Multilevel Hierarchical Model Research Articles

Aerodynamic shape optimization at low Reynolds number using multi-level hierarchical Kriging models

Aerodynamic shape optimization at low Reynolds number using multi-level hierarchical Kriging models

Assessing the effect of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence: evidence from PMA Ethiopia 2020 cross-sectional survey

ObjectivesThis study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.DesignWe use data...

Multilevel Hierarchical Bayesian Modeling of Cross-National Factors in Vehicle Sales

SUVs (sport utility vehicles), as a car segment, have become a foundation within the automotive industry due to their versatility, which is used by a wide range of customers. Recognising the complex interplay between geographical and economic conditions across countries, we delve into cross-national factors that significantly influence SUV sales. This article presents an analysis of the global sales of SUVs (sport utility vehicles) using multilevel hierarchical Bayesian modelling. We identify key predictors of SUV sales, including the effects of fuel prices, income levels and geographical aspects. We prepared four statistical models that differ in their probability distribution or hierarchical internal structure. The last presented model, with Student’s t-distribution and separate distribution for unique alpha parameter values, turned out to be the best one. Our analysis contributes to a deeper understanding of the automotive market dynamics, and it can also assist manufacturers and policymakers in designing effective sales strategies.

Short-term outcomes of asphyxiated neonates depending on requirement for transfer in the first 24 h of life

ImportanceIn neonates with birth asphyxia (BA) and hypoxic-ischemic encephalopathy, therapeutic hypothermia (TH), initiated within six hours, is the only safe and established neuroprotective measure to prevent secondary brain injury. Infants born outside of TH centers have delayed access to cooling. ObjectiveTo compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)). DesignNationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes. SettingAll discharges from German hospitals from 2016 to 2021. ParticipantsFull term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life. ExposuresPostnatal transfer to a pediatric department within 24 h of admission to an external hospital. Main outcomesIn-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2. ResultsOf 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41–4.89), 2.99 (2.65–3.38), and 1.76 (1.52–2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29–2.17)) and seizures (1.26 (1.07–1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64–1.02)) in TNs. Conclusion and relevanceThis comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.

Corruption spills over on citizens: The case of self‐reported motivation to cheat on tax

AbstractCorruption poses a significant threat to societies’ social and economic fabric, eroding trust and contractual relationships between governments and citizens. This study investigates the repercussions of corruption spillover on individuals and explores how they adjust their motivation to engage in tax cheating by exploiting two distinct types of corruption heterogeneities at both individual and national levels. Leveraging newly collected individual corruption experiences locally from the World Value Survey alongside national‐level corruption data from Transparency International, we employ multilevel hierarchical modeling to estimate the effects of corruption on individual tax behavior. Our findings reveal that corruption negatively impacts people's willingness to comply with tax laws, with individuals who have personally experienced corruption exhibiting a more pronounced erosion of tax morale compared to those who have not. By shedding light on the intricate dynamics of corruption's influence on tax compliance, this paper contributes to our understanding of the broader implications of corruption for people and society. This paper can also inform policymakers and stakeholders in designing targeted interventions to mitigate the adverse consequences of corruption and restore citizens’ trust in their government.

Impact of Local Tailoring on Acute Stroke Care in 21 Disparate Emergency Departments: A Prospective Stepped Wedge Type III Hybrid Effectiveness-Implementation Study.

Faster delivery of tPA (tissue-type plasminogen activator) results in better health outcomes for eligible patients with stroke. Standardization of stroke protocols in emergency departments (EDs) has been difficult, especially in nonstroke centers. We measured the effectiveness of a centrally led implementation strategy with local site tailoring to sustain adherence to an acute stroke protocol to improve door-to-needle (DTN) times across disparate EDs in a multihospital health system. Prospective, type III hybrid effectiveness-implementation cohort study measuring performance at 21 EDs in Utah and Idaho (stroke centers [4]/nonstroke centers [17]) from January 2018 to February 2020 using a nonrandomized stepped-wedge design, monthly repeated site measures and multilevel hierarchical modeling. Each site received the implementation strategies in 1 of 6 steps providing control and intervention data. Co-primary outcomes were percentage of DTN times ≤60 minutes and median DTN time. Secondary outcomes included percentage of door-to-activation of neurological consult times ≤10 minutes and clinical effectiveness outcomes. Results were stratified between stroke and nonstroke centers. A total of 855 474 ED patient encounters occurred with 5325 code stroke activations (median age, 69 [IQR, 56-79] years; 51.8% female patients]. Percentage of door-to-activation times ≤10 minutes increased from 47.5% to 59.9% (adjusted odds ratio, 1.93 [95% CI, 1.40-2.67]). A total of 615 patients received tPA of ≤3 hours from symptom onset (median age, 71 [IQR, 58-80] years; 49.6% female patients). The percentage of DTN times ≤60 minutes increased from 72.5% to 86.1% (adjusted odds ratio, 3.38, [95% CI, 1.47-7.78]; stroke centers (77.4%-90.0%); nonstroke centers [59.3%-72.1%]). Median DTN time declined from 46 to 38 minutes (adjusted median difference, -9.68 [95% CI, -17.17 to -2.20]; stroke centers [41-35 minutes]; nonstroke centers [55-52 minutes]). No differences were observed in clinical effectiveness outcomes. A centrally led implementation strategy with local site tailoring led to faster delivery of tPA across disparate EDs in a multihospital system with no change in clinical effectiveness outcomes including rates of complication. Disparities in performance persisted between stroke and nonstroke centers.

Factors associated with health professionals’ stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations.BackgroundHealth professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations).MethodsThis study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals’ stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep.ResultsThe main findings reveal that the incompatibility of health professionals’ work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor’s good leadership qualities were also associated with health professionals’ job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes.

Multi-fidelity expected improvement based on multi-level hierarchical kriging model for efficient aerodynamic design optimization

To reduce the computational burden of aerodynamic design optimization, a multi-fidelity expected improvement (MFEI) method is developed, based on the error analysis of a multi-level hierarchical kriging (MHK) model for accelerating optimization convergence. By maximizing the MFEI function, a new sample of arbitrary fidelity level is determined to ameliorate the accuracy of the MHK model, and convergence to the high-fidelity optimum is ensured. The proposed optimization method based on MFEI and MHK is demonstrated by two analytical function cases and verified by two aerodynamic design optimizations: drag minimizations of an RAE2822 aerofoil and an ONERA M6 wing in transonic flows. It is shown that the MFEI method tends to infill more gainful samples of lower fidelities during optimization, so fewer highest-fidelity samples are required. This confirms that the proposed method can obtain optimal results within a limited computational budget and is more efficient than the existing single-fidelity or two-fidelity methods.

Postoperative Outcomes Associated with the Timing of Surgery After SARS-CoV-2 Infection.

Examine the association between prior SARS-CoV-2 infection, interval from infection to surgery, and adverse surgical outcomes. Earlier series have reported worse outcomes for surgery after COVID-19 illness, and these findings have led to routinely deferring surgery seven weeks after infection. We created a retrospective cohort of patients from the US Veterans Health Administration facilities nationwide, April 2020 to September 2022, undergoing surgical procedures. Primary outcomes were 90-day all-cause mortality and 30-day complications. Within surgical procedure groupings, SARS-CoV-2 infected and uninfected patients were matched in a 1:4 ratio. We categorized patients by 2-week intervals from SARS-CoV-2 positive test to surgery. Hierarchical multilevel multivariable logistic regression models were used to estimate the association between infection to surgery interval versus no infection and primary end points. We identified 82,815 veterans undergoing eligible operations (33% general, 27% orthopedic, 13% urologic, 9% vascular), of whom 16,563 (20%) had laboratory-confirmed SARS-CoV-2 infection before surgery. The multivariable models demonstrated an association between prior SARS-CoV-2 infection and increased 90-day mortality (odds ratio (OR) 1.42, 95% CI: 1.08, 1.86) and complications (OR 1.32, 95% CI: 1.11, 1.57) only for patients having surgery within 14 days of infection. ASA-stratified multivariable models showed that the associations between increased 90-day mortality (OR 1.40, 95% CI: 1.12, 1.75) and complications (OR 1.73, 95% CI: 1.34, 2.24) for patients having surgery within 14 days of infection were confined to those with ASA 4-5. In a contemporary surgical cohort, patients with prior SARS-CoV-2 infection only had increased postoperative mortality or complications when they had surgery within 14 days after the positive test. These findings support revising timing recommendations between surgery and prior SARS-CoV-2 infection.

Socioecological Approach to Understanding Overnutrition Among Married and Cohabiting Women in Nigeria

Overweight and obesity are currently an epidemic affecting both developed and developing countries. Sub-Saharan Africa has a double burden of being underweight and obese and has recently been battling an alarming increase in the prevalence of overweight. This study investigates the predictors of overnutrition among married women of reproductive age in Nigeria using the socioecological model (SEM) as a framework. The study hypothesizes that the Southern region will have a higher burden of overnutrition than the Northern region. The 2018 Nigeria Demographic and Health Survey (NDHS) was analyzed. A total of 8,531 non-pregnant married women met the inclusion criteria. Hierarchical multilevel logistic regression models were fitted, informed by the SEM framework. The occurrence of overnutrition was found to be 31.4%, with regional variations showing 31.7% in the South and 31.3% in the North. When all covariates were fitted in a model, being older, being a Christian, having tertiary education, having an older partner with tertiary education, being wealthy, and living in the urban area were predictors of overnutrition in multivariate analysis. Overnutrition among Nigerian married women was high, especially in the Southern region. Predictors of overweight are at all the SEM levels; therefore, it is better to consider all the levels when planning public health interventions.

Intenção de amamentar entre gestantes e variáveis associadas: estudo transversal em uma comunidade brasileira

ABSTRACT Objective: To investigate exclusive breastfeeding (EBF) intention and associated variables among women in the third trimester of pregnancy. Methods: The data were collected with a questionnaire for the pregnant women (n=653), from December/2018 to November/2019. They answered the Infant Feeding Intentions (IFI) scale, translated and adapted to Brazilian Portuguese, and a questionnaire on sociodemographic, biological, family, pregnancy, breastfeeding, health care, and habits variables. Descriptive statistics and multiple logistic regression analyses were performed with a 5% significance level, following a multilevel hierarchical model that estimated the association between the dependent and independent variables. The outcome EBF intention measured by the IFI score was dichotomized by the median (&lt;16 or =16). Results: Mean±standard deviation score for the IFI scale was 14.4±2.6 (score 0: very strong intention to not breastfeed at all; score 16: very strong EBF intention up to six months). The results from the regression analysis showed that pregnant women who had no intention to bottle feed (OR=4.33; 95%CI 2.79-6.72) or did not know (OR=1.85; 95%CI 1.21–2.82), those who planned the pregnancy (OR=1.52; 95%CI 1.09–2.12), those who believed they would have help to care for the baby (OR=3.60; 95%CI 1.51–8.56) or did not know (OR=3.97; 95%CI 1.26–12.51), and those who reported knowing the World Health Organization recommendations on breastfeeding (OR=1.73; 95%CI 1.13–2.64) were more likely to show a very strong EBF intention. Conclusions: Pregnant women in the third trimester of pregnancy presented a strong EBF intention. The higher EBF intention score was significantly associated with the structural, setting, and individual determinants.

The Path of “Dual-Teacher” Teacher Cultivation in Applied Local Higher Teacher Colleges under the Background of Big Data

Abstract The cultivation path of the applied “dual-teacher” teacher team in this paper mainly relies on the qualification standard and evaluation system. Big data technology is used to collect data, deeply mine fragmented data, and further extract index factors that affect the quality of teachers. The multi-level fuzzy hierarchical evaluation model realizes the quantification of the decision-making process with less quantitative information, and determines the weights through the multi-level comparison of importance, to test and evaluate the teaching ability of “dual-teacher” teachers. The results show that, among the 166 survey respondents, 77 respondents belong to the “ Dual-teacher” teachers, accounting for about 45.03%. The primary needs and ways for most of the teachers to participate in the training of “dual-teacher” teachers are to improve the practical ability of industry and enterprise positions (score 0.86) and the school-based training of dual-teacher teachers (0.93), which is centralized in the college. In evaluating “dual-teacher” teaching, the weight of industry-teaching integration is 0.3378, so the ability of industry-teaching integration is a more meaningful indicator. College students are satisfied with “dual-teacher teaching”, and the score shows that the essential satisfaction is more than half of the total number of samples, which is 343.

The Diagnostic Accuracy (DA) of ColonView Fecal Immunochemical Test (FIT) in Detecting Colorectal Adenoma (CRA) Can Be Improved by the Diagnostic Models (DM) that Include Triage and Risk Features of CRA.

This study assessed whether the diagnostic accuracy (DA) of ColonView (CV) fecal immunochemical test (FIT) in detecting colorectal adenoma (CRA) can be improved by the diagnostic models (DM) that include triage and risk features of CRA. A total of 5,090 participants of colorectal neoplasia (CRN) screening were recruited prospectively between January 2014 and December 2016. The CRN cohort of 486 patients included 222 CRA patients and 264 non-CRA patients of whom three consecutive fecal samples were analyzed by two fecal occult blood (FOB) assays (CV FIT test, HemoccultSENSA test). Hierarchical multilevel logistic models were used to test the DA of CV test and DMs, visualised as hierarchical summary receiving operating characteristic (HSROC) curves. In conventional receiving operating characteristic (ROC) analysis, the area under the curve (AUC) values of the age, height, weight, and body mass index (BMI) were 0.60, 0.57, 0.54, and 0.51, respectively. The AUC values for different DMs ranged from 0.69 (for DM without triage I/II and SENSA), and the highest AUC value of 0.70 was reached for DM with all variables included. In HSROC analysis, the AUC values for i) lowR variables, ii) highR variables, and ii) DMs were as follows: i) AUC=0.506, ii) AUC=0.566 and iii) AUC=0.732. The differences in AUC values were: between i) and ii) p=0.008; between i) and iii) p<0.0001; between ii) and iii) p<0.0001. The results demonstrated that DMs, particularly those including risk factors, significantly improved the DA of the CV FIT test in detecting CRA compared to traditional low-risk (lowR) and high-risk (highR) features alone. This study provides novel evidence supporting the enhanced diagnostic performance of DMs in combination with CV FIT testing for the detection of CRA.

Critical Uncertainty Analysis of the Application of New-Generation Digital Technology in China’s Construction Industry—A Study Based on the LDA-DEMATEL-ISM Improvement Model

As the main driving force for the digital transformation of the construction industry, the uncertainty of digital technology in the application process has seriously hindered the high-quality development of the construction industry. In order to promote the wide application of digital technology in the construction industry and clarify the key uncertainties in its application process, this paper identifies the uncertainty index system of digital technology application based on the LDA topic model and literature analysis; the DEMATEL-ISM method is used to construct the multilevel hierarchical structure model of the uncertainty indicators in the application of digital technology to study the mutual influence among the indicators and to find the key uncertainty indicators. The research results show that the uncertainty indicators of the application of digital technology in the construction industry are divided into five levels: policy, industry, personnel, economy and law, and that the perfection of the policy guarantee system is the key uncertainty indicator for the investment return period of digital technology application. The standard contract model for digital technology is a direct uncertainty indicator for the application of digital technology in the construction industry. The results of this study help researchers and practitioners to focus on the key barriers and provide a list of key elements for construction companies to promote the application of next-generation digital technologies to improve digitalization of the construction industry. This study also provides a policy reference to further promote the digital transformation of the construction industry.

How do organizational culture and leadership style affect nurse presenteeism and productivity?: A cross sectional study of Hong Kong acute public hospitals

BackgroundPresenteeism is defined as a type of work behavior in which employees are physically present at work when ill, often with reduced performance. While organizational culture and leadership style are known to impact the organizational behavior of hospital staff, as indicated by increased burnout and decreased work engagement, their impact on nurse presenteeism and productivity has not been explored. Moreover, nursing studies often neglect the importance of using multi-level analysis, adopting aggregated unit-level scores to account for collective perceptions to evaluate culture and leadership. ObjectiveThis study aims to evaluate the impact of unit-level organizational culture and leadership style on individual-level nurse presenteeism and productivity in acute care hospitals using multilevel analysis. DesignCross-sectional study. Setting(s)Three major acute care public hospitals in Hong Kong, where public hospitals provide over 90 % of inpatient services. ParticipantsAll full-time nurses (N = 4657) in the three study hospitals were invited to participate in this study. A total of 2339 nurses responded to the survey for a 65 % response rate. MethodsOrganizational culture and leadership style are characterized using the competing values framework and a two-factor leadership style typology, respectively. Multilevel hierarchical linear modeling was applied with unit-level clustering in each hospital. ResultsHierarchical culture was the dominant culture (M = 3.64, SD = 0.74) in our nurse sample. None of the unit-level organizational culture and leadership styles were associated with nurse presenteeism, however, rational organizational culture at the unit-level was significantly associated with increased productivity (regression coefficient: 0.17, 95 % CI: 0.04–0.31). ConclusionsThis study provides hospital managers with improved understanding of the differential impact of unit-level organizational culture and leadership style on nurse presenteeism and productivity. Unit-level leadership style did not have a direct impact on nurse presenteeism and productivity in this study, while the externally focused rational organizational culture increased nurse productivity. Further research is needed to understand the impacts of modifiable work factors and nurse psychosocial emotions on presenteeism and productivity.

A Study of the Factors Influencing the Construction Risk of Steel Truss Bridges Based on the Improved DEMATEL–ISM

To enhance the safety management of steel-truss-bridge construction, an evaluation method based on the improved DEMATEL–ISM was proposed to analyze the risk factors involved in such construction. Decision Making Trial and Evaluation Laboratory (DEMATEL) is a method for systematic factor analysis that utilizes graph-theory and -matrix tools, allowing for the assessment of the existence and strength of relationships between elements by analyzing the logical and direct impact relationships among various elements in a system. The distinctive feature of Interpretative Structural Modeling (ISM) is the decomposing of complex systems into several subsystems (elements) and constructing the system into a multi-level hierarchical structural model through algebraic operations. Specifically, triangular fuzzy numbers are introduced initially to improve the direct influence matrix in the DEMATEL method, thereby reducing the subjectivity of expert evaluations. The degree of influence, influenced degree, centrality degree, and causality degree of each influencing factor are determined and ranked based on the above analysis. In response to the characteristics of top-push construction, 20 key factors were selected from four aspects: “human, material, environment, and management”. The top five identified influencing factors are displacement during pushing (X10), safety-management qualification (X18), local buckling (X14), overturning of steel beams (X13), and collision with bridge piers during guide beam installation (X7). Subsequently, corresponding solutions were proposed for different influencing factors. The results of the study offer targeted measures to enhance the safety management of steel truss bridge construction and provide a reference for accident prevention.

Hindering or Helping? User Preferences for Features of Recorded Mindfulness Training

ObjectivesDespite its numerous benefits, practicing mindfulness involves certain challenges. This study investigates the impact of various characteristics of recorded mindfulness practice instructions on recipients’ evaluations, focusing on elements that may evoke negative reactions and hinder mindfulness practice.MethodA total of 138 participants evaluated 24 recordings of mindfulness practice excerpts. The recordings differed in terms of the speaker’s gender, the form and pace of the message, the presence of whispering, and the number of artifacts. Respondents rated each recording using a scale and provided open-ended responses about their subjective perception of the recordings. The study employed hierarchical multilevel modeling to analyze the collected data.ResultsThe results indicated that recipient gender did not influence preferences for male or female-voiced recordings. However, properties such as form, pace, whispering, and artifacts did affect evaluations. Least favored instruction elements included plural pronouns, slow pacing, primarily whispered speech, and a high number of artifacts. Some differences in evaluations were observed between female and male recording conditions. Additionally, qualitative data revealed participants’ subjective reactions to recordings with varying characteristics, and the study identified the most favorable characteristics of the recordings.ConclusionsThe study results identified which qualities of recorded mindfulness instructions are least preferred and may present obstacles to initiating or continuing the practice. Therefore, this study may help create more optimal instructions and improve the design of apps and platforms offering mindfulness practice recordings, enhancing the quality and accessibility of practice for a broader audience.PreregistrationThis study is not preregistered.

Triage Process at Endoscopy With ColonView Fecal Immunochemical Test (FIT) Will Enhance Diagnostic Accuracy (DA) of Colorectal Cancer Screening.

This study assessed the diagnostic accuracy (DA) of the predictive features of colorectal cancer (CRC, predictCRC), triage process (triage), and ColonView (CV) fecal immunochemical test (FIT) in a CRC screening setting. The diagnostic score models (DMs) including predictCRC with triage and CV test were also calculated. The study cohort of 544 patients included 58 CRC patients and 486 non-CRC patients who submitted three consecutive fecal samples for analysis, by two fecal occult blood (FOB) assays (CV FIT test, HemoccultSENSA test). Hierarchical multilevel logistic models were used to test the DA (for CRC) of each item of predictCRC (with triage I and II) and DMs, visualized as hierarchical summary receiving operating characteristic (HSROC) curves. The DA of the predictCRC location of neoplasm (Loc), triage I, and triage II showed 49%, 41%, and 93% sensitivity (Se), and 70%, 99.5%, and 88% specificity (Sp), respectively. The PPV+ of triage I (92%) was higher than that of Loc (22%) or triage II test (45%). In the conventional receiver operating characteristic (ROC) analysis, the area under the curve (AUC) values for the different DMs ranged from 0.880 (for DM without triage I and II), whereas the highest AUC value of 0.960 was reached for DM with triage I and II included in the formula. In the HSROC analysis, the AUC values were as follows: i) with all predictCRCs, AUC=0.717 and ii) with DMs, AUC=0.937. In the roccomp analysis, the difference in AUC values between i) and ii) was statistically significant (p<0.0001). In the detection of CRC, the DA of the new DMs with triage was far superior to that of DMs without triage. This is the first study to report evidence of improved DA in the detection of CRC using DMs including predictCRC with triage and CV FIT test.

Is everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking

ObjectiveReassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary associations between state anxiety and reassurance seeking behaviors. MethodIn a sample of 104 university-affiliated young adults, we sought to replicate cross-sectional associations of reassurance seeking with trait anxiety (Aim 1) and intolerance of uncertainty (Aim 2). We then used ecological momentary assessment (EMA) to evaluate concurrent fluctuations in daily anxiety and reassurance seeking across 14 consecutive days (Aim 3). Hierarchical multi-level models for intensive longitudinal data were used to evaluate the relationship between state anxiety and daily reassurance seeking. ResultsIn baseline analyses, trait anxiety and intolerance of uncertainty were significantly associated with greater trait reassurance seeking, controlling for depression. Analyses of the EMA data showed that daily reassurance seeking behaviors fluctuated concurrently with daily anxiety during the 14 days, while controlling for trait anxiety and depression. ConclusionGiven evidence of concurrent fluctuations between state anxiety and reassurance seeking, the behavior should be considered as a potential target in treatment for anxiety disorders.

Causal Analysis of Fall Accidents in Hydraulic Engineering Based on Text Mining and Decision-Making Trial and Evaluation Laboratory and Interpretative Structural Modeling

Hydraulic engineering construction safety has become a major concern in engineering sustainability. Fall accidents, as a common type of accident during the hydraulic engineering construction process, have caused physical and fatal injuries and property losses on an individual and societal scale. With a sizable workforce, complex operational structures and demanding construction conditions, hydraulic engineering projects present more pronounced safety management challenges than other infrastructure initiatives. As a result, the risk of accidents, particularly fall accidents, is heightened in this domain. To prevent fall accidents and minimize losses, this study used the investigation reports of 389 cases of fall accidents as the analyzed corpus, and 16 contributing factors of fall accidents were extracted with the utilization of text mining. Accident feature terms were visualized through word clouds and ring bar graphs. The logical relationship among the influencing factors was quantified based on Decision-Making Trial and Evaluation Laboratory and Interpretative Structural Modeling (DEMATEL-ISM). The contributing factors and occurrence mechanism of fall accidents in hydraulic engineering were analyzed by establishing a multilevel hierarchical hybrid model. The results showed that the multilevel hierarchical hybrid model was divided into five levels. Thirteen causal chains were obtained. Chaotic security management, weak safety awareness and an inadequate safety system were the most critical factors, while the remaining eleven transitional factors and four surface factors also contributed significantly to the occurrence of accidents. Human and management factors dominated the overall factor transfer pathway. This study proposes countermeasures to the above-mentioned factors and provides a theoretical basis for the sustainable and safe construction of hydraulic engineering.