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In their Commentary to Herodotus’ History, How and Wells (1912) comment that the ‘Story of Mycale given in H. evades detailed criticism by its slightness’ (Volume 2, 395). The other major source for information, Diodorus, also offers no more than cursory treatment of this military engagement (See Green, 2006). The superficial coverage in the ancient literature is then reflected in the evident lack of interest of modern studies in their brief assessments of the battle. Considering the very clear literary construction in Herodotus’ account (see Flower and Marincola, 2002) of what is universally regarded as a historical event, there has been too little consideration of the problems evident from a close inspection of the narrative. Moreover, since the works of Herodotus and Diodorus differ in the information they contain it is possible, as a result of a comparative reading of the texts, to advance new ideas about Mycale, the prelude to this event and of its aftermath.

Throughout the COVID-19 pandemic, China effectively contained the virus, resulting in increased public trust in the government. Mobile government (mGovernment) applications (apps) played a critical role in this improvement. This study aims to examine how mGovernment apps build citizens' trust in governments during public crises. The DeLone and McLean Information Systems Success Model (ISSM) is used to evaluate the quality of these apps. Public satisfaction serves as an intermediary variable, while public awareness of epidemic risks in sudden public relations crises acts as a moderating variable to explore the impact of mGovernment apps on government trust. Data analysis is conducted using SPSS Statistics 22.0 and AMOS 21.0. The study's results show that the system quality, information quality, and service quality of mobile government apps influence citizens' trust in governments through the mediating effect of public satisfaction. All three factors positively correlate with public satisfaction, with service quality having the greatest impact. Similarly, system quality, information quality, and service quality are positively correlated with public trust in governments, with system quality having the most noticeable influence. There is a strong correlation between public satisfaction and trust in governments, and the mediating effect of public satisfaction is significant. In addition, epidemic risk perception moderates the relationship between public satisfaction and citizens' trust in governments.

Background Wearable technology is used in healthcare to monitor the health of individuals. This study presents an updated systematic literature review of the use of wearable technology in promoting child and adolescent health, accompanied by recommendations for future research. Methods This review focuses on studies involving children and adolescents aged between 2 and 18 years, regardless of their health condition or disabilities. Studies that were published from 2016 to 2024, and which met the inclusion criteria, were extracted from four academic databases (i.e. PubMed, Cochrane, Embase, and Web of Science) using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol. Data on intervention purposes, interventions deployed, intervention duration, measurements, and the main outcomes of the studies were collected. Results A total of 53 studies involving 14,852 participants were reviewed. They focused on various aspects, including the ownership and use of wearable devices ( n = 3), the feasibility ( n = 22), effectiveness ( n = 4), and adherence ( n = 2) of intervention strategies, or a combination of multiple aspects ( n = 22). Among the interventions deployed, Fitbit was the most frequently used, featuring in 26 studies, followed by ActiGraph ( n = 11). In intervention studies, the majority of studies focused on pre-morbidity prevention ( n = 26) and the treatment of illnesses ( n = 20), with limited attention given to postoperative monitoring ( n = 4). Conclusions The use of wearable technology by children and adolescents has proven to be both feasible and effective for health promotion. This systematic review summarizes existing research by exploring the use of wearable technology in promoting health across diverse youth populations, including healthy and unhealthy individuals. It examines health promotion at various stages of the disease continuum, including pre-disease prevention, in-disease treatment, and postoperative monitoring. Additionally, the review provides directions for future research.

Abstract Previous studies have identified a correlation between individuals’ perception of news quality and their intention to avoid political news. However, limited research exists that examines the mechanisms that mediate or moderate this relationship, particularly in the context of short-form video platforms. This study, using a sample of 523 active users of Douyin, a Chinese short-form video platform, addresses this gap by examining the mediating influence of psychological reactance and the moderating impact of relative entertainment motivation on the connection between perceived news quality and intentional news avoidance. The study finds that the negative association between perceived news quality and intentional news avoidance is mediated by psychological reactance, while both the direct effect of perceived news quality on intentional news avoidance, and the indirect effect through psychological reactance, are moderated by relative entertainment motivation. Specifically, these effects are stronger for individuals with high relative entertainment motivation. These findings suggest that if users possess high relative entertainment motivation, their psychological reactance and intentional news avoidance can be reduced if the quality of news improves. This study contributes to current understanding of users’ deliberate avoidance of news and offers insights for owners and developers of short-form video platforms and algorithms.

Objectives Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about whether this translates into clinical benefits because of the coadministration of propofol and its detrimental effects, restricting myocardial protective processes.Methods In this single-blinded, parallel-group randomised controlled feasibility trial, higher-risk patients undergoing elective coronary artery bypass graft (CABG) surgery with an additive European System for Cardiac Operative Risk Evaluation ≥5 were randomised to receive either propofol or total inhalational anaesthesia as single agents for maintenance of anaesthesia. The primary outcome was the feasibility of recruiting and randomising 50 patients across two cardiac surgical centres, and secondary outcomes included the feasibility of collecting the planned perioperative data, clinically relevant outcomes and assessments of effective patient identification, screening and recruitment.Results All 50 patients were recruited within 11 months in two centres, allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up.Conclusions It is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates.Trial registration number NCT04039854.

IntroductionVillage clinics (VCs) are the foundation of the three-tiered health service system in China, delivering basic and routine outpatient services to citizens in rural China. VC technical efficiency and its convergence play a critical role in policy decisions regarding the distribution of health service resources in rural China.MethodsThis study measured VC technical efficiency (using the slacks-based measure model), its convergence (using the convergence model), and the factors that influence the convergence in Shanxi Province, China. Data were obtained from the Shanxi Rural Health Institute 2014–2018 Health Statistics Report, which involved 3,543 VCs.ResultsThe results showed that VC technical efficiency was low and differed by region. There was no α convergence in VC technical efficiency, but evidence of β convergence was found in Shanxi. The main factors that influence convergence were the building area of each VC (BA), proportion of government subsidies (PGS), and ratio of total expenditure to total income of each VC (RTETI).ConclusionThe government should increase investments in VCs and improve VC technical efficiency. Meanwhile, the government should be aware of and take measures to curb the inequity in VC technical efficiency among different regions and take suitable measures to curb this disparity.

[This corrects the article DOI: 10.1371/journal.pone.0296525.].

BackgroundAtrial Fibrillation After Cardiac Surgery (AFACS) occurs in about one in three patients following Coronary Artery Bypass Grafting (CABG). It is associated with increased short- and long-term morbidity, mortality and costs. To reduce AFACS incidence, efforts are often made to maintain serum potassium in the high-normal range (≥ 4.5mEq/L). However, there is no evidence that this strategy is efficacious. Furthermore, the approach is costly, often unpleasant for patients, and risks causing harm. We describe the protocol of a planned randomized non-inferiority trial to investigate the impact of intervening to maintain serum potassium ≥ 3.6 mEq/L vs ≥ 4.5 mEq/L on incidence of new-onset AFACS after isolated elective CABG.MethodsPatients undergoing isolated CABG at sites in the UK and Germany will be recruited, randomized 1:1 and stratified by site to protocols maintaining serum potassium at either ≥ 3.6 mEq/L or ≥ 4.5 mEq/L. Participants will not be blind to treatment allocation. The primary endpoint is AFACS, defined as an episode of atrial fibrillation, flutter or tachycardia lasting ≥ 30 seconds until hour 120 after surgery, which is both clinically detected and electrocardiographically confirmed. Assuming a 35% incidence of AFACS in the 'tight control group', and allowing for a 10% loss to follow-up, 1684 participants are required to provide 90% certainty that the upper limit of a one-sided 97.5% confidence interval (CI) will exclude a > 10% difference in favour of tight potassium control. Secondary endpoints include mortality, use of hospital resources and incidence of dysrhythmias not meeting the primary endpoint (detected using continuous heart rhythm monitoring).DiscussionThe Tight K Trial will assess whether a protocol to maintain serum potassium ≥ 3.6 mEq/L is non inferior to maintaining serum potassium ≥ 4.5 mEq/L in preventing new-onset AFACS after isolated CABG.Trial registrationClinicalTrials.gov Identifier: NCT04053816. Registered on 13 August 2019. Last update 7 January 2021.

This study investigates how first-time mothers participate in online discussions in WeChat groups to support their adaptation to motherhood. Online ethnography and in-depth interviews are employed to examine the psychological and behavioural aspects of these first-time mothers within WeChat groups, as well as the group construction process. The study’s findings show that WeChat groups, formed around common identity, have integrated new media technology into the cultural practices of distinct social groups. Within these groups, first-time mothers establish unique information exchange networks with other first-time mothers, enabling the sharing of experiences, emotions, and resources, ultimately creating de facto identity communities. Moreover, WeChat groups serve as vital channels for acquiring and distributing social capital, expanding parenting resources and social networks. The study highlights the crucial role of WeChat groups in providing support to first-time mothers as they navigate motherhood while fostering a sense of camaraderie and belonging within this virtual community.

Objectives The Healthy China 2030 strategy outlines the government's plans for healthcare reform, emphasizing the need for increased awareness about infectious diseases to prevent and fight future infections. Information campaigns can be used as a medium to raise awareness and encourage citizens’ willingness to protect themselves against diseases, such as COVID-19. Extant studies have found that individual health behavior decision-making can be changed under different information frames. However, limited evidence is available about emerging infectious diseases. Based on the Prospect Theory and Theory of Planned Behavior, the impact of information frames on self-protective behavior—vaccination against COVID-19 is investigated in this study. Methods A 2(gain/loss frame)*2(factual/emotional frame) intergroup experimental design was designed to explore the effects of different information frames. 228 valid participants in China were recruited and the experiment was performed online. Results First, the gain frame was more effective in promoting public self-protection behavior than the loss frame under information frame intervention. Compared with the factual frame, the emotional frame is more effective in reducing individual risk perception. Second, perceptual behavior control has masking effects on self-protection behavior under the influence of the gain/loss frame. Third, age, subjective norms, attitudes, and the gain frame, have predictive effects on self-protection behavior. Conclusions This study provides empirical evidence on the impact of information framing interventions on public self-protection behavior during the COVID-19 pandemic and provides important practical implications for public administrators and media practitioners.

Abstract Background As a new disease, communities possess little natural immunity to COVID-19 and vaccines are considered critical to preventing and reducing the incidence of severe illness. This study, inspired by Protection Motivation Theory (PMT), examines the relationship between citizens’ threat appraisal, coping appraisal, subjective norms, negative affect, and their COVID-19 vaccination intentions. Methods A sample of 340 citizens from two main cities in Mainland China, Xi’an and Wuxi, was used for data analysis. Structural Equation Modeling (SEM) was employed with latent and observed variables to test hypotheses. Data were analyzed using AMOS 24.0. Results Several findings extend current understanding. Firstly, our proposed model explains 73% of the variance in vaccination intentions. Secondly, perceived severity only indirectly shapes COVID-19 vaccination intentions through negative affect. Thirdly, negative affect and response costs are negatively related to COVID-19 vaccination intentions. Finally, Perceived probability, subjective norms, response efficacy and self-efficacy are positively related to COVID-19 vaccination intentions; among them, self-efficacy contributes the most, followed by response efficacy and subjective norms, and lastly perceived probability. Conclusion Theoretically, this study increases current understanding about subjective norms and affective responses. We provoke a certain amount of thought about the role of affect response in relation to threat appraisal and vaccination intentions. Specifically, governments must be vigilant that citizens’ negative affect, such as fear, may cause vaccine hesitation.

Objective: The objective of this article is to explore the concept of contextual intelligence (CI) as an important individual trait in complex decision-making environments and to understand its antecedents. Research Design & Methods: We surveyed 52 professionals from the pharmaceutical/biotech sector to explore the antecedents of CI behaviours by using Spearman’s rho correlation analysis, Student’s t-tests, and a two-stage cluster analysis. Findings: Gender does not appear to differentiate the level of CI, while age is only negatively correlated with future-minded behaviour. Respondents with doctorate education were characterised by a higher level of communitarian behaviours than those with lower education qualification attainment. Implications & Recommendations: In roles which are subject to VUCA (volatility, uncertainty, complexity, and ambiguity) conditions, the integration of linguistics, cultural awareness, and analytical abilities are important besides interpersonal skills, especially in face-to-face or virtual interactions. Contribution & Value Added: Our study provides a novel empirical contribution to the concept of CI through an exploratory study of medical affairs professionals and their self-reported CI behaviour profiles, including several individual-level characteristics.

Sufferers’ mental illnesses experience changes in communication, cognition, and behavior, exposing differences in social behavior and relationships. Many who suffer from mental health problems notice that the reduced communication ability leads to social inclusion and distrust of others. Online Mental Health Communities (OMHCs) facilitate a new means of communication between patients and physicians. Based on the trust source credibility framework, trust transitivity theory, social resources and physician-patient interactions, this study aims to evaluate the factors that influence patients’ trust in OMHCs. We crawled the data from Haodf.com, the leading healthcare community platform in China, to study the factors that influence patients’ trust using the ordinary least squares regression method. 725 psychologists’ records were collected on 19 November, 2019, 20 December, 2019, and 20 May, 2020. Compared with face-to-face physician appointments, Chief Physicians are more likely to gain patients’ initial trust online. Further, psychologists’ integrity, online reputation, and group size have significant positive impact on the initial trust of patients. Similarly, patients’ online initial trust and efforts have significantly positive influences on their continuous trust online. To improve relationships between physicians and patients, physicians must strengthen their clinical abilities and be honest with patients. The findings of this study provide insights into the factors that influence patients’ trust in OMHCs.

Despite numerous instruments existing to assist in the measurement of specific cyberbullying behaviors or cyberbullying in general, it is still unclear their purpose, corresponding scenarios, and their effectiveness. This study, therefore, aims to provide a comprehensive review of academic efforts on cyberbullying definitions, measurements, and their effectiveness in children and adolescents in the past two decades. A systematic review was performed using ASReview, an open source machine learning systematic review system. Three bibliographic citation databases, including Web of Science core collection, PubMed, and EBSCO were adopted for all relevant literature published from January 2001 to August 2021. In total, twenty-five studies, mentioning seventeen cyberbullying measurement scales, met the study collection criteria. The results found that most failed to provide a clear definition of cyberbullying, often providing unclear and inconsistent descriptions for the youth. Similarly, studies found it difficult to clearly reflect the three key elements of bullying, namely: harmfulness, repetitiveness, and the power imbalance between bullies and victims. With regard to cyberbullying types, most presented two or three categories, including victimization, perpetration, and bystanding, while some suggested four types based on the nature of the cyberbullying behavior, including written or verbal, visual or sexual, character impersonation, and exclusion. If characteristics are considered, cyberbullying becomes more specific with multiple categories being proposed, including flaming (or roasting), harassment, denigration, defamation, outing, jokes, online sexual harassment, and cyberstalking. With regard to measurements, many scales have been proposed and frequently refined to capture specific cyberbullying experience of the youth. This study emphasizes the value and importance of providing clear cyberbullying definitions and helps scholars in youth cyberbullying choose appropriate measurement scales.

BackgroundThe COVID-19 pandemic has created one of the greatest challenges to humankind, developing long-lasting socio-economic impacts on our health and wellbeing, employment, and global economy. Citizen engagement with government social media accounts has proven crucial for the effective communication and management of public health crisis. Although much research has explored the societal impact of the pandemic, extant literature has failed to create a systematic and dynamic model that examines the formation mechanism of citizen engagement with government social media accounts at the different stages of the COVID-19 pandemic. This study fills this gap by employing the Heuristic-Systematic Model and investigating the effects of the heuristic clues including social media capital, information richness, language features, dialogic loop, and the systematic clue including content types, on citizen engagement with government social media across three different stages of the pandemic, employing the moderating role of emotional valence.MethodsThe proposed model is validated by scraping 16,710 posts from 22 provincial and municipal government micro-blog accounts in the Hubei province, China.ResultsResults show that the positive effects of social media capital on citizen engagement were observed at all stages. However, the effects of information richness, language features, dialogic loop, and content types, and the moderating effect of emotional valence, varied across the different pandemic development stages.ConclusionsThe findings provide suggestions for the further effective use of government social media, and better cope with crises. Government agencies should pay attention to the content and form of information shared, using technical means to analyze the information needs of citizens at different stages of public health emergencies, understanding the content most concerned by citizens, and formulating the content type of posts.

Plain English summary Patient and Public Involvement (PPI) describes the active involvement of patients and the public in the research process. Through PPI, patients and members of the public are increasingly involved in the design and conduct of clinical trials. PPI has been shown to improve the quality and relevance of research. During the COVID-19 pandemic, clinical trials have been playing a vital role in helping us find ways to prevent and treat the infection and improve our understanding of the virus. It is important that patients and the public are actively involved in deciding how COVID-19 research is carried out. Unfortunately, Research Ethics Committees in the UK have seen far less PPI for COVID-19 research studies compared with research before the pandemic. A key reason for this is that research is being designed much faster than normal and researchers may feel they do not have time to properly involve patients and the public. In this paper, we share our experiences of PPI for a COVID-19 clinical trial. We show that it is possible to rapidly involve patients and the public in COVID-19 clinical trials. We also explain how the design of the clinical trial was changed in response to feedback from public contributors. Lastly, we discuss the wider learning from this process which might be useful for researchers planning PPI activities for COVID-19 clinical trials in the future. Abstract Background: Clinical trials are playing a critical role in the global public health response to the COVID-19 pandemic. Despite the increasing recognition of the value of PPI in clinical trials, just 22% of the COVID-19 research proposals reviewed by Research Ethics Committees in the UK at the start of the pandemic reported PPI. There is a perception that PPI might result in delays in delivering research and therefore delays in obtaining important results. In this paper, we report our experience of rapid PPI for a COVID-19 clinical trial. Methods: RAPID-19 is a COVID-19 clinical trial which was planned to be submitted for fast-track ethics review in the United Kingdom. During the development of the trial protocol, the PPI Panel at the London School of Hygiene & Tropical Medicine Clinical Trials Unit was involved in the design of the study. The meeting with the PPI Panel lasted just over 1 h and was conducted by teleconference. Results: Although we only had a short period of time to explore the study with the PPI Panel, we were able to gain valuable insight into how the trial would be perceived by potential trial participants. Substantive changes were made to the trial to improve the acceptability of the research without compromising the study timelines. Having access to public contributors with relevant lived experience is an important resource for a Clinical Trials Unit and is critical for rapid PPI. The move to remote working due to lockdown required virtual discussions which helped to overcome some of the barriers to organising face-to-face meetings at short notice. Conclusions: PPI for clinical trials can be conducted in a time-efficient manner within the pressured environment of a pandemic. Involving PPI contributors at an early stage in protocol development maximised the opportunity to shape and influence the trial as well as limited potential delays which could occur if changes to the protocol had to be made at a later stage.

Abstract A major challenge with modern aircraft design is the occurrence of structural features of varied length scales. Structural stiffness can be accurately represented using homogenisation, however aspects such as the onset of failure may require information on more refined length scale for both metallic and composite components. This work considers the errors encountered in the coarse global models due to the mesh size and how these are propagated into detailed local sub-models. The error is calculated by a goal oriented error estimator, formulated by solving dual problems and Zienkiewicz-Zhu smooth field recovery. Specifically, the novel concept of this work is applying the goal oriented error estimator to shell elements and propagating this error field into the continuum sub-model. This methodology is tested on a simplified aluminium beam section with four different local feature designs, thereby illustrating the sensitivity to various local features with a common global setting. The simulations show that when the feature models only contained holes on the flange section, there was little sensitivity of the von Mises stress to the design modifications. However, when holes were added to the webbing section, there were large stress concentrations that predicted yielding. Despite this increase in nominal stress, the maximum error does not significantly change. However, the error field does change near the holes. A Monte Carlo simulation utilising marginal distributions is performed to show the robustness of the multi-scale analysis to uncertainty in the global error estimation as would be expected in experimental measurements. This shows a trade-off between Saint-Venant’s principle of the applied loading and stress concentrations on the feature model when investigating the response variance.

BackgroundDigital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. ObjectiveThis scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. MethodsPrimary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics’ Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. ResultsA total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). ConclusionsThe application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance.

BackgroundPatient body weight is a frequently used measure in biomedical studies, yet there are no standard methods for processing and cleaning weight data. Conflicting documentation on constructing body weight measurements presents challenges for research and program evaluation. ObjectiveIn this study, we aim to describe and compare methods for extracting and cleaning weight data from electronic health record databases to develop guidelines for standardized approaches that promote reproducibility. MethodsWe conducted a systematic review of studies published from 2008 to 2018 that used Veterans Health Administration electronic health record weight data and documented the algorithms for constructing patient weight. We applied these algorithms to a cohort of veterans with at least one primary care visit in 2016. The resulting weight measures were compared at the patient and site levels. ResultsWe identified 496 studies and included 62 (12.5%) that used weight as an outcome. Approximately 48% (27/62) included a replicable algorithm. Algorithms varied from cutoffs of implausible weights to complex models using measures within patients over time. We found differences in the number of weight values after applying the algorithms (71,961/1,175,995, 6.12% to 1,175,177/1,175,995, 99.93% of raw data) but little difference in average weights across methods (93.3, SD 21.0 kg to 94.8, SD 21.8 kg). The percentage of patients with at least 5% weight loss over 1 year ranged from 9.37% (4933/52,642) to 13.99% (3355/23,987). ConclusionsContrasting algorithms provide similar results and, in some cases, the results are not different from using raw, unprocessed data despite algorithm complexity. Studies using point estimates of weight may benefit from a simple cleaning rule based on cutoffs of implausible values; however, research questions involving weight trajectories and other, more complex scenarios may benefit from a more nuanced algorithm that considers all available weight data.

BackgroundVisual impairments related to non-correctable vision loss, including blindness and low vision, have been consistently shown to lower a person's health-related quality of life. This study assessed the reliability, validity, and discrimination of the Quality of Life Scale for Children with Visual Impairments (QOLS-CVI) in China.MethodsThe Pediatric Quality of Life Inventory™ 4.0 and World Health Organization Quality of Life-Disability Scale for physical disability were selected to define conceptual frameworks and item libraries based on relevant existing studies. According to two rounds of expert consultations and group discussions, some items were modified, and the draft scale was developed. Two item selection processes based on classical test theory and item response theory were used to conduct a preliminary survey and a formal survey in special schools in Shanxi and Hebei Provinces. Finally, the reliability and validity of the quality of life scale for visually impaired children in China were verified.ResultsThe final QOLS-CVI consisted of 38 items, 10 subdomains, and 6 domains. Reliability was verified by Cronbach's alpha coefficient, split-half reliability, and test-retest reliability (Cronbach's alpha for the full scale, 0.841; split-half reliability, 0.629; and test–retest reliability, 0.888). The validity results showed that the multidimensional scale met expectations: exploratory factor analysis and confirmatory factor analysis indicated good fitting models for children with visual impairments.ConclusionsThe QOLS-CVI was determined to be reliable and valid and to have strong feasibility and effectiveness. This scale can be used as an evaluation tool to study the QOL and social-participation ability of children with visual impairments.

Abstract Introduction Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli infections have become endemic worldwide. We aimed to describe the molecular and clinical epidemiology of ESBL-producing E. coli infections during a period of rising global prevalence. Methods Three hundred sixty-nine consecutive ESBL-producing E. coli infections in Detroit from 2010–2011 were analyzed. Sequence typing (ST) and CH typing were performed. Clinical characteristics and outcomes were compared between patients infected with ST131 and non-ST131 isolates. Results Ninety-six percent of isolates were ST 131, and 78.6% of ST 131 isolates produced bla CTX-M-15. Median time to effective therapy was 48 h vs. 35 h (P = 0.38) in the ST131 vs. non-ST131 groups. Ninety-day mortality rates (8% vs. 8%, P = 1.0) were similar between the two groups. Conclusion bla CTX-M-15 ST131 E. coli predominated in Detroit during an early period of global ST131 dissemination. Patients with ST131 E. coli infections had similar clinical outcomes to those with non-ST131 E. coli infections.

Chinese public hospitals have increased usage of TikTok to communicate with citizens on health-related matters. This study aims to investigate the engagement of citizens with the official TikTok accounts of public hospitals, and identify the major characters of the videos with the highest public engagement level, as well as underlying factors that make them successful. A comprehensive search on TikTok, a video-sharing social networking service, was completed to identify all official accounts of public hospitals in Mainland China. Data was collected from 40 public hospitals with the top 100 TikTok videos being identified for content analysis. The majority of them were created by public hospitals located in the Central and Western regions of China. The common features of the top 100 identified videos include: low message sensation value and short video length, and are typically accompanied by background music, subtitles, and an introduction at the beginning of the video. The most frequently viewed video type is film clips which are used to disseminate knowledge of diseases and promote healthcare professionals. Health communication via the official TikTok accounts of public hospitals in China offers significant potential. Hospitals are encouraged to engage citizens in health-related conversations to build their credibility and professional image online. Among the popular short-videos, the message sensation value is not largely connected to video popularity, while the content of videos seems more important. This requires skills in video creation or procurement, and editing, while rhetoric should be cautiously applied. The content of videos should provide education and positive energy.

Abstract Background The provision of medical services by Medical Teams (MT) on Online Healthcare Communities (OHCs) is a novel method employed by geographically-dispersed healthcare professionals to serve one patient simultaneously, allowing patients to receive more specific, targeted and comprehensive advice. As a relatively new method of service delivery, little attention has been paid to identifying the determinants of Team-based Service Demands (TSD). Based on Upper Echelons Theory and Social Exchange Theory, this study examines the impact of both professional capital (status capital and decisional capital) and team heterogeneity (team size and dispersion) on TSD. Methods This study uses data collected from 890 MTs, employing 3994 team members, operating on haodf.com, a Chinese OHC, to examine effects of both leader and team characteristics on TSD. Results Our findings suggest that a MT’s characteristics have a significant impact on TSD. Firstly, the decisional capital of both leaders and teams were positively related with TSD, while only the status capital of leaders saw a positive impact. Secondly, team heterogeneity influenced TSD in two ways: (1) provided a direct negative impact and (2) positively moderated the relationship between professional capital and TSD. Conclusion This paper comprehensively studies the impact of TSD from the perspectives of professional capital and team heterogeneity, expanding current theoretical understanding of team heterogeneity and social capital in OHCs. Further, it provides practical suggestions for platform development and team leaders managing MTs in online environments.

Background: Cyberbullying is well-recognized as a severe public health issue which affects both adolescents and children. Most extant studies have focused on national and regional effects of cyberbullying, with few examining the global perspective of cyberbullying. This systematic review comprehensively examines the global situation, risk factors, and preventive measures taken worldwide to fight cyberbullying among adolescents and children.Methods: A systematic review of available literature was completed following PRISMA guidelines using the search themes “cyberbullying” and “adolescent or children”; the time frame was from January 1st, 2015 to December 31st, 2019. Eight academic databases pertaining to public health, and communication and psychology were consulted, namely: Web of Science, Science Direct, PubMed, Google Scholar, ProQuest, Communication & Mass Media Complete, CINAHL, and PsycArticles. Additional records identified through other sources included the references of reviews and two websites, Cyberbullying Research Center and United Nations Children's Fund. A total of 63 studies out of 2070 were included in our final review focusing on cyberbullying prevalence and risk factors.Results: The prevalence rates of cyberbullying preparation ranged from 6.0 to 46.3%, while the rates of cyberbullying victimization ranged from 13.99 to 57.5%, based on 63 references. Verbal violence was the most common type of cyberbullying. Fourteen risk factors and three protective factors were revealed in this study. At the personal level, variables associated with cyberbullying including age, gender, online behavior, race, health condition, past experience of victimization, and impulsiveness were reviewed as risk factors. Likewise, at the situational level, parent-child relationship, interpersonal relationships, and geographical location were also reviewed in relation to cyberbullying. As for protective factors, empathy and emotional intelligence, parent-child relationship, and school climate were frequently mentioned.Conclusion: The prevalence rate of cyberbullying has increased significantly in the observed 5-year period, and it is imperative that researchers from low and middle income countries focus sufficient attention on cyberbullying of children and adolescents. Despite a lack of scientific intervention research on cyberbullying, the review also identified several promising strategies for its prevention from the perspectives of youths, parents and schools. More research on cyberbullying is needed, especially on the issue of cross-national cyberbullying. International cooperation, multi-pronged and systematic approaches are highly encouraged to deal with cyberbullying.

Abstract This letter to the editor is in response to the consensus statement from the Ultrasound Subcommittee of the European Society of Radiology, the European Union of Medical Specialists (UEMS) Section of Radiology, and the European Federation of Societies for Ultrasound in Medicine and Biology. It highlights the role of the non-medical sonographer in the UK and the evidence underpinning this safe and effective practice.

Micromachining techniques have been applied widely to many industrial sectors, including aerospace, automotive, and precision instruments. However, due to their high-precision machining requirements, and the knowledge-intensive characteristics of miniaturized parts, complex manufacturing process problems often hinder production. To solve these problems, a systematic scheme for structured micromachining process problem solving and an innovation support system is required. This paper presents a knowledge-based holistic framework that enables process planners to achieve micromachining innovation design. By analyzing innovation design procedures and available knowledge sources, an open multi-source Machining Process Innovation Knowledge (MPIK) acquisition paradigm is presented, including knowledge units and a knowledge network. Further, a MPIK network-driven structured process problem-solving and heuristic innovation design method was explored. Subsequently, a knowledge-driven heuristic design system for machining process innovation was integrated in the Computer-Aided Process Innovation (CAPI) platform. Finally, a case study involving specific process problem-solving and innovation scheme design for micro-turbine machining was studied to validate the proposed approach.

Artificial Intelligence (AI) is transforming healthcare and shows considerable promise for the delivery of medical education. This systematic review provides a comprehensive analysis of the global situation, effects, and challenges associated with applying AI at the different stages of medical education. This review followed the PRISMA guidelines, and retrieved studies published on Web of Science, PubMed, Scopus, and IEEE Xplore, from 1990 to 2022. After duplicates were removed (n = 1407) from the 6371 identified records, the full text of 179 records were screened. In total, 42 records were eligible. It revealed three teaching stages where AI can be applied in medical education (n = 39), including teaching implementation (n = 24), teaching evaluation (n = 10), and teaching feedback (n = 5). Many studies explored the effectiveness of AI adoption with questionnaire survey and control experiment. The challenges are performance improvement, effectiveness verification, AI training data sample and AI algorithms. AI provides real-time feedback and accurate evaluation, and can be used to monitor teaching quality. A possible reason why AI has not yet been applied widely to practical teaching may be the disciplinary gap between developers and end-user, it is necessary to strengthen the theoretical guidance of medical education that synchronizes with the rapid development of AI. Medical educators are expected to maintain a balance between AI and teacher-led teaching, and medical students need to think independently and critically. It is also highly demanded for research teams with a wide range of disciplines to ensure the applicability of AI in medical education.

The anterior cruciate ligament (ACL) provides stabilization support for the back and forth motion of the knee joint. ACL ruptures account for 50% of all sports-related knee injuries with approximately 76.6% of them requiring reconstructive surgery, necessitating long-term patient rehabilitation. Compliance with rehabilitation management programs, following ACL reconstruction, is fundamental for the successful restoration of the knee’s kinematics and reducing the risk of secondary osteoarthritis. Existing recovery programs are often paper-based and require patients to perform exercises at home, unsupervised, resulting in a low level of self-efficacy; by promoting self-efficacy in home-based settings, rehabilitation outcomes can improve. This paper reports the design development of the Sana system, a mobile and wearable application that adopts behavioral design principles and gamification theory to improve long-term post-operative outcomes for ACL reconstruction recovery. A feasibility study was conducted from 15 October 2019–13 May 2020, employing the double diamond framework and a human-centered design approach (BS EN ISO 9241-210: 2019). Eighteen participants were recruited, including eight domain experts (in fields such as user experience design, human factors, and physiotherapy), and ten representative users who had undergone long-term rehabilitation for musculoskeletal injuries.

Mutation rates can evolve through genetic drift, indirect selection due to genetic hitchhiking, or direct selection on the physicochemical cost of high fidelity. However, for many systems, it has been difficult to disentangle the relative impact of these forces empirically. In RNA viruses, an observed correlation between mutation rate and virulence has led many to argue that their extremely high mutation rates are advantageous because they may allow for increased adaptability. This argument has profound implications because it suggests that pathogenesis in many viral infections depends on rare or de novo mutations. Here, we present data for an alternative model whereby RNA viruses evolve high mutation rates as a byproduct of selection for increased replicative speed. We find that a poliovirus antimutator, 3DG64S, has a significant replication defect and that wild-type (WT) and 3DG64S populations have similar adaptability in 2 distinct cellular environments. Experimental evolution of 3DG64S under selection for replicative speed led to reversion and compensation of the fidelity phenotype. Mice infected with 3DG64S exhibited delayed morbidity at doses well above the lethal level, consistent with attenuation by slower growth as opposed to reduced mutational supply. Furthermore, compensation of the 3DG64S growth defect restored virulence, while compensation of the fidelity phenotype did not. Our data are consistent with the kinetic proofreading model for biosynthetic reactions and suggest that speed is more important than accuracy. In contrast with what has been suggested for many RNA viruses, we find that within-host spread is associated with viral replicative speed and not standing genetic diversity.

Background: Novel cardioprotective strategies are required to improve clinical outcomes in higher-risk patients undergoing coronary artery bypass graft (CABG) with or without valve surgery. Remote ischaemic preconditioning (RIPC) in which brief episodes of non-lethal ischaemia and reperfusion are applied to the arm or leg has been demonstrated to reduce perioperative myocardial injury (PMI) following CABG with or without valve surgery. Objective: To investigate whether or not RIPC can improve clinical outcomes in this setting in the Effect of Remote Ischaemic preconditioning on Clinical outcomes in patients undergoing Coronary Artery bypass graft surgery (ERICCA) study in patients undergoing CABG surgery. Design: Multicentre, double-blind, randomised sham controlled trial. Setting: The study was conducted across 30 cardiothoracic centres in the UK between March 2010 and March 2015. Participants: Eligible patients were higher-risk adult patients (aged > 18 years of age; additive European System for Cardiac Operative Risk of ≥ 5) undergoing on-pump CABG with or without valve surgery with blood cardioplegia. Interventions: Patients were randomised to receive either RIPC (four 5-minute inflations/deflations of a standard blood pressure cuff placed on the upper arm) or the sham control procedure (simulated RIPC protocol) following anaesthetic induction and prior to surgical incision. Anaesthetic management and perioperative care were not standardised. Main outcome measures: The combined primary end point was the rate of major adverse cardiac and cerebral events comprising cardiovascular death, myocardial infarction, coronary revascularisation and stroke within 12 months of randomisation. Secondary end points included perioperative myocardial and acute kidney injury (AKI), intensive care unit and hospital stay, inotrope score, left ventricular ejection fraction, changes in quality of life and exercise tolerance. Results: In total, 1612 patients (sham control group, n = 811; RIPC group, n = 801) were randomised in 30 cardiac surgery centres in the UK. There was no difference in the primary end point at 12 months between the RIPC group and the sham control group (26.5% vs. 27.7%; hazard ratio 0.95, 95% confidence interval 0.79 to 1.15; p = 0.58). Furthermore, there was no evidence for any differences in either adverse events or the secondary end points of PMI (72-hour area under the curve for serum high-sensitivity troponin T), inotrope score, AKI, intensive therapy unit and hospital stay, 6-minute walk test and quality of life. Conclusions: In patients undergoing elective on-pump CABG with or without valve surgery, without standardisation of the anaesthetic regimen, RIPC using transient arm ischaemia–reperfusion did not improve clinical outcomes. It is important that studies continue to investigate the potential mechanisms underlying RIPC, as this may facilitate the translation of this simple, non-invasive, low-cost intervention into patient benefit. The limitations of the study include the lack of standardised pre-/perioperative anaesthesia and medication, the level of missing and incomplete data for some of the secondary end points and the incompleteness of the data for the echocardiography substudy. Trial registration: ClinicalTrials.gov NCT01247545. Funding: This project was funded by the Efficacy and Mechanism Evaluation programme, a MRC and NIHR partnership, and the British Heart Foundation.

An introduction to Veterinary Evidence from the Editor-in-Chief

Veterinary Evidence Editor-in-Chief Rich Evans caught up with long-time EBVM advocate Dr. Steve Budsberg at this year’s American College of Veterinary Surgeons Symposium and took the opportunity to ask Dr. Budsberg his take on some of the current issues in EBVM. Dr. Budsberg, an orthopedic surgeon at the University of Georgia, USA, is a past president and charter member of the Evidence-base Veterinary Medical Association and on the program committee for Veterinary Evidence Today: The 2016 EBVM Network Conference, to be held in November, in Edinburgh.

Technology has become a necessity in our everyday lives and essential for completing activities we typically take for granted; technologies can assist us by completing set tasks or achieving desired goals with optimal affect and in the most efficient way, thereby improving our interactive experiences. This paper presents research that explores the representation of user interaction levels using an intelligent hybrid system approach with agents. We evaluate interaction levels of Human-Computer Interaction (HCI) with the aim of enhancing user experiences. We consider the description of interaction levels using an intelligent hybrid system to provide a decision-making system to an agent that evaluates interaction levels when using interactive modules of a museum exhibition. The agents represent a high-level abstraction of the system, where communication takes place between the user, the exhibition and the environment. In this paper, we provide a means to measure the interaction levels and natural behaviour of users, based on museum user-exhibition interaction. We consider that, by analysing user interaction in a museum, we can help to design better ways to interact with exhibition modules according to the properties and behaviour of the users. An interaction-evaluator agent is proposed to achieve the most suitable representation of the interaction levels with the aim of improving user interactions to offer the most appropriate directions, services, content and information, thereby improving the quality of interaction experienced between the user-agent and exhibition-agent.

Since the mid 90s corpora has become very important for computational linguistics. This paper offers a survey of how they are currently used in different fields of the discipline, with particular emphasis on anaphora and coreference resolution, automatic summarisation and term extraction. Their influence on other fields is also briefly discussed. Since the mid 90s corpora has become very important for computational linguistics. This paper offers a survey of how they are currently used in different fields of the discipline, with particular emphasis on anaphora and coreference resolution, automatic summarisation and term extraction. Their influence on other fields is also briefly discussed.

Resumo São apresentadas diversas observações botânicas e etnobotânicas de algumas plantas pouco conhecidas, que são alimentos comuns para várias tribos de índios. As plantas estudadas pertencem aos gêneros Erythroxylon (coca), Hevea (seringueira), Micrandra, Vaupesia, Macoubea (amapá-doce), Maranta, Calathea (ariá), Pourouma (mapati), Pouteria (ucuqui), e outros.