Multilevel Approach Research Articles

Genomic Exploration of Essential Hypertension in African-Brazilian Quilombo Populations: A Comprehensive Approach with Pedigree Analysis and Family-Based Association Studies.

Essential Hypertension (EH) is a global health issue. Despite extensive research, much of EH heritability remains unexplained. We investigated the genetic basis of EH in African-derived individuals from partially isolated quilombo populations in Vale do Ribeira (SP-Brazil). Samples from 431 individuals (167 affected, 261 unaffected, 3 unknown) were genotyped using a 650k SNP array. Estimated global ancestry proportions were 47% African, 36% European, and 16% Native American. We constructed six pedigrees using additional data from 673 individuals and created three non-overlapping SNP subpanels. We phased haplotypes and performed local ancestry analysis to account for admixture. Genome-wide linkage analysis (GWLA) and fine-mapping via family-based association studies (FBAS) were conducted, prioritizing EH-associated genes through systematic approach involving databases like PubMed, ClinVar, and GWAS Catalog. Linkage analysis identified 22 regions of interest (ROIs) with LOD scores ranging 1.45-3.03, encompassing 2363 genes. Fine-mapping (FBAS) identified 60 EH-related candidate genes and 117 suggestive/significant variants. Among these, 14 genes, including PHGDH , S100A10 , MFN2 , and RYR2 , were strongly related to hypertension harboring 29 suggestive/significant SNPs. Through a complementary approach - combining admixture-adjusted GWLA based on Markov chain Monte Carlo methods, FBAS on known and imputed data, and gene prioritizing - new loci, variants, and candidate genes were identified. These findings provide targets for future research, replication in other populations, facilitate personalized treatments, and improve public health towards African-derived underrepresented populations. Limitations include restricted SNP coverage, self-reported pedigree data, and lack of available EH genomic studies on admixed populations for independent validation, despite the performed genetic correlation analyses using summary statistics.

External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension.

Introduction. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health. This study sought to understand Family and Consumer Sciences (FCS) Extension agents' perceptions of PSE change supports, benefits for their communities, and resources and partnerships important for implementation. Method. The Consolidated Framework for Implementation Research was used to develop a survey to assess outer setting domains related to PSE work. In addition to close-ended questions, the survey included several open-ended, qualitative questions exploring the benefits, resources, and relationships required to implement PSE changes. The surveys were collected online from FCS agents in two states. Descriptive statistics were calculated, open responses were coded, and key themes were established. Results. FCS agents (n=116) indicated high levels of agreement about having necessary support from state-level specialists (71%) and the overall Extension organization (64%). The largest gaps in support were reported as grant or external funding sources, time, and county programming funds. Half of the sample agreed that PSE training was adequate, but only 38.5% reported previously participating in PSE-specific training. Open-ended question responses revealed diverse relationships and numerous benefits of PSE work, including more sustainable health behavior changes and greater local Extension visibility. Discussion. Our findings corroborate previous work and identify potential gaps that future interventions can address to better support Extension and public health professionals when implementing PSE work at the community level.

Analyzing women’s knowledge of pregnancy complications in Ethiopia through a multilevel approach

Pregnancy complications can’t always be predicted. However, pregnant women must be aware of these pregnancy complications to avoid serious complications and begin treatment as soon as possible. Maternal mortality can be decreased by offering high-quality maternity services and educating women about the early warning signs of pregnancy. Therefore, the current study aimed to assess individual and community-level factors associated with women’s knowledge about pregnancy complications in Ethiopia based on the 2019 Ethiopian mini-demographic health survey data (EMDHS). The study analyzed data from the 2019 EMDHS, including a weighted sample of 1,655 reproductive-age women. Multilevel binary logistic regression analysis was used to fit the associated variables. Using the interclass correlation (ICC), deviance, proportional change variance (PVC), and median odds ratio (MOR), the comparison and fit of the models were evaluated. The significant variables associated with knowledge about complications during pregnancy were identified using an adjusted odds ratio (AOR) and a 95% confidence interval (CI). The proportion of mothers with good knowledge of pregnancy complications was 44.8% (CI 42.4%–47.2%). The multi-level analysis revealed that secondary education (AOR = 1.54, 95% CI = 1.04–2.29), a higher education level (AOR = 1.74, 95% CI = 1.11–2.72), four and above ANC Visits (AOR = 0.74, 95% CI = 0.49–0.98), women who lived in Amhara (AOR = 2.10, 95% CI = 1.24–3.55), and SNNPR (AOR = 3.92, 95% CI = 2.10–7.31) were positively associated with knowledge about pregnancy complications while, women residing in Harari (AOR = 0.20, 95% CI = 0.98–0.44) and Dire-Dawa (AOR = 0.48, 95% CI = 0.24–0.95) were negatively associated with knowledge about pregnancy complications. This study found that nearly half (44.8%) of the study participants demonstrated knowledge about pregnancy complications. This suggests a significant gap in awareness that could potentially impact access to obstetric care for women experiencing complications during pregnancy. Therefore, prioritizing enhancements in antenatal counseling services and community health education regarding pregnancy complications is crucial.

Computational Multiscale Study of the Interaction Between the PDMS Polymer and Sunscreen-Related Pollutant Molecules

Sunscreen molecules play a critical role in protecting skin from ultraviolet radiation, yet their efficient detection and separation pose challenges in environmental and analytical contexts. In this work, we employ a multilevel modeling approach to investigate the molecular interactions between representative sunscreen molecules and the polydimethylsiloxane (PDMS) polymer, a material widely recognized for its sorbent properties. Our goal is to explore how these interactions can be fine-tuned to facilitate the effective separation of sunscreen molecules in portable membrane inlet mass spectrometry (MIMS) systems, potentially leading to the development of new membrane materials. Using a combination of advanced computational techniques—force field molecular dynamics simulations, semiempirical GFN2-xTB, and density functional theory calculations—we assess the interaction strength and noncovalent interactions of sunscreen molecules, namely oxybenzone, naphthalene, benzo[a]anthracene, avobenzone, and 1,3,5-trichlorobenzene, with PDMS. Additionally, the effect of temperature on the interaction dynamics is evaluated, with the aim of extending the sorbent capacities of PDMS beyond light polar molecules to larger, polar sunscreen compounds. This study provides critical insights into the molecular-level interactions that may guide the design of novel membrane materials for efficient molecular separation.

Investigating the links between questionable research practices, scientific norms and organisational culture

BackgroundThis study investigates the determinants of engagement in questionable research practices (QRPs), focusing on both individual-level factors (such as scholarly field, commitment to scientific norms, gender, contract type, and career stage) and institution-level factors (including industry type, researchers' perceptions of their research culture, and awareness of institutional policies on research integrity).MethodsUsing a multi-level modelling approach, we analyse data from an international survey of researchers working across disciplinary fields to estimate the effect of these factors on QRP engagement.ResultsOur findings indicate that contract type, career stage, academic field, adherence to scientific norms and gender significantly predict QRP engagement. At the institution level, factors such as being outside of a collegial culture and experiencing harmful publication pressure, and the presence of safeguards against integrity breaches have small associations. Only a minimal amount of variance in QRP engagement is attributable to differences between institutions and countries.ConclusionsWe discuss the implications of these findings for developing effective interventions to reduce QRPs, highlighting the importance of addressing both individual and institutional factors in efforts to foster research integrity.

Water diplomacy in the pursuit of water security: A multilevel approach

Water diplomacy in the pursuit of water security: A multilevel approach

Examining the structure of the revised community of inquiry framework: a multi-level approach

Examining the structure of the revised community of inquiry framework: a multi-level approach

Seeing adolescents grow from many angles using a multilevel approach: A tribute to the contributions of Dante Cicchetti to the field of developmental psychopathology.

Dante Cicchetti propelled forward the field of developmental psychopathology by advancing this framework and championing new methods, including emphasizing the central role that multilevel analysis holds for explicating pathways of risk and resilience. His work continues to change the face of existing science. It has also paved the way for the formation of new projects, like the Research Domain Criteria initiative. This paper uses our laboratory's work on multilevel approaches to studying adolescent depression, non-suicidal self-injury, and suicidal thoughts and behaviors to shine a spotlight on Dr Cicchetti's contributions. In addition, we review recent developments, ongoing challenges, and promising future directions within developmental psychopathology as we endeavor to carry on the tradition of growth in the field.

Social determinants of breast cancer screening: a multilevel analysis of proximal and distal factors related to the practice of mammography.

Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach. This nationwide cross-sectional study included 4,924 women aged 50-70 participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient (ICC) and proportional change in variance (PCV) were calculated. 62.8% of women underwent timely mammography. Age (OR=0.96; 95%CI 0.94-0.97), health insurance (OR=2.22; 95%CI 1.87-2.63), education (OR=2.1; 95%CI 1.74-2.64), and income (OR=1.56; 95%CI 1.23-1.97) were associated with mammography practice. Women in non-marital (OR=0.61; 95%CI 0.52-0.72) or larger households (OR=0.61; 95%CI 0.51-0.63) were less likely to have timely mammograph; living in a larger city was positively associated (OR=1.28; 95%CI 1.12-1.46). Women in provinces with higher physician density (OR=1.06; 95%CI 1.01-1.11) and lower maternal mortality ratio (OR=0.9; 95%CI 0.87-0.96) had higher chances of timely mammography. The ICC and PCV suggested that the explored healthcare indicators largely explained the macro-contextual effect. Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources. Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.

When does the energy transition impact household affordability? A mixed-methods comparison of fourteen coal and carbon-intensive regions

Understanding what conditions promote or hinder energy affordability in energy transitions is crucial for coal and carbon-intensive regions (CCIRs) dealing with the trade-off between phasing out fossil fuels and deepening social inequalities. While previous studies have included household and national-level conditions, this paper addresses the research gap covering regional-level conditions by drawing from regional energy governance, energy justice, and sociotechnical transition frameworks. A mixed-method approach consisting of a fuzzy-set qualitative comparative analysis and case-study analysis is applied to 14 CCIRs in Europe, Asia, and North America. Results show that energy affordability in CCIRs is influenced by combinations of regional and (inter)national conditions. Whereas the existing literature and transition policies do not differentiate between the CCI sector’s transition type, this paper highlights that conditions underlying energy (un)affordability differ when the CCI sector is phased out or has the option to transition. Based on the findings, this study calls for a multi-level governance approach to alleviating and preventing energy unaffordability and recommends that policy mixes like the EU Just Transition Fund consider the different types of CCIR transitions.

Impact of COVID-19 Pandemic on Emergency Department Visits for Opioid Use Disorder Across University of California Health Centers

Introduction: Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present. Methods: In this analysis we searched the University of California (UC) Health Data Warehouse—a database of electronic health records from six UC health centers—for opioid-related ED visits, identifiying using the following International Classification of Diseases, 10th Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018–October 2019) and during the pandemic (April 2020–December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05. Results: Before COVID-19, a steadily increasing trend in ED visit rates was observed for all outcomes (P < 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95%CI 1.02–1.29, P = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991–1.00, P = 0.06). Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10–1.89, P = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998–1.02, P = 0.12). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02–1.06, P = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90–.93, P < .001). No immediate increase in visit rates was observed for either opioid. Conclusion: While opioid-related ED admissions among the UC health centers showed an overall decrease, prescription and synthetic opioid overdoses remained significantly higher than pre-pandemic trends as of December 2022. A multilevel approach to improve awareness of new opioid health policies could ameliorate these alarming rises in the post-pandemic era.

Developing a multi-level european-wide composite indicator to assess vulnerability dynamics across time and space

The escalating frequency of extreme climatic events and ongoing urbanisation expose European communities to increasing disaster risks, which are determined not only by the hazardous events themselves, but also by the exposure and vulnerability to these hazards. Consequently, effective risk management strategies cannot overlook a comprehensive understanding of the factors influencing vulnerability of the communities. This paper addresses this need by presenting a European-wide framework for the development of a Vulnerability Index (VI) that evaluates vulnerability at both national and subnational scales. Adopting a multi-dimensional and multi-level approach, the VI captures socio-economic, political, environmental, and physical factors contributing to community resilience. A standardised, supranational methodology is employed, providing harmonised cross-country information and time series data for vulnerability and its underlying indicators. This comprehensive assessment facilitates the understanding of socio-economic dynamics, enabling the formulation of targeted policy actions at both country and subnational levels. By offering insights into current vulnerability trends, the VI underlines the importance of governance, economic factors, and disaster preparedness in reducing vulnerability at different administrative levels, while highlighting the role of social factors, such as poverty and social exclusion, in community vulnerability at sub-regional levels.

It takes a village: The role of community attributes in shaping solar photovoltaic adoption intention in Germany

The shared attributes, attitudes, and beliefs of communities can either act as a catalyst or a barrier to the adoption of pro-environmental behaviours such as the adoption of solar photovoltaic (PV). Using a multilevel mixed-effect modelling approach on survey data from 1800 German homeowners, we examine how individual/household and objective community attributes and their interplay shape the intention to adopt solar PV. Research findings indicate that a significant explanation of intention to adopt solar PV is related to unobserved community characteristics (13 %); with community level covariates including a proxy for spatial peer effects explains 8 % of this variance. Testing for spatial peer effects via a cross-level interaction, our findings suggest that a higher diffusion rate of PV installations in a community can positively influence intention to adopt Solar PV for households who on average have a low intention to adopt. Understanding the degree that individual versus area-based effects impact intention to adopt can provide policymakers with a framework to develop policies to incentivize the uptake of Solar PV among traditionally “hard-to-convince” population groups at the local level.

Innovative Hybrid Energy Storage Systems with Sustainable Integration of Green Hydrogen and Energy Management Solutions for Standalone PV Microgrids Based on Reduced Fractional Gradient Descent Algorithm

This paper investigates innovative solutions to enhance the performance and lifespan of standalone photovoltaic (PV)-based microgrids, with a particular emphasis on off-grid communities. A major challenge in these systems is the limited lifespan of batteries. To overcome this issue, researchers have created hybrid energy storage systems (HESS) along with advanced power management strategies. This study introduces innovative multi-level HESS approaches and a related energy management strategy designed to alleviate the charge/discharge stress on batteries. Comprehensive Matlab Simulink models of various HESS topologies within standalone PV microgrids are utilized to evaluate system performance under diverse weather conditions and load profiles for rural site. The findings reveal that the proposed HESS significantly extends battery life expectancy compared to existing solutions. Furthermore, the paper presents a novel energy management strategy based on the Reduced Fractional Gradient Descent (RFGD) algorithm optimization, tailored for hybrid systems that include photovoltaic, fuel cell, battery, and supercapacitor components. This strategy aims to minimize hydrogen consumption of Fuel Cells (FCs), thereby supporting the production of green ammonia for local industrial use. The RFGD algorithm is selected for its minimal user-defined parameters and high convergence efficiency. The proposed method is compared with other algorithms, such as the Lyrebird Optimization Algorithm (LOA) and Osprey Optimization Algorithm (OOA). The RFGD algorithm exhibits superior accuracy in optimizing energy management, achieving a 15% reduction in hydrogen consumption. Its efficiency is evident from the reduced computational time compared to conventional algorithms. Although minor losses in computational resources were observed, they were substantially lower than those associated with traditional optimization techniques. Overall, the RFGD algorithm offers a robust and efficient solution for enhancing the performance of hybrid energy systems.

Commercial determinants of health and cancer prevention in South Africa

Aim Commercial determinants, encompassing marketing strategies, corporate social responsibility, and lobbying, significantly contribute to avoidable cancer deaths globally. In South Africa, 30-50% of cancers are preventable, but SA focuses mainly on tobacco control, ignoring major causes of cancer such as alcohol, obesity, and ultra-processed foods. This paper highlights the role of these commercial determinants in contributing to cancer in SA. It outlines strategies and barriers in addressing these determinants. Approach While conventional approaches focus on individual responsibility relating to risk factors like tobacco, alcohol, and unhealthy diets, the role of industries in promoting these risk factors remains inadequately addressed. The paper explores the marketing and non-marketing methods employed by industries, such as tobacco, alcohol, and ultra-processed products, to maximise profits while neglecting public health consequences. Findings The article sheds light on industry tactics, including strategic partnerships, sponsorship, and diversionary narratives during crises, aimed at safeguarding profits. It emphasises the less-explored realm of non-marketing strategies, such as political lobbying, industry-funded research, and the ‘revolving door’ phenomenon where industry insiders become policymakers. Conclusions The article advocates for a paradigm shift in cancer prevention policies, urging the government to implement a comprehensive suite of measures that include increased taxation on harmful products, strict restrictions on marketing, enhanced product labelling, and eliminating conflict of interest in health research and policies. Addressing the commercial determinants necessitates not only recognising their impact but also adopting a multi-level governance approach that prioritises public health over corporate profits. The paper concludes by emphasising the urgency of recognising the links between alcohol, food regulation, and cancer prevention. The overarching goal is to shift power relations, fostering governance for the collective good and ensuring equitable access to preventive measures, especially for vulnerable populations.

NRN1 genetic variability and methylation changes as biomarkers for cognitive remediation therapy response in schizophrenia

Cognitive remediation therapy (CRT) demonstrates potential in enhancing cognitive function in schizophrenia (SZ), though the identification of molecular biomarkers remains challenging. The Neuritin-1 gene (NRN1) emerges as a promising candidate gene due to its association with SZ, cognitive performance and response to neurotherapeutic treatments. We aimed to investigate whether NRN1 genetic variability and methylation changes following CRT are related to cognitive improvements.Twenty-five SZ patients were randomly assigned to CRT or treatment-as-usual (TAU) groups, with cognitive function and NRN1 methylation assessed pre- and post-intervention using the MATRICS Consensus Cognitive Battery and EpiTYPER. Besides, eleven NRN1 polymorphisms were genotyped. Methylation changes (Δm = post - pre) were analyzed via sparse Partial Least Square Discriminant Analysis (sPLS-DA) to identify latent components (LCs) distinguishing CRT from TAU. To further explore methylation patterns of these LCs, CpG units were grouped into two subsets, yielding Δm means for those with increased and decreased methylation. Cognitive changes (Δcog = post - pre) were used to identify CRT improvers (CRTI, Δcog ≥1), and the association between methylation changes and cognitive improvements post-therapy was also tested.We identified two LCs that differentiated CRT from TAU with a classification error rate of 0.28. The main component, LC1, included 25 CpG units. The subsets of CpG units with increased and decreased post-therapy methylation differed significantly between the two treatment arms, suggesting that differences were not merely data-driven but reflected meaningful biological variation. Additionally, CpG units linked to therapy were also associated with cognitive improvement, with LC1 and the subset of CpG units showing increased methylation post-therapy distinguishing CRT-I from the rest of the patients across multiple cognitive domains. Furthermore, the effect of LC1 on speed processing improvement after CRT was enhanced by considering the NRN1-rs9405890 polymorphism. Notably, these CpG units, particularly those with increased methylation after CRT, overlapped with key gene regulatory elements.Our model, integrating genetics and epigenetics, boosts the understanding of CRT response variability and highlights this multi-level approach as a promising strategy for identifying potential NRN1-related biomarkers of CRT effects, though further studies with larger samples are needed.

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study

BackgroundRacism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children’s mental health and sleep problems if interpersonal racial discrimination was eliminated. MethodsWe drew on cross-sectional data from the Speak Out Against Racism (SOAR; N=2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N=8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10-15 years; LSAC: 4-5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10-15 years; LSAC: 12-13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10-15 years; LSAC: 14-15 years). An interventional effects causal mediation approach was used. FindingsAboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40·1% versus 13·5%; LSAC: 25·3% versus 7·6%) and sleep problems (SOAR: 28·5% versus 18·4%; LSAC: 14·0% versus 9·9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children’s experiences of interpersonal racial discrimination could reduce 42·4% and 48·5% of mental health and sleep inequities in SOAR (equivalent to 11·2% and 4·7% absolute reductions) and 25·6% and 1·6% of mental health and sleep inequities in LSAC (equivalent to 5·5% and 0·1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes. InterpretationTargeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.Funding: National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia

P2.04A.06 A Multilevel Approach to Address Disparities in Lung Cancer Screening: The PREP Trial

P2.04A.06 A Multilevel Approach to Address Disparities in Lung Cancer Screening: The PREP Trial

PROGRESS: A Patient-centered Engagement Infrastructure and Multi-level Approach to Enrich Diversity, Equity, and Inclusion in a National Randomized Online Behavioral Pain Treatment Study

Twenty percent of individuals experience chronic pain worldwide posing significant challenges to those living with it. Pain research is crucial for developing and characterizing effective strategies to reduce the burden of chronic pain. Traditional research approaches often yield homogeneous study samples that poorly generalize and have unknown applicability across diverse patient populations. The Pain Relief with Online Groups that Empower Skills-based Symptom Reduction (PROGRESS) study aims to address disparities in pain research engagement and patient outcomes through the intentional inclusion of people with varied backgrounds and experiences of pain, and through a multilevel design informed by diverse stakeholder recommendations. The composition of three advisory boards (Patient Engagement and Diversity Board, Local Patient Advisory Board, and the National Patient Advisory Panel) prioritized diversity in patient/expert advisor background, geographic location, race, and ethnicity. Our engagement approach aligns with the Foundational Expectations for Partnerships in Research by Patient-Centered Outcomes Research Institute (PCORI), which emphasizes diverse representation, early and ongoing engagement, dedicated funds for advisor compensation, collaborative decision making, meaningful participation, and continuous assessment. The first 24 months of study advisor engagement has yielded multiple recruitment strategies resulting in a study population enriched with a breadth of identities within PROGRESS (e.g., inclusive patient-facing materials). Lessons learned underscore the importance of investing time in building patient and stakeholder relationships, trust, and embracing diverse viewpoints amongst the study team. PROGRESS demonstrates the potential of diverse patient-centered engagement to support evidence-based outcomes and practices that are more inclusive, equitable, and representative of the broader population. PerspectiveThe PROGRESS study demonstrates how diverse patient engagement and inclusive advisory boards enhance research outcomes. By aligning with PCORI standards and employing innovative recruitment strategies, it highlights the vital role of stakeholder relationships and diverse perspectives. Key lessons learned emphasize adaptive strategies and continuous feedback for advancing equitable pain research.

Daily sibling interactions among latino children in middle childhood: An examination of familism values and sibling roles

Siblings are children’s most frequent daily companions in middle childhood and these relationships are theorized to be dynamic in nature but are rarely studied in a way that captures their day-to-day variation. Guided by cultural-ecological and relationship perspectives, this study examined the role of older siblings’ familism values and caring roles as predictors of average levels of and day-to-day variation in siblings’ positive and negative exchanges across seven days and tested moderation by child sex. Participants were older ( M = 10.6 years; SD = 0.39; 46.6% female) and younger siblings ( M = 8.2 years; SD = 1.07; 47.2% female) in 307 Latino sibling dyads recruited from 11 elementary schools in the southwestern U.S. Data were collected via home visits with parents, and in afterschool sessions and seven nightly phone calls with siblings. Analyses were conducted using a random variability model in a multilevel structural equation modeling approach. Findings revealed consistent associations between older siblings’ familism values and sibling roles and both average levels of and intraindividual variation in older siblings’ positivity and negativity. For younger siblings, some findings were moderated by child sex with more consistent links to younger sisters’ positivity and negativity than younger brothers’. Discussion highlights how older siblings’ cultural values and roles shape both overall levels of and day-to-day fluctuations in siblings’ exchanges and offers future directions of research.