Despite the Zambian government making progress on prioritising gender mainstreaming, female participation in science, technology and innovation in academia, research and development is still low. This study aims to determine the integration of gender dimensions and the factors that influence female participation in science and health research in Zambia.2 test and independent t-test) and multivariate regression analysis will be conducted to test the association and identify factors influencing female participation in science and health research . An inductive approach will be used to analyse qualitative data using NVivo. Survey and IDI will be corroborated.We propose a descriptive cross-sectional study design employing in-depth interviews (IDIs) and survey as data collection techniques. Twenty schools offering science-based programmes will be purposively selected from University of Zambia (UNZA), Copperbelt University, Mulungushi University and Kwame Nkrumah University. In addition, two research institutions, Tropical Disease Research Centre and Mount Makulu Agricultural Research Station, will be included. Survey respondents will include a random sample of 1389 academic and research staff from the selected schools. A total of 30 IDIs will be conducted with staff and heads of selected schools and research institutions. Data collection will be conducted over a 12-month period. Before commencement of data collection, in-depth literature search and record review on gender dimensions in science and health research will be conducted to gain insight into the subject matter and inform research instrument design. Survey data and IDIs will be collected using a structured paper-based questionnaire and semistructured interview guide, respectively. Descriptive statistics will be computed to summarise respondents’ characteristics. Bivariate analysis . Participants gave informed consent to participate in the study before taking part. Study findings will be disseminated through a written report, stakeholder meetings and publication in a peer-reviewed international journal. Use of a mixed-methods cross-sectional design employing in-depth literature review, survey and in-depth interview techniques increases the internal validity of the study.Use of probability proportional to size and random sampling techniques to select schools and study participants, respectively, minimises bias due to selection bias.Training of data collectors minimises measurement error.Cross-sectional design of the study does not allow for causal inference.Recruiting study participants from only four public institutions of higher learning and two research institutions may introduce selection bias and limit validity of study findings.Selection of all the 16 schools offering science-based programmes from only two public institutions in may introduce selection bias.Gender mainstreaming is a public policy concept of assessing different implications of any public policy action, legislation and programmes on people of different genders.Globally, countries are increasingly recognizing the importance of supporting the study of science and technology in higher institutions of learning for both men and women.7Nevertheless, women and girls around the world are still excluded from participation in science and technology, and gaps remain in the area of women researchers and scientists in top managerial positions throughout the world.Zambia is one of the UN Member States that have adopted the gender mainstreaming concept and developed a national gender policy.Although the Zambian government has made significant progress in adopting the policyReasons for the low female participation in this field are not well understood.To what extent is gender mainstreaming integrated in science and health research?What is the proportion of women participating in science and health research in Zambia?What factors influence female participation in science and health research in the country?This study aims to explore the integration of gender dimensions and determine the predictors of female participation in scientific and health research in the country. The specific objectives are:Explore integration of gender policy in academic and research institutions.Explore female participation in science and health research activities.Identify the factors that affect female participation in science and health research and development.Determine the predictors of female participation in scientific and health research.This knowledge is important for informing policy and programming for the advancement of gender equality, equal opportunities and participation in science, health research and development in order to promote quality scientific and health outcomes and technological excellence. Incorporating gender dimensions and deliberately encouraging women to participate in science and health research is crucial in realising the key role that women can play in the development and advancement of science, and their commitment to inclusive science and research development. Gender equality in science and research is not only a matter of fairness but is important for enhancing the recruitment of the most talented individuals, irrespective of gender, and for tapping a partially unexploited resource.33 34We propose to conduct a descriptive mixed-methods cross-sectional study design employing in-depth interviews (IDIs) and survey as data collection techniques. Use of qualitative and quantitative data collection and analysis techniques will make the study comprehensive and allow for triangulation and corroboration of the findings. This will in turn increase the internal validity of the findings.35 36The study will be conducted at four public institutions of higher learning in Zambia  and two public research institutions  and Mount Makulu Agricultural Research Station). In addition, one Science-Granting Council (SGC) and the Higher Education Loans and Scholarship Board (HESB), two government ministries (Gender and Higher Education) and United Nations agencies (UNICEF and UNESCO) will be included in the study. UNZA is located in Lusaka, the capital city of Zambia. It is the largest and oldest public university in the country. It was founded in 1965 and established by the Act of Parliament No. 66 of 1965. The first intake of students took place on 17 March 1966. It offers a number of academic programmes at diploma, undergraduate and postgraduate levels. The university has 13 faculties including Agricultural Sciences, Education, Engineering, Graduate School of Business, Health Sciences, Law, Medicine, Mining, Public Health, Natural Sciences, Nursing Sciences, Social Sciences and Humanities, Veterinary Medicine. It also has the directorate of research and graduate studies (DRGS). The Copperbelt University is the second largest and oldest public university. It is located in Kitwe, Zambia and has 12 schools including: School of the Built Environment, School of Business, Dag Hammarskjold Institute for Peace and Conflict Resolution, Directorate of Distance Education and Open Learning, School of Engineering, School of Graduate Studies, School of Mathematics and Natural Science, School of Medicine, School of Mines and Mineral Resources, School of Natural Resources, School of Information and Communication Technology, and School of Humanities. Mulungushi University and Kwame Nkrumah University are located in Kabwe, the capital of Central Province. TDRC is a public health research institution located in Ndola, Copperbelt Province. Mount Makulu Agricultural Research Station is a public agricultural research institution located in Chilanga District, Lusaka Province─approximately 20 km from the national capital, Lusaka. HESB is a public institution located in Lusaka. It provides loans and scholarships to students in to pursue higher education both in Zambia and outside.A total of 16 schools offering science-related and health-related programmes will be purposively selected from the selected institutions. Ten schools offering science-related and health-related programmes will be purposively selected from UNZA, namely: Medicine, Public Health, Nursing Sciences, Health Sciences, Veterinary Medicine, Mines, Engineering, Natural Sciences, Agricultural Sciences, Directorate of Research and Postgraduate Studies. Seven schools offering science-related and health-related programmes at Copperbelt University will be included in the study: School of Engineering, School of Mathematics and Natural Science, School of Medicine, School of Mines and Mineral Resources, School of Natural Resources, School of Information and Communication Technology, and School of Graduate Studies. In addition, two schools from Mulungushi University and one from Nkrumah University will be included in the study. Two research institutions, TDRC from Ndola Zambia and Mount Makulu Agricultural Research Station in Chilanga, will be included in the study.Survey participants will comprise a systematically selected sample of 1389 male and female academic and research staff from the selected schools. The academic and research institutions, science granting council and scholarship board have been selected because they are public and are involved in science and health research.To be eligible, survey participants will be:Lecturers and researchers at any academic rank (from the lowest level to full professor).Those having worked in the selected institution for at least 3 months.IDI participants will include staff from the selected schools and research institutions. To be eligible, IDI participants will be:Administrative staff from academic institutions .Administrative staff from research institutions .Academic staff at all ranks.Technical staff from research institutions.Survey participants will be selected using a stratified sampling technique. First, the number of staff from each school will be obtained. To ensure that all schools are proportionately represented, probability proportional to size will be conducted to determine how many participants will be selected from each school. Next, a list of all the lecturers in each selected school will be compiled to serve as a sampling frame. To ensure inclusion of both male and female participants from various academic and administrative ranks and also to ensure that they have an equal chance of being selected, information on the sex  of potential respondents will be obtained from the administrative managers and separate lists will be prepared for each sex. The sampling frame will also include other variables: qualification , position and rank in the organisation (from lowest rank to the full professor), administrative rank . In order to be comprehensive, a checklist will be prepared by the research team in consultation with administrative staff from the respective organisation. Each potential participant will be assigned a unique number in the sampling frame. A random number generator will be used to select participants from the list. This process will be done for each institution and school.Purposive sampling will be used to recruit IDI participants from the selected institutions. In order to compare and contrast the respondents’ views, both male and female participants will be included. We plan to conduct a total of 30 IDIs in both academic and research institutions. However, the actual number of IDIs to be conducted will be determined by the point of saturation.37–39In order to get variability in responses, and to compare and contrast the similarities and differences in participant perspectives on the subject, efforts will be made to ensure that both male and female respondents are included in the IDIs and questionnaire survey. Efforts will also be made to have a mix of survey participants from the lowest (lecturer 3) to the highest (full professor) ranks.In order to detect the difference in participation in scientific and health research between women and men, we will use the power approach to estimate the sample size. The power approach is used to compute the sample required to determine the minimum difference between two or more groups in comparative studies.Power =80%95% CIα=0.05Groups = two Sampling ratio =1Minimum detectable difference =15.0%Margin of error =5%.604 per group or 1208 for the total sample. Allowing for a 15% non-response rate (NRR) gives a total sample size of 1389 (or 695 for each group) survey respondents required to have enough power to measure the proportion of women participating in STI and carry out multivariate analysis to determine the predictors of female participation in STI with 95% confidence.Inputting these assumptions into the online advanced power and sample size calculatorThe study variables will include the outcome and independent variables as follows:Female participation in science and health research and development.Demographic information: age, sex, number of children.Field of study.Academic rank.Attitude towards scientific and health-related research.Treatment at the workplace.Workplace culture.In order to gain insight into the gender integration issues and inform design of data collection instruments, we propose a review of existing documents and policies from the UN agencies, government ministries of gender and higher education, HESB, science granting councils, and academic and research institutions. The proposed search will include: (A) Enrolment and graduation data from the four selected academic institutions, (B) Administrative data on staffing profile in the selected schools; (C) Data on both external and internal research grants in the academic institutions, (D) Data on local grants from science granting councils, (E) Review of national and institutional documents on gender policy and integration.To determine the factors influencing gender integration and female participation in science and health research, a survey using a structured questionnaire will be conducted among a randomly selected sample of 1389 academic staff from the selected schools. To qualitatively explore the respondents’ perspectives and gain insight into gender integration and female participation in science and research, IDIs will be conducted with administrative and academic staff from the academic and research institutions as shown in 10.1136/bmjopen-2022-064139.supp1Supplementary dataData collection will be conducted over a 12-month period. IDIs will be conducted by a pair of trained research assistants under the supervision of the research team members. Research assistants will be selected from the Master of Public Health students in the School of Public Health at UNZA. Only students with experience in qualitative research will be selected. Survey questionnaires will be emailed to the respondents by the members of the research team.Prior to data collection, research assistants will undergo training for a total of 5 days. The training will be conducted by the principal investigators (PIs) and the co-investigators, and will be in two phases: theory and fieldwork. Phase I will include theory in research and will take 3 days. Topics will include: (1) Basic principles of qualitative and quantitative research, (2) Purpose and objectives of the study, (3) Data collection and interviewing techniques, (4) Research ethics, and (5) Informed consent in human subjects’ research. Phase II will be field practicals and will include pretesting of the data collection tools and consent form, and will take 2 days, after which the instruments will be revised based on the collected and analysed data and feedback from the research assistants. Each IDI and questionnaire is expected to last between 30 min and 45 min.We plan to conduct record review first followed by IDIs, and then use insights from the literature review and qualitative study to revise and improve the questionnaire for the quantitative survey.A paper-based, standard, structured and pretested questionnaire  will be 10.1136/bmjopen-2022-064139.supp2Supplementary dataIDIs will be collected using a pretested interview guide  that has10.1136/bmjopen-2022-064139.supp3Supplementary data10.1136/bmjopen-2022-064139.supp4Supplementary data10.1136/bmjopen-2022-064139.supp5Supplementary dataPossible biases in the study include selection bias, measurement error and confounding due to various background characteristics. To minimise selection bias, systematic stratified sampling will be used to select participants from the line lists maintained in the study sites. In addition, a group of research team members will work together to select the study sample. Other measures to increase validity of the study will include : (A) Estimation of the sample size using scientific methods to minimise random error; (B) Pretesting and revision of data collection instruments translated into the local languages  to minimise measurement error, (C) Sampling procedures will be followed to minimise selection bias; (D) Training of research assistants to minimise measurement error. In addition, research assistants will work under supervision from the field supervisors; (E) Survey data will be entered and analysed by an independent and competent person to reduce data entry errors; (E) Coding and analysis of qualitative data will be done by two research team members to increase internal validity. Confounding due to background variables will be controlled for during data analysis. During fieldwork, the team will ensure quality in the data collection process by a) ensuring that questionnaires are completely filled in, a) taking extensive notes during key informant interviews, b) having evening meetings to review the day’s activities and challenges.Quantitative/survey data will be analysed using SPSS V.21 . Descriptive statistics and frequencies will be used to summarise survey data. Categorical data will be presented using percentages, quantitative data will be presented using the mean and SD (or median and IQR). Before running bivariate and multivariate regression analyses, factor analysis will be conducted on each psychosocial measure using principal axis factoring as an extraction method and oblimin rotation. Next, inspection of the scree plot  will be done and sum measures will be created with an eigenvalue score of 1.0 or higher and those items with factor loadings of 0.4 or higher. Reliability test for internal consistency using Cronbach’s α will be conducted on each of the items. Items that show strong internal consistency (Cronbach’s α 0.70 or r >0.40) will be combined and averaged into one variable.2 test  to test the association between the independent and outcome variables. Multivariate logistic regression analysis will be conducted to identify predictors of female participation in science and research .Bivariate analysis will be done using Pearson’s correlation (for continuous variables) and χQualitative data analysis will be done using an inductive approach which ensures that subthemes are derived from the predetermined themes by content analysis and grouping all similar statements made with respect to particular themes. The voice recordings from the key informant interviews will be transcribed by the research assistants. After verification of accuracy in transcription, each transcript will then be thoroughly read by one research assistant while the other one will be listening to the corresponding voice recording. Each transcript will then be compared with the handwritten field notes that the research assistants will prepare during the IDIs. After proof-reading and making corrections, the transcripts will be saved on a password-protected file, in a computer kept by the PI, for safety. The Word documents will then be imported into NVivo V.11 MAC for coding and analysis. The exported data will then be coded using a codebook and guiding framework, and the categories and key subthemes will be identified.The study design was determined by the call for application for a research grant on gender dimensions in STI under the strategic research fund. Thus, the participants and the public were not directly involved in the conceptualisation and design of the study. Nevertheless, selection of the 16 schools from the two institutions was done in consultation with the authorities from the ministries of higher education and gender. Further, recruitment of study participants will be done in collaboration with the respective school deans and their assistants. To inform the institutions about the study, a letter will be written to the registrars and heads of the research institutions. Next, meetings will be held with the two respective school deans and the heads of the two research institutions to discuss the study and recruitment of survey and IDI participants. Finally, a report will be written and shared with key stakeholders, including the funding organisation and ministries of higher education and gender. In addition, a dissemination meeting will be held in Lusaka to share the results with the two ministries and heads of the participating schools and institutions.This study poses minimal risk to study participants. Research assistants will not administer the questionnaire; questionnaires will be delivered to the respondents’ office for self-administration. Completed questionnaires will be sealed in an envelope for research assistants to collect. Participation in the study may cause some discomfort from answering certain questions, particularly if the respondent had a negative gender-related experience. To reduce the risk of disclosure of personal or sensitive information, data collectors will be trained to ensure that they advise participants not to share anything that they are not comfortable with; and that they do not have to respond to any question unless they feel comfortable doing so. Since the questionnaire will be self-administered, respondents will have minimal risk of COVID-19 infection.The study may expose IDI participants and study team members to COVID-19 infection. Biosafety measures will be taken during data collection including consistent wearing of face masks, social distancing and conducting virtual interviews to minimise the risk of infection to the research team and study participants. In addition, data collectors and study participants will be encouraged to consistently use face masks and hand sanitisers before and after each interview. Used face masks will be disposed of according to the health guidelines. Data collectors are also trained to minimise any potential discomfort or harm to all participants during all study activities to the greatest extent possible. The study team will reduce any waiting by participants by scheduling appointments during times convenient to participants and interviews are kept to as short a time as possible. To ensure data quality, weekly research meetings will be held to ensure effective and efficient execution of the project.There are no direct individual benefits to participating in the study. If the proposed study is effectively implemented, the findings will be disseminated among the stakeholders. The findings are likely to lead to design of evidence- informed strategies to improve female participation in science and research.Confidentiality of collected data from study participants will be assured throughout the study. The interview will be carried out in the participant’s office or place of choice. Data collection will not be conducted until we can confirm that the time and location are acceptable to the participants. On completion of IDI and survey, all survey data will be entered in Excel and stored on a secure pass-code protected computer kept by the PI. IDI audio recordings will be transcribed and stored on the same computer. Both survey and IDI data will be de-identified and the linking file with identifiable data and basic demographics will be stored in a separate file. Only the PI and some identified research teams will have access to the identifiable data. All analyses will be conducted on de-identified data.Ethical clearance and approval were obtained from the UNZA Biomedical Research Ethics Committee (UNZA BREC 1674–2022). Permission to conduct the study was granted by the National Health Research Authority. Before being recruited into the study, the purpose, process and duration of the study, benefits and associated risks, privacy and confidentiality will be explained to the respondents. Data collectors will explain that there are no direct individual benefits to participating in the study. They will also explain potential risks the study may pose to study participants and that participation in the study is not likely to pose significant risk. To reduce the risk of disclosure of personal or sensitive information, data collectors will be trained to ensure that participants are helped not to share anything that they are not comfortable with; and that they do not have to respond to any question unless they feel comfortable doing so. Participants will also be told that they are free to stop the discussion at any time if they need to. Moreover, participation may expose the study participants and study team to COVID-19 infection. To minimise the risk of infection to the research team and study participants, biosafety measures will be taken during data collection including social distancing and conducting virtual interviews. In addition, data collectors and study participants will be encouraged to consistently use face masks and hand sanitisers before and after each interview. Used face masks will be disposed of according to the health guidelines. Data collectors will also be trained to minimise to the greatest extent possible any potential discomfort or harm to the participants during all study activities. The study team will minimise any waiting by participants by scheduling appointments during times convenient to participants and ensuring that interviews are kept to as short a time as possible. Those who accept to participate will be asked to sign the consent form  and be e10.1136/bmjopen-2022-064139.supp6Supplementary dataIf the study is successful, the findings will be disseminated among the stakeholders. A report will be written at the end of the project and shared with key stakeholders, including the funding organisation and Ministry of Health. In addition, study findings will be disseminated to key stakeholders in Zambia, then through open-access peer-reviewed journals, websites and international conferences.This study has several limitations. First, the study will only include 1389 survey respondents and 30 IDI participants from four academic and two research institutions. The study findings may not be generalisable to other institutions. Moreover, schools connected to the arts and humanities have been excluded as these often have a relatively high proportion of women; the actual proportion of women in these schools is not known. In addition, these schools have been excluded because our project is on science and health research. To make the study findings more representative, a large-scale study is needed involving more academic and research institutions. The purpose of the current study is to gain insight on gender integration in science and health research, describe female participation in science and health research, and identify the associated factors. Second, non-response may affect the external validity of the study. To mitigate this, we have allowed for a 15% NRR. Furthermore, limited access to research data from the selected institutions may affect the quality of the study. Finally, the cross-sectional study will not allow for conclusion on causality. An experimental study is needed to allow for conclusion on causation of low female participation in science and research.Despite these limitations, we believe that the study is likely going to contribute to the scientific body of knowledge on the integration of gender mainstreaming in science and research. The findings will also provide insight on female participation in science and research and the factors which affect their participation. Currently, no such study has been conducted in the country and information on this subject is scant.There is no cash payment provided to participants for any portion of the study. Participants volunteer the time taken to complete this survey. As a small token of appreciation for their time and opportunity costs, IDI participants will receive a bottle of water or soft drink, in line with UNZA BREC procedures.


Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self‐renew and differentiate into a variety of tissues. Moreover, the non‐coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD. The clinical treatment of IDD includes conservative therapy and surgical therapy. Currently, treatments based on MSCs and ncRNAs are regarded as potential targets. Some ncRNAs verified by clinical trials can be used in gene therapy, and drugs targeting those ncRNAs can also be designed to treat IDD. Intervertebral disc degeneration (IDD) is a pathological change defined as the aging process and damage of intervertebral disc (IVD) caused by a series of complex molecular mechanisms that finally leads to serious clinical symptoms. Low back pain (LBP) is one of the typical clinical symptoms of IDD. It is not only a common reason for patients to go to the hospital, but also one of the leading causes of disability.in vitro have proved that biotherapy can promote the proliferation of NPCs, inhibit the fibrosis of IVD, preserve the water content and reverse the process of IDD. This article reviews the standard therapy and new biotherapy of IDD and puts forward the direction and prospect in the future.IVDs are located between the upper and lower vertebrae, firmly connecting the centrums, and the IVDs can decompress, absorb shocks, and increase the range of spinal movement Figure . Each IVConservative treatment is mainly suitable for the treatment of patients with early IDD, its main purpose is to relieve a patient's LBP and improve quality of life, which cannot cure the IVD, so it is regarded as palliative treatment. With the aggravation of IDD, conservative treatment often cannot control the clinical symptoms, and further surgical treatment will be taken.et al.Currently, the commonly used drugs for the treatment of LBP are non‐steroidal anti‐inflammatory drugs (NSAIDs), opioid painkillers, muscle relaxants, benzodiazepines, antidepressants, corticosteroids, antiepileptic drugs, and so on. NSAIDs are widely used to treat LBP patients, including non‐selective NSAIDs and selective COX‐2 NSAIDs. A published Cochrane review suggested that NSAIDs are more effective than placebo for treating LBP  and low risk of side effects .et al.et al.Non‐drug therapy mainly includes bed rest, traction, stent fixation, exercise therapy, acupuncture, massage, electromagnetic or electrothermal therapy, psychotherapy, and so on.et al.et al.The internal mechanics of the IVD can be changed and the neuropathic pain can be treated by heating, radiofrequency or injection of various chemicals into the IVD. These methods include intra‐discal electrothermal therapy (IDET),Intervertebral disc fusion has always been regarded as the standard for surgical treatment of symptomatic IDD.Intervertebral disc fusion surgery usually involves the following steps. First, the surgeon separates the tissue and removes the damaged IVD, cleans up the IVD space, then places the prepared cage into the intervertebral space, which provides additional support for the spine after the operation. Then pedicle screws are used to fix the upper and lower vertebrae. After completing this critical step, the operator uses X‐rays to observe and correct the angle of screw placement and check the position of the cage.et al.et al.In terms of pain relief and functional improvement, the effect of intervertebral disc fusion is effective. Fritzell Although intervertebral disc fusion can relieve discogenic pain caused by IDD and improve patients' disability, it can cause severe problems in the long run because it eliminates the movement of the adjacent vertebral body. When two vertebrae are fused, it seriously limits the damping effect of the IVD during motion, increasing the load and stress of the surrounding tissue and IVD, which will lead to the degeneration of other IVD in adjacent segments.et al.et al.et al.Total disc replacement (TDA) was used by Fernström firstly in the 1960s.Qualified intervertebral disc implants must meet these requirementsCompared with intervertebral disc fusion, there seems to be no significant difference in the incidence of surgical complications of TDA. One studyIn the field of surgery, there are always contradictory data in the comparison of intervertebral disc replacement and fusion. Each operation is supported by corresponding evidence and it is also affected by the experience and ability of surgeons. In the actual diagnosis and treatment, in the case of ineffective conservative treatment, we can choose any kind of operation as long as it can reduce the pain of patients. Achieving good patient satisfaction is the most important.Recent studies have explored how to use mesenchymal stem cells and gene therapy to prevent, slow down, or even reverse IDD, and may provide a new direction for the treatment of IDD. A brief overview of this section will be given below.Mesenchymal stem cells (MSCs) are pluripotent adult stem cells with the ability to self‐renew and differentiate into a variety of tissues, including bone marrow mesenchymal stem cells (BM‐MSCs), cartilage mesenchymal stem cells, muscle mesenchymal stem cells, and adipose mesenchymal stem cells.et al.In 2003, Sakai et al.et al.The molecular mechanism of MSCs in the treatment of IDD is very complex. Xu et al.et al.et al.As mentioned earlier, MSCs is a very potential site for the treatment of IDD. At present, there have been corresponding clinical trials and case reports on the use of MSCs in the treatment of patients with IDD. Kumar Although encouraging achievements have been made in the application of MSCs in the treatment of IDD, there are still some problems. First of all, we still need to further study the molecular mechanism of MSCs in the treatment of intervertebral disc degeneration, including their targets and signal pathways, some biomolecules that can promote the efficacy of MSCs and establish a complete molecular mechanism structure. Finally, a large number of high‐quality clinical studies are still needed to test the feasibility and safety of MSCs therapy.Non‐coding RNAs (NcRNAs), which include microRNAs (miRNAs), circRNAs, and long non‐coding RNAs (lncRNAs), cannot be transcribed and translated into proteins, but play an important role in molecular regulation. Among them, miRNAs generally directly target a protein or signal pathway to play its regulatory function. circRNAs and lncRNAs generally act as miRNAs sponges and regulate the expression of miRNAs. At present, it has been confirmed that ncRNAs play a vital role in the treatment of tumourThere are a variety of molecular mechanisms and biological effects of ncRNAs in regulating IDD Table .83, 8As mentioned earlier, ncRNA is also a potential unit for the treatment of IDD, but how to transform the relationship between ncRNA and IDD into practical treatment is an urgent problem. It is also not known whether the use of ncRNA in the treatment of human IDD can achieve the same effect as at the cellular level and in animal experiments.IDD is a common clinical degenerative disease, which can easily lead to low back pain, disc herniation, and other diseases, seriously affecting the quality of life of patients and bringing great economic burden to the society. At present, there are standard treatments for intervertebral disc degeneration in clinic, but these treatments encounter a “bottleneck,” that is, they can not reverse the occurrence of IDD, but can only relieve the pain of patients. Treatments based on MSCs and ncRNA are potential targets for the treatment of IDD and are of great research value. The molecular mechanism of MSCs in the treatment of IDD needs to be further explored, and a large number of clinical trials need to be designed to verify its feasibility and safety. Quite a number of ncRNA experiments have been carried out, but the role of some ncRNA in IDD is still controversial and needs to be verified by further experiments. Verified by reliable clinical trials, these reported data can be directly used in gene therapy for IDD, and drugs targeting ncRNA can also be designed to provide new ideas for the treatment of IDD.The authors have declared that there are no competing interests.Table S1 Recent 5‐year research progress related to ncRNA and IDDClick here for additional data file.


The paralyzed vocal fold positioning and the degree of dysphonia are important inputs when one is deciding upon treatment options for unilateral vocal fold paralysis (UVFP).To check voice characteristics and paralyzed vocal fold position in men with UVFP.This is a retrospective historical cross-sectional cohort study, with data from 24 men with UVFP with mean age of 60.7 years, submitted to voice assessment by three speech therapists and three ENT physicians used laryngeal images to classify the position of the paralyzed vocal fold.The paralyzed vocal fold was found in the paramedian position in 45.83% of the cases; in the intermediary position in 25%; lateral in 20.83%, and it was in the median position in 4.16%; the dysphonia resulting from the UVFP was characterized by moderate hoarseness, roughness and stress in the voice; breathiness (most had severe breathiness); weakness and instability(mostly mild); the position of the paralyzed vocal fold had a significant influence on the general degree of vocal deviation.The general degree of dysphonia is associated with the paralyzed vocal fold position; dysphonia is characterized by hoarseness, breathiness, roughness and stress of moderate to severe levels. The precise incidence of vocal fold paralysis in the Brazilian Population is still unknownSome studiesAs far as gender is concerned, the literature studied does not mention the prevalence as to vocal fold mobility changes. Nonetheless, when the cause of this immobility is associated with thyroid disorder treatments, it is more frequent among femalesRecent studiesThus, studiesBreathiness and the difficulty to communicate effectively are the greatest losses complained by patients with UVFPThe paralyzed vocal fold positioning and the degree of dysphonia are important factors to decide upon treatment options - surgery and speech therapy, in cases of UVFPThis is a historical cohort, retrospective study, carried out by studying the medical charts and voice and laryngeal tests in male patients from a private medical office, residents from Rio Grande do Sul, Brazil, diagnosed with UVFP, between January 2003 and April of 2009. This research project was previously approved by the Ethics in Research committee of the institution of origin, under protocol # 2008029.In the present study, we included data from male patients, diagnosed with UVFP in the age range of young adults all the way to elderly, or more ; with a minimum paralysis time of nine months , checked by a digital sound pressure level measuring device from TM.RADIO SHACK In this assessment, the subject was standing up, with the arms extended along the body and the microphone was placed in a pedestal at 90° angle from the individual's mouth, always keeping the same distance between the microphone and the individual's mouth (ten centimeters).The patient's voice sampling was done by a speech therapist in the same day of the videolaryngostroboscopy, by means of uttering a stretch of spontaneous speech, reading a text and counting numbers. The vocal sample was recorded with an Vegas Movie Studio 8.0, software, from Sony and saved in a DVD for later analysis. In order to carry out the visual-perceptive assessment of the position of the paralyzed vocal fold, we had three otorhinolaryngologists, experienced in laryngology. Each professional carried out his assessment, independently from the opinion of the others, by observing the laryngeal images during the sustained utterance of the /e/ vowel, saved in a DVD. The position of the paralyzed vocal fold was classified as follows: median, paramedian, intermediate or lateralThe laryngeal images were edited by means of the VCS 2050 audiometer, from Auditec, in order to check for possible auditory changes which could compromise voice analysis.The auditory-perceptive evaluation was done by three speech therapists, voice experts, with much experience in this type of test. Before the beginning of the assessment, the examiners were submitted to a hearing screening, with a scanning in the frequencies between 500 and 8 KHz (kilohertz), in 25 dB (decibels), with the After hearing screening, each speech therapist carried out her auditory-perceptive assessment, independently from the assessment of her peers, based on her clinical experience. Vocal quality was classified and quantified by means of the RASATIKendall W  approach, which aimed at checking whether or not there was statistical significance on the agreement among the examiners.For result purposes, we considered the prevailing opinion among the three examiners as far as laryngeal images and voice analyzes of the patients with UVFP are concerned. The judgment about the answers of the examiners, in both assessments, was submitted to reliability analyses, with the use for the: Kruskal-Wallis test. Analyzing the position of the paralyzed vocal fold, for a greater analyses consistence, we chose to group the median and paramedian positions, because of the low frequency of the median position.In order to describe the sample profile, according to the study variables, we used descriptive statistics; the Binomial test was employed in order to check whether or not the etiology found in the literature also happened in the sample studied and the predominance of the paralyzed side. In comparing the categorical variables among the groups, we used the Fisher's exact test when the expected values were lower than five; in the numerical values between three or more groups we used the SAS System for Windows  software, version 8.02. The level of significance adopted for the statistical tests was 5%.All data was analyzed and computed by the Results from the 24 patients involved in this study are depicted on tables, according to the data obtained from the charts and assessments of voice and laryngeal protocols for each patient. The data marked with an asterisk (*) was statistically significant.p=0.007*;Statistical tests: Binominal test to check which is the predominant etiology in the sample: p=0.103;Binominal test to check which paralyzed side prevailed in the sample: paralyzed side: p=0.003*;Kruskal-Wallis test: Ratio between UVFP AND GDVT: p=0.430.Kruskal-Wallis Test: Relationship between Age Range x UVFP: Fisher's Exact Test: As far as the etiology is concerned, the occurrence of lung cancer was significant among the male individuals with UVFP , of the In the present investigation, the left side paralysis was frequent, and there was no significant relationship between the paralyzed side and the other variables in the study . Some ofAs far as the age range is concerned, we noticed a predominance of the elderly population, with a mean of 60.7 years . AccordiAmong dysphonia evaluation measures, vocal quality analyses is very much used, having seen that voice is an acoustic phenomenon and its auditory perception, even when influenced by subjective characteristics of the listener, is the most proper tool for its assessment, since it identifies the change characteristic and severity. Thus, it is recommended to use scales for an auditory-perceptive voice test, since it enables for a common and consistent language, which makes possible to compare studies. The GRBAS scale is considered by many authors as the most utilizedEvaluation Vocale Assistée software, which indicated high Jitter Shimmer rates.Dysphonia stemming from the UVFP is usually characterized by weak, hoarse and breathy voice, with an increase in the fundamental frequency and limitations to the speech sound intensityPioneer studies about the vocal fold have indicated that the degree of symptom severity and the lesion site could be confirmed based on vocal fold positionOne study showed that UVFP signs and symptoms may vary depending on the position of the paralyzed vocal fold, with higher or lower degrees of breathiness, hoarseness and diplophoniaThe assessment of a paralyzed vocal fold is no easy task for the ENT physician . Even thIn another study•In UVFP, the general degree of dysphonia is influenced by the paralyzed vocal fold position, being significantly higher in the lateral and intermediary positions;•Dysphonia caused by UVFP is mainly characterized by moderate to severe hoarseness, breathiness, roughness and stress.In the sample studied we observed that:


This paper deals with the mitigation process of the COVID-19 pandemic. Scholars propose and discuss several mitigation strategies to face the COVID-19 disruptions, mainly focusing on technology and supply chain redesign related aspects. Less attention has been paid to the organizational aspects of the mitigation process. We address this gap through an in-depth analysis of the reactive organizational practices implemented by an Italian company during the COVID-19 pandemic. We further compare these practices with those proposed in the disruption management literature to identify common traits and differences. The results show that the overall management of a pandemic’s mitigation process does not significantly differ from that of conventional disruptions, since both contexts require the same basic organizational practices. However, some peculiarities on how these practices should be implemented in a pandemic setting do emerge, such as the implementation of a cyclic rather than linear problem-solving process, the adoption of a learning-by-doing approach, the need of a risk-taker mindset and the importance of creativity and improvisation. Besides complementing the literature, these findings allow to provide indications to managers on how to organize and coordinate the activities during the mitigation process, as well as on what capabilities and competencies should be leveraged to face the pandemic’s disruptions. Since more than one year, the Corona Virus Disease 2019 (COVID-19) has been causing an unprecedented series of supply chain shocks that go beyond the more traditional disruptive threats and events  and collected information on key performance indicators. The questions reported in Table Data was collected through semi-structured interviews conducted in November 2020-February 2021. The interviews’ content was linked to the mitigation practices implemented by Company Alfa from the beginning of the COVID-19 spreading, namely from January–February 2020. Following the recommendations of Yin , we creagovernance, interfaces and operations was developed and shared among the three authors. This guaranteed that all of them understood and interpreted the three categories in the same way. In the second sub-step, each author independently read the transcribed interviews and identified text segments  referring to the organizational practices implemented by the company. Each text segment was then coded by each author with one of the three abovementioned categories, relying on the definitions developed in the first sub-step. For instance, when an interviewee referred to “interactions”, “information sharing” or “coordination” activities, the relative text segment was typically coded with the interfaces label. The authors then met, compared the results of the coding process and solved the few misalignments. For instance, they agreed that in some sentences, practices belonging to two different categories could be identified. A double label was thus assigned to these text segments. In addition, one particular matter had to be addressed. Since monitoring activities were frequently mentioned during the interviews, one author wondered if it was appropriate to consider a fourth category of practices called monitoring. After a brief discussion, the authors decided to avoid this change because the relative practices would be the same of the operations category. Indeed, real-time monitoring activities characterize every operational practice carried out in a pandemic context, since they enhance the ability to quickly react to these extreme disruptions. At the end of the second sub-step, all the text segments that were not associated to any category were excluded from further analysis. In the third sub-step, each author independently reviewed the text segments coded within each category and inductively identified a list of implemented practices. A meeting was then organized to compare the three lists of practices developed by the three authors. The seven practices common to all the three lists were immediately confirmed. For all the others, a debated discussion was initiated. The main point of divergence was not whether a practice had been implemented or not. The issue was whether it was worth listing it as a separate practice instead of including it as a specification of one of the other practices. An alignment was found through both a brainstorming among the authors and some additional feedbacks collected from the interviewees. For instance, during the interviews, we were told that a specific document, called disruptions’ register, was created to store all the information concerning the mitigation process. According to two authors, this activity should be listed as a separate practice, while the third author considered it as an example of adoption of well-defined procedures . The global supply chain director of Company Alfa was thus contacted to provide further information concerning the disruptions’ register. From this discussion, it emerged that in fact this document was of key importance for the management of the mitigation process, since it helped the company not only to have an updated overview of the situation, but also to observe the evolution of the mitigation process and of the implemented solutions. Being this aspect quite peculiar, also the third author finally agreed to list it as a separate practice. At the end of the process, a set of ten practices was created by the authors. Furthermore, a table with a list of these practices, together with the related description was created. Indeed, besides identifying and listing the practices implemented in governance, interfaces and operations, it was also important to thoroughly analyze them. This allowed, in a further step, to identify common traits and differences vis-a vis the mitigation practices described in disruption management literature  to solve the eventual misalignments in the third sub-step of the coding process , as we previously described; and (2) to approve the description of the practices included in the final table.Reliability and validity of the overall process of analysis were guaranteed following the guidelines of Yin . First, The COVID-19 pandemic impacted the entire Company Alfa’s supply chain.The first problem concerned the availability of raw materials, whose scarcity progressively increased during the first months of the pandemic. On the one hand, many suppliers closed their activities because of financial or labor scarcity problems. On the other hand, the service level of the remaining suppliers often decreased, and the deliveries agreed with Company Alfa, in terms of both time and quantity, became less reliable.As concerns the demand side, the problem was not only the unpredictability, but also the extent of variability of customers’ demand. Many customers closed their companies, while some others, whose plant continued to operate, experienced an increase in consumption up to 200%, which was completely unpredictable. This situation made the production planning process increasingly difficult and the inventory stock levels extremely variable.The main challenges regarded however the logistics activities. The capacity of many freight ship companies saturated in a short time. As a result, the costs of alternative transportation modes  significantly increased. Furthermore, it became increasingly difficult for road carriers to find available drivers, being these not willing to cross Europe and, in particularly, to move to Italy, which was put under the spotlight by mass-media worldwide because it was among the early countries impacted by the first pandemic wave. Crossing international borders created another tough challenge for Company Alfa’s logistics processes. Many countries closed their borders, creating long queues in custom clearance activities, while others introduced quarantine periods for people coming from abroad regions. In both cases, the direct consequence was a potential explosion of delivery times and the need to identify alternative route options.However, besides the abovementioned problems, the most critical aspect was that the situation was continuously evolving, since new disruption points emerged every day in different areas of the supply chain and in different locations. In this sense, the toughest challenge concerned again the logistics area. Every day a different country closed its borders and another reopened them. In some cases, the entrance into a country was open but the exit was closed. Even when borders were open, queues of 40–50 km could be created because of restrictions in border controls introduced by some countries.To face the challenges previously discussed, Company Alfa designed and activated a mitigation process consisting of a set of organizational actions and practices involving all the three categories listed in Table governance, the overall management of the mitigation process was assigned to a cross-functional task force, created by selecting young, flexible and creative managers belonging to the main business areas of the company. The global supply chain director was in charge of leading the task force. As a recognized leader, he was entrusted with the autonomy of taking the financial and organizational decisions deemed most appropriate for solving the identified problems. Furthermore, each member of the task force was required to monitor the situation and collect daily information on his/her own functional area . Particular attention was given to the overall task force management. The leader rewarded initiatives instead of punishing mistakes and encouraged the development of numerous and quick, even if rough, ideas to solve the problems, instead of slow optimal solutions. For this purpose, a rewarding system assigning appropriate scores to the task force members was created. Every time a member of the group proposed an idea, he/she earned some points, which varied according to the type of problem that the idea would solve. In particular, the leader assigned: 1 point for the ideas concerning a problem related to the stock levels; 2 points for the ideas aimed at avoiding a potential disruption of the production lines; 3 points for those related to a problem potentially affecting the final customers. If the proposed idea effectively solved the problem, this score was doubled. Therefore, even ineffective ideas allowed the task force members to increase their score. The members achieving the highest scores were rewarded with a cash prize, a training course or the involvement into innovative company projects. Finally, emotional moments to share extra work experiences were also organized to favor team building and trust development.As regards interfaces, coordination and cooperation inside and outside company’s boundaries were promoted in the mitigation process. Daily meetings were organized among the task force members to share the updated situation of the various functional areas and to support the task force leader in identifying quick and shared solutions for solving the problems and managing the disruptions. Furthermore, constant interactions and information sharing activities with supply chain partners were carried out, not only to develop an updated overview of the supply chain situation, but also to quickly identify new disruption points and mitigate their effects. For instance, the interactions with transportation providers turned out to be fundamental, especially at the beginning of the pandemic, to avoid transportation costs increase and, probably, lead time explosion for the items coming from Asian suppliers. Indeed, in January 2020, when the pandemic was struggling China, the capacity of freight ship companies started decreasing considerably. Thanks to the coordination mechanisms that were put in place, Company Alfa identified this problem early enough and booked a certain number of shipments for the following months, anticipating the related expenses but securing the availability of the maritime carriers. Companies that waited too much to take this decision had to choose alternative transportation modes, the airways in particular, whose costs rose, up to five times. The interactions with truck drivers were instead fundamental to avoid lead time explosions for the intra-European transportations. Drivers continuously informed Company Alfa about the traffic situation, especially at the borders. Thus, when a border closed or a long queue was in place because of borders’ controls, Company Alfa could immediately work to find alternative transportation routes and inform the other carriers directed at the same border.For what concerns the management of operations is concerned, the overall mitigation process was organized in a very structured way. First, detailed procedures were designed and used to monitor and manage supply chain disruptions as they appeared. The members of the task force constantly updated and shared files with (1) suppliers’ closures, (2) customers’ closures, (3) borders’ situation and (4) average components’ coverage. Furthermore, specific countermeasures were immediately applied to solve the less challenging issues . For the most severe disruptions , a problem-solving process involving the entire task force was instead activated. From the interviews, it emerged that this process had a peculiar structure. Indeed, the severe issues faced by Company Alfa were unprecedented, there were no pre-defined solutions to manage them and there was no time to look for optimal countermeasures. Therefore, the company adopted a trial-and-error approach based on continuous improvement, as highlighted in Fig. disruptions’ register was also created to store information about the disruptions, the proposed solutions, their positive or negative effectiveness and eventual ideas for their further improvement. As Fig. learning-by-doing approach. However, from the interviews with the task force members, it also emerged that, while at the beginning of the pandemic the uncertainty was extremely high and the errors several, with the passing of time the task force members started learning from previous disruptions and developed new knowledge and capabilities to face them. Thus, the problem-solving process became more and more linear and lean, bypassing not only the cyclic approach, but also many previously implemented steps .As far as les with  supplierles with  supplierA summary of all the organizational practices described above is provided in Table Thanks to the well-structured mitigation process, Company Alfa could reduce the negative effects of the COVID-19 disruptions. In particular, it was able to guarantee a very high service level to customers during all the worst months of the pandemic, as shown in Fig. price paid to obtain all these results was completely offset by the earned benefits.It is also worth highlighting that the average stock levels of the company increased quite significantly during the pandemic. Figure governance, the creation of a cross-functional recovery team, the identification of an appropriate leader for the team, the clear definition of roles and responsibilities, which have a key importance in general disruption management, represent a fundamental starting point also for the mitigation process of a worldwide pandemic. A similar conclusion can be drawn for the other categories , where the crucial importance of coordination and cooperation inside and outside company’s boundaries, as well as the use of structured information sharing process are confirmed.By comparing the reactive organizational practices implemented in Company Alfa Table  with thoA general conclusion from the above is that the organizational mitigation process of a pandemic seems to be quite similar to that of general disruptions. However, from a deeper reflection on the case study it also emerges that some differences exist, mainly concerning how the practices (rather than what practices) are implemented.governance is concerned, the empirical evidence shows the importance of developing a decentralized decision-making to quickly react to the daily disruptions. The task force and the leader had the autonomy of implementing and testing the countermeasures deemed most appropriate to solve the problems and this allowed to bypass top management involvement that can often slow down the decision-making process. In this sense, the case study seems to suggest that the sense of urge due to limited time available to mitigate the pandemic effects requires a capable and empowered task force, being top management support alone insufficient to properly organize a quick and effective mitigation process. A further peculiar aspect worth discussing in the governance category is the environment that companies should create to maximize the effectiveness of the mitigation process during a pandemic, in terms of culture and mindset. According to the case study results, a successful element of Company Alfa’s mitigation process was the overall task force management, based on the promotion of collaborative culture and trust development. This was effectively integrated with the creation of extra-work experiences to favour team building. Furthermore, the executives and the task force leader worked to develop a risk-taker mindset among the task force by adopting an incentive system that promoted the development of innovative and quick solutions. All the interviewees told us that, when a new issue arose, they were encouraged to develop numerous ideas in the shortest time possible and they were rewarded accordingly, no matter of the ideas’ effectiveness. In addition, errors and mistakes were not punished, providing a further incentive to exploit employees’ creativity and improvisation qualities. It is worth highlighting that this approach may also have some drawbacks. The frequent meetings and interactions within the task force, if not well managed, may become ineffective and dispersive. Furthermore, the development of many alternative solutions may be linked to the loss of best ideas in the noise. Therefore, the approach adopted by Company Alfa, to be effective, required a clear definition of the goals to be achieved in each meeting, but also a leader who properly managed these meetings, avoiding the proliferation of discussions not strictly related to the mitigation process.As far as interfaces, a peculiar aspect of the pandemic setting concerns the final purpose of coordination and information sharing with partners. Unlike conventional disruptions, these activities seem to be important not only to carry out the mitigation actions and processes, but also to quickly identify the new disruption points or events that emerge every day, as well as to forecast them in advance. This was particularly evident for the transportation activities between European countries, where governments continuously changed the regulations on logistics and freight transport and it was thus necessary to listen to weak signals , to be in continuous contact and to coordinate with supply chain partners to avoid an explosion of delivery times. Therefore, the disruption identification phase, that typically precedes the mitigation process in general disruption management, should be considered as a part of the mitigation process itself in case of epidemic outbreaks, hence increasing the need of external coordination and information sharing.As regards the operations category, interesting elements of peculiarity of the pandemic mitigation process concern the structure and the characteristics of the problem-solving process. First and foremost, empirical evidence shows that, especially at the beginning of the epidemic outbreak, the systematic problem-solving process was cyclic rather than linear, as depicted in Fig. learning-by-doing approach). This also explains why cycle after cycle experiences cumulate and the process becomes more and more linear and lean: thanks to the evaluation and monitoring of the various solutions and of their effectiveness, the task force progressively acquires appropriate knowledge and experience, speeding up the overall problem-solving process. Not by chance, Company Alfa decided to keep some practices implemented during the pandemic's mitigation process also in the future, in order to strengthen the learning process and experience of the workforce. For instance, it established the organization of regular meetings within the pandemic’s task force to reflect on the weakest points of the company’s supply network and become more and more aware of the potential disruptions. In this way, Company Alfa expects to be better prepared in case of future extreme events and to re-implement all the aforementioned strategies with even stronger effectiveness.For what concerns instead the To sum up, Fig. This research provides the following theoretical contributions.governance, interfaces and operations categories, as claimed by Norrman and Jansson . In this sense, some aspects of the disruption management process were probably simplified since products could be easily shifted among customers. Considering all these peculiarities of Company Alfa, we invite future research studies to corroborate or complement our results by extending the analysis to companies operating in other sectors or countries, having different sizes and managing more complex product personalization activities.interface category considering its viewpoint only. Future research could thus extend the study by including some interviews with all the partners involved in the mitigation process and shifting the focus on the external coordination mechanisms. This would allow to shed light on the drivers, dynamics and barriers of inter-firm coordination during a pandemic’s mitigation process.Second, we explored the organizational practices implemented by Company Alfa in the Third, this study does not take into consideration the role of environmental and social practices in the mitigation process, despite their relevance in the current business scenario. Since many authors claim that companies with good values of environmental and social performance experienced fewer negative effects during the COVID-19 pandemic (e.g., Hwang et al. A further limitation of this research may be linked to the temporal distance between our interviews and the actual execution of the investigated activities. Since the first decisions concerning the mitigation process had to be taken starting from January 2020, the description provided by the interviewees may have been more rational and less impulsive than what would have happened some months before. The results of the empirical study should thus be interpreted with such awareness.Finally, this study focuses only on organizational reactive strategies to manage the mitigation process of a pandemic. On the one hand, it can be extended by including in the analyses the non-organizational mitigation strategies, such as those explored in Sect.


It shows that social support plays a complete mediating role, and the effect size of the mediation model reaches 49.70%. It shows that the current college students' English learning positive psychological quality is not high. In response to this, it is necessary to strengthen the tendency and ability to use social support and use the family environment to communicate more to achieve the cultivation of positive psychological quality.During the COVID-19 pandemic, long-term isolation and loneliness will cause college students' psychological fluctuations. Especially in online teaching, the lack of communication for a long time has led to a greatly reduced learning enthusiasm of college students. Therefore, this paper aims to explore the cultivation methods of the positive psychological quality of college students under the epidemic situation through the research on the positive psychology of college students' English learning. Aiming at the psychological status of college students, this paper focuses on analyzing the relationship between social support, psychological capital, and psychological health to explore more targeted ways of cultivating positive psychology. Because of the online and offline teaching mode, this paper focuses on analyzing the support environment of the online teaching mode, and analyses the current forms of English teaching. Experiments show that the direct path from psychological capital to mental health is not significant. However, the mediating path of psychological capital to mental health through social support was significant ( At the end of 2019, the outbreak of the novel coronavirus pneumonia caused by the novel coronavirus broke out across the country. On January 30, 2020, the World Health Organization declared the novel coronavirus pneumonia outbreak a “public health emergency of international concern.” More than 30 provinces, cities and regions have launched first-level responses to major public health emergencies. The Ministry of Education has decided to postpone the start of the spring semester of 2020, and carry out online teaching of “suspending classes without stopping.” The COVID-19 pandemic has ushered us into a brave new world of business and management. The nature, values, processes, systems and more of our workplace are changing dramatically at a rate we could not have imagined before. New work patterns, occupations, and even industry boundaries have emerged in a relatively short period in the form of a global movement. Organization members' attention shifts from gain, competition, efficiency, and scale to a fundamental desire for survival, resilience, and regeneration. Although it can look forward to the gradual arrival of dawn and the cessation of the pan-human social catastrophe, the transformation seems unstoppable. New technologies, such as artificial intelligence, blockchain, VR/AR, Internet of Things, big data analysis, etc., lead the workplace to reengineering. People went from being interested in this transformation to being familiar with it, and moving forward firmly.The epidemic has caused great damage to China's economy and people's lives in a very short period. And in the early stage of the prevention and control of the new crown pneumonia epidemic, that is, the incubation period and the outbreak period of public opinion, the negative public opinion is clamoring, bringing an additional burden to the prevention and control of the epidemic. In order to effectively block the threat posed by the epidemic to schools and teachers, and students, colleges and universities are encouraged to change their teaching thinking, promote the reform of learning methods, and complete the migration and integration of offline teaching to online teaching. However, such isolation will undoubtedly bring a greater psychological burden to college students. Therefore, it is particularly important to cultivate the positive psychological quality of college students' English learning.It explores the current situation and problems of “Internet + Education” online teaching. The optimization is an inevitable requirement of curriculum teaching reform and innovation. This research aims to analyze and study the positive psychological quality, core elements, teaching mode and predicament of online teaching of English learning for college students under the background of COVID-19 and propose development strategies. Specifically: (1) Scientifically determine the connotation of “Internet + education,” and explore the value of “Internet + education” from the perspective of theory and practice. (2) The core elements of “Internet + Education” are analyzed; the typical models and characteristics of large-scale “Internet + Education” in the context of COVID-19 are summarized; the “Internet + Education” model is constructed, and its application principles are pointed out. (3) because of the current situation and dilemma of college students' psychological pressure under COVID-19, the development strategy of college students' positive psychological cultivation is proposed.The positive psychology of college students is the basis of their normal life and study, so there are many analyses of the positive psychology of college students' study. Katz J. studied the relationship between positive psychology and memory, etc. He found that self-regulation training was beneficial in improving memory, concentration, and executive function and reducing levels of anxiety, stress, and depression . Shuang However, it can be found that the current research on the psychology of college students is more aimed at purely psychological aspects without taking into account the background of the current epidemic. The purpose of Goldman D. T. was to assess the current evidence on the use of telemedicine in the surgical subspecialty during the COVID-19 pandemic. He argued that telemedicine has increased access to care for surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown . The purDuring the epidemic prevention and control period, “Internet + education” has become the main solution for “suspending classes without stopping learning.” Online teaching has become the most widely used form of “Internet + education” in the context of COVID-19. The implementation of large-scale online teaching involves multiple elements. All elements cooperate with each other to support the smooth development of online teaching.“Internet + education” in the context of COVID-19 can be regarded as the deployment and operation of a macro system involving many elements. For example, education administrative departments and schools in the category of teaching management system; enterprises, teaching platforms, teaching resources, learning tools, etc. in the category of a teaching support system ; teacherAs a bridge connecting teachers and students and carrying various teaching resources, the teaching platform is very important for developing online teaching activities. Under the epidemic situation, online teaching platforms are in a state of blooming. By investigating various live broadcast platforms during the epidemic, this paper summarizes two main types of online teaching platforms: live-streaming online teaching platforms and resource-based online teaching platforms.The characteristics of live broadcast platforms are that the teaching content is broadcast in real-time, and students and teachers can achieve online synchronous classrooms. The live online teaching platform is aimed at large classes and can give full play to allocating and sharing resources. Real-time interaction in teachers' teaching is beneficial to increasing students' participation in learning activities. The live teaching platform can more easily restore the offline classroom form online, which is conducive to students' mastery of learning content and methods , 12. ComThe online teaching software is classified based on analyzing and summarizing various online teaching tools. According to various online teaching software characteristics, it can be divided into resource design support tools, subject support tools, course library support tools, and evaluation content support tools. The specific classification of online teaching tools is shown in The typical online teaching modes shown in The online teaching of “Internet + education” is different from traditional classroom teaching and has its own characteristics. This study considers online teaching as a new teaching method based on the information technology environment. The information technology environment is a distinctive feature of online teaching. Teachers and students separated by time and space need various learning supports to rebuild the learning community environment in online teaching. Furthermore, large-scale and long-term online teaching differs from traditional classroom teaching , 14.Understanding anxiety requires dialectical thinking. Anxiety is a personal experience of unpleasant emotions, but if it develops into a serious psychological state, it can cause obstacles to personal action. Appropriate anxiety can make students work hard, but excessive anxiety can make college students depressed or even seriously affect their adaptability to society. Their mental health is directly related to the quality of school personnel training and the university's long-term development. They are not only the happiness and hope of the family but also the development and progress of the society. The research field of this paper will aim to expand the applicability of anxiety theory and thus will also help to enrich mental health education in colleges and universities. In the era of the epidemic, the sources of psychological stress of college students are shown in Against the background of unresolved unemployment stock, domestic college graduates are still increasing every year. According to data released by the Ministry of Education, in 2020, graduates from ordinary colleges and universities nationwide reached 8.74 million. However, as the sudden new crown epidemic has caused a greater impact on the social and economic downturn, the employment difficulty coefficient of college graduates has increased significantly, and the employment situation has become more severe. During this special period, many offline presentations and recruitment have been suspended due to the epidemic, and many recruitment activities have been changed to online. Circumstances like this have had a huge impact on the way communication is done in employment. For example, traditional offline recruitment has been changed to online interviews, and communication methods have become more virtual. This is a new challenge for the employment of University graduates. According to the employment situation data of fresh college graduates released by Liepin Big Data Research Institute, <30% of graduates have signed contracts for employment.Communication from different angles has different definitions, and communication in practical applications also has different modes. As the name suggests, formal communication is used in more formal situations. In other informal cases, it is informal communication. From the perspective of the carrier of information, communication can be divided into verbal communication and non-verbal communication. Verbal communication mainly refers to oral or written communication, including oral and written communication. Non-verbal communication requires the help of certain media to achieve the purpose of information transmission, including expressions, body behavior and other forms , 16. FroAs can be seen from * are the loss functions of semi-supervised support vector machine (S3VM) with labeled data and unlabeled data, respectively.In stress relief, it is often necessary to determine the source of the stress to make a better-targeted analysis. Semi-supervised support vector machine (S3VM) is a typical semi-supervised machine learning algorithm. Support Vector Machine (SVM) is a classification algorithm. The classification test is determined using the criteria of minimum empirical risk and maximum “marginal.” In semi-supervised learning, there are labeled datasets:assifier , 20. Thet decreases slower than t−1, t follows formula (14),In order to speed up the convergence of Stochastic Gradient Descent (SGD), Average Stochastic Gradient Descent (ASGD) performs better and converges faster than ordinary Stochastic Gradient Descent (SGD). Updating the weights is done in the same way as stochastic gradient descent, and can recursively average all previous weights.0 can be obtained from a small number of experiments on a subset of the training data.ηC* are parameters that need to be predefined, and here they are empirically set asThe objective function of this paper is in the form of formula (11). Among them, C and This study was conducted using questionnaires. In order to test the discriminant validity of the items, confirmatory factor analysis was used to construct multiple competition models, and the fit indices of the competition models were compared , 22. DueTo avoid the interference of severe common method bias, the unmeasured potential method factor effect control method was used to test for common method bias. It adds the common method factor to the three-factor model. The fit index of the model did not improve significantly . This indicates that there is no serious common method bias in this study.Hypothesis 1: There is a significant positive correlation between psychological capital, social support and mental health under major epidemics;Hypothesis 2: Psychological capital and social support levels can significantly and positively predict mental health under major epidemics;Hypothesis 3: Social support plays a partial mediating role between psychological capital and mental health in a major epidemic.Descriptive statistical analysis was performed on the level of psychological capital, and the results are shown in The differences of psychological capital in demographic variables were analyzed, and the results are shown in The results show that there is no significant difference in the level of psychological capital in terms of gender and whether it is an only child. There are significant differences in different grades and places of residence. Among them, the psychological capital level of the fourth grade (M = 69.82) was significantly lower than that of other grades. The psychological capital level of rural students (M = 80.06) was significantly higher than that of urban students. The psychological capital level of students who did not live with their parents (M = 84.47) was significantly higher than that of the other two groups.As shown in The differences in the demographic variables of social support were analyzed, and the results are shown in The results showed that there was no significant difference in the level of social support in terms of gender and whether one was an only child. However, there are substantial differences in different grades and places of residence. Among them, the fourth grade's social support level (M = 40.51) is significantly lower than that of other grades. The social support level of students from rural areas (M = 45.92) is significantly higher than that of students from urban areas.In order to gain a more detailed understanding of the sources of social support, a frequency analysis was performed for each option of items 7 and 8. Items 7 and 8 select sources for “financial support and help with practical problems” and “comfort and concern.” The specific analysis results are shown in The results in In order to understand the mental health status of college students under major epidemics, descriptive statistical analysis was first conducted on the total score of mental health and the three dimensions of anxiety, depression and stress symptoms. The results are shown in It can be seen from the analysis results that the average mental health score is 32. 32, slightly higher than the theoretical median (31. 5), with a standard deviation of 13.66. It shows that college students have certain mental health problems in the major epidemic situation. From the score of each dimension, the score of anxiety and depression dimension is higher than that of stress dimension, which reflects that the level of anxiety and depressive symptoms is more common in college students than stress symptoms.On this basis, the differences in the psychological health level of demographic variables were analyzed, and the analysis results are shown in The results showed that there were no significant differences in the level of mental health in terms of gender, place of residence, and whether they were an only child. There are significant differences in different grades and living conditions with parents. Among them, the mental health symptom score of seniors (M = 40.51) was significantly higher than that of freshman and sophomore students, and the score was also higher than that of juniors, but it was not significant.Commonly used test methods for mediating effects include four-step method, Sobel test and Bootstrap confidence interval method. However, the four-step method has low test power for the mediating effect. The Sobel test is susceptible to sample size and distribution normality. The principle of the Bootstrap method is to perform repeated sampling from an original sample and replace it again. The size of the sample drawn is the same as the original sample. The values of N statistics are obtained from N samples, and the Bootstrap distribution of the statistics is formed, avoiding the influence of non-normal distribution. The test of the mediation effect is mainly aimed at the statistic ab, and the confidence interval of ab is obtained . If the interval does not contain 0, the mediation effect in the model is significant.p < 0.001). It shows that social support plays a complete mediating role, and the effect size of the mediation model reaches 49.70%.As shown in The specific path coefficients of the mediation model are shown in In terms of mental health status, the overall mental health problems of the surveyed groups are not serious, but they cannot be ignored. In particular, the analysis of differences in demographic variables shows that, from the perspective of different learning stages of students, freshmen, sophomores, juniors and seniors have significant differences in mental health. Seniors have the worst mental health. The reason for such a result is mainly because the lower grade students do not have the pressure of employment and further education. However, senior students are faced with the enormous pressure of employment and postgraduate entrance examination, as well as the uncertainty of future development after graduation, which lead to their mental health facing many challenges in practice. Coupled with the epidemic's impact, their depression, anxiety and stress conditions are not optimistic. Especially if the opportunity is not seized during the employment period, some graduates may lose the opportunity of employment. For them, this pressure can be imagined. Of course, in the lower grades, the learning tasks of the junior and senior students are relatively heavy. Therefore, their psychological pressure and other three dimensions are significantly worse than the freshman and second graders. In addition, other factors during the pandemic can negatively impact the mental health of college students. As the epidemic lasted for a very long time, students spent a long time at home. In order to prevent the epidemic, many parents have restricted students from going out during the epidemic. As a result, students have very limited space for activities in family life, and they can only pass the time by watching TV, playing with mobile phones, etc. It is difficult to gain a sense of value and achievement from various activities, which will negatively affect their positive and healthy psychological state.Psychological teachers and counselors can increase the chances of successfully obtaining social support by helping college students cultivate a higher level of psychological capital and enhance their tendency and ability to use social support. At the same time, families, schools, and society should objectively provide sufficient material or emotional, social support so that social support can have a greater role in promoting mental health.From the perspective of developmental psychology, college students are still in the stage of psychological development and are gradually participating in social integration. Compared with adults who have formed mature social, behavioral abilities and established a relatively stable social network, college students are still in a dynamic socialization process. In this process, changes in social support will have a more obvious impact on college students. For example, there is an attachment relationship with parents during childhood, gradually transitioning to adolescence, adapting to the social resources provided by teachers, classmates, institutions, etc., and forming new social relationships. Good social resource acquisition and social communication process help them to form a more positive cognition of interpersonal relationships and social environment, gain a higher sense of trust and security, etc., thus promoting the development of mental health. At the same time, good teacher-student relationships and family function are also positive factors for college students to obtain and feel social support, which is helpful for students' social adaptation. In the long run, this will contribute to the mental health development of college students.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.HY was conceived of the study and participated in its design, as well as supervised the study, and critically revised the manuscript. XL wrote the manuscript. Both authors read and approved the final version of the manuscript.This work was supported by Anhui Provincial Education Quality Engineering Project under grant no. 2020jyxm0143 and Anhui Polytechnic University Research Project under grant no. Xjky2022207.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.