be designed to bring awareness to gamers' own escapism motives and to persuade them to face the pressures and problems in real life. Highlights • Clustering gamers with gaming motives using a person-centered approach. • Four clusters were identified, namely: high-, medium-, low-, and healthy-engagement. • Academic performance showed no difference across the 4 clusters. • High-engagement cluster developed more negative consequences across five time points. • Escapism motives seem to be a risky driving force for gamers. [ABSTRACT FROM AUTHOR]

Compared to reading text alone, pictures are regarded as easier for readers to comprehend the context. For EFL readers, their reading behavior on text with pictures needs to be carefully inspected. The study aims to examine how different are the viewing behaviors of EFL beginners versus intermediate readers on reading narrative paragraphs and accompanying pictures. Seventeen junior high and twenty-one senior high students represented as EFL beginners and intermediate readers, respectively. Both of them read consecutively three screens with narrative texts and pictures illustrating the texts. The results showed that both beginners and intermediate readers paid more attention to the texts than the pictures. The beginners almost solely fixated on the texts and few fixations fell on to the pictures while the intermediates had more fixations on both texts and pictures. The eye-movement data in the specific AOIs showed that the intermediates made more references between text and pictures when they encountered difficult words or processed semantic meaning making. The beginners were less efficient in reading, having less fixated time on each screen, and encountered greater difficulties in comprehension than the intermediates. Based on eye-movement data, a personalized strategy to alter display sequence could be provided to support EFL beginners: Before going into narrative reading, a reminding message could be dispatched onscreen guiding them to view standalone pictures and to inspect pictorial components carefully to serve as the macro-reading strategy. The personalization could also be realized by posting cognitive and meta-cognitive level questions during the inspection of picture. [ABSTRACT FROM AUTHOR]

PURPOSE: To improve care coordination for complex cancers, it is critical to establish a more nuanced understanding of the types of providers involved. As the number of provider types increases, strategies to support cancer care coordination must adapt to a greater variety of information needs, communication styles, and treatment strategies. METHODS: We categorized providers into 11 types, using National Provider Identifier specialties. Using Medicare claims, we counted the number of unique combinations of provider types billed during preoperative, operative, and postdischarge care for colon cancer surgery and assessed how this count varies across hospitals. The study included 70,567 beneficiaries in fee-for-service Medicare A and B for 6 months before and 60 days after an admission for colectomy for colon cancer between 2008 and 2011. RESULTS: We observed 1,554 preoperative provider-type combinations, 975 operative combinations, and 1,571 postdischarge combinations. The three most common combinations in the preoperative phase were general medicine only, other medical specialists only, and general medicine and other medical specialists. In the operative phase, the three most common combinations were primary surgery, anesthesiology, and pathology; general medicine, other medical specialists, radiology, primary surgery, anesthesiology, and pathology; and other medical specialists, radiology, primary surgery, anesthesiology, and pathology. In the postdischarge phase, the three most common combinations were general medicine, general medicine and other medical specialists, and general medicine and oncology. On average, each hospital had 15 preoperative, 11 operative, and 15 postoperative combinations. High-volume, larger, teaching, urban, and noncritical access hospitals had more combinations in all phases. CONCLUSION: Many provider-type combinations are involved in colon cancer surgery care. Substantial variation exists across hospitals types, suggesting that certain hospitals need additional resources and more flexible infrastructure to coordinate care. [ABSTRACT FROM AUTHOR]

We examined care and communication factors that affect physical and mental health for patients with complex vascular anomalies (VAs). VA patients (N = 135) completed an online survey with measures of ability to navigate healthcare, quality of information exchange, perceived stigma, and demographic variables. We performed linear regression to determine if these variables were associated with mental and physical health. Physical and mental health were associated with information exchange (β =.41, 95% CI=.12 −.69; β =.33, 95% CI=.04 −.62), stigma (β = −.49, 95% CI=−.74 to −.24; β = −.63, 95% CI=−.89 to −.38), and education (β = 4.00, 95% CI=.63 - 7.38; β = 3.44, 95% CI=.06 to 6.82). Ability to navigate healthcare was associated with health outcomes in our bivariate model, but not significant in a multivariate model. The results underscore the importance of effective information exchange. Poor information exchange was associated with worse physical and mental health. VA patients with lower education levels and higher perceived stigma reported poorer health outcomes and likely face many struggles accessing care. Patient-centered information exchange between clinicians and patients is needed to address unmet information needs. Clinicians can also reduce perceived stigma by validating patients, and should provide resources to reduce disparities related to education. • Patients with vascular anomalies (VAs) face many challenges accessing expert care. • Effective information exchange with clinicians is associated with better physical and mental health. • VA patients who perceive more stigma report poorer physical and mental health. • Education level is associated with VA patients' physical and mental health. • Interventions are needed to improve information exchange, reduce stigma, and reduce disparities related to education. [ABSTRACT FROM AUTHOR]

Objectives Study Design Methods Results Conclusions Patient engagement is critical for the effective development and use of artificial intelligence (AI)‐enabled tools in learning health systems (LHSs). We adapted a previously validated measure from pediatrics to assess adults' openness and concerns about the use of AI in their healthcare.Cross‐sectional survey.We adapted the 33‐item “Attitudes toward Artificial Intelligence in Healthcare for Parents” measure for administration to adults in the general US population (AAIH‐A), recruiting participants through Amazon's Mechanical Turk (MTurk) crowdsourcing platform. AAIH‐A assesses openness to AI‐driven technologies and includes 7 subscales assessing participants' openness and concerns about these technologies. The openness scale includes examples of AI‐driven tools for diagnosis, prediction, treatment selection, and medical guidance. Concern subscales assessed privacy, social justice, quality, human element of care, cost, shared decision‐making, and convenience. We co‐administered previously validated measures hypothesized to correlate with openness. We conducted a confirmatory factor analysis and assessed reliability and construct validity. We performed exploratory multivariable regression models to identify predictors of openness.A total of 379 participants completed the survey. Confirmatory factor analysis confirmed the seven dimensions of the concerns, and the scales had internal consistency reliability, and correlated as hypothesized with existing measures of trust and faith in technology. Multivariable models indicated that trust in technology and concerns about quality and convenience were significantly associated with openness.The AAIH‐A is a brief measure that can be used to assess adults' perspectives about AI‐driven technologies in healthcare and LHSs. The use of AAIH‐A can inform future development and implementation of AI‐enabled tools for patient care in the LHS context that engage patients as key stakeholders. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the level of health information exchange (HIE) in U.S. hospitals is related to technology capabilities, incentives to exchange, or both.Study Setting: A total of 1,812 hospitals attesting to stage 2 of Medicare's Meaningful Use Incentive Program through April 2016.Study Design: Hospital-level, multivariate OLS regression with state fixed effects was used to analyze the relationship between technology capability and incentives measures, and percent of care transitions with summary of care records (SCRs) sent electronically to subsequent providers.Principal Findings: Stage 2 hospitals reported sending SCRs electronically for an average of 41 percent (median = 33 percent) of transitions. HIE level is related to four capability measures, one incentive measure, and one measure that is related to both capability and incentive. Percent of transitions with SCRs sent electronically was 3 percentage points higher (95 percent CI: 0.1-5.1) for hospitals with a third-party HIE vendor, 3 percentage points higher (95 percent CI: 0.5-5.4) for hospitals with an EHR vendor as their HIE vendor, and 3 percentage points higher (95 percent CI: 0.4-5.4) for hospitals that automatically alert primary care providers. The direction and statistical significance of the relationships between specific EHR vendor and electronic SCR transmission level varied by vendor. Nonprofits and government hospitals performed 5 percentage points higher (95 percent CI: 1.5-9.1) and 8 percentage points higher (95 percent CI: 3.4-12.3) than for-profits. Hospitals in systems performed 3 percentage points higher (95 percent CI: 0.8-6.1).Conclusion: The overall level of HIE is low, with hospitals sending an SCR electronically for less than half of patient transitions. Specific hospital characteristics related to both technology capabilities and incentives were associated with higher levels of HIE. [ABSTRACT FROM AUTHOR]

Evidence linking electronic health record (EHR) adoption to better care is mixed. More nuanced measures of adoption, particularly those that capture the common incremental approach of adding functions over time in US hospitals, could help elucidate the relationship between adoption and outcomes. We used data for the period 2008-13 to assess the relationship between EHR adoption and thirty-day mortality rates. We found that baseline adoption was associated with a 0.11-percentage-point higher rate per function. Over time, maturation of the baseline functions was associated with a 0.09-percentage-point reduction in mortality rate per year per function. Each new function adopted in the study period was associated with a 0.21-percentage-point reduction in mortality rate per year per function. We observed effect modification based on size and teaching status, with small and nonteaching hospitals realizing greater gains. These findings suggest that national investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time. [ABSTRACT FROM AUTHOR]

Abstract: To deepen our understanding of those aspects of problems that cause the most difficulty for solvers, this study integrated eye‐tracking with handwriting devices to investigate problem solvers' online processes while solving geometry problems. We are interested in whether the difference between successful and unsuccessful solvers can be identified by employing eye‐tracking and handwriting. Sixty‐two high school students were required to complete a series of geometry problems using pen tablets. Responses, including eye movement measures, wrote/drew trace, perceived cognitive load and questionnaires concerning the source of difficulties, were collected. The results suggested that the technique could enhance methods to diagnose difficulties by differentiating between successful and unsuccessful solvers. We considered mental rotation could be a primary obstacle in the integrating stage of diagram comprehension. The technique can be extensively applied in various instructional scenarios. Educational implications for problem solving are discussed. [ABSTRACT FROM AUTHOR]

The diffusion of health information exchange (HIE), in which clinical data are electronically linked to patients in many different care settings, is a top priority for policy makers. To drive HIE, community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improved patient care. To assess the current landscape, we conducted a national survey of community and state HIE efforts soon after federal funding ended. We found 106 operational HIE efforts that, as a group, engaged more than one-third of all US providers in 2014. However, the number of operational HIE efforts is down from 119 in 2012, representing the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation. These findings raise important questions about whether the current vision for HIE efforts will allow for the broad exchange of clinical data, or whether alternative approaches would be more successful. [ABSTRACT FROM AUTHOR]

The associations between problematic Internet use (PIU) and depressive symptoms have been found to be positive and statistically significant. However, whether the trajectory change of depressive feeling is related to PIU has not been discovered. The present study aimed to investigate the trajectory change of depressive symptoms in a group of Taiwanese college students and to examine the influence of the initial level and the changing rate in depression on the PIU level, with a simultaneous evaluation of gender effect. The survey employed a five-wave panel design in which the data were collected five times from the freshman to junior years for the same participants. The first-year data included 757 freshmen (51.1% male). The results showed that the females exhibit a faster decreasing rate in depression than the males. A student with a higher initial level of depression tends to have a serious initial level of PIU. Additionally, the PIU level at the end of study period could be reduced while the rapidly decreasing rate of depression was observed. The faster the decline in depression is, the lower the PIU level is. The trajectory change of depression plays an important role in predicting the severity of PIU. [ABSTRACT FROM AUTHOR]

Viral- and host-targeted traditional Chinese medicine (TCM) formulae NRICM101 and NRICM102 were administered to hospitalized patients with COVID-19 during the mid-2021 outbreak in Taiwan. We report the outcomes by measuring the risks of intubation or admission to intensive care unit (ICU) for patients requiring no oxygen support, and death for those requiring oxygen therapy. This multicenter retrospective study retrieved data of 840 patients admitted to 9 hospitals between May 1 and July 26, 2021. After propensity score matching, 302 patients (151 received NRICM101 and 151 did not) and 246 patients (123 received NRICM102 and 123 did not) were included in the analysis to assess relative risks. During the 30-day observation period, no endpoint occurred in the patients receiving NRICM101 plus usual care while 14 (9.27%) in the group receiving only usual care were intubated or admitted to ICU. The numbers of deceased patients were 7 (5.69%) in the group receiving NRICM102 plus usual care and 27 (21.95%) in the usual care group. No patients receiving NRICM101 transitioned to a more severe status; NRICM102 users were 74.07% less likely to die than non-users (relative risk= 25.93%, 95% confidence interval 11.73%-57.29%). NRICM101 and NRICM102 were significantly associated with a lower risk of intubation/ICU admission or death among patients with mild-to-severe COVID-19. This study provides real-world evidence of adopting broad-spectrum oral therapeutics and shortening the gap between outbreak and effective response. It offers a new vision in our preparation for future pandemics. [Display omitted] [ABSTRACT FROM AUTHOR]

This study examined the measurement structure, cross-year stability of achievement goals, and mediating effects of achievement goals between self-efficacy and math grades in a national sample of Taiwan middle school students. The measurement model with factorial structure showed good fit to the data. In the panel data (N = 343), four achievement goals showed strong measurement invariance, suggesting factor loadings and intercepts of the items remained invariant across a year. Though mean scores of the four latent achievement goals held quite stable, the rank order of students across two time-points changed more profoundly in the two avoidance goals than in the approached goals. In the cross-sectional data (N = 748), we found approach-based goals were positive mediators between self-efficacy and math grades while avoidance-based goals were negative mediators. This result could be relevant for middle-school students in learning mathematics. Some instructional implications are provided. [ABSTRACT FROM PUBLISHER]

The present study aimed to use a latent profile analysis to distinguish between populations in terms of life domain importance and satisfaction profiles. Then, a multinomial logistic regression was used to determine how background variables (e.g., gender, living areas, and school levels) and self-perceived health predict each latent quality of life (QoL) profile. We also investigated how the latent groups of adolescents predicted negative and positive well-being indicators (e.g., problem behaviors and overall life satisfaction). The sample consisted of 720 Taiwanese secondary school students. Three latent groups were established as follows: 'unimportant-unsatisfied,' 'important-unsatisfied,' and 'important-satisfied.' The results indicate the following: (a) boys were more likely to fall into the 'unimportant-unsatisfied' group than were girls; (b) better health increased the likelihood of being in the 'important-satisfied' group; (c) high school students were more likely to be in the 'unimportant-unsatisfed' group than were middle school students; and (d) no relationship was found between latent groups and living areas. The function of importance rating was not present when evaluating the importance-satisfaction profiles and their relationship with problem behaviors and overall life satisfaction. The problems of the 'unimportant-unsatisfied' profile among youth are discussed. [ABSTRACT FROM AUTHOR]

We studied the content of the team mental model with a case study about a successful online game team. This team was formed by high-ranking managers in a large raid guild to conduct a raid in War of Worldcraft. They were interviewed with a set of 5-W questions developed according to the conceptualizations of team mental model (Levine & Moreland, 1991). Toward the interview protocol, a content analysis was conducted with two-cycle coding method from exploratory to explanatory and a hierarchical framework from code, category, theme, to theory were generated to describe the team mental model. In the first cycle, 17 codes were extracted from participants' own wording for concepts that were shared by whom controlled various gaming characters. These codes are knowledge convergence about the problem at-hand, actors, events, affects and outcomes – what the core gamers have experienced through the collaborative gaming process. In the second cycle, coding was guided by learning theories. Six categories, mingled from 17 codes, showed collective knowledge of co-work process, leaders' works, work under supervision, seeking joint fun, relationship oriented, and balance between extrinsic-intrinsic motivations. From 6 categories, two themes were synthesized: the team (1) performed “joint hard work” for (2) seeking “joint hard fun.” The first theme comprised declarative and procedural knowledge representations and we consider it to be the commonality between this game team and ordinary work/learning teams. The second theme was composed of affective and cognitive evaluation components about intrinsic motivation which is in accordance with Self-determination theory (SDT, Deci & Ryan, 2000). In general, “Jointly hard work for hard fun” is the gist content of the team mental model. We found ample evidences that members explicitly recall shared motivational beliefs of team mates and emotional–motivational events in gaming. Based on the results of this study, several implications have been addressed for teachers to enhance students' intrinsic motivation in conducting quality Computer-Supported Collaborative Learning. Future studies are needed to further explore the relationship between the quality of team mental models and team-level performance. [Copyright &y& Elsevier]

This study focuses on the design of several social agents that are intended to collect the self-reflections of learners while learners are immersed in simulation activities for knowledge building. The design of the agents follows 5W principles and seeks to encourage learners to expend mental effort upon multi-faceted learning and self-reflection. Using semantic networks, we developed dialogue lines for reflection-prompting agents. We analyzed the participants' answers using natural language processing technology to classify the sentences into positive and negative rankings. A preliminary field study with 117 high school students was conducted over three weeks to test the effects of agent-prompted self-reflection. The results demonstrated that 96% and 62% of participants separately completed the first and the second simulation activities (including the agent-prompted self-reflections respectively). Those who did not finish the activities were generally limited by time restrictions rather than a lack of motivation, as the participants typically considered the interactions with the agents to be interesting. The self-reflections elicited through the agent interviews were consistent with the reflections obtained from paper-pencil questionnaires and appeared to be stable over time. Future study, including investigations using a randomized experimental design with a control group, is needed to fully assess the effects of agent-prompted self-reflection. [ABSTRACT FROM AUTHOR]

Image searches are now crucial for obtaining information, constructing knowledge, and building successful educational outcomes. We investigated how reading ability and Internet experience influence keyword-based image search behaviors and performance. We categorized 58 junior-high-school students into four groups of high/low reading ability and frequent/infrequent Internet usage. Participants used Google Image to complete four tasks: finding four images that match four given sentences. The results indicate that reading ability exerted a stronger influence than Internet experience on most search behaviors and performance. Positive relations were found between search performance and two behavior indicators of search outcome evaluation. Students with better reading ability tended to use/revise appropriate keywords, as well as evaluate/select images that matched multiple aspects of the task descriptions. Students with low reading ability/frequent Internet experience tended to enter a single keyword and carelessly select images, while those with low reading ability/infrequent Internet experience tended to use improper keywords and were unskillful in handling search engines. Combined, our results show that successful keyword-based image searches are strongly dependent on reading ability and search result evaluation skills. [ABSTRACT FROM AUTHOR]

Early adolescent in-game playfulness (state), playfulness trait rated during the study procedure, and psychological needs fulfilled through online gaming were explored. Taiwan adolescents (N = 132) were recruited to connect to an online game for a certain period of time. Immediately after this gaming procedure, they completed questionnaires of players' momentary playfulness and psychological needs. Online game playfulness trait was mapped onto 2 broad dimensions: self-game focused and cognition-affect driving. In-game playfulness was a more suitable indicator (than playfulness trait) to describe adolescents' immediate experience of playfulness. Adolescents' psychological needs included in-game autonomy, ingame competence, and in-game relatedness, and adolescents' psychological needs predicted in-game playfulness. [ABSTRACT FROM AUTHOR]

Abstract: The authors address the role of computer support for building conceptual self-awareness—that is, enabling students to think outside of concept boundaries in hope of enhancing creative potential. Based on meta-cognition theory, we developed an integrated concept mapping system (ICMSys) to improve users’ conceptual self-awareness in addition to applying concept mapping techniques in traditional learning scenarios. Since the ICMSys accommodates different perspectives, selected ideas made by peers are retained with the help of integrated concept map (ICMap) representations used as stimuli for reflective thinking. Results from a case study with 32 information management undergraduates indicate: (a) increased levels of conceptual self-awareness, (b) evidence of conceptual improvement in the students’ redrawn concept maps, (c) that ICMap viewing frequency exerted a positive impact on level of conceptual self-awareness, and (d) a significant correlation between level of conceptual self-awareness in redrawn personal concept maps and actual conceptual changes as determined by three experts. We describe student perceptions of the ICMSys in terms of comprehension practicality and conceptual self-awareness, and give suggestions for future research. [Copyright &y& Elsevier]

The authors describe their design for an Internet-based learning environment called BeyondShare in which students are encouraged to gain a deep understanding of the learning material, reflect on the quality of individual constructions through sharing and peer evaluation, and synthesize cross-unit knowledge by integrating self- and peer-produced constructions. A sharing typology may consist of basic sharing, sharing with notification, sharing with feedback, or sharing with interaction. BeyondShare distinguishes itself by combining sharing activities with task structuring and cooperation/competition to achieve active learning. A formal evaluation of BeyondShare was performed with a class of 34 college students who created concept maps for a computer programming language and who were encouraged to become active learners by exchanging roles throughout the experiment. Evaluation results indicate that the students viewed BeyondShare as an easy-to-use environment that motivated them toward comprehensive knowledge integration by sharing construction products with their peers. Potential activities and suggested modifications are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on the relationship between peer feedback, cognitive and metacognitive strategies, and achievement in networked peer assessment. The results of a regression analysis revealed a significant relationship between the use of cognitive and metacognitive strategies in feedback and in students' own achievement under networked peer assessment. The results indicated that students' use of advanced level cognitive and metacognitive strategies was a positive and significant predictor of their own achievements.

Abstract: Although research has suggested that group composition plays an important role in collaborative learning, the role of motivation in group composition has rarely been taken into account. This study investigates the effects of group composition of self-efficacy (e.g. low, high, and mixed self-efficacy) on group motivation (i.e. collective efficacy), collaborative learning behavior, and performance in a computer-supported collaborative learning environment. The results indicate that high self-efficacy groups have higher collective efficacy beliefs than low self-efficacy groups. Furthermore, high self-efficacy groups use more high-level cognitive skills during group discussion than low self-efficacy groups, despite no significant difference in usage of lowlevel cognitive skills among the three groups. This study also demonstrates that collective efficacy has positive effects on discussion behaviors and group performance. Students with higher collective efficacy not only use more high-level cognitive skills in group discussion, but also demonstrate better academic performance. Our research further indicates that students’ use of high-level cognitive skills in group discussion has positive effects on group performance. Finally, implications and suggestions for future research are also provided. [Copyright &y& Elsevier]

Although the Web allows for flexible learning, research has found that online students tend to lack focus, willingness to participate, confidence, and discipline. This study thus attempts to promote Web-based self-regulated learning from the social cognitive perspective, which emphasizes the interactions among personal, behavioral, and environmental influences. This study has identified the most significant factors for personal, behavioral, and environmental influences in the social cognitive model of self-regulated learning, and also applied this model to the development of the NetPorts web-based learning system. NetPorts, in turn, allows us to empirically analyze the interactions between the aforementioned factors. Our Web-based findings support the social cognitive view of self-regulated learning: students who hold higher levels of motivation apply more effective strategies, and respond more appropriately to environmental demands, in the Web-based learning environment. These findings also further validate the application of the social cognitive model to Web-based learning through the NetPorts. [ABSTRACT FROM AUTHOR]

Abstract: Teachers interested in small-group learning can benefit from using psychological factors to create heterogeneous groups. In this paper we describe a computer-supported grouping system named DIANA that uses genetic algorithms to achieve fairness, equity, flexibility, and easy implementation. Grouping was performed so as to avoid the creation of exceptionally weak groups. We tested DIANA with 66 undergraduate computer science students assigned to groups of three either randomly (10 groups) or using an algorithm reflecting [Sternberg, R. J. (1994). Thinking styles: theory and assessment at the interface between intelligence and personality. In R. J. Sterberg, & P. Ruzgis (Eds.), Personality and Intelligence (pp. 169–187). New York: Cambridge University Press.] three thinking styles (12 groups). The results indicate that: (a) the algorithm-determined groups were more capable of completing whatever they were “required to do” at a statistically significant level, (b) both groups were equally capable of solving approximately 80% of what they “chose to do,” and (c) the algorithm-determined groups had smaller inter-group variation in performance. Levels of satisfaction with fellow group member attitudes, the cooperative process, and group outcomes were also higher among members of the algorithm-determined groups. Suggestions for applying computer-supported group composition systems are offered. [Copyright &y& Elsevier]

Based on social constructivist theory, a web-based interactive learning environment was developed (called the CORAL-View System) to enhance Taiwanese university students collaborative skills via design projects. This paper consists of a description of the program itself and our formative and summative evaluations of the system. Using the interactive powers of computer networks, we created modules that allowed students to a) discuss their ideas and observe/evaluate their classmates' products-in-progress, b) investigate rationales behind design products, c) examine connections between theory and observable events, and d) modify their designs according to their observations. Specifically, the program contains a team-formation module (for the task of matching student skills for establishing project teams), a structured discussion module, a Vee diagram design module, and a log file management module. Results from the formative and summative evaluations of student achievement and attitudes toward both the system and col- laborative design process were encouraging. Students produced creative and feasible design products and expressed satisfaction with the CORAL-View functions. [ABSTRACT FROM AUTHOR]

Although questionnaire data are normally obtained from students by paper and pencil, doing so occasionally leads to missing values when used carelessly. As a viable alternative, a web-based questionnaire environment can be designed to prevent missing values. Previous researchers have evaluated the learning effectiveness of web-based learning by considering only the ability or achievement of students. However, this approach does not identify which students learn better than others, which students provide correct advice, and which learning tendencies do students lack of. This work constructs a web-based thinking style questionnaire, verifies the reliability of thinking styles in two studies, and adopts the thinking styles data filled by students as variables to evaluate the learning effectiveness of web-based learning. [ABSTRACT FROM AUTHOR]

Although the effectiveness of self, peer, and instructor assessment in higher education is well studied, the possibility of using networked system to facilitate alternative assessment in undergraduate level has seldom been studied. Quantitative analysis of self, peer and instructor assessment under a networked system is also rare. In addition to outlining procedures of networked innovative assessment, this study also provides a long-term measure of peer-self, peer-instructor and self-instructor correlation coefficients with networked innovative assessment procedures. Analytical results indicated that undergraduate students could evaluate peers adequately but they over-mark themselves usually. Although the findings of this study have agreed with previous research, authors believe that networked innovative assessment procedures should be further improved and extended to other course topics for further evaluation of its effectiveness. [ABSTRACT FROM AUTHOR]

Describes the INCOMAS system, an item bank based and networked concept map educational assessment system that combines the Web technologies, computer networks and the database. Management problems associated with the practical operation of Web-based concept map testing system; System architecture of INCOMAS.

The present study examined excessive Internet use of Taiwanese adolescents and a psychological aspect of users, sensation seeking, thus to differentiate motivation of Internet dependents and non-dependents. Seven hundred and fifty three Taiwanese high school students were selected using cluster sampling and 88 of them were categorized as Internet dependent users. Results indicated that Internet dependents spent more time on-line than non-dependents. While Internet dependents perceived significantly more negative Internet influences on daily routines, school performance, and parental relation than non-dependents, both Internet dependents and non-dependents viewed Internet use as enhancing peer relations. Making friends through the Internet has become a popular activity among adolescents, potentially leading to its excessive use. Internet dependents scored significantly higher on overall sensation seeking and disinhibition than Internet non-dependents. However, both groups did not differ in the life experience seeking subscale and thrill and adventure seeking subscale. This finding contradicts that of Lavin, Marvin, McLarney, Nola, and Scott [CyberPsychol. Behav. 2 (2000) 425]. Possible reasons for this discrepancy and for the relation between Internet dependence and disinhibition in Taiwanese adolescents are also discussed. [Copyright &y& Elsevier]

Examines attitudes toward networked peer assessment in senior high school and undergraduate students in Taiwan. Steps of networked peer assessment; Response of students to statements assessing satisfaction with peer assessment activities; Feasibility of applying networked peer assessment to the students.

This paper described the use of a networked peer assessment system to facilitate the development of inquiry-oriented activities for secondary science education. Twenty-four preservice teachers in Taiwan participated in this study and experienced a three-round peer assessment for developing science activities. The findings suggested that teachers tended to develop more creative, theoretically relevant, and practical science activities as a result of the networked peer assessment. However, the peers'' evaluations were not highly consistent with experts'' (e.g., university professors) grades. This study also revealed that students who offered detailed and constructive comments on reviewing and criticizing other peers'' work might help them improve their own work, especially in the beginning stage of revising their original work. [Copyright &y& Elsevier]

Presents a web-learning strategy peer review used by computer science students in an Operating Systems class in Taiwan. Features of the developed web-based peer review system; Measurement of student performance under peer review; Characterization of an effective individual as strategic adapter to peer comments.

This study explored the interplay between young people's attitudes toward computer networks and Internet addiction. Ninety possible Internet addicts were selected for examination after analyzing the questionnaire responses of an initial sample of 753 Taiwanese high school adolescents. It was found that the subjects' attitudes toward computer networks could explain many aspects of Internet addiction. However, actual behaviors on Internet usage and perceptions on the usefulness of Internet were more important than affective responses toward computer networks in predicting adolescents' Internet addiction. [ABSTRACT FROM AUTHOR]

This paper described an attempt of using a www-based concept map testing system, which was developed to assess high school students' concepts in physics. A total of ninety Taiwanese eleventh graders were tested through the on-line system and they, then, completed a questionnaire. The responses of the questionnaire revealed that the speed of information transferring, supported by the system was not quick enough. However, students did not think on-line test would cause some problems of cheating. More than a half of the subjects showed willingness of using the system in the future. [ABSTRACT FROM AUTHOR]

Deals with design of a systematic means of accumulating and commenting on homework samples by students. Targeted collection of a student's work to illustrate a student's progress; Three key sets of functions of the networked portfolio system.

In research on math self-concept (MSC) formation, very few studies have juxtaposed the effects of math grades, math ability, school-average math grades, and school-average math ability. However, these factors are important in enabling Taiwanese senior school students to achieve proper MSC and choose a suitable academic track. Thus, the present study aimed to model the relationship of these factors with MSC. The study also examined the gender effect and school location (rurality) effect. The sample contained 1,196 10th-grade students from 31 senior high schools in Taiwan. A doubly latent multilevel linear model was adopted to account for both sampling and measurement errors. The results suggested that math grades relative to the school-average math grade are key in MSC formation. There were school location and gender effects but no significant interaction between gender and school-level math grade or ability. These effects are discussed, as are the implications in practical settings. [ABSTRACT FROM AUTHOR]

How to direct students' attention in the class is a basic but crucial skill for both expert and novice teachers because too many students have various difficulties to invest lengthy attention on teacher's lecture and teaching materials. This preliminary study explored the use of mobile eye trackers in a natural classroom for recording L2 students' sustainable attention toward the projection screen which was presenting peer- or self-works or attention toward teachers who were evaluating their works. Some cases in a 12th grade class were selected to show the effects of individual factor (ability) and teacher factor (gesture) on classroom attention. In the first session, the projection screen showed texts of self-introduction, while in the second session it showed slides with graphics and texts. Mobile eye tracker, Pupil Labs, were used to collect data. The projection screen and the position of teacher were set as AOIs. Scores of English test (TOEIC) and Digital information literacy test were also collected. We found, firstly, some teacher gestures easily lost students' focus on the contents (projector screen) and secondly there was at least one case who had poor English ability but actively paid attention in a lengthy duration. Though teachers urge to know students' attention process in the classroom, related eye movement research is still limited. Therefore, we provide several suggestions on how to conduct quality observation using mobile eye tracker, such as, how to set up AOIs to make heat maps useful and synchronize data with multiple devices for future researchers. [ABSTRACT FROM AUTHOR]

Narratives are authentic reading materials for English as a foreign language (EFL) learners. The emphasis on texts alone may implicitly introduce an avoidance of illustrations for EFL readers. Furthermore, post comprehension checks are commonly applied as assessments in language learning, and they rarely reveal the cognitive processes of reading. The current study investigated reading comprehension processes on 58 EFL struggling and proficient learners (Mage= 17.8) via eye-tracking techniques. Participants were systematically and randomly assigned into four groups, in which they were provided with/without guidance to read two different level narratives (simple/complex text) embedded with structures (prologue/climax/resolution) of illustrated texts. Guided groups were instructed to read illustrations before reading the experimental illustrated text, while non-guided groups were not provided instructions. The data analysis, fixation counts and dwell time, showed that struggling students read the complex text following the guidance to rely on illustrations. The proficient learners processed illustrations when reading the simple text. The findings suggest that with guidance, struggling learners relied on illustrations as a bridging mechanism to comprehend and integrate complex text whereas proficient learners processed simple text through illustrations to solve critical uncertain words. This study contributes to reading empirically and practically. Empirically, it demonstrates that illustrations have brought a better understanding of reading comprehension, especially when learners' native language is not English. Practically, for classroom teachers, with their instruction on reading illustrations, learners can have an effective understanding of simple and complex texts. [ABSTRACT FROM AUTHOR]

Background: Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs.Methods: 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO.Results: 298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation.Conclusion: Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs. [ABSTRACT FROM AUTHOR]

As noted in previously published literature, college students frequently experience academic stress, financial stress, and the stresses caused by intimate, peer, and parent–adolescent relationships. The present study uses latent profile analysis to identify stress profiles based on the aforementioned five stressors among 430 college freshmen. Thereafter, we compare the levels of depression and problematic Internet use (PIU) among the different profile groups and investigate whether background variables could predict each latent stress group. Three latent groups were labelled as follows: Ordinary (n = 257, 59.77%); all moderate‐high (n = 98, 22.79%); and college‐life moderate‐high (n = 75, 17.44%). Compared with the ordinary group, the all moderate‐high and college‐life moderate‐high groups displayed significantly higher levels of depression. Moreover, the all moderate‐high group had a severer level of PIU than the college‐life moderate‐high and ordinary groups. Interestingly, males and students who were dating were more likely to fall under the all moderate‐high group than the college‐life moderate‐high group; but students who were more concerned with their academic performance were more likely to fall under the college‐life moderate‐high group than the all moderate‐high group. These findings have important implications for college educators and school counsellors with regard to developing appropriate interventions as required. [ABSTRACT FROM AUTHOR]

Purpose. This study aimed to clarify whether it is appropriate to choose any measurement location for pulse diagnosis research. Methods. A total of 37 subjects were recruited and measured for pulse pressure waves at 18 locations (9 per hand of “three positions and nine indicators”). These data were Fourier-transformed to the frequency spectrum, and the harmonics of C0-C10 of each location were obtained. Box plots of the harmonics were generated using SPSS v.22.0 and R v.3.4.1. Data were compared with multivariate analysis of variance (MANOVA) with a randomized block design. Results. The results showed that certain harmonics were different at different positions and different indicators; the harmonics of the same indicator at different positions (except for C8 and C10) and those of different indicators for the same position (except for C4 and C5) were significantly different (p<0.05). Conclusions. In future researches of pulse diagnosis, due to the significant differences between positions and indicators, it is recommended that the measurement position should be carefully chosen instead of choosing any measurement location to ensure the integrity of the acquired information for further analyzing physiological or pathological status. [ABSTRACT FROM AUTHOR]