Multilevel Analysis Approach Research Articles

Spatiotemporal Dynamics in Bird Species Assembly in the Coastal Wetlands of Sicily (Italy): A Multilevel Analytical Approach to Promote More Satisfactory Conservation Planning

Spatiotemporal Dynamics in Bird Species Assembly in the Coastal Wetlands of Sicily (Italy): A Multilevel Analytical Approach to Promote More Satisfactory Conservation Planning

Examining the Prevalence and Predictors of Stunting in Indian Children: A Spatial and Multilevel Analysis Approach

Examining the Prevalence and Predictors of Stunting in Indian Children: A Spatial and Multilevel Analysis Approach

Ecological Function Zoning Framework for Small Watershed Ecosystem Services Based on Multivariate Analysis from a Scale Perspective

A thorough comprehension of distribution features of ecosystem services (ESs) and the influencing mechanisms can offer scientific guidance for the ecosystem management of small watersheds. We analyzed the spatial distribution patterns, interrelationships, and service hotspots of ESs across pixel and administrative scales using a multi-level statistical analysis approach in the Ashi River Basin. Through the quantitative calculation of the InVEST model, the findings revealed a decrease in soil retention, water yield, total nitrogen and phosphorus export, carbon storage, and habitat quality, while an increase in food production was observed during the period from 1995 to 2015. Through the geographical detector, the spatial heterogeneity of most individual ESs was influenced by land use patterns. Through redundancy analysis, terrain factors had the highest contribution rate to the integral ESs. Socio-economic factors and climate factors also drove the ESs’ amount and spatial distribution. At the pixel scale and administrative scale, there were distinctions in the correlations between all ESs, reflected by the fact that the relationships between ESs at the administrative scale were generally weaker and no more significant than at the pixel scale. Based on the number and distribution of hotspots in ESs and the clustering results of influencing factors, the framework of ecosystem zoning was constructed. This basin was divided into three ecological zones, and the management policies were formulated according to the ecological environment. This study clarifies the internal and mutual connection between ESs and influencing factors across two scales, thus contributing to the advancement of management strategies for ecological conservation and socio-economic development within the context of small watersheds.

Inconsistency in psychological resilience and social support with mental health in early adolescents: A multilevel response surface analysis approach

BackgroundGiven the high prevalence of adolescent mental health problems, promoting understanding and implementation of protective factors is crucial for prevention and intervention efforts addressing adolescent mental health problems. This study aims to investigate whether consistency and inconsistency in protective factors are associated with adolescent mental health problems and to inform adolescent mental health interventions that target the unique needs of adolescents and promote adolescent mental health. MethodsWe used multistage cluster sampling to conduct psychological resilience, social support, and mental health questionnaires from April to June 2023 among 10,653 Chinese adolescents (52.3 % were boys). Data were analyzed using polynomial regressions with response surface analysis. ResultsThe higher levels of psychological resilience and social support in adolescents were associated with fewer mental health problems (anxiety: a1 = −1.83, P < 0.001; depression: a1 = −2.44, P < 0.001; and perceived stress: a1 = −1.20, P < 0.001). When the level of psychological resilience was greater than social support, the greater the discrepancy the higher the perceived stress among adolescents (a3 = 1.19, P < 0.001). Moreover, the consistency of psychological resilience and social support had a greater impact on girls' mental health (anxiety: a1 = −1.97, P < 0.001; depression: a1 = −2.71, P < 0.001; perceived stress: a1 = −1.23, P < 0.001). LimitationsThe cross-sectional study design limited the inference of causal relationships between variables. ConclusionsThese results emphasize that adolescents need a balanced development of protective factors and targeted intervention programs for different mental health problems.

A life span perspective on competencies for a healthy, physically active lifestyle: Findings of a data pooling initiative with over 7000 individuals.

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity-related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health-enhancing PA (movement competence, control competence, self-regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15-97years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub-samples (n=48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task-specific self-efficacy) congruently showed negative associations with age (0.054≤ ≤0.211). However, parameters of control competence remained stable across the life span (-0.066≤β≤0.028). The three indicators of self-regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self-control (β=0.106) and emotional attitude toward PA (β=0.088). The associations of some indicators varied significantly across sub-samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self-regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de-stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly.

Agroecosystem-based analysis of household dietary diversity and its linkage with agricultural production diversification in the Upper Blue Nile Basin, Ethiopia: Multilevel analysis approach

Even though the UN's Sustainable Development Goals emphasize improving dietary diversity and overall nutritional status globally by promoting sustainable agriculture, inadequately diversified dietary intake remains a public health problem in many low-income countries, including in Sub-Saharan Africa. The main objective of this study was to gather relevant information to gain an improved understanding of household dietary diversity and explore the role that production diversification could play within household diets and nutrition so that appropriate interventions could be implemented with the goal of enhancing nutrition-sensitive agriculture while also considering the varied features across the agroecosystems. Agroecosystem-based cross-sectional study design was employed. Data were collected predominantly through semi-structured questionnaires and analyzed by descriptive and inferential statistics, and a multilevel mixed-effect model. Results showed that the usual dietary intake of households has a monotonous pattern dominated by starchy staple foods, and consumption of fruits, vegetables, and animal-sourced foods was very limited. One out of five households had inadequate dietary diversity but varied significantly across agroecosystems. About 26% of the heterogeneity in dietary diversity was attributed due to agroecosystem level factors. In the fixed-effect part of the model, production diversification, wealth status, number of meals per day, market access, and annual mean rainfall were significantly associated with household dietary diversity status. The findings of our research contribute to give insights on the linkage between dietary diversity and production diversification among subsistence rural farmers across contrasting agroecosystem zones. Therefore, understanding agroecosystem variations and local context in the rural subsistence farming setup is a key point in designing nutrition-sensitive agriculture.

Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review.

This study aimed to identify the individual, organizational, and environmental factors which contributed to COVID-19-related outcomes in long-term care facilities (LTCFs). A systematic review was conducted to summarize and synthesize empirical studies using a multi-level analysis approach to address the identified influential factors. Five databases were searched on 23 May 2023. To be included in the review, studies had to be published in peer-reviewed journals or as grey literature containing relevant statistical data. The Joanna Briggs Institute critical appraisal tool was employed to assess the methodological quality of each article included in this study. Of 2137 citations identified after exclusions, 99 records met the inclusion criteria. The predominant individual, organizational, and environmental factors that were most frequently found associated with the COVID-19 outbreak comprised older age, higher dependency level; lower staffing levels and lower star and subset domain ratings for the facility; and occupancy metrics and co-occurrences of outbreaks in counties and communities where the LTCFs were located, respectively. The primary individual, organizational, and environmental factors frequently linked to COVID-19-related deaths comprised age, and male sex; higher percentages of racial and ethnic minorities in LTCFs, as well as ownership types (including private, for-profit, and chain membership); and higher occupancy metrics and LTCF's size and bed capacity, respectively. Unfolding the risk factors collectively may mitigate the risk of outbreaks and pandemic-related mortality in LTCFs during future endemic and pandemics through developing and improving interventions that address those significant factors.

Evaluating the impact of individual and country-level institutional factors on subjective well-being among entrepreneurs

This study examines entrepreneurs' subjective well-being (SWB) in the form of life satisfaction. It presents a multilevel analysis approach explaining the relationship between individual-level variables (demographics and developed personal characteristics), country-level institutional variables (political stability, corruption perception index, paying tax regulations, and business freedom), and entrepreneurs' SWB. The multilevel mixed-effects logistic regression analysis is used to test the econometric model with data from the Life in Transition Survey III for 34 countries. Findings show that both individual and governing factors play a significant role in shaping entrepreneurs' SWB. The individual-level variables such as job satisfaction, financial situation, generalized trust, optimism, and social standing are the most critical factors driving self-employed life satisfaction. On the institutional level, business freedom and political stability are the most instrumental, followed by the corruption perception index and paying tax regulatory. Overall, this research enhances comprehension regarding SWB within the entrepreneurship domain, yielding significant implications for entrepreneurship theory and practice within the well-being framework, along with providing pertinent recommendations for policymakers.

Psychophysiological Effects of Slow-Paced Breathing on Adolescent Swimmers' Subjective Performance, Recovery States, and Control Perception.

This study examined the effect of a Slow-Paced Breath (i.e., 6 breaths per minute) without Biofeedback (SPB-NoHRVB) protocol on semi-elite adolescent swimmers' psychological and physiological states during a seven-week ecological training period. A linear mixed-effects multilevel regression analysis approach was used with 13 adolescent national-level swimmers. Athletes were randomly assigned to an intervention group (n = 7) and a control group (n = 6). Seven waves of assessments were completed weekly during a seven-week training preparation in ecological conditions. During the protocol, swimmers completed subjective quantitative measures (RESTQ-36-R-Sport; cognitive perceived stress and control states about the training process, training subjective performance, and subjective internal training load) and physiological heart rate (HR) (HR of exercise, absolute and normalized HR recovery during the first 60 s of recovery; HRR60 and nHRR60) and heart rate variability (HRV) (MeanRR, RMSSD, LFnu and HFnu, LF/HF ration) tests (through a submaximal heart rate (5'-5' test) once a week. Results revealed that the SPB-NoHRVB protocol significantly predicts biopsychosocial recovery states, cognitive perception of control, and training subjective performance (i.e., a significant effect of the SPB-NoHRVB protocol with the dependent variables simple time trajectories). However, no significant effects were found for biopsychosocial stress scales, cognitively perceived stress, HR, or HRV markers. Our results suggest that SPB-NoHRVB induces simple evolutions over time for crucial variables in athletes' adaptation to the training process (i.e., cognitive appraisals and biopsychosocial states). In contrast, it highlights that SPB-NoHRVB does not induce better stress states. This specific effect on the resource component is an exciting result that will be discussed in the manuscript.

Application of Italian Guidelines for structural-foundational and seismic risk classification of bridges: the Fabre experience on a large bridge inventory

The recent issuance of Guidelines for the classification and management of risk, safety assessment, and monitoring of existing bridges has standardized the methodology for analyzing the safety and managing bridges at a national level. The Guidelines propose a multi-level analysis approach, where the assessment of structures is conducted with increasing levels of detail and complexity. This paper describes the work carried out by the Fabre Consortium, the Italian scientific alliance on risk assessment and monitoring of civil infrastructural systems, together with ANAS s.p.a., one of the major Italian road authorities, for the implementation of the Italian Guidelines to a large bridge inventory distributed over the Italian territory. This paper is specifically devoted to structural-foundational and seismic risk classification. The results of the application of the methodology to a large database is presented together with statistical analyses on parameters determining hazard, vulnerability and exposure and with the definition of the most recurrent typological bridge classes within the bridge inventory.

Individual and community level factors associated with modern contraceptive utilization among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis of the 2019 Ethiopia Mini-Demographic and health survey

BackgroundA demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies that used Ethiopia Demographic and Health Survey (EDHS) data did not assess individual and community-level factors in contraceptive utilization. Thus, the study employs a multilevel mixed effects analysis approach, which allows for the examination of individual and community-level factors that influence contraceptive utilization.MethodsThis study analyzed the 2019 Ethiopia Min Demographic and Health Survey datasets. A total of 1916 married women in the 2019 surveys were included in the analysis. The data were analyzed using Stata version 17.0. The data were analyzed using Multi-level mixed-effect logistic regression to identify the individual and community-level factors associated with modern contraceptive utilization. An adjusted odds ratio with a 95% confidence interval was used to.Show the strength and direction of the association and statistical significance was declared at a P value less than 0.05.ResultsFactors significantly associated with modern contraceptive utilization were; Muslim and protestant followers [AOR = 0.31, 95% CI: (0.134, 0.714)] and [AOR = 0.35, 95% CI: (0.173, 0.691)] respectively, women with no education (OR = 0.46; 95% CI: 0.293, 0.710), those women who belong to the poor and middle wealth of household [AOR = 0.35, 95% CI: (0.237, 0.527)] and [AOR = 0.56, 95% CI: (0.347, 0.919)] respectively, women who had one to five and greater than or equal to six living children [AOR = 11.36, 95% CI:(2.119, 60.918)] and [AOR = 7.44, 95% CI:(1.437, 38.547)]respectively, Women in clusters poor wealth status [AOR = 0.40, 95% CI: (0.183, 0.875)] and women who belong to the Somali region [AOR = 0.20, 95% CI: (0.0.070, 0.506)].ConclusionThe study revealed that both individual and community-level factors determined modern contraceptive utilization. At the individual level, the religion of women, educational status, the wealth of the household, and the total number of living children were significantly associated with modern contraceptive utilization. At community-level factors, community wealth status and belonging to the Somali region were significantly associated with modern contraceptive utilization. The findings suggest that interventions aimed at increasing modern contraceptive utilization should target women with lower levels of education, those living in households with lower wealth, and those with larger families. Additionally, efforts should be made to improve access to modern contraceptives in communities with lower wealth status and in regions where traditional beliefs may hinder their use.

An ecological study protocol for the multimodal investigation of the neurophysiological underpinnings of dyadic joint action.

A novel multimodal experimental setup and dyadic study protocol were designed to investigate the neurophysiological underpinnings of joint action through the synchronous acquisition of EEG, ECG, EMG, respiration and kinematic data from two individuals engaged in ecologic and naturalistic cooperative and competitive joint actions involving face-to-face real-time and real-space coordinated full body movements. Such studies are still missing because of difficulties encountered in recording reliable neurophysiological signals during gross body movements, in synchronizing multiple devices, and in defining suitable study protocols. The multimodal experimental setup includes the synchronous recording of EEG, ECG, EMG, respiration and kinematic signals of both individuals via two EEG amplifiers and a motion capture system that are synchronized via a single-board microcomputer and custom Python scripts. EEG is recorded using new dry sports electrode caps. The novel study protocol is designed to best exploit the multimodal data acquisitions. Table tennis is the dyadic motor task: it allows naturalistic and face-to-face interpersonal interactions, free in-time and in-space full body movement coordination, cooperative and competitive joint actions, and two task difficulty levels to mimic changing external conditions. Recording conditions-including minimum table tennis rally duration, sampling rate of kinematic data, total duration of neurophysiological recordings-were defined according to the requirements of a multilevel analytical approach including a neural level (hyperbrain functional connectivity, Graph Theoretical measures and Microstate analysis), a cognitive-behavioral level (integrated analysis of neural and kinematic data), and a social level (extending Network Physiology to neurophysiological data recorded from two interacting individuals). Four practical tests for table tennis skills were defined to select the study population, permitting to skill-match the dyad members and to form two groups of higher and lower skilled dyads to explore the influence of skill level on joint action performance. Psychometric instruments are included to assess personality traits and support interpretation of results. Studying joint action with our proposed protocol can advance the understanding of the neurophysiological mechanisms sustaining daily life joint actions and could help defining systems to predict cooperative or competitive behaviors before being overtly expressed, particularly useful in real-life contexts where social behavior is a main feature.

Individual and organizational effects of international mobility policy: Effects of Mexico’s Scholarship Program in nanotechnology

Abstract This paper addresses policy effects of international mobility in developing countries. It proposes a multilevel approach to study research training policies, specifically focusing on international mobility schemes as capacity-building instruments, where effects need to be identified at both individual and organizational levels. The paper asserts that current categorizations of country efforts to build a solid scientific base should consider transference of effects in domestic research contexts. Using a survey and interview-based study of a mobility policy in Mexico, and nanotechnology-related disciplines and sectors, this paper’s findings suggest that mobility policies are crucial in creating high-quality individual research skills, but that their impact on building domestic research capacity may be modest. This paper contributes to the evaluation literature on national research training programs and their influence on research capacity in two ways. First, it mobilizes a multilevel analytical approach to examine the effects of policies on individuals and organizations, offering a broader conceptualization of impact. Second, by introducing these individual and organizational effects, the paper provides insights into how effects are enacted and transferred.

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

The prevalence and multilevel analysis of minimum dietary diversity intake and its determinants among 6–23 months old infants in The Gambia: further analysis of the Gambian demographic and health survey data

BackgroundPoor infant and young child feeding (IYCF) practices are a significant issue both globally and in developing nations, and they have a significant role in undernutrition, healthy growth, and development, particularly in the first 2 years of life. Improving children's general health and wellbeing requires recognizing and decreasing preventable drivers of malnutrition. Hence, this study aimed to assess the prevalence and possible determinants of minimum dietary diversity among 6–23 months old babies in the Gambia.MethodsData from the 2019–2020 Gambia demographic and health survey were used. The study included a total of 2100 weighted 6–23 months old children. To identify characteristics significantly linked with minimum dietary diversity among infants, a multilevel fixed-effect analysis approach was used. After adjusting other confounding variables, variables with a p value of 0.25 were incorporated into a multivariable multilevel regression analysis to determine associated variables. An adjusted odds ratio with a 95% confidence interval was then applied.ResultsOnly 22.22% (95% CI 18.55, 21.99) of infants had received the minimum dietary diversity. Mothers, who had mass media exposure (aOR = 2.71, CI = (1.02, 6.21), wealthier (aOR = 1.70, CI = 1.02, 2.85), child age of (aOR = 4.14, CI = 2.98, 5.76), and (aOR = 4.97, CI = 3.54, 6.98), have shown a positive statistical association with the outcome variable, respectively. Regarding regions mothers who came from Kanifing (aOR = 0.49, CI = 0.25, 0.94), Janjanbureh (aOR = 0.38, CI = 0.18, 0.82), and Basse (aOR = 0.51, CI = 0.26, 0.99) had showed less likelihood odds to provide the minimum dietary diversity (MDD) for their babies compared to Banjul local government area, respectively.ConclusionThe World Health Organization dietary evaluation tool suggests that the MDD value be extremely low, even though it might be slightly higher than the numbers for some nations. The country may need to take drastic measures to tackle child malnutrition.

Social Norms Predict Bullying: Evidence from an Anti-Bullying Intervention Trial in Indonesia

AbstractSocial norms pertaining to negative or violent interpersonal behaviours constitute a promising target for programs designed to reduce bullying. Yet, there is a lack of evidence on anti-bullying programs targeting social norms in non-Western, low- and middle-income countries. Here, we report findings on the relationship between social norms and bullying from one such large-scale program, the feasibility trial of the ROOTS-Indonesia intervention. This intervention was delivered across 12 secondary schools in two different regions in Indonesia. We report findings based on a total of 7,203 students at baseline (in South Sulawesi, n = 1901, mean age = 13 years, 53% female; and in Central Java, n = 5302, mean age = 13.3 years, 48% female). Via a multilevel analytic approach, we found consistent evidence that the extent to which negative behaviours were considered normative by students was associated with how much they would engage in bullying, both as perpetrators and as victims. Our data reveal some encouraging trends suggesting the ROOTS-Indonesia intervention reduced negative social norms. We note a trend such that where social norms decreased the most at follow-up, the rates of bullying similarly decreased the most. Overall, we provide further evidence that social norms are a promising avenue for the reduction of negative interpersonal behaviours.

Systematic review of international marketing capabilities in dynamic capabilities view – calibrating research on international dynamic marketing capabilities

PurposeThis study aims to conduct a thorough literature review to map current studies on international marketing capabilities (IMCs) applying dynamic capabilities view (DCV). The aim of this study is to increase the chances for more conceptual and terminological rigor in future research in this particular research area.Design/methodology/approachThis is a systematic literature review following the established review process of reviews in leading (international) marketing journals. A multilevel analytical approach was adopted, combining inductive coding with deductive coding and following the logic of antecedents-phenomena-consequences.FindingsSynthesis of 20 rigorously selected previous empirical studies on IMCs applying DCV reveals that academic interest in these capabilities is well justified and growing and there are some well researched antecedents to focal capabilities (e.g. inter-organizational capabilities, outside-in market orientation) as well as their prevalent consequences (e.g. export and innovation performance). There is little knowledge of moderators to these links, especially with regard to consequences. This review illustrates that the current research lacks consistency in how key constructs are defined and measured, provides the guide to future conceptualization and measurement of so-called International Dynamic Marketing Capabilities (IDMCs) and proposes some concrete research directions.Originality/valueThe authors extend prior research in the investigated topic by critically evaluating prior works, providing improved conceptualization of IDMCs as well as concrete research agenda for IDMCs structured along recommendations for Theory, Context and Methods (TCM framework).

Individual and Family Determinants for Quality of Life in Parents of Children With Inborn Errors of Metabolism Requiring a Restricted Diet: A Multilevel Analysis Approach

ABSTRACT Inborn errors of metabolism (IEMs) requiring a restricted diet can have a significant impact on both children and their caregivers. Previous research has shown conflicting findings in the quality of life (QoL) of caregivers specifically, as many factors can influence daily interactions: home care demands, the potential for acute health crises and hospitalization, dietary constraints, medications, and others. Influencing factors have previously been reported to include emotional, adaptive, and socioeconomic factors, and previous research has varied greatly in sample characteristics, methods of collecting data and measuring QoL, and methods of analysis. This study was performed to clarify previous findings and provide a clearer picture of QoL in parents of children with IEMs requiring a restricted diet compared with the general population based on parent self-report. The final analysis included 785 parents of 578 children with IEMs requiring a restricted diet. Quality of life was assessed using the World Health Organization Quality of Life–BREF and was compared with age- and sex-matched control subjects from the general population. Parents of children with IEMs requiring a restricted diet in this study population experienced a significantly lower QoL in the areas of physical health (mean, −6.09 [SD, 15.01]) and social relationships (mean, −6.82 [SD, 17.71]), as well as a significantly higher QoL in psychological health (mean, +3.10 [SD, 14.25]). Multivariate models were examined to determine factors responsible for these differences in QoL; parental anxiety was negatively associated with all QoL domains. Other factors negatively associated with at least 1 domain included being a father (physical health and social relationships), older parent (physical and psychological health), having an education higher than high school (psychological health), and using more social support–seeking coping strategies (physical health and environment). Factors positively associated with at least 1 domain included having an education level higher than high school (environment), being a working parent (physical and psychological health, environment), and using more positive thinking coping strategies (psychological health). Child-related factors negatively associated with parental QoL included having at least 1 disease complication (social relationships and environment) and a higher number of hospital medical providers (physical health). A child being older positively impacted parental QoL in the environment domain. It is not uncommon for parents of children with chronic diseases or impairments to experience a lower QoL. In this study, some aspects of QoL were enhanced by the demands of caregiving, and some were negatively impacted. Discrepancies in previous literature may be partially attributed to varying tests, variable characteristics within a sample (eg, longer time since diagnosis), or differences in analysis methods. The results in this study indicate a potential need for resources to support parents of children with IEMs requiring a restricted diet. Previous literature has shown efficacy in providing in-home health care professionals for occasional relief of caregiving duties for parents, as well as support groups of parents in similar situations. Parental anxiety in particular was shown to impact QoL negatively in all domains, and thus targeting interventions toward reducing parental anxiety might be one way to improve QoL. The adaptation of parents to their child's condition and to the demands of caregiving could explain some aspects of the QoL difference from the general population, but these differences should still be addressed to improve QoL.

A multilevel social-ecological network approach for reconciling coastal saltmarsh conservation and development

In a large-scale region, governance for connectivity in an ecological system often conflicts with management boundaries, causing inefficiencies. Collaboration among management organizations in different areas can help overcome this problem. However, few studies quantified the collaborations' practical relationship with connectivity, considering that some potentially connected paths are easy to neglect by managers. In this paper, collaborations among government agencies in project application process were analyzed, and a multilevel social-ecological network analysis (SENA) approach was developed to identify the collaboration's effect on genetically connected coastal areas. The network framework and methods were shown in a case of coastal saltmarsh conservation and development in the Yellow River Delta, China. Collaboration patterns in conservation and development networks were analyzed and compared among local, subregional, and regional government agencies working in genetically connected coastal areas. Project information flow, reflecting communication frequency and decision-making chances among government agencies was quantified and correlated with ecological connectivity to inform governance effects. Results showed areas with the potential to realize social-ecological alignment, where collaborative networks were measured by network density (percentage of connected network edges). The current reveals that development has more significant potential than conservation at most levels to overcome the misalignment of the social-ecological system, also known as scale mismatch. Empirical evidence also showed a correlation between communication capacity in development networks and improved ecological conditions. The multilevel SENA advanced in this paper can be used for natural resource management when connectivity plays a major role.

Asynchronous Heart Rate Variability Biofeedback Protocol Effects on Adolescent Athletes' Cognitive Appraisals and Recovery-Stress States.

This study examined the effect of an asynchronous heart rate variability biofeedback (HRV-BFBasync) protocol on national-level adolescent swimmers' cognitive appraisals and recovery-stress states during a six-week ecological training period. A polynomial mixed-effects multilevel regression analysis approach was used with 27 adolescent national-level swimmers randomly assigned to an intervention group (n = 14) and a control group (n = 13). Six waves of assessments of cognitive appraisals and recovery-stress states were completed during six weeks of training preparation in ecological conditions. The results revealed that the HRV-BFBasync protocol significantly predicts lower levels of biopsychosocial stress states and cognitive stress. However, no significant effects were found for biopsychosocial recovery scales and cognitive perceived control. The results suggested that total stress states, sport-specific stress, and cognitive perceived stress evolutions are a function of polynomial time third-degree interactions with HRV-BFB protocol. Overall, this study suggested that the HRV-BFBasync protocol leads adolescent athletes to experience lower biopsychosocial and cognitive stress levels during training periodization. Our results also suggest that HRV-BFB induces complex evolutions over time for stress and recovery states but does not have a predictive function for the recovery states and perceived control.