Multilevel Construct Research Articles

P113. Integrated interbody fusion in multilevel cervical constructs in clinical practice

BACKGROUND CONTEXT Although extremely effective at a single level, anterior cervical discectomy and fusion (ACDF) with an anterior cervical plate (ACP) for a multilevel construct can be associated with a number of peri- and postoperative complications. Such complications include esophageal dysphagia, loss of sagittal balance secondary to plate installation, and technical difficulties with the placement of anterior cervical plate over a multiple fusion levels. As an alternative, and quite possibly superior to cervical plating, individual cervical integrated interbody fusions with subsequent compressive/lag fixation, has emerged as a promising alternative. This has the potential to allow for smaller exposure, zero anterior profile, and individual, but multilevel specific sagittal realignment. PURPOSE The purpose of the study was to retrospectively evaluate patients treated from single to multiple levels with integrated interbody fusion by a single surgeon. STUDY DESIGN/SETTING Retrospective patients' data analysis. PATIENT SAMPLE A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathy were surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. OUTCOME MEASURES Patients were evaluated for patient-derived outcome measures, and radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment and fusion status), and device-related complications. METHODS A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathywere surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. Patients were assessed pre- and post-operatively at 6 weeks, 3, 6 months, 1 and 2 years. RESULTS The average age at time of surgery was 53.4±10.7 years. All had failed conservative treatment. Seventy-four patients underwent the procedure at single level, 68 patients at 2-levels, 39 patients at 3-levels, and 17 patients at 4-levels, 4 patients at 5-levels and 1 patient at 6-levels. Blood loss was minimal and no intraoperative complications were recorded. Hospital stay was minimal with 92% of patients being released the following day. Radiographic results showed lordosis was maintained in the global spine and bone formation was present in the inner column of the device. Overall fusion rate was 92%. The revision surgery patients showed better alignment than preoperatively with static plates. There were no signs of heterotopic ossification of the ligaments or vertebral bodies. At 6 months, none of the patients reported chronic dysphagia. There were no device failures out to last follow-up. Eighty-six percent of patients were able to return to the same level of work as prior to surgery. CONCLUSIONS For patients undergoing single and multi-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. Previously, studies with static integrated interbody fixation devices have not reported as well as ACP with regards to fusion and clinical outcomes. The benefit of a lag design to provide better fixation and more accurate maintenance of the lordotic curve of the cervical spine was seen in our series. Patients reported they were well satisfied with their results and experienced significant pain relief. The opportunity to either revise a previous ACDF with ACP or add to a pre-existing ACDF offers greater flexibility to treat the pathology at the index level rather than approach as a global construct. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Conceptualising and measuring employee engagement as a role-related, multi-level construct

Orientation: Based on different roles that managers occupy at different levels in organisations the question often arises: ‘how will these multiple roles and levels affect their engagement?’Research purpose: This study aimed to establish if employee engagement is a multi-level construct based on the multiple roles that individuals occupy in organisations.Motivation for the study: Several engaging management practices on different organisational levels were identified that either engage or disengage employees that are not being considered in the current mono-level, mono-role engagement models.Research design, approach and method: This quantitative study is based on a cross-sectional survey conducted amongst 1750 individuals with managerial responsibilities in three different organisations. About 610 participants attempted to complete the survey, but only 425 fully completed responses could be used for final statistical analysis.Main findings: Four different structural models were confirmed in the study. The first three confirmed different pull and push factors for individual, team and management engagement. The fourth model established that all three engagement constructs contribute to an engaging climate in organisations without any significant collinearity between the three engagement constructs.Practical/managerial implications: The empirical evidence confirms unique sets of pull and push factors on individual, team and managerial levels. Human resource practitioners should, therefore, take note of which factors promote employee engagement on each level.Contribution/value-add: The study confirms that employee engagement can be viewed as a multi-role, multi-level construct where significant spillover and/or crossover effects between different levels and roles are possible.

Using a Multi-level Framework to Test Empirical Relationships Among HIV/AIDS-Related Stigma, Health Service Barriers, and HIV Outcomes in KwaZulu-Natal, South Africa.

HIV/AIDS-related (HAR) stigma is an ongoing problem in Sub-Saharan Africathat is thought to impede HIV preventive and treatment interventions. This paper uses a systematic sample of households (Level 1) nested within near-neighbor clusters (Level 2) and communities (Level 3) to examine multilevel relationships of HAR stigma to health service barriers (HSBs) and HIV outcomes in KwaZulu-Natal, South Africa, thereby addressing methodological and conceptual gaps in the literature from this context. Findings suggest differential patterns of prediction at Level 1 when examining two different dimensions of stigma: more highly stigmatizing attitudes predicted more household health service barriers; and perceptions of greater levels of community normative HAR stigma predicted higher household HIV ratios. Level 2 findings were similarly dimension-differentiated. Cross-level analyses found that near-neighbor cluster-level (setting level) consensus about (standard deviation) and level of (mean) community normative HAR stigma significantly predicted household-level HSBs and HIV ratio, controlling for household-level community normative HAR stigma. These differential patterns of prediction suggest that HAR stigma is a multi-level construct with multiple dimensionsthat relate to important outcomes differently within and across multiple ecological levels. This has important implications for future research, and for developing interventions that address setting-level variation in stigma.

IDENTITY PHENOMENON RESEARCH: THEORETICAL LEVEL

Classical and modern theories of identity, such as E. Giddens concept of self-identity, social identity of I. Hoffmann, non-reflective identity of M. Foucault, the theory of recognition and social imaginary of C. Taylor, the concept of imaginary communities of B. Anderson, the theory of «using the Other» and the exclusive identity of I. Neumann are analyzed. As a result of the analysis, methodological benchmark principles for the conceptualization of identity phenomenonare defined. It is suggested to consider the phenomenon of identity as a multi-level construct, also, the principles of identity typology are developed. According to this typology, ontological (personal identity) and social (collective identity) dimensions of the phenomenon are distinguished. It is admitted that personal identity, in addition to being directly connected with emotions, is the result of an individual’s personal experience. Meanwhile collective identity is a phenomenon of a social level, mental awareness of the existence of a community that shares common for an individual interests/values. As types of personal identity, the reflective, when the individual asks himself «whom I relate to/ want to relate myselfto?», and non-reflective – the individual unconsciously reproduces certain practices, patterns of behavior –forms of the phenomenon are analyzed. Within the framework of collective identity, it is suggested to distinguish between identities according to the institutional level (regional/local or national/state), as well as according to the attributes of a social group (ethnic, racial, linguistic, gender, etc.). The attention is drawn to the further perspective of the social identity study precisely through the prism of the institutional level. In particular, the following research question is identified as an important aspect of the further research: how the features of the reproduction of certain formal and informal practices affect the formation and «renewal»/reconstitution of regional and national identities.

How dimensions of internationalization shape the MNE's renewal capability: Multidimensional and multilevel considerations

We investigate the theoretical and empirical implications of internationalization as a multidimensional and multilevel construct and its relationship to the renewal capability of the firm. Theoretically, internationalization describes a diverse range of cross-border activities by the multinational enterprise (MNE), and thus carries with it multiple dimensions of depth, breadth, and speed. Empirically, internationalization contains both within- and between-MNE variance, each with potentially different effects on the MNE's renewal capability. Using a unique, longitudinal dataset of 94 MNEs, we find support that each dimension and level of internationalization relates differently to the renewal capability of the MNE. At the within-level, the MNE internationalization breadth is negatively related to the its renewal capability, yet internationalization speed is positively related to renewal. At the between-level, the depth of internationalization is positively related to the MNE's renewal capability. In concert, our results suggest that the effects of internationalization on important outcomes cannot be simplified into general relationships. Rather, attention to the nuances of internationalization, especially as related to the MNE's capabilities, is needed.

On the Differential and Shared Effects of Leadership for Learning on Teachers’ Organizational Commitment and Job Satisfaction: A Multilevel Perspective

Purpose: Over the past years “leadership for learning” (LFL) has become popular among educational scholars. LFL refers to the idea that effective leaders demonstrate a contextually contingent mix of instructional, transformational, and shared leadership practices that may have differential effects at various organizational levels. These assumptions have rarely been investigated within a coherent empirical design. We examine the shared and differential effects of LFL on teachers’ job satisfaction and organizational commitment, which are relevant antecedents for learning, improvement, and change on all levels of a school. Method: Drawing on survey data ( nteachers = 3,746, nschools = 126) from Germany and on well-established instruments like the Multifactor Leadership Questionnaire or Teaching and Learning International Survey, multilevel associations of LFL and teachers’ job satisfaction and organizational commitment were explored. This was done by applying doubly latent structural equation models. Findings: Our results indicate that (1) it is statistically necessary to model perceived leadership practices as a multilevel construct, (2) shared leadership is a strong predictor of individual and shared job satisfaction and organizational commitment of teachers whereas (3) individual consideration only shows significant associations on the individual level (4) that LFL is contextually sensitive. Implications for Research and Practice: Findings make a strong case for studying LFL within a multilevel framework and also for applying complex study and analytical designs, which should take the complexity of the theoretical assumptions into consideration all the way along from questionnaire design, through the process of data collection up to the point of data analysis.

Team-level identification predicts perceived and actual team performance: Longitudinal multilevel analyses with sports teams.

Social identification and team performance literatures typically focus on the relationship between individual differences in identification and individual‐level performance. By using a longitudinal multilevel approach, involving 369 members of 45 sports teams across England and Italy, we compared how team‐level and individual‐level variance in social identification together predicted team and individual performance outcomes. As hypothesized, team‐level variance in identification significantly predicted subsequent levels of both perceived and actual team performance in cross‐lagged analyses. Conversely, individual‐level variance in identification did not significantly predict subsequent levels of perceived individual performance. These findings support recent calls for social identity to be considered a multilevel construct and highlight the influence of group‐level social identification on group‐level processes and outcomes, over and above its individual‐level effects.

Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

The purpose of this study was to compare the rates of adjacent segment degeneration (ASD), sagittal alignment parameters, and patient-reported outcomes in patients who underwent multi-level versus single-level anterior cervical discectomy and fusion (ACDF). A retrospective cohort analysis was performed on consecutive patients who underwent an ACDF. Pre- and post-operative radiographic assessment included ASD, change in C2-C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis. Patient-reported outcomes were obtained. Of the 404 that underwent an ACDF with a minimum of 6 months of follow-up (average 28 months), there was no significant difference in the rate of radiographic ASD overall (p=0.479) or in the proximal or distal adjacent segments on multivariate analysis. Secondarily, the multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures (p<0.001) and are able to maintain the corrected cervical lordosis and fusion segment lordosis over time. From the immediate post-operative period to final follow-up, the single-level ACDFs show continuing lordosis improvement (p=0.005) that is significantly greater than that of the multi-level constructs. There were no significant differences between pre-operative, post-operative, or change in patient-reported outcomes. Two years following an ACDF, patients who underwent multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures, while single-level ACDFs show significantly greater amounts of lordosis improvement over time. Multi-level procedures may not be at a significantly greater risk of developing early radiographic evidence of ASD compared to single-level procedure. These slides can be retrieved under Electronic Supplementary Material.

The relationship between ICT and student literacy in mathematics, reading, and science across 44 countries: A multilevel analysis

This study conceptualized ICT as multi-level (country-, school-, and student-level) constructs and examined their relationships with student mathematics, reading, and scientific literacy. Three-level hierarchical linear models (HLM) were employed to analyse the Programme for International Student Assessment (PISA) 2015 data of 305,414 15-year-old students from 11,075 schools across 44 countries. The findings indicated that (i) national ICT skills had a more positive effect on student academic performance than did national ICT access and use; (ii) students ICT availability at school positively associated with student academic success, whereas student ICT availability at home negatively associated with student academic success; (iii) student ICT academic use negatively correlated with student performance, while ICT entertainment use positively correlated with student performance; and (v) student attitudes toward ICT demonstrated mixed effects on student academic success – specifically, student interest, competence, and autonomy in using ICT had positive correlations, while student enjoyment of social interaction around ICT had a negative correlation with student academic performance.

Towards a systems thinking based view for the governance of a smart city’s ecosystem

PurposeThis paper aims to investigate the role of Smart Technologies and Big Data as relevant dimensions in affecting the emerging social and economic dynamics of society with the aim to trace possible guidelines and pathways for decision makers and researchers interested in the governance of the Smart City’s ecosystem. The increasing attention to the domain of technologies and the amazing scenario that is emerging as a consequence of the influence of Smart Technology and Big Data in everyday life require reflection upon the ways in which the world is changing.Design/methodology/approachThe paper adopts the interpretative lens provided by the systems thinking to investigate the challenging domain of the Smart City. A qualitative and interpretative approach is adopted to reflect upon the role of technologies in everyday life.FindingsThe Smart City ecosystem is defined as a multilevel construct useful for understanding how technical and technological dimensions of the Smart City can be managed not only as supportive instruments but also as key pillars to support, facilitate and ensure an effective cognitive alignment among all the involved actors.Originality/valueThis paper provides a tangible evidence of the systems thinking contribution in analysing, understanding and managing dimensions and paths of social dynamics. A contribution to previous studies is provided with reference to systems thinking, Big Data and Smart City.

A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries

BackgroundLittle is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.MethodsBetween February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).ResultsPractitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.ConclusionsThis study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

Single-stage multi-level construct design incorporating ribs and chest wall reconstruction after en bloc resection of spinal tumour.

Multi-level reconstruction incorporatingthe chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed. Multi-level TES was performed for five patients with primary or recurrent thoracic spinal malignancies through posterior-lateral approach. The involved ribs and chest wall were removed to achieve tumour-free margin. Then titanium mesh with allograft bone and pedicle screw-rod system were adopted for the circumferential spinal reconstruction routinely. Titanium rods were modified accordingly to attach to the screw-rod system proximally, and the distal end of rods was dynamically inserted into the ribs. The mean surgery time was 6.7hours (range 5-8), with the average blood loss of 3260ml (range 2300-4500). No severe neurological complications were reported while three patients had complaints of slight numbness of chest skin (no. 1, 3, and 5). No severe respiratory complications occurred during peri-operative period. No implant failure and no local recurrence or distant metastases were observed with an average follow-up of 12.5months. The single-stage reconstructions incorporating spine and chest wall are straightforward and easy to perform. The preliminary outcomes of co-reconstructions are promising and favourable. More studies and longer follow-up are required to validate this technique.

The Development and Validation of a Cross-Industry Safety Climate Measure: Resolving Conceptual and Operational Issues

Although safety climate research has increased in recent years, persisting conceptual ambiguity not only raises questions about what safety climate really is—as operationalized in the literature—but also inhibits increased scientific understanding of the construct. Consequently, using climate theory and research as a conceptual basis, we inductively articulated safety climate’s general content domain by identifying seven core indicators of safety’s perceived workplace priority: leader safety commitment, safety communication, safety training, coworker safety practices, safety equipment and housekeeping, safety involvement, and safety rewards. These indicators formed the basis for a generalized safety climate measure that we designed for use across organizations, industries, and construct levels. We then conducted a multilevel construct validation of safety climate using the newly created measure in two separate studies. Results from five samples spanning multiple organizations, industries, and cultural settings revealed that the identified safety climate indicators were parsimoniously explained by an overarching safety climate factor at the individual and workgroup levels. In addition, multilevel homology tests indicated that safety climate’s associations with past safety incidents were nearly two times stronger at the workgroup level relative to the individual level, although this difference was not statistically significant. Finally, workgroup-level validity evidence demonstrated expected associations between safety climate and organization-reported pre- and postsurvey safety incidents. On the basis of this supportive evidence, we recommend that this conceptualization and measure of safety climate be adopted in research and practice to facilitate future scientific progress.

Examining Measurement Isomorphism of Multilevel Constructs: The Case of Political Trust

There is a growing recognition of the importance of testing for measurement equivalence when comparing latent constructs—such as political trust—across countries and over time. Indeed, equivalence of measurements across countries and time points is a precondition for making meaningful and valid comparisons of means, scores, and relationships between constructs. Until recently, most efforts in this area of comparative research have focused on establishing measurement equivalence across groups, such as countries or cultural regions. In contrast, scarce attention has been paid to examining the measurement equivalence of constructs across levels of data. Rather, most empirical studies that use cross-national survey data assume that the factorial structure of a given construct is isomorphic, in other words, similar in measurement and meaning at the individual and country level. This assumption is not always justified, as the dimensions found at the individual level of data do not always generalize to the country level. In such cases, the results and substantive conclusions based on the assumption of measurement isomorphism may be misleading. In this article, we emphasize the importance of examining measurement isomorphism when working with cross-national survey data and describe a testing procedure using multilevel confirmatory factor analysis. We illustrate the procedure by examining cross-level equivalence of the political trust scale included in the European Social Survey (2008–2009). The results of the analysis indicate that the structure of political trust factor can be considered configurally isomorphic across individual and country levels. In addition, the measurement scale across the two levels is found to be partially isomorphic. These findings could be regarded as an encouraging result for the applied researchers who use the aggregated individual scores of political trust. At the same time, we demonstrate that measurement isomorphism cannot be simply assumed and hence should be examined prior to analysis to ensure valid and meaningful results.

Complicating Narratives: Defining and Deconstructing Ethical Challenges in Community Psychology

In this concluding essay, we review the case studies presented in this Special Issue and examine whether community psychology has a distinctive approach to defining and resolving the core ethical canons of the Belmont Report (1979): Respect for Persons, Beneficence, and Justice. For two of these Principles-Respect for Persons and Beneficence-community psychologists elaborate upon and extend their definitions to consider their meaning in community-based, social justice-oriented research. The field's approach to Respect for Persons is multilevel in nature; in addition to respecting individuals and their diverse identities, we also have obligations to respect our community partnerships, the communities with whom we work, and the populations and cultures represented in our work. Similarly, for community psychologists, Beneficence is a multilevel construct that considers risks and benefits at the group, community, and cultural levels of analysis. With respect to Justice, community psychologists' views of our ethical responsibilities are qualitatively different in meaning from the original Belmont Report and from disciplinary-specific interpretations of this principle in ethical guidance documents from psychology, sociology, and evaluation. Our valuing of social change demands that we contribute to individual and group empowerment and liberation, and in so doing, that we avoid collusion with oppressive systems. Thus, we define our ethical responsibilities for promoting Justice as more action-oriented than do other disciplines. The essay closes with an exploration of future directions for developing a comprehensive ethical framework for community psychology.

Resilience in Organizations: An Integrative Multilevel Review and Agenda for the Future

The interest of organization and management researchers in the resilience concept has steadily grown in recent years. Although there is consensus about the importance of resilience in the organizational context, many questions are still open to research. For example, it largely remains unclear how resilience works at different levels within organizations and, in particular, how the levels interact. With this paper, we want to advance knowledge about the complex resilience construct. We conducted a systematic literature review to provide a comprehensive overview of previous resilience research at three different levels (individual, team, and organization) and to identify main research gaps. Furthermore, our review shows what is already known about resilience as a multilevel construct and interactions among different resilience levels. Based on the presentation and discussion of our findings, we deduce implications for future research and an effective management of resilience in organizations.

Should Functional Units Be Ambidextrous? Balancing Exploitation and Exploration in Sales Units

The concept of ambidexterity became prevalent in organizational research and led to the conviction that success depends on companies’ ability to orchestrate exploration and exploitation. Although g...

School Values: A Comparison of Academic Motivation, Mental Health Promotion, and School Belonging With Student Achievement

School vision and mission statements are an explicit indication of a school's priorities. Research has found academic motivation, mental health promotion, and school belonging to be the most frequently cited themes in these statements. The present study sought to examine whether these themes relate to student academic achievement, as indicated by National Assessment Program — Literacy and Numeracy (NAPLAN) scores. A stratified sample of 287 secondary schools in Victoria, Australia was analysed using two language analytic approaches: qualitative emergent coding and supervised lexical analysis. The highest academic scores occurred when mental health promotion was included, though results depended to some extent on the analytic approach and the level of aggregation. Results do suggest that explicitly prioritising both academic performance and mental health is beneficial. Further, the study provides an approach for using language analysis to investigate multilevel constructs in schools.

Impact of Different Levels of Epistemic Beliefs on Learning Processes and Outcomes in Vocational Education and Training

Epistemic beliefs are individuals’ beliefs about knowledge and knowing. Modelling them is currently based on two central assumptions. First, epistemic beliefs are conceptualized as a multi-level construct, i.e. they exist on a general, academic, domain-specific and/or topic-specific level. Second, research assumes that their more concrete levels predict learning processes and outcomes more strongly than their more general levels. However, studies directly investigating these assumptions are still missing. 975 prospective retailers, wholesalers, bank assistants, and industrial assistants reported their grades and learning motivation in accounting and marketing as well as their epistemic beliefs in an effort to prove both assumptions within the context of Vocational Education and Training. Second-order confirmatory factor analysis confirms the multi-level conceptualization of epistemic beliefs. The findings here indicate a superiority of domain- and topic-specific epistemic beliefs compared to general epistemic beliefs for predicting motivation and achievement in marketing and accounting. The study concludes that domainand topic-specific epistemic beliefs explain different facets of learning phenomena. In addition, further research should concentrate more on both the domain- and topic-specific levels.

Which Size Matters? Effects of Crowd Size on Solution Quality in Big Data Q&amp;A Communities

Question Answering websites have evolved into one of the most important platforms for knowledge sharing and problem solving online. Despite widespread adoption of Q&amp;As by technical communities as well as an abundance of domain experts, many questions fail to attract a sufficient audience to obtain a good solution or any solution at all. We investigate the effects of crowd size on solution quality in Stack Exchange Q&amp;A communities on topics related to big data. We find that three distinct levels of group size in the crowd (topic audience size, question audience size, and number of contributors) affect solution quality. Therefore, we argue that group size in the crowd is not unitary, but rather a multi-level construct. This work advances a theoretical model of group size in the crowd and the relation between crowd size and performance. The work also has practical implications for system designers trying to route crowds to problems efficiently.