Multilevel Regression Techniques Research Articles

Examining the Etiology of Asian American Suicide in the United States.

Research highlights racial and ethnic disparities in suicide, but Asian American suicide receives very little attention in the literature. This is the first comprehensive, large-scale, nationally representative study of completed suicide among Asian Americans in the United States. Descriptive and multilevel regression techniques compared the risk factors for completed suicide across 227,786 Asian American, White, African American, Hispanic, and American Indian suicide decedents from 2003 to 2019. Results indicated that Asian American suicide decedents were significantly less likely than their counterparts to have several risk factors for suicide. Asian Americans were less likely to be male, uneducated, and unmarried. Asian Americans were less likely to use alcohol and drugs, to have mental health problems, and to die by firearm, relative to other suicide methods. Asian Americans were less likely to have a history of prior suicide attempts, to have intimate partner problems, and to have criminal legal problems. Conversely, Asian Americans were more likely to reside in places with higher levels of concentrated disadvantage, residential instability, racial and ethnic heterogeneity, and population density. The results underscore the need for race-specific suicide prevention strategies that, for Asian Americans in particular, take into account cultural values and barriers to help-seeking behavior.

The well-being equation: How inner fulfilment drives the impact of older persons on the Ghanaian society.

Understanding and managing the complex processes of ageing is a critical function of gerontological nursing, especially when it comes to older people's well-being and their contributions to society. Globally, older persons contribute in many ways to families and communities. However, the relationship between older person's overall well-being and their propensity to contribute to society remains an important gap in research. The study examined the association between well-being and the impact of older persons on Ghanaian society. A secondary analysis of longitudinal survey data of the 2014/15 Study on Global Ageing and Adult Health (SAGE Wave 2) conducted by the World Health Organization was used. The multilevel logistic regression technique was used to examine four dimensions of well-being and their associations with high social contribution among older persons. The output was reported as odds ratios (OR). The results show that older persons who had high physical and psychological well-being were more likely to contribute to society (OR = 1.25, 95% CI = 0.93, 1.68), (OR = 1.75, 95% CI = 1.32, 2.33). However, those with high levels of emotional and spiritual well-being were less likely to make social contributions (OR = 0.66, 95% CI = 0.49, 0.88), (OR = 0.88, 95% CI = 0.66, 1.18). This study shows a positive association between well-being and older persons' societal impact. Good mental and physical health encourage societal involvement among older persons, while high emotional and spiritual well-being may lead to less societal contribution. These findings are important for nursing policies promoting social contribution and well-being among older persons 60 years and over in Ghana.

Predicting mental depression

In this study, a multilevel linear regression technique based on neural network tailored association is suggested to predict human mental depression. The suggested technique uses a neural network configured for association-based multiple linear regression to forecast the mental depression dataset. The spectrum of depression is predicted using a variety of statistical techniques, including both multiple linear regression and linear regression with neural network tuning. When predicting the severity of depression, tweaked algorithms perform less well. They have been fine-tuned for significant differences in the accuracy, timing, and speed of depression predictions. To address these difficulties, a multiple linear regression solution based on neural network tailored association is suggested. The Multiple linear regression using a neural network that has been tweaked for association yields high compared to other statistical approaches, accuracy prediction is roughly 91%.

Changes in discourse on unmet need for family planning among married women in India: evidence from NFHS-5 (2019–2021)

Unmet needs for contraception in India have declined over time but the rate has not been uniform among women across geographies and socio-economic strata. Identifying the characteristics of women in communities where unmet need is still high is important to devise appropriate strategies to ensure access and uptake of modern contraceptive methods. The current study examined whether there was a national decline in unmet need over time and if regional disparities exist in unmet need. Demographic variations in unmet need based on factors such as maternal age, education, religion, caste, wealth index quintile, family size, and access to antenatal care (ANC) were also documented. Our approach was to document the prevalence of total unmet need for family planning and unmet need for spacing among married Indian women and quantify variability based on socio-economic and demographic drivers within a hierarchal framework, thus providing both macro and micro perspectives. We used data from the fourth and fifth rounds of the National Family Health Survey (NFHS) collected from all the States and Union Territories (UTs) in India. Quantile regression analysis and multilevel regression techniques were used to understand the predictors for the total unmet need for family planning and the unmet need for spacing. Results show a considerable decline in the prevalence of unmet need for family planning in India from NFHS-4 to 5 (from 12.9 to 9.3%) in the last six6 years. The north-eastern states show a significant reduction in unmet need for family planning in Manipur (17.8%), Nagaland (13.5%), and followed by Sikkim (9.1%). The predictors such as years of schooling, place of residence, caste, religion, wealth quintile, number of antenatal care (ANC) visits, and children ever born have a significant association with unmet needs for family planning and spacing among married women in India. There is a significant association between years of schooling with the total unmet needs for family planning at (q25) quantiles and the unmet need for spacing at (q25, q50) quantiles. Results reveal that the demand for unmet need for spacing and limiting was the highest among the women in the age categories 15–19 (17.8%) and 20–24 (17.3%). The demand for limiting was the highest (6.8%) among Muslim women. Across wealth quantile categories, the overall unmet demand (11.4%) for spacing and limiting was the highest among the women in the lowest socioeconomic groups. We conclude that greater access to frontline health workers among young wives, and significant investment in education in general, will continue to reduce the unmet needs for family planning in India.

Mental Depression Deduction Using Modified Regression Model to Prevent Suicidal Attempt

This study explores a novel approach for predicting depression using association-based multilevel linear regression. The suggested approach, known as association-based multilevel linear regression, uses data on mental depression to predict the prevalence of depression. Several statistical techniques can be used to forecast depression. Several statistical methods, including Linear Regression (LR), Multilevel Linear Regression (MLR), Naïve Bayes algorithm and Decision Tree (DT) were used in this investigation. Because these algorithms are able to predict mental depression based on certain characteristics such as precision and efficiency, their performance reduces. The results of these algorithms' predictions vary significantly, especially in terms of accuracy. The mental health data is fed into a developed model that has been trained to make predictions in order to address the aforementioned problem. Depression is the subject of conversation. A great degree of accuracy is shown by the association-based multilevel linear regression technique and the evaluation of prediction of accuracy in relation to other statistical methods. This study used association-based multilevel linear regression technique. When compared to traditional methods, the method exhibits a substantially greater level of accuracy, almost 99%.

Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries

BackgroundIncreasing trends in risky health behaviours contribute to chronic health problems among the rapidly growing ageing population. Therefore, we examined the association between risky health behaviours and chronic health conditions among persons 50 years and older.MethodsThis study was a secondary analysis of longitudinal survey data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave 1) conducted by the World Health Organization. Multilevel logistic regression techniques were used to examine high social cohesion among the aged. The output was reported as odds ratios (OR) and adjusted odds ratios (aOR).ResultsGenerally, the level of chronic conditions was 81.5% for all countries. Older adults in Ghana had the highest chronic conditions (94.0%) while the Russian Federation recorded the lowest (58.6%). The risk of chronic conditions was higher among the oldest-old (OR = 1.70, 95% CI = 1.29, 2.25), those who smoke tobacco (OR = 1.13, 95% CI = 1.01, 1.25) or drink alcohol (OR = 1.17, 95% CI = 1.06,1.29), and among those who live in rural areas (OR = 1.31, 95% CI = 1.16, 1.49). However, the odds were lower among females (OR = 0.88, 95% CI = 0.69,0.85), and those who were not working (OR = 0.52, 95% CI = 0.47, 0.58).ConclusionWe conclude that it is important to improve the health status of older people. To achieve this, there must be interventions and policies to facilitate the adoption of healthy or physically active lifestyles among older people. This could be achieved by strengthening advocacy and health education about the dangers of living a sedentary lifestyle, consuming alcohol and tobacco. Whatever behavioural change interventions, advocacy and health education must target high-risk sub-populations including the oldest-old, and those with low economic status. Given the regional disparities identified, it is necessary to prioritise older people residing in rural areas. The study underscores a need to provide more primary healthcare facilities in the rural areas of the countries included in this study. Such an initiative is likely to increase accessibility to healthcare services and information that would impact positively on the lifestyle behaviours of older people.

Effects of person-centred planning and practices on the health and well-being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data.

A person-centred service planning and practice approach (PCP) is one that is driven by service users' individual preferences, needs and priorities. The approach has been identified as a best practice and is codified in US policies that encourage and, in some contexts, require state systems of home and community-based services to adopt and demonstrate person-centred practice. However, there is insufficient research on PCP's direct impact on outcomes for service users. This study aims to contribute to the evidence base in this area by investigating the association between service experiences and outcomes of adults with intellectual and developmental disabilities (IDD) receiving state-funded services. The data for the study come from the 2018-2019 National Core Indicators® In-Person Survey that links survey responses with administrative records for a sample of 22 000 adults with IDD receiving services from 37 state developmental disabilities (DD) systems. Associations among service experiences and outcomes of survey participants are examined through multilevel regression techniques that include participant-level responses and state-level measures of PCP. The state-level measures are constructed by combining administrative records describing participants' service plans with the priorities and goals they expressed in response to the survey. Case managers' (CM) accessibility and attentiveness to individual preferences, as reported by survey participants, are significantly associated with self-reported outcomes such as perceived control over life decisions and sense of health and well-being. Controlling for participants' experiences with their CMs, their reports of the person-centred content of their service plans have net positive associations with outcomes. After accounting for experiences with the service system as reported by participants, the state system's person-centred orientation, measured by the extent to which service plans across the state reflect participants' wishes for improving their social connections, remains a significant predictor of participants' sense of control over their daily lives. This study contributes to the evidence base supporting PCP as a service model by identifying pathways that link person-centred service planning and delivery and person-centred orientation of state systems to positive outcomes reported by adults with IDD and by demonstrating the value of linking survey and administrative data. The key implication of the findings for policy and practice is that an overall person-centred orientation of state DD systems as well as PCP training for people who support planning for and delivery of direct supports will substantially improve the lives of adults with IDD.

Sound quality metric indicators of rotorcraft noise annoyance using multilevel analysis.

It is hypothesized that sound quality metrics, particularly loudness, sharpness, tonality, impulsiveness, fluctuation strength, and roughness, could all be possible indicators of the reported annoyance to helicopter noise. To test this hypothesis, a psychoacoustic test was conducted in which subjects rated their annoyance levels to synthesized helicopter sounds. After controlling for loudness, a previous analysis using linear regression identified sharpness and tonality as important factors in predicting annoyance, followed by fluctuation strength. The current work focuses on multilevel regression techniques in which the regression slopes and intercepts are assumed to take on normal distributions across subjects. The importance of each metric is evaluated, and the variation of regression parameters among subjects is evaluated using simple models. Then more complete models are investigated, which include the combination of selected metrics and subject-specific effects. While the conclusions from linear regression analysis are affirmed by multilevel analysis, other important effects emerge. In particular, subject-specific intercepts are shown to be more important than subject-specific slopes. In addition, subject-specific slopes for fluctuation strength and sharpness are more important than for tonality. Using a multilevel framework, the relative importance of sound quality metrics is reexamined, and the potential for modeling human annoyance to helicopter noise based on sound quality metrics is explored.

The effect of institutions on intrapreneurship: An analysis of developed vs developing countries

ABSTRACT This article examines the interaction effects of formal and informal institutions on intrapreneurship in developed and developing countries. We use a multilevel logistic regression technique and data from the Global Entrepreneurship Monitor (GEM) for the years 2014–2020 with information from 29 developed countries (237,053 observations) and 31 developing countries (177,201 observations). The main findings highlight that informal institutions (fear of failure and media attention) are more relevant than the social status of entrepreneurs as predictors of intrapreneurship, in both developed and developing countries. In addition, the moderation of economic freedom as a formal institution differs depending on the economic development context. In developed countries, economic freedom enhances to a greater extent the relationship between social status and intrapreneurship, as well as between media attention and intrapreneurship. These findings can be useful for the design of intrapreneurship policies in adapting their strategies to the specific institutional environment.

You will take care of me when I am old: Norms on children’s caregiver obligations - An analysis with data from the European Values Study

Objective: We explore gender differences in support of the norm that children must provide care for their parents. Background: Society's values and norms play a crucial role in deciding whether to provide family care. We investigate these values and norms on family care by analyzing which individual and country level factors affect them. Method: We use data from the European Values Study wave 5 and multilevel regression techniques. The question, "Adult children have the duty to provide long-term care for their parents", serves as our dependent variable. The explanatory variables at the individual level are gender and further socio-demographic variables. At the country level, we include expenditures on health care, and the female labor force participation rate. Results: The results show that women, as well as those living in countries with high expenditure on health care and high female labor force participation rates, are less supportive of the norm that children have an obligation to provide care for their parents. Furthermore, the gender effect is stronger in countries with a higher female labor force participation rate. Conclusion: Norms and values on family care are not fixed and can change, as suggested by the differences between countries. They are also not shared by all social groups equally, as the differences between women and men and along other socio-demographics show.

Schools’ We-mentality and Students’ Civic Engagement – A Text-based Approach

This paper studies the role of schools' we-mentality in shaping students' civic outcome. A school's we-mentality is important for the students' perception and education of sense of community. We-mentality is measured by an automated content-analysis approach applied to the schools' general principle. Data stem from a survey conducted in 13 German schools with 488 students. Using OLS and multi-level regression techniques, I find that stronger we-mentality is associated with more students being engaged in local civic activities. Moreover, students that exhibit stronger trust in others and are willing to engage with new and unknown tasks show more positive attitudes towards civic issues. The results hold relevance for the educational design of schools in fostering adolescents' civic education and participation.

Exploring job resources as predictors of employees' effective coping with job stress

PurposeThe purpose of this paper is to shed more light on the relative impact of the various workplace resources on employees' effective coping with job stress symptoms, taking into account synergistic and antagonistic effects. The authors used job demands-resources (JD-R) theory as an overarching theoretical framework to test the hypotheses.Design/methodology/approachThe authors used a factorial survey experiment and a within-person design. Data were obtained from a random sample of 97 Greek employees working in public and private organizations. Multilevel modeling regression techniques were used for data analyses. The authors examined the relative effect of various job resources at different levels on employees' ratings of effective coping with job stress symptoms. In parallel, the authors investigated the possible synergistic and antagonistic interactions between the specific job resources.FindingsThe authors found that managers' leadership and humor style, their relationship with subordinates and coworkers’ support had positive effects on employees' coping with job stress. In addition, the authors found that the manager's leadership style interacts with manager–subordinate relationship quality and coworkers’ support as well as the latter interacts with the manager's humor style and manager–subordinate relationship quality. The study model explained 50% of the variance in effective coping with stress ratings.Originality/valueThe study highlights the importance of workplace resources as contextual variables, for the effective coping with stress symptoms at work. It highlights that a combination of workplace resources produces a net effect that was better than would have been expected based solely on the individual performance of these job resources. As such, the research answer calls to attend to the effects of synergistic effects of workplace resources on effective coping with stress symptoms at work.

Youth Cohort Size, Structural Socioeconomic Conditions, and Youth Protest Behavior in Democratic Societies (1995–2014)

Conventional literature associates large youth cohort size (YCS) with increased risk of political violence in countries with such demographic profiles. Key questions which remain unanswered, however, are whether YCS is also associated with young people’s proclivities toward more peaceful forms of protests, and whether structural socioeconomic conditions influence such a relationship? Using multilevel binary logistic regression techniques on pooled individual level data for 51 democratic countries purposively sampled from World Values Survey Waves 3 to 6, and country level data from World Bank, and UN Population Division, I show that YCS demonstrates a positive relationship with young people’s participation in peaceful demonstrations. This relationship is, however, moderated by structural factors such as education and unemployment, which end up reducing young people’s likelihood of participation. I argue that resource limitation, as predicted by the Civic Voluntarism Model, better explains the relationship between YCS and individual youth protest behavior in democratic societies, more than socioeconomic grievance, as suggested by grievance theory. An important implication of this finding is that participation in elite-challenging behaviors such as peaceful protests, can be expected to be more common among young people in affluent democratic societies, than their peers elsewhere in the democratic world.

Effects of Arterial Carbon Dioxide Tension on Cerebral and Somatic Regional Tissue Oxygenation and Blood Flow in Neonates After the Norwood Procedure With Deep Hypothermic Cardiopulmonary Bypass.

Neonates undergoing the Norwood procedure for hypoplastic left heart syndrome are at higher risk of impaired systemic oxygen delivery with resultant brain, kidney, and intestinal ischemic injury, shock, and death. Complex developmental, anatomic, and treatment-related influences on cerebral and renal-somatic circulations make individualized treatment strategies physiologically attractive. Monitoring cerebral and renal circulations with near infrared spectroscopy can help drive rational therapeutic interventions. The primary aim of this study was to describe the differential effects of carbon dioxide tension on cerebral and renal circulations in neonates after the Norwood procedure. Using a prospectively-maintained database of postoperative physiologic and hemodynamic parameters, we analyzed the relationship between postoperative arterial carbon dioxide tension and tissue oxygen saturation and arteriovenous saturation difference in cerebral and renal regions, applying univariate and multivariate multilevel mixed regression techniques. Results were available from 7,644 h of data in 178 patients. Increases in arterial carbon dioxide tension were associated with increased cerebral and decreased renal oxygen saturation. Differential changes in arteriovenous saturation difference explained these effects. The cerebral circulation showed more carbon dioxide sensitivity in the early postoperative period, while sensitivity in the renal circulation increased over time. Multivariate models supported the univariate findings and defined complex time-dependent interactions presented graphically. The cerebral and renal circulations may compete for blood flow with critical limitations of cardiac output. The cerebral and renal-somatic beds have different circulatory control mechanisms that can be manipulated to change the distribution of cardiac output by altering the arterial carbon dioxide tension. Monitoring cerebral and renal circulations with near infrared spectroscopy can provide rational physiologic targets for individualized treatment.

Nexus between maternal underweight and child anthropometric status in South and South-East Asian countries

ObjectivesMaternal underweight and childhood malnutrition are life-threatening public health concerns in several South and South-East Asian nations. The aim of this study was to better design interventions and prevent malnutrition of children in the region by exploring the association of maternal underweight with children's anthropometric status. MethodsThe Demographic and Health Survey's (DHS) most recent nationally representative data from eight South and South-East Asian states, collected between 2014 and 2018, were pooled for the present study. A multivariable logistic regression model was designed to explore the association between maternal underweight and child anthropometric status. Owing to the hierarchical structure of the DHS data, the study also employed the multilevel logistic regression technique. ResultsAmong the total participants (N = 213 730), 22.66% of women were found to be underweight, whereas 39.03%, 35.88%, and 22.11% of their children had stunting, underweight, and wasting, respectively. The logistic regression model showed that the children from underweight mothers were 1.27 (95% confidence interval [CI]. 1.24–1.30), 1.69 (95% CI, 1.65–1.73), and 1.48 (95% CI, 1.45–1.52) times more likely to experience stunting, underweight, and wasting, respectively, than those with healthy-weight mothers. The significant association between maternal underweight and stunting, underweight, as well as wasting was additionally established by the multilevel logistic regression analysis. ConclusionsFindings indicate that maternal underweight is positively associated with children's anthropometric status, such as stunting, underweight, and wasting. The information from this research will guide actors and policymakers to scale up interventions with all-inclusive nutritional issues and promote healthier weight status among mothers to ensure higher odds of healthier anthropometric status in their children in the South and South-East Asian countries.

How older people experience the age-friendliness of The Hague: A quantitative study

The municipality of The Hague has been a member of the WHO's Global Network for Age-Friendly Cities and Communities since 2015. The municipality commissioned a survey to investigate how older citizens view the age-friendliness of their city. A cross-sectional survey was conducted among a diverse sample of 393 community-dwelling older citizens. The survey made use of the Age Friendly Cities and Communities Questionnaire (AFCCQ), and multilevel regression techniques to investigate how social groups differ on the domains of the AFCCQ. The Hague scored a satisfied as an overall score (16.9 ± 8.87), and a satisfied on social participation (2.6 ± 2.46), civic participation and employment (1.4 ± 1.34), communication and information (1.4 ± 1.32), respect and social inclusion (1.6 ± 1.59), community support and health services (2.7 ± 2.79), transportation (1.7 ± 1.26) and financial situation (1.9 ± 1.26). The Hague has an above-average score in the field of housing (2.4 ± 1.06). For Outdoor spaces and buildings, the municipality scores a moderate positive score (0.9 ± 1.41). Significant differences were found for sex, age, socio-economic position, receiving care support, and use of mobility aids. The findings show that older people have different perceptions regarding their city's age-friendliness. Policy makers must acknowledge this heterogeneity among their older citizens and adapt city policies accordingly.

Adherence to Growth Hormone Treatment Using a Connected Device in Latin America: Real-World Exploratory Descriptive Analysis Study.

BackgroundRecombinant human growth hormone (rhGH) therapy is an effective treatment for children with growth disorders. However, poor outcomes are often associated with suboptimal adherence to treatment.ObjectiveThe easypod connected injection device records and transmits injection settings and dose data from patients receiving rhGH. In this study, we evaluated adherence to rhGH treatment, and associated growth outcomes, in Latin American patients.MethodsAdherence and growth data from patients aged 2-18 years from 12 Latin American countries were analyzed. Adherence data were available for 6207 patients with 2,449,879 injections, and growth data were available for 497 patients with 2232 measurements. Adherence was categorized, based on milligrams of rhGH injected versus milligrams of rhGH prescribed, as high (≥85%), intermediate (>56%-<85%), or low (≤56%). Transmission frequency was categorized as high (≥1 per 3 months) or low (<1 per 3 months). Chi-square tests were applied to study the effect of pubertal status at treatment start and sex on high adherence, and to test differences in frequency transmission between the three adherence levels. Multilevel linear regression techniques were applied to study the effect of adherence on observed change in height standard deviation score (∆HSDS).ResultsOverall, 68% (4213/6207), 25% (n=1574), and 7% (n=420) of patients had high, intermediate, and low adherence, respectively. Pubertal status at treatment start and sex did not have a significant effect on high adherence. Significant differences were found in the proportion of patients with high transmission frequency between high (2018/3404, 59%), intermediate (608/1331, 46%), and low (123/351, 35%) adherence groups (P<.001). Adherence level had a significant effect on ∆HSDS (P=.006). Mean catch-up growth between 0-24 months was +0.65 SD overall (+0.52 SD in patients with low/intermediate monthly adherence and +0.69 SD in patients with high monthly adherence). This difference translated into 1.1 cm greater catch-up growth with high adherence.ConclusionsThe data extracted from the easypod Connect ecosystem showed high adherence to rhGH treatment in Latin American patients, with positive growth outcomes, indicating the importance of connected device solutions for rhGH treatment in patients with growth disorders.

Socioeconomic and Geographic Correlates of Intimate Partner Violence in Sri Lanka: Analysis of the 2016 Demographic and Health Survey

Intimate partner violence (IPV) is a serious public health issue and violation of human rights. The prevalence of IPV in South Asia is especially pronounced. We examined the associations between socioeconomic position (SEP), geographical factors and IPV in Sri Lanka using nationally representative data. Data collected from Sri Lanka's 2016 Demographic and Health Survey were analysed using multilevel logistic regression techniques. A total of 16,390 eligible ever-partnered women aged 15-49years were included in the analysis. Analyses were also stratified by ethnicity, type of violence, neighbourhood poverty and post-conflict residential status for selected variables. No schooling/primary educational attainment among women (OR 2.46 95% CI 1.83-3.30) and their partners (OR 2.87 95% CI 2.06-4.00), financial insecurity (OR 2.17 95% CI 1.92-2.45) and poor household wealth (OR 2.64 95% CI 2.22-3.13) were the socioeconomic factors that showed the strongest association with any IPV, after adjusting for age and religion. These associations predominately related to physical and/or sexual violence, with weak associations for psychological violence. Women living in a post-conflict environment had a higher risk (OR 2.96 95% CI 2.51-3.49) of IPV compared to other areas. Ethnic minority women (Tamil and Moor) were more likely to reside in post-conflict areas and experience poverty more acutely compared to the majority Sinhala women, which may explain the stronger associations for low SEP, post-conflict residence and IPV found among Tamil and Moor women. Policies and programs to alleviate poverty, as well as community mobilisation and school-based education programs addressing harmful gender norms may be beneficial. Trauma informed approaches are needed in post-conflict settings. Further exploratory studies investigating the complex interplay of individual, household and contextual factors occurring in this setting is required.

Determinants of adherence to continuous positive airway pressure therapy in adults with obstructive sleep apnea

Objectives Adherence to continuous positive airway pressure (CPAP) devices in patients with obstructive sleep apnea (OSA) determines the effectiveness of the treat- ment. Likewise, the assessment of the control of the disease must consider the infor- mation referred by the patient, among other value-based health measures related to the satisfaction of the intervention. The objectives of this study were a) Determine the factors related to adherence to CPAP devices in subjects with OSA affiliated to an insurance company of the healthcare system in Colombia. b) Assess symptom control associated to the disease from the individual ́s perspective and his/her satisfaction with the treatment received. Materials and Methods 1,501 subjects with OSA were surveyed by telephone to explore: sociodemographic factors, habits and lifestyles, use of CPAP and its adverse events, control of the disease, comorbidities, access to care and therapy satisfaction. Using multilevel logistic regression techniques, the influence of the various factors on adherence to CPAP was analyzed, using Stata 13 software. Results Adherence to CPAP therapy was of 58% and the control of symptoms was of 41.7%. The factors that determined the use of CPAP were knowledge on how the device operates, and the disturbances during sleep due to the mask or nasal pad. The- rapy satisfaction was predominantly very good or good. Conclusion Even with moderate adherence values and a good experience with CPAP therapy, symptomatic control of the disease is poor. Many of the factors that affect the use of CPAP are modifiable with a proper approach by the devices ́ service provider.

Improved Direction-of-Arrival Estimation of an Acoustic Source Using Support Vector Regression and Signal Correlation.

The direction-of-arrival (DoA) estimation of an acoustic source can be estimated with a uniform linear array using classical techniques such as generalized cross-correlation, beamforming, subspace techniques, etc. However, these methods require a search in the angular space and also have a higher angular error at the end-fire. In this paper, we propose the use of regression techniques to improve the results of DoA estimation at all angles including the end-fire. The proposed methodology employs curve-fitting on the received multi-channel microphone signals, which when applied in tandem with support vector regression (SVR) provides a better estimation of DoA as compared to the conventional techniques and other polynomial regression techniques. A multilevel regression technique is also proposed, which further improves the estimation accuracy at the end-fire. This multilevel regression technique employs the use of linear regression over the results obtained from SVR. The techniques employed here yielded an overall improvement over the classical generalized cross-correlation technique.