ABSTRACT
The COVID-19 pandemic caused colleges and universities to rely heavily on online learning to continue knowledge dissemination to learners. This study used the second-generation model of unified theory of acceptance and use of technology (UTAUT2) to comprehensively analyze the mediating effects of self-efficacy, which affects learners' effective use of online tools for learning, and capability of metacognition and self-regulation, which can independently adjust learning progress into the UTAUT2 model, on the learner's willingness to continue online learning [i.e., their behavioral intention (BI)] by constructing a UTAUT2-based e-learning model. This study administered questionnaires to undergraduates in universities in East China to collect data. The effects of performance expectancy, effort expectancy (EE), social influence (SI), and facilitating conditions (FCs), hedonic motivation (HM), price value (PV), and habits on BI (directly or through mediators) were analyzed through data analysis and structural equation modeling, and the UTAUT2-based e-learning model was accordingly modified. The results indicated that the self-efficacy enhanced the effects of EE, SI, FCs, HM, and PV on learners' BI; that metacognition and self-regulation (MS) capabilities enhanced the effects of EE on learners' BI; and that habits had a direct and strong effect on BI. This study also provided some suggestions to enhance higher education learners' willingness to continue online learning, such as improving social recognition and support, careful design of teaching content, easy-to-use technology, financial support. These results and suggestions may guide colleges and universities in conducting, continuing, or enhancing online education, particularly as the pandemic continues.
ABSTRACT
ObjectiveTo delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.DesignRetrospective case series.SettingTongji Hospital in Wuhan, China.ParticipantsAmong a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.Main outcome measuresClinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms.ResultsThe median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83;73%) than in recovered patients (88;55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113;100%), type I respiratory failure (18/35;51%), sepsis (113;100%), acute cardiac injury (72/94;77%), heart failure (41/83;49%), alkalosis (14/35;40%), hyperkalaemia (42;37%), acute kidney injury (28;25%), and hypoxic encephalopathy (23;20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.ConclusionSevere acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.