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Knowing the factors affecting students' learning achievement in digital learning is a crucial educational issue nowadays. However, recent research has paid less attention to how an individual's internal factors (prior knowledge) influence their learning achievement through cognitive engagement, and previous studies generally employed students' self-reported data, which are subjective. This study investigated the relationships between students' prior knowledge, cognitive engagement, and learning achievement in digital game-based learning by using eye-tracking technology to analyze their visual behaviors. A total of 55 university students volunteered to use the game to learn about programming, during which their visual behaviors were recorded by an eye tracker to investigate their cognitive engagement and visual transition patterns. Their prior knowledge of programming was assessed one week before the game started, while their learning achievement was tested immediately after the game ended. The results of the study showed that: (1) Students' prior knowledge had a moderately positive predictive effect on their learning achievement; (2) Students' learning concentration played a mediating role in the predictive effect of prior knowledge on learning achievement; (3) Students' cognitive strategies moderated the predictive effect of prior knowledge on learning achievement; and (4) Groups of students with different prior knowledge and cognitive engagement adopted significantly different modes of visual transformation in the game. These findings further revealed the complex relationship between learners' prior knowledge, cognitive engagement and learning achievement in the game environments, which would be a good reference for understanding individual differences in the game environment and for designing game-based adaptive learning systems.

Background. Most documented "superspreading events" of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China. Methods. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events. Results. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of ⩽1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68-28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02-0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04-13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28-48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00-18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97-70.80). Conclusions. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future. [ABSTRACT FROM AUTHOR]