Multilevel Ordinal Regression Research Articles

Marginal deterrence: The effect of illicit incentive on robbery escalation

The extant literature on marginal deterrence supports the notion that individuals maintain a dynamic decision-making process that yields several ranked outcomes after weighing the risks and rewards. In this article, we conduct a novel large-scale empirical analysis of the marginal deterrence principle to advance theory on the magnitude of potential deterrent effects. We regress a stratified outcome variable representative of six decision outcomes for the crime of robbery on a unique exogenous illicit incentive measure. We employ a multilevel ordinal regression equation that nests 29,297 robbery incidents within 98 cities to test the marginal deterrence thesis. Our analysis yields a statistically significant positive relationship with our criminogenic incentive measure. More specifically, the model provides suggestive evidence that as the illicit incentive increases the odds of violence escalating in a robbery incident also increases. The results from this analysis provides theoretical, methodological, and practical implications for attenuating societal harm. Moreover, we expand on how to measure the scaling severity of harm within the criminal decision-making process. From a policy perspective, we provide support for harm indices and crime prevention.

Racial/ethnic differences in the association between transgender-related U.S. state policies and self-rated health of transgender women

BackgroundPolicy protections for transgender adults in the United States are consistently associated with positive health outcomes. However, studies over-represent non-Latinx White transgender people and obscure variation in policies’ intended goals. This study examined racial differences in the relationship between transgender-related policies and transgender women’s self-rated health. Guided by Critical Race Theory, we hypothesized that policies conferring access to resources (e.g., healthcare) would be associated with better self-rated health among all participants while policies signifying equality (e.g., nondiscrimination laws) would be associated with better self-rated health only for White participants.MethodsUsing cross-sectional data collected between March 2018-December 2020 from 1566 transgender women, we analyzed 7 state-level ‘access policies,’ 5 ‘equality policies,’ and sum indices of each. Participants represented 29 states, and 54.7% were categorized as people of color. We fit a series of multilevel ordinal regression models predicting self-rated health by each policy. Multivariate models were adjusted for relevant covariates at the individual- and state-level. We then tested moderation by race/ethnicity using interaction terms and generated stratified predicted probability plots.ResultsIn bivariate models, 4 access policies, 2 equality policies, and both indices were associated with better self-rated health, but associations did not persist in adjusted models. Results from the multivariable models including interaction terms indicated that policies concerning private insurance coverage of gender-affirming care, private insurance nondiscrimination, credit nondiscrimination, and both indices were statistically significantly associated with better self-rated health for White participants and worse self-rated health for participants of color.ConclusionsThe policies included in this analysis do not mitigate racism’s effects on access to resources, indicating they may be less impactful for transgender women of color than White transgender women. Future research and policy advocacy efforts promoting transgender women’s health must center racial equity as well as transgender people of color’s priorities.

A Comparative Analysis of Advertising in the 2020 Presidential Elections & Phoenix Mayoral Elections using Natural Language Processing

This language model examines advertisements used for political campaigns, specifically the 2023 Phoenix mayoral election. Political microtargeting looks at the tone of content throughout Instagram and Facebook ads during the 8 months leading up to the election. Through various processing techniques, both written and spoken language within ads was collected and used Facebook ad API, associated with a target demographic or group within the platform. This allows campaigns to send targeted messages to voters based on factors like location, media preference, associated political beliefs, age, and other critical variables. This data was then compared to a peer-reviewed study by the University of Amsterdam, that studied Facebook and Instagram ads 8 months before the 2020 US Presidential election. Media companies often offer paid advertisements to a targeted audience, and during highly polarized world events such as an election, uncivil negative ads can be pushed to groups to which the shown ideology appeals. (Votta, F.) The question posed by Votta in the comparative study was: “TO WHAT EXTENT IS POLITICAL MICROTARGETING USED BY POLITICAL ADVERTISERS TO DELIVER TOXIC CAMPAIGN MESSAGES?” To study whether this optimization was occurring, the advertisements were run through a multilevel ordinal regression(Votta [https://www.aup-online.com/content/journals/10.5117/CCR2023.1.001.VOTT] et al., 2023). They took ads from official political campaigns and compared them to third-party groups. They then analyzed the size of the desired audience and compared the size of the audience to the verbal tone of the listed advertisement. Our results indicate that while traditional media remains an important part of electoral voting, show out, and postage signs and campaign events serve a purpose in reaching a wide, unrestricted audience, social media advertising presents a valuable resource in targeting specific groups of individuals who will be most susceptible to guided advertisement. Last, we analyze the implications of our findings in the 2020 Phoenix mayoral election, how city elections differ from a presidential election, and how micro-targeted advertisements might affect voter behavior.

The effect of liquid consistency on penetration-aspiration: a Bayesian analysis of two large datasets.

Thickened liquids are commonly recommended to reduce the risk of penetration-aspiration. However, questions persist regarding the impact of bolus consistency on swallowing safety. The common practice of summarizing Penetration-Aspiration Scale (PAS) scores based on worst scores is a bias in prior analyses. The aim of this study was to examine the impact of liquid consistency on PAS scores using a Bayesian multilevel ordinal regression model approach, considering all scores across repeated bolus trials. A second aim was to determine whether PAS scores differed across thickener type within consistency. We analyzed two prior datasets (D1; D2). D1 involved 678 adults with suspected dysphagia (289 female; mean age 69 years, range 20-100). D2 involved 177 adults (94 female; mean age 54 years, range 21-85), of whom 106 were nominally healthy and 71 had suspected dysphagia. All participants underwent videofluoroscopy involving ≥3 boluses of 20% w/v thin liquid barium and of xanthan-gum thickened barium in mildly, moderately and extremely thick consistencies. D2 participants also swallowed trials of slightly thick liquid barium, and starch-thickened stimuli for each thickened consistency. Duplicate blinded rating yielded PAS scores per bolus, with discrepancies resolved by consensus. PAS ratings for a total of 8,185 and 3,407 boluses were available from D1 and D2, respectively. Bayesian models examined PAS patterns across consistencies. We defined meaningful differences as non-overlapping 95% credible intervals (CIs). Across D1 and D2, penetration occurred on 10.87% of trials compared to sensate (0.68%) and silent aspiration (1.54%), with higher rates of penetration (13.47%) and aspiration (3.07%) on thin liquids. For D1, the probability of a PAS score > 2 was higher for thin liquids with weighted PAS scores of 1.57 (CI: 1.48, 1.66) versus mildly (1.26; CI: 1.2, 1.33), moderately (1.1; CI: 1.07, 1.13), and extremely thick liquids (1.04; CI: 1.02, 1.08). D2 results were similar. Weighted PAS scores did not meaningfully differ between thin and slightly thick liquids, or between starch and xanthan gum thickened liquids. These results confirm that the probability of penetration-aspiration is greatest on thin liquids compared to thick liquids, with significant reductions in PAS severity emerging with mildly thick liquids.

Electrocardiographic Abnormalities and Their Association with Outcomes in Randomized Clinical Trials of Pulmonary Arterial Hypertension.

Rationale: Pulmonary arterial hypertension (PAH) is a progressive disease with manifestations including right atrial enlargement, right ventricular dysfunction, dilation, and hypertrophy. Electrocardiography (ECG) is a noninvasive, inexpensive test that is routinely performed in clinical settings. Prior studies have described separate abnormal findings in the electrocardiograms of patients with PAH. However, the role of composite ECG findings reflective of right heart disease (RHD) for risk stratification, clinical trial enrichment, and management of patients with PAH has not been explored. Objectives: To describe a pattern of RHD on ECG in patients with PAH and to investigate the association of this pattern with clinical measures of disease severity and outcomes. Methods: We harmonized individual participant data from 18 phase III randomized clinical trials of therapies for PAH (1998-2013) submitted to the U.S. Food and Drug Administration. RHD was defined as the presence of right ventricular hypertrophy, right axis deviation, right atrial enlargement, or right bundle branch block on ECG. Random effects linear regression, multilevel ordinal regression (cumulative link model), and Cox proportional hazards models were used to assess the association of RHD by ECG with 6-minute walk distance (6MWD), World Health Organization (WHO) functional class, and clinical worsening after a priori adjustment for age, sex, body mass index, and PAH etiology. Effect modification of treatment and ECG abnormalities was assessed by including an interaction term. Results: A total of 4,439 patients had baseline ECG, and 68% of patients had evidence of RHD. RHD on ECG was associated with higher pulmonary vascular resistance (P < 0.001) and higher mean pulmonary artery pressures (P < 0.001). Patients with RHD on ECG had 10 meters shorter 6MWD (P = 0.005) and worse WHO functional class (P < 0.001) at baseline. RHD on baseline ECG was associated with increased risk of clinical worsening (hazard ratio, 1.42; 95% confidence interval; 1.21, 1.67; P < 0.001). Patients with RHD had greater treatment effect in terms of 6MWD, WHO functional class, and time to clinical worsening than those without (P for interaction = 0.03, 0.001, and 0.03, respectively). Conclusions: RHD by ECG may be associated with worse outcomes and potentially greater treatment effect. Electrocardiograms could be an inexpensive, widely available noninvasive method to enrich clinical trial populations in PAH.

Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension – a randomized controlled trial in primary care

Objective To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). Design A parallel group, non-blinded, randomized controlled trial, conducted October 2018–February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. Setting 31 primary healthcare centers in Sweden. Subjects 949 patients treated for hypertension. Main outcome measures The effects on preference-based patient participation, that is, the match between a patient’s preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. Results At baseline, 43–51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for ‘managing treatment myself’ at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. Conclusion The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.

Growth in Infancy and Childhood and Age at Menarche in Five Low- or Middle-Income Countries: Consortium of Health Orientated Research in Transitional Societies (COHORTS)

BackgroundEarlier age at menarche is associated with behavioral and noncommunicable disease risks. The influence of birth weight (BW) (intrauterine) and postnatal growth on age at menarche is not well studied in low- and middle-income countries (LMICs). ObjectiveTherefore, we investigated these associations in 5 LMIC birth cohorts. MethodsWe analyzed data from Brazil, Guatemala, India, the Philippines, and South Africa (n = 3983). We derived stunting (< −2 SD scores) at 24 mo using the WHO child growth standards. We generated interaction terms with categorized BW and conditional weight (lighter < 0 or heavier ≥ 0), and height (shorter < 0 or taller ≥ 0) z-scores. We categorized early-, modal-, and late-onset menarche and used multilevel ordinal regression. We used multilevel linear regression on continuous age at menarche. ResultsMean age at menarche was 12.8 y (95% CI: 12.7 12.9). BW was not associated with age at menarche. Conditional height at 24 mo and mid-childhood (OR: 1.35; 95% CI: 1.27, 1.44 and 1.32; 1.25, 1.41, respectively) and conditional weight at 24 mo and mid-childhood (OR: 1.15; 1.08, 1.22 and 1.18; 1.11, 1.25, respectively) were associated with increased likelihood of early-onset menarche. Being heavier at birth and taller at 24 mo was associated with a 4-mo (95% CI: 0.8, 7.6) earlier age at menarche than being lighter at birth and shorter at 24 mo. Being heavier at birth but lighter in mid-childhood was associated with a 3-mo (95% CI: 0.8, 4.8) later age at menarche than being lighter at birth and mid-childhood. Age at menarche was 7 mo later in stunted than nonstunted girls. ConclusionAge at menarche is inversely related to relative weight gain but also to rapid linear growth among those born shorter but remained stunted, and those born taller and grew excessively. These findings do not deter the global health goal to reduce growth faltering but emphasize the potential adverse effects of an obesogenic environment on adolescent development.

Losartan in hospitalized patients with COVID-19 in North America: An individual participant data meta-analysis.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) have been hypothesized to benefit patients with COVID-19 via the inhibition of viral entry and other mechanisms. We conducted an individual participant data (IPD) meta-analysis assessing the effect of starting the ARB losartan in recently hospitalized COVID-19 patients. We searched ClinicalTrials.gov in January 2021 for U.S./Canada-based trials where an angiotensin-converting enzyme inhibitors/ARB was a treatment arm, targeted outcomes could be extrapolated, and data sharing was allowed. Our primary outcome was a 7-point COVID-19 ordinal score measured 13 to 16 days post-enrollment. We analyzed data by fitting multilevel Bayesian ordinal regression models and standardizing the resulting predictions. 325 participants (156 losartan vs 169 control) from 4 studies contributed IPD. Three were randomized trials; one used non-randomized concurrent and historical controls. Baseline covariates were reasonably balanced for the randomized trials. All studies evaluated losartan. We found equivocal evidence of a difference in ordinal scores 13-16 days post-enrollment (model-standardized odds ratio [OR] 1.10, 95% credible interval [CrI] 0.76-1.71; adjusted OR 1.15, 95% CrI 0.15-3.59) and no compelling evidence of treatment effect heterogeneity among prespecified subgroups. Losartan had worse effects for those taking corticosteroids at baseline after adjusting for covariates (ratio of adjusted ORs 0.29, 95% CrI 0.08-0.99). Hypotension serious adverse event rates were numerically higher with losartan. In this IPD meta-analysis of hospitalized COVID-19 patients, we found no convincing evidence for the benefit of losartan versus control treatment, but a higher rate of hypotension adverse events with losartan.

Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models

Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model's assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (-40.40, 95% CI -40.41 to -40.32), home delivery (-35.51, 95% CI -35.55 to -35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (-12.65, 95% CI -12.69 to -12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services.

Pattern of weight gain in pregnant women in slum areas of Hamadan using multilevel ordinal regression

BackgroundAdequate gestational weight gain (GWG) is an important factor for maternal and fetal health. This is especially important in low-income and slum areas due to limited access to health services and malnutrition. Thus, the purpose of this study is to evaluate the pattern of GWG changes in the slum areas of Hamadan in Iran.MethodsIn this longitudinal study, the study sample consisted of 509 pregnant women who referred to nine health care clinics in the slum areas of Hamadan. Women's weight gain based on the recommended GWG by U.S. Institute of Medicine (IOM) was divided into three categories: Inadequate weight gain, Adequate weight gain, and Excessive weight gain. In order to evaluate the trend of GWG, a multi-level ordinal model was used.ResultsAccording to pre-pregnancy BMI, a little more than half people (56.6%) were overweight or obese. 85.4% women in the first trimester and 49.1% in the second trimester did not have adequate GWG, but in the third trimester (38.9%) had adequate GWG. Based on multivariate analysis, pre- pregnancy BMI has a significant effect on the odds of inadequate GWG (P-value = 0.021); with one unit increase in pre-pregnancy BMI, the odds of inadequate GWG grows by 1.07 times compared to adequate and excessive GWG.ConclusionsIn general, women did not have adequate weight gain in the first and second trimesters.Thus, designing appropriate interventions to achieve optimal GWG seems to be necessary in slums.

The Effect of Supplemental Instruction on STEM Course Performance

ABSTRACT This study investigates the relative impact of online delivery of supplemental instruction (SI) to undergraduate students enrolled in STEM courses at a large, four-year, Hispanic Serving Institution (HSI) in the southern United States. A multi-condition, randomized trial comparing the relative performance of in-person to online SI was implemented across 20 classroom-based courses over six academic semesters. Application of multilevel ordinal regression models to data obtained from implementation of two experimental conditions revealed that students assigned to in-person SI had higher final course grades than their online SI counterparts, but only when the online SI condition did not include access to the session recordings. These results suggest that synchronous online delivery of SI can be as efficacious as in-person SI when supplemented with asynchronous course resource supports. Implications for the design and future testing of SI models are discussed.

Student-Athlete Identity Variation Across the Undergraduate Period: A Mixed-Methods Study.

We examined the influence of individual and contextual characteristics on student-athlete identities and then explored identity variations across the undergraduate college years. Our main analysis relied on a quantitative study of a large sample of cross-sectional data (n = 862: females = 490, males = 372) with follow-up data for 102 participants. We also used qualitative semi-structured interviews within a small sub-sample (n = 4) who participated in international competitions to provide deeper insight into their identities across time. We used the Portuguese version of the Baller Identity Measurement Scale (BIMS) to explore student-athlete identities, and we examined the influence of sex, student-athlete status (based on institution documents), the participant's competitive level in the sport, and the student athlete's university type. We modelled response probability on BIMS items with multilevel ordinal regression in a cumulative model based on the Bayesian framework. For the follow-up in-depth qualitative interviews of four participants competing at the international level, we used thematic analysis, with two independent researchers generating thematic codes. We found a non-significant trend toward a decreased student-athlete identity across the undergraduate years. Participants' statements reflected their difficulty combining both aspects of the student-athlete identity, such that they tried to shift their identities, depending on the circumstances, while their athletic identity seemed to be privileged. Hence, participants had difficulty combining a dual academic-sport career within a context oriented toward academic achievement and transition to professional life. The higher education context was unprepared to support student-athletes toward a dual academic-sport career.

Participation in the under-18 Euroleague Next Generation Tournament does not predict attaining NBA, Euroleague, or Eurocup

We examined whether participation and individual performance in the under-18 Euroleague Next Generation Tournament (NGT) predicted a future contract with an NBA, Euroleague, or Eurocup squad. Data from 1446 players between 2002–2003 and 2011–2012 seasons were considered. We considered information about each player, including country, the number of games played, and performance index rating (PIR). We tracked the players’ highest club level attained in their adult careers. We used a multilevel ordinal regression with a cumulative model in a fully Bayesian framework to examine the probability of the players playing in the NGT attaining the NBA, Euroleague, or Eurocup. Furthermore, we explored in the model if PIR in the NGT was a relevant predictor of achieving the highest club level in adult careers. From the total sample, only a very small percentage attain the NBA (20 in 1446, 1.4%), Euroleague (103 in 1446, 7.2%), and Eurocup (60 in 1446, 4.2%). The results highlight that a very small number of players with a very high PIR per game in the NGT had a higher chance to play in the NBA, Euroleague, or Eurocup. The probability of attainment of NBA and Euroleague for the population of highly selected basketball players playing the under-18 NGT in the first 10 years of the NGT was small. Hence, caution is warranted when assuming the effectiveness of current talent development models, even at the late stages of young players’ development, often labelled as young elite players.

The Choice between Democracy and Authoritarian Government in the Minds of Citizens of Post-Communist Countries: Factors and Dynamics

This paper is dedicated to studying the value of democracy and authoritarian government in the political consciousness of citizens of post-communist countries three decades after the democratic transition. The author primarily examines the dynamics of said value and the complex ways in which a country’s socio-demographic characteristics, political regime type and economic development can impact their acceptance of democratic values. The author also analyzes such a thesis as “crisis of democracy”, particularly in post-communist regimes, what sort of causes, factors lie at the bottom this crisis and how potential deconsolidation can affect political culture. The study is built on comparative data from surveys by project “Life in Transition Survey”, which was conducted in 28 post-communist countries in 2006, 2010 and 2016. In the beginning the author’s reasoning is rooted in modernization theory and transitology — the most prevalent approaches in the study of post-communist regimes — with them being examined in critical light, and used as a foundation to put forward three key theses on the effect of individual and national factors on the value of democracy. The study shows that levels of support for democracy can vary significantly from country to country. Regardless, it is in higher demand in the vast majority of post-communist societies compared to the authoritarian alternative and the absentee position. However, while continuing to be the most sought after, democracy’s value rating is deteriorating. With the help of multi-level ordinal regression analysis, the author was able to identify certain stable patterns: first of all, the more social resources people possess — the more inclined they are to maintain the value of democracy, secondly, the less economically developed a country — the higher the value of democracy among its citizens, thirdly, regime type does influence the value of democracy, but the effects of such influence vary from year to year. Nevertheless, these results in part disprove the logic of modernization theory and transitology. The author offers his own original explanations and interpretations of the results.

Trend and determinants of quality of family planning counseling in Ethiopia: Evidence from repeated PMA cross-sectional surveys, (2014-2019).

The modern contraceptive prevalence rate (mCPR) among married women has increased by nearly five-fold in Ethiopia from 8.1% in 2000 to 37% in 2019. Despite this increase, receipt of high quality contraceptive counselling, as measured by the percentage of contraceptive users who were told about other methods, counseled on side effects and counseled what to do in the event that they encountered side effects, has declined in recent years. The quality of family planning counseling service measured by using these three components, known as the Method Information Index(MII), is an index designed to measure quality and a key indicator of the FP2020 initiative. The effects of potential client and service provider-level factors on receipt of high quality counseling and its progress over time have not been well studied in Ethiopia. We pooled data from seven Performance Monitoring for Action (PMA), formerly PMA2020, survey-rounds to examine the trend and effect of potential factors on receiving high quality of family planning counseling service in Ethiopia. Data from a total of 15,597 women aged 15 to 49 from seven survey-rounds were used in the analysis. To account for the study design and unequal probabilities of selection from target-populations for sampled women, design-based analysis was used to compute proportions. Multilevel ordinal regression model with enumeration area as a second level were employed to examine potential factors associated with quality of family planning counseling service. We found that the percentage of women who received high quality family planning counseling service declined from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally. Amhara region had the lowest percentage of women receiving high quality counseling at both the earliest(2014) and latest(2019) survey rounds(17% and 6%, respectively). Results show that lack of media exposure about family planning, having no formal education, using short-acting methods, and getting the service from pharmacy were the main factors associated with receiving low quality family planning counseling service. Given the importance of continuous provision of information on the range of family planning methods, it is imperative to use media and particularly regional media which can effectively address the rural populations in local languages as an important vehicle of information on family planning. Interventions aimed at improving quality of family planning counseling need to be mindful of regional disparities in the severity of the problem to ensure equity in service access. To improve the coverage of high quality family planning counseling service, there is an urgent need to re-visit the format of family planning counselling services.

Meal preparation and consumption before and during the COVID-19 pandemic: The relationship with cooking skills of Brazilian university students

ObjectiveThis study aimed to analyze meal preparation and the place of its consumption by university students before and during the COVID-19 pandemic, according to their individual characteristics and cooking skills. Methods: Data were collected with 1919 Brazilian university students using the Brazilian Cooking Skills Questionnaire (BCSQ) and questions about gender, living arrangement, knowing how to cook and location of meal consumption. Bayesian multilevel ordinal regression models were used to estimate the probabilities of meal preparation and local location of its consumption by Brazilian university students before and during the COVID-19 pandemic, according to their individual characteristics and cooking skills. Results: Most of participants showed reported a high level of cooking skills (70.7%). Also, they reported a decrease in ordering delivery of take-away food and eating fast-food, while increasing homemade meals with fresh ingredients, ultra-processed food or both during the pandemic compared to the period before the quarantine. Lastly, they increased their cooking frequency during the pandemic, regardless of their cooking skills level. However, the group with high cooking skills had a greater increase in the use of fresh ingredients. Conclusions: The study showed that the pandemic was an opportunity for university students to increase their cooking skills and frequency of cooking at home with a variety of foods. Particular attention should be given to those with low cooking skills and that use ultra-processed foods, promoting interventions to disseminate information and with behavior change components to teach about healthy cooking to increase cooking knowledge and skills, focusing on preparation of fresh ingredients.

Children’s engagement during collaborative learning and direct instruction through the lens of participant structure

The joint effects of instructional approach and participant structure on children’s engagement were investigated in 24 fifth-grade classrooms during a six-week unit on wolf management. 96 four-minute episodes sampled from the lesson videos were coded in 30-second intervals for individual students’ momentary cognitive-behavioral engagement, momentary emotional engagement, and current participant structure. Multilevel ordinal regression analyses showed that children were three times more likely to be cognitively and behaviorally engaged and one-and-a-half times more likely to be emotionally engaged during collaborative groups than direct instruction. Children’s cognitive-behavioral engagement depended upon participant structure: Children in collaborative groups were most engaged in lessons during peer interaction, whereas children receiving direct instruction were more engaged when interacting with the teacher. Children were more likely to be emotionally engaged when talking with peers, the teacher, or both peers and the teacher than when alone. The study contributes to new understanding of engagement as a function of the nature and conditions for participation in lessons.

Differences in progression by surgical specialty: a national cohort study

The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of...

Identifying L2 Developmental Indices while Controlling for L1 Effects: A Multilevel Ordinal Logistic Regression Analysis

This study aimed to identify second language (L2) developmental indices while controlling for the effects of first language (L1). More specifically, this study investigated the differences in the use of metadiscourse markers among learners from different L1 backgrounds. The following research questions were explored: (1) Which metadiscourse markers can be used as developmental indices to predict learners’ proficiency levels? (2) How strongly do learners’ L1s impact their L2 development? To answer these questions, multilevel ordinal logistic regression analysis was performed comparing the metadiscourse in English essays written by three Asian learner groups (i.e., Japanese, Thai, and Taiwanese). The results suggest that the frequencies of transitions and self-mentions are the best predictors of language development of metadiscourse categories. Additionally, this study showed that the multilevel regression model can measure the significance of each metadiscourse category more accurately than the single-level model. Therefore, we must consider the influence of learners’ L1s for precise detection of the linguistic features that predict their proficiency levels. Through this application of multilevel ordinal regression analysis to learner corpus research, this study illustrated the effectiveness of multilevel analysis for tracking the language acquisition process.

A Bayesian Multilevel Ordinal Regression Model for Fish Maturity Data: Difference in Maturity Ogives of Skipjack Tuna (Katsuwonus pelamis) Between Schools in the Western and Central Pacific Ocean

The maturity ogive is vital to defining the fraction of a population capable of reproduction. In this study, we proposed a novel approach, a Bayesian multilevel ordinal regression (i.e., Bayesian continuation ratio model), to model the maturity ogive. The model assumes that the observed maturity stage originates from the categorization of latent continuous variables. We demonstrated this approach by testing whether there are differences in the maturity ogive of skipjack tuna (Katsuonus pelamis) in the western and central Pacific Ocean between two school types, i.e., free-swimming and floating-object-associated schools. The model results show that K. pelamis, given the same fork length, are more likely to have a higher maturity stage in a free-swimming school than those associated with floating objects. The gonadosomatic index revealed the same conclusion. Our results indicate that fish aggregation devices (FADs) could negatively affect the maturity of K. pelamis and consequently reduce the population reproductive potential. This study provides (1) an alternative approach to analyze fisheries ordinal data; (2) important quantitative evidence to evaluate the existing ecological hypotheses; and (3) implications for tuna fisheries management.