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the presence of bronchial mucus plugs (BMp) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMp presence in children with Mpp were proposed using a cohort of patients who underwent bronchoscopy intervention at Children's Hospital in Eastern China. Patients with MPP in an earlier period formed the training cohort (n = 872) for nomogram development, and those thereafter formed the validation cohort (n = 399) to confirmed model's performance. BMP in children with MPP were found in 196 (22.5%) and 91(22.8%) patients in the training and validation cohorts, respectively. the independent risk factors associated with BMp were age >5years (OR 2.06; 95% CI 1.43 to 2.98), higher IL-10 level (>10 ng/L, 2.19; 95% CI 1.46 to 3.28), higher IFN-γ level (>30 ng/L, 1.69; 95% CI 1.13 to 2.54), and presence of complication (3.43; 95% CI 1.45 to 8.09). Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.771(95% CI, 0.734-0.808) and 0.796 (95% CI, 0.744-0.848) in predicting BMP in the training and validation cohorts, respectively. The nomogram achieved an optimal prediction of BMP in children with MPP. Using this model, the risk of BMP formation would be determined, contributing to a rational therapeutic choice.

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When an organization introduces an information system (IS), management often expects employees to utilize the system. However, rather than use the system directly, designated users may delegate some parts of their IS use to other users while assuming primary responsibility and accountability for the system use tasks. This behavior is called indirect IS use, a behavior that is acknowledged in some studies but not adequately scrutinized. This research distinguishes between direct and indirect IS use and proposes a model of their respective antecedents. The research was carried out in three stages. First, we conceptually distinguished direct and indirect IS use and drew on a social power lens to develop a theoretically driven research framework. Second, we contextually refined the research framework with a case study in a Confucian society. Third, we validated the research model through a survey of 213 Chinese physicians. Results revealed that direct and indirect IS use are partially substitutive, as demonstrated by the varying effects of social power and physiological power on these types of IS use. Further insights were gained by splitting the two forms of IS use based on the extent of clinical accountability risks and combining the two types of IS use based on their sum or relative amount. With the distinct relationships between social power and different forms of IS use, management could employ the appropriate strategies to influence the desired system usage behavior from its employees.

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