Percentile Bootstrap Method Research Articles

Confidence Interval Estimating the Mean of Normal Distribution and Skewed Distribution

The confidence interval is an important statistical estimator of population location and dispersion parameters. The purpose of this paper is to comprehend CI utilising various techniques. This includes classical CI, percentile bootstrap method, bootstrap-t and proposed bootstrap-t decile mean method. Distributions that are skewed and normal are used to generate data. The efficiency of the proposed method is evaluated on the basis of an extensive simulation study. The simulation findings show that the performance of the Student-t and three bootstrap approaches varies dramatically depending on sample size and skewness type. The coverage probability and length of the proposed confidence interval are compared with certain existing and widely used confidence intervals. For illustrative purposes, two real-life data sets are analysed, which, to some extent, support the simulation study conclusions. This paper's findings will be useful to a variety of researchers with practical experience in the fields of science and social sciences.

Emergency department nurses' reflective thinking and patient safety competency: The mediating effect of patient safety culture

AimThis study aimed to identify the mediating effect of patient safety culture on the relationship between reflective thinking and patient safety competency in emergency department nurses. BackgroundGiven the complexity and the need for timely assessments and interventions in the emergency department, the patient safety competency of nurses is crucial for preventing safety incidents. MethodsThis study utilized a cross-sectional descriptive correlational design with a convenience sample of 200 emergency department nurses. Participants completed a web-based, self-administered questionnaire that assessed reflective thinking, patient safety culture, and patient safety competency. The percentile bootstrap method for mediation analysis was performed to ascertain the mediating role of patient safety culture in the relationship between reflective thinking and patient safety competency. ResultsBoth reflective thinking and patient safety culture were significant predictors of patient safety competency. Furthermore, patient safety culture was found to mediate the relationship between reflective thinking and patient safety competency among emergency department nurses. ConclusionsThe findings suggest that emergency department nurses could benefit from a competency enhancement program or quality improvement projects that focus on reflective thinking and patient safety culture, which are significant predictors of patient safety competency.

The influence of self-efficacy on social adaptability among college students: The mediating role of psychological resilience

Against the backdrop of rapid social development, given the importance of good social adaptability for individuals' careers and daily lives, the purposed of this study is to explore the influence of self-efficacy of vocational college students on social adaptability. A questionnaire survey was conducted on 940 vocational college students in China using the Self-Efficacy Scale, Social Adaptability Scale, and Psychological Resilience Scale to obtain valid samples. SPSS and AMOS are used to further explore the explanatory and predictive relationships between variables. A mediation effect is proposed to establish a structural model, and the bias-corrected percentile Bootstrap method is used to conduct an empirical test on the constructed model. The research results show that the self-efficacy of vocational college students in China has a significant positive impact on social adaptability. Moreover, psychological resilience plays a mediating role in the influence of self-efficacy on social adaptability. Based on these results, schools can promote the improvement of students' social adaptability by cultivating their self-efficacy. Through targeted mental health education and training, students' self-efficacy and psychological resilience can be enhanced, thereby improving social adaptability and enabling them to better cope with academic pressure and life challenges and adapt to vocational and social lives.

Advantages of Monte Carlo Confidence Intervals for Incremental Cost-Effectiveness Ratios: A Comparison of Five Methods

Cost-effectiveness analysis studies in education often prioritize descriptive statistics of cost-effectiveness measures, such as the point estimate of the incremental cost-effectiveness ratio (ICER), while neglecting inferential statistics like confidence intervals (CIs). Without CIs, it is impossible to make meaningful comparisons of alternative educational strategies, as there is no basis for assessing the uncertainty of point estimates or the plausible range of ICERs. This study evaluates the relative performance of five methods of constructing CIs for ICERs in randomized controlled trials with cost-effectiveness analyses. We found that the Monte Carlo interval method based on summary statistics consistently performed well regarding coverage, width, and symmetry. It yielded estimates comparable to the percentile bootstrap method across multiple scenarios. In contrast, Fieller’s method did not work well with small samples and small treatment effects. Further, Taylor’s method and the Box method performed least well. We discuss two-sided and one-sided hypothesis testing based on ICER CIs, develop tools for calculating these ICER CIs, and demonstrate the calculation using an empirical example. We conclude with suggestions for applications and extensions of this work.

Assisted Fluid Management and Sublingual Microvascular Flow During High-Risk Abdominal Surgery: A Randomized Controlled Trial.

Implementation of goal-directed fluid therapy (GDFT) protocols remains low. Protocol compliance among anesthesiologists tends to be suboptimal owing to the high workload and the attention required for implementation. The assisted fluid management (AFM) system is a novel decision support tool designed to help clinicians apply GDFT protocols. This system predicts fluid responsiveness better than anesthesia practitioners do and achieves higher stroke volume (SV) and cardiac index values during surgery. We tested the hypothesis that an AFM-guided GDFT strategy would also be associated with better sublingual microvascular flow compared to a standard GDFT strategy. This bicenter, parallel, 2-arm, prospective, randomized controlled, patient and assessor-blinded, superiority study considered for inclusion all consecutive patients undergoing high-risk abdominal surgery who required an arterial catheter and uncalibrated SV monitoring. Patients having standard GDFT received manual titration of fluid challenges to optimize SV while patients having an AFM-guided GDFT strategy received fluid challenges based on recommendations from the AFM software. In all patients, fluid challenges were standardized and titrated per 250 mL and vasopressors were administered to maintain a mean arterial pressure >70 mm Hg. The primary outcome (average of each patient's intraoperative microvascular flow index (MFI) across 4 intraoperative time points) was analyzed using a Mann-Whitney U test and the treatment effect was estimated with a median difference between groups with a 95% confidence interval estimated using the bootstrap percentile method (with 1000 replications). Secondary outcomes included SV, cardiac index, total amount of fluid, other microcirculatory variables, and postoperative lactate. A total of 86 patients were enrolled over a 7-month period. The primary outcome was significantly higher in patients with AFM (median [Q1-Q3]: 2.89 [2.84-2.94]) versus those having standard GDFT (2.59 [2.38-2.78] points, median difference 0.30; 95% confidence interval [CI], 0.19-0.49; P < .001). Cardiac index and SVI were higher (3.2 ± 0.5 vs 2.7 ± 0.7 l.min-1.m-2; P = .001 and 42 [35-47] vs 36 [32-43] mL.m-2; P = .018) and arterial lactate concentration was lower at the end of the surgery in patients having AFM-guided GDFT (2.1 [1.5-3.1] vs 2.9 [2.1-3.9] mmol.L-1; P = .026) than patients having standard GDFT strategy. Patients having AFM received a higher fluid volume but 3 times less norepinephrine than those receiving standard GDFT (P < .001). Use of an AFM-guided GDFT strategy resulted in higher sublingual microvascular flow during surgery compared to use of a standard GDFT strategy. Future trials are necessary to make conclusive recommendations that will change clinical practice.

Influence of tree size on the scaling relationships of lamina and petiole traits: A case study using Camptotheca acuminata Decne.

There is a lack of research on whether tree size affects lamina and petiole biomass allocation patterns, whereas the trade-off between leaf biomass allocated to the lamina and the petiole is of significance when considering the hydraulic and mechanical function of the leaf as a whole. Here, Camptotheca acuminata Decne was selected for study because of the availability of trees differing in size growing under the same conditions. A total of 600 leaves for two tree size groups and 300 leaves per group differing in height and trunk diameter were collected. The lamina fresh mass (LFM), lamina dry mass (LDM), lamina area (LA), petiole fresh mass (PFM), and petiole length (PL) of each leaf was measured, and reduced major axis regression protocols were used to determine the scaling relationships among the five functional traits. The bootstrap percentile method was used to determine if the scaling exponents of the traits differed significantly between the two tree size groups. The results indicated that (i) there was a significant difference in the LFM, LDM, PFM, PL, LMA, LFMA and PFM/LFM between large and small trees, but no significant difference in LA; (ii) the LA versus LFM, LA versus LDM, LFM versus PFM, LA versus PFM, and PL versus PFM scaling relationships of the two groups were allometric (i.e., not isometric); (iii) there were significant differences in the scaling exponents of LA versus LFM, LA versus PFM, PL versus PFM between the two groups, but there was no significant difference in the LFM versus PFM scaling relationship between the two groups of trees. The data were also consistent with the phenomenon known as "diminishing returns". These data indicate that tree size influences leaf biomass allocation patterns in ways that can potentially influence overall plant growth, and therefore have an important bearing on life-history strategies.

Evaluation of the Effect of Parental Participation on Chinese Adolescent Behavioral Development Through the Mediating Effect of Peers: A Moderated Mediation Model.

With the rapid changes in the social environment, adolescents are facing increasing academic pressure and challenges to their physical and mental development in the socialization process. The purpose of this study was to investigate the influence mechanisms of parental participation on adolescent behavioral development (learning persistence, expressive language ability and knowledge absorption ability), revealing the mediation role of adolescent positive and negative peer interactions between parental participation and behavioral development, and whether differences in parents and children's educational expectations moderate this process. This study was measured using the Parental Participation Questionnaire, Peer Interaction Questionnaire, Behavioral Development Scale, and Educational Expectancy Gap from the China Education Panel Survey. A total of 7730 seventh-grade students and their parents were invited to participate, to establish a moderated mediation model, and the significance of the mediation effect was tested using the bias-corrected percentile Bootstrap method. (1) High frequent parental participation has a significant positive effect on adolescent behavioral development, including behavioral participation, emotional participation, and educational participation all exerting varying degrees of positive influence, as well as positively influencing adolescents' peer interactions. (2) Positive and negative peer interactions play the mediation role of 12.3% and 2.5% respectively in the process of parental participation affecting adolescent behavioral development. (3) Comparing "educational expectation gap - equal", the "educational expectation gap - high" negatively moderates the effect of parental participation on adolescent behavioral development and positive peer interaction (inhibitory effect), the "educational expectation gap - low" positively moderates the effect of parental participation on negative peer interaction (facilitation effect), which meant that the "educational expectation gap - equal" between parents and children is a more desirable state. These findings provide empirical support and effective operational suggestions to further promote positive adolescent behavioral development. Particularly for developing countries, it is recognized that positive parental participation and peer interaction, as well as equal educational expectation of parents and children, are protective factors for adolescent development.

The association between physical exercise behavior and psychological resilience of teenagers: an examination of the chain mediating effect

The health of young people is crucial for the future and development of a nation. It is the collective responsibility and imperative mission of society to ensure the holistic well-being, both physically and mentally, of young individuals. Therefore, it is essential to thoroughly comprehend the factors that influence their health in order to expedite the exploration of effective solutions. The objective of this study is to comprehend the mechanisms that underlie the correlation between physical exercise behavior and psychological resilience among teenagers, while also examining the mediating role played by social sensitivity and need to belong. So put forward the hypothesis: (1) physical exercise behavior can positively predict the psychological resilience. (2) Social sensitivity and need to belong plays a mediating role between physical exercise behavior and psychological resilience. (3) Social sensitivity and need to belong plays a chain mediating role between physical exercise behavior and psychological resilience. Using the cluster sampling method, a total of 1106 students (with an average age of 15.7 and a standard deviation of 0.598) who met the requirements were surveyed from Shandong Province in China. Standard scales were utilized to assess Physical Exercise Behavior, Psychological Resilience, Social Sensitivity, and Need to Belong. For data analysis, Pearson's correlation analysis and bias-corrected percentile Bootstrap method were sequentially conducted. (1) The present study did not find any significant methodological bias, and the observed correlations between physical exercise behavior, psychological resilience, social sensitivity, and need to belong were all statistically significant; (2) Based on the self-determination theory, this study elucidates the relationship between physical exercise behavior and psychological resilience among teenagers. The findings indicate that physical exercise behavior positively predicts the need to belong and psychological resilience, while negatively predicting social sensitivity. Similarly, social sensitivity negatively predicts the need to belong and psychological resilience. Moreover, the need to belong directly and positively predicts psychological resilience. Importantly, all hypotheses proposed in this paper were empirically supported. (3) The indirect effect of the path mediated by social sensitivity is 0.009, while the indirect effect of the path mediated by need to belong is 0.033. Additionally, the combined indirect effect of both social sensitivity and need to belong as mediating variables is 0.014. (4) The cumulative sum of all these indirect effects amounts to 0.056. Based on the self-determination theory, we propose a chain mediation model, specially, physical exercise behavior can significantly positively predict psychological resilience, among which, social sensitivity and need to belong play a significant mediating role between Physical exercise behavior and psychological resilience. In addition, the adoption of good physical exercise behavior can enhance the psychological resilience of adolescents by diminishing social sensitivity and augmenting the need to belong.

A quantile shift approach to main effects and interactions in a 2-by-2 design

When comparing two independent groups, shift functions are basically techniques that compare multiple quantiles rather than a single measure of location, the goal being to get a more detailed understanding of how the distributions differ. Various versions have been proposed and studied. This paper deals with extensions of these methods to main effects and interactions in a between-by-between, 2-by-2 design. Two approaches are studied, one that compares the deciles of the distributions, and one that has a certain connection to the Wilcoxon–Mann–Whitney method. There are many quantile estimators, but for reasons summarized in the paper, the focus is on using the Harrell–Davis quantile estimator used in conjunction with a percentile bootstrap method. Included are results comparing two methods aimed at controlling the probability of one or more Type I errors.

The effect of life events on NSSI: the chain mediating effect of sleep disturbances and PLEs among Chinese college students.

This study aimed to explore the relationship between life events and non-suicidal self-injury (NSSI) in college students, as well as the mediating effect of sleep disturbances and psychotic-like experiences (PLEs). After excluding invalid questionnaires, 5,754 were retained, and the valid efficiency was 75.94%. The subjects were aged 16 to 29 years (M = 19.166; SD = 1.392), with 1,969 males (34.22%) and 3,785 females (65.78%). Life events, sleep disturbances, PLEs, and NSSI were assessed using standard scales. Data were analyzed by Pearson Correlation Analysis and bias-correction percentile Bootstrap method. The results show that (1) life events were significant positive predictors of NSSI, sleep disturbances, and PLEs; (2) sleep disturbances, PLEs, and the chain mediation between the two, were mediators between life events and NSSI. Life events are thus shown to be an important external factor influencing NSSI in university students, and this process is mediated through sleep disturbances, PLEs, and the chain between the two. Interventions for NSSI can therefore be made by improving college students' sleep quality and reducing PLEs.

The mediating effect of life satisfaction between daily living abilities and depressive symptoms in the Chinese older people: evidence from CHARLS 2020.

Depressive symptoms represent a significant public health challenge, impacting the mental well-being of older adults. Despite this, the understanding of how activities of daily living (ADL) abilities correlate with life satisfaction and depressive symptoms among older Chinese adults remains limited. This study aims to investigate the relationship between ADL and depressive symptoms in older people Chinese individuals, with a specific focus on examining the mediating role of life satisfaction within this context. The study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2020. A cohort of 8,343 individuals aged 60 years and above was included. The analysis was conducted using STATA 17.0 and SPSS 26.0, employing descriptive statistics, chi-square tests, Pearson correlations, and mediation analysis using the percentile Bootstrap method with 5,000 resamples to explore the interrelations among ADL, life satisfaction, and depressive symptoms. ADL is positively correlated with life satisfaction (r = 0.129, p < 0.01) and negatively correlated with depressive symptoms (r = -0.313, p < 0.01). Additionally, life satisfaction and depressive symptoms are negatively correlated with each other (r = -0.360, p < 0.01). In the model of the mediating effect, ADL directly, significantly and negatively predicts depressive symptoms in the Chinese older people (β = -0.193, t = -17.827, p < 0.001). After incorporating life satisfaction into the regression equation, the direct predictive effect of ADL on depressive symptoms remains significant (β = -0.177, t = -17.099, p < 0.001); furthermore, ADL has a significant positive predictive effect on life satisfaction (β = 0.007, t = 4.959, p < 0.001) and life satisfaction significantly negatively predicts depressive symptoms (β = -2.235, t = -27.799, p < 0.001). Furthermore, the direct effect of ADL on depressive symptoms (-0.177) and its mediating effect (-0.016) account for 91.71% and 8.29% of the total effect (-0.193), respectively. ADL is inversely associated with the risk of depressive symptoms among older people Chinese individuals, with life satisfaction serving as a significant mediator in this relationship. Interventions aimed at improving life satisfaction in older people individuals with ADL impairments may effectively reduce or prevent the onset of depressive symptoms.

Reliability estimation stress–strength dependent model based on copula function using ranked set sampling

In the stress-strength reliability analysis, it is usually assumed that both stress and strength are independent variables. In most cases, stress and strength depend on each other. In this paper, Clayton copula function is selected when stress and strength variables follow Kumaraswamy distribution and Weibull distribution respectively, and the maximum likelihood estimate and least squares estimate of unknown parameters of stress-strength dependent model are derived by two-step method under ranked set sample. At the same time, the approximate confidence intervals are constructed by using the asymptotic distribution of maximum likelihood and the parametric bootstrap percentile method. In addition, the simulation results of simple random sample and ranked set sample are compared by Monte Carlo simulation method. Finally, a real case is selected to illustrate the feasibility of the proposed model.

A study on the effect of school and family environments and self-efficacy on health literacy of college students.

Health literacy is an important means to improve health outcomes and reduce health disparities. It plays an important role in promoting multiple health-related behaviors of individuals. Numerous studies have demonstrated a number of sociodemographic and school characteristics, and family related factors were related to health literacy among college students. However, these characteristics and factors were relatively unchangeable. Research on the relationship between factors, that can be intervened, and health literacy remains scarce. This study aims to explore the association between personal and changeable environmental factors, and the level of health literacy in college students. A cross-sectional study, which used a stratified random sampling method, was conducted at a university in Wuhan (N = 447). The survey questionnaire included sociodemographic characteristics, the School Environment Questionnaire, the Family Environment Questionnaire, the General Self-Efficacy Scale Questionnaire, and the Health Literacy Questionnaire. We used Spearman correlation tests, and Student's tests or analyses of variance to describe the relationship among continuous variables. In addition, we employed linear regression analysis to test the mediating effect based on the bias-corrected nonparametric percentile Bootstrap method. Factors related to socioeconomic status, such as living costs (p = 0.011), residential area (p = 0.003), annual household income (p = 0.001), and parents' education level (fathers: p = 0.001; mothers: p = 0.01) and occupation type (fathers: p < 0.001; mothers: p = 0.044), had close correlations with health literacy. School and family environments and self-efficacy had a positive impact on college students' health literacy (β = 0.235, p < 0.001; β = 0.323, p < 0.001; β = 0.489, p < 0.001). Self-efficacy had a mediating effect on the relationship between school and family environments, as well as health literacy. The total, direct, and indirect effects of the school environment on health literacy were 0.235, 0.157, and 0.078, respectively. The total, direct, and indirect effects of the family environment on health literacy were 0.323, 0.189, and 0.134, respectively. This study confirms that improving school and family environments could directly or indirectly increase college students' health literacy through promoting their self-efficacy. Socioeconomic status has a significant impact on their health literacy. Moreover, other factors that affect students' health literacy and relationships among self-efficacy, surrounding environments, and health literacy may need to be explored in the future.

Leaf-age and petiole biomass play significant roles in leaf scaling theory.

Foliage leaves are essential for plant survival and growth, and how plants allocate biomass to their leaves reveals their economic and ecological strategies. Prior studies have shown that leaf-age significantly influences leaf biomass allocation patterns. However, unravelling the effects of ontogeny on partitioning biomass remains a challenge because it is confounded by the effects of environmental factors. Here, we aim to elucidate whether leaf-age affects the allocation to the lamina and petiole by examining leaves of known age growing in the same general environmental context. We sampled 2698 Photinia serratifolia leaves developing in the same environment from April to November 2021, representing eight leaf-ages (n > 300 for each leaf-age). Petiole and lamina biomass, and lamina area were measured to evaluate the scaling relationships using reduced major axis regression protocols. The bootstrap percentile method was used to determine the differences in scaling exponents among the different leaf-ages. ANOVA with Tukey's HSD was used to compare the ratios of petiole and lamina biomass to lamina area across the leaf-ages. Correlation tests were used to determine if exponents, intercepts, and ratios differed significantly across the different leaf-ages. The data indicated that (i) the ratio of petiole and lamina biomass to lamina area and the scaling exponent of lamina biomass versus lamina area correlate positively with leaf-age, and (ii) the scaling exponent of petiole biomass versus lamina area correlates negatively with leaf-age. Leaf maturation process involves an inverse proportional allocation between lamina and petiole biomass for expanding photosynthetic area. This phenomenon underscores the effect of leaf-age on biomass allocation and the importance of adopting an ontogenetic perspective when entertaining plant scaling theories and unravelling the principles governing shifts in biomass allocation throughout the leaf lifespan.

Mediating role of physical activity in the relationship between psychological distress and intimate relationships among stroke patients.

Stroke patients often experience psychological distress, which can impact their intimate relationships with spouses, subsequently influencing their treatment and recovery. Physical activity is considered a key rehabilitation method for stroke patients. This paper aims to analyze whether psychological distress affects intimate relationship between spouses through physical activity. To explore the mediating effect of physical activity between psychological distress and intimate relationship in stroke patients. A total of 256 stroke patients who underwent treatment at the First People's Hospital of Shangqiu between July 2021 and July 2022 were enrolled in this study. The participants completed questionnaires, including the Kessler Psychological Distress Scale (K10), the Quality of Relationship Index (QRI), International Physical Activity Questionnaire, and a general information questionnaire. Data analysis were performed using SPSS 23.0. The Harman test was employed to detect common method deviations, and Spearman correlation was used for correlation analysis. The mediating effect was assessed using Process 3.4.1, with significance testing of the regression coefficients conducted using the bias-corrected percentile Bootstrap method (5000 iterations, 95% confidence interval). Statistical significance was set at P < 0.05. The results showed that patients scored an average of 21.61 ± 6.44 points on the K10, 32.40 ± 6.19 points on the QRI; the median physical activity level according to the International Physical Activity Questionnaire was 1861 (566, 2846) MET·min/w. The level of physical activity (the physical activity intensity of the patients reflected by the International Physical Activity Questionnaire-Long Form scale) negatively correlated with psychological distress and intimacy (P < 0.05), and positively correlated with each other (P < 0.05), with the correlation stronger at lower physical activity levels compared to higher ones. The mediating effect of physical activity between psychological distress and intimate relationship was calculated to be 40.23%. Bootstrap analysis further validated the results. The mediating effect of psychological distress on intimate relationships through physical activity level was -0.284, with a confidence interval of -0.409 to -0.163, excluding 0, confirming a significant mediating effect of psychological distress on intimate relationships. Physical activity significantly affects relationship between psychological distress and intimate relationships among stroke patients. Addressing the role of physical activity may have implications for improving patient outcomes and rehabilitation strategies.

Sleep Hygiene, Mediating the Association Between Circadian Typology and Psychological Distress: An Association Elicited by Mediation Analysis Model Among Young Sudanese Adults, 2022-2023

BACKGROUND: Circadian rhythms are regulated by genetic and environmental components. The association of intrinsic and extrinsic factor modulates physiological and individual sleep schedules sleep hygiene and even different chronotype. Evidence suggests evening-type individuals have a higher risk of reporting psychological distress than morning-type individuals. However, less is known regarding the underlying processes that might mediate this association among Sudanese young adults. This study aimed at assessing the mediating role of sleep hygiene on the relationship between circadian typology and psychological distress among young Sudanese adults. METHODS: This is a cross sectional study. Conducted among medical students, graduates and medical interns of Al-Neelain University. Between April and August 2022. Morningness–Eveningness 19 items Questionnaire (MEQ) was used to assess chronotype preference. Kessler10-item Questionnaire was used to assess Psychological Distress, and sleep hygiene index (SHI) was used to screen Sleep hygiene behaviors. Hayes PROCESS macro (model 4) was used to perform the mediation analysis. RESULTS: Among 303 medical students who complete the study questionnaire. Mean of age for study participants was (22.71±2.49). Sleep hygiene index mean score was (29.35±5.46) indicating poor sleep hygiene behaviors. Most of the population were Neutral in their circadian typology preference (58.1%). (89.8%) of our population had psychological distress, Chronotype correlated with severe psychological distress and poor sleep hygiene behaviors (r=-0.141, P&lt;0.05) (r=-0.292, P&lt;0.001) respectively. Poor sleep hygiene behaviors also correlated with severe psychological distress (r=0.466, P&lt;0.001). Individuals who were severely psychologically distressed mostly had higher sleep hygiene mean scores than normal individuals (29.35±5.46), (21.61±6.42) (p&lt;0.001). Sleep hygiene index scores were lower for Morning circadian typologies [definite Morning 22.50± (7.00), moderate morning 24.89± (5.63)] compared to evening typologies [definite evening 32.25± (4.43), moderate evening 29.00± (6.09)]. Which indicated good sleep hygiene behaviors for Morning chronotype groups. Figure 1.0 illustrates the distribution of mean sleep hygiene index scores across circadian preference groups. Multiple regression analysis results showed that there was no significant direct effect of chronotype on psychological distress β=-.0096, SE= .0496, t=-.1937, P=.8466, CI [-.1073-.0881]. We also found a significant indirect effect of sleep chronotype on psychological Distress (β=-0.113, SE=0.0265, CI [-.1698 - -.0649]. According to bias-corrected percentile bootstrap method the total effect was negatively significant, (β=-0.123, SE=0.0534, t=-2.30, p&lt;0.05, CI [-0.2280 - -0.0178], indicating a full complimentary mediation between evening chronotype and impaired psychological wellbeing through sleep hygiene behaviors. CONCLUSION: Sleep hygiene was found to mediate the correlation between eveningness and impaired psychological wellbeing, Improvement of Sleep hygiene behaviors is advised to enhance morning circadian typology as to prevent and reduce psychological distress. Interventions to enhance morning circadian typology should be prioritized to medical students, graduates and medical interns who are prone to eveningness to minimize the risk for psychological distress.

The mediating effect of personality on mental workload and perceived professional benefits of nurses in East China

BackgroundNursing work is a work with high-stress load, and nurses with different personality may have different subjective feelings about their workload. Therefore, it is particularly necessary to comprehend the perceived professional benefits of nurses engaged in nursing work under high-pressure background, especially during the epidemic period. This study explored the relationship between mental workload, personality, and perceived professional benefits of nurses, and offer advices for the intervention of nurses with different personality to improve their perceived professional benefits.Materials and methodsIn this study, we used a cross-sectional study with a convenient sampling. 473 in-service nurses in Class A tertiary hospitals of Zhejiang Province were recruited by using the NASA Mission Load Index scale of nurses, the brief version of China’s Big Five Personality Questionnaire, and the Nurses’ perceived professional benefits questionnaire from July 2020 to March 2021. Sample size is 54.91%, and the response rate is 100%. Cronbach’s alpha method was used to evaluate the reliability of the instruments. Descriptive statistical analysis was used to describe the socio-demographic data of the subject, and scores for research variables. The Mann-Whitney U-test, and Kruskal-Wallis H rank-sum test were used to compare the scores of perceived professional benefits with different demographic characteristics. Correlation analysis results were presented as the Spearman correlation coefficient. The plug-in v2.16.3 provided by SPSS software was used for linear regression analysis, and the deviation-corrected percentile Bootstrap method was used to examine the mediating role of personality (neuroticism, conscientiousness, agreeableness, openness and extroversion).ResultsAge, length of service in nursing, and record of formal schooling can affect nurses’ perceived professional benefits. Mental workload, and perceived professional benefits were all above the median value. The mental workload was negatively correlated with perceived professional benefits (r= -0.129, P < 0.01), positively correlated with neuroticism (r = 0.242, P < 0.01), negatively correlated with agreeableness, openness, extroversion (r=-0.229~-0.221, P < 0.01), and negatively correlated with conscientiousness, but the differences were not significant. Nurses’ perceived professional benefits were negatively correlated neuroticism (r=-0.109, P < 0.05), but positively associated with conscientiousness, agreeableness, openness, and extroversion (r = 0.098 ~ 0.326, P < 0.05). The mental workload can directly affect the perceived professional benefits in the direct effects, and can also affect the it through the mediating effect of agreeableness, extroversion, neuroticism, and openness.ConclusionsAge, length of service in nursing, and record of formal schooling could affect nurses’ perceived professional benefits, and personality played a partial mediating role in the influence of mental workload on the perceived professional benefits. The results of this study can provide strategies for nurses’ human resource management. According to different demographic factors, and personality, various measures should be taken to guide nurses to evaluate the mental workload correctly, reduce their emotional pressure, increase job resources, and improve their perceived professional benefits.

An alternative derivation of weak convergence concerning quasi-likelihood estimation with a small-sample correction for simultaneous testing

Often arises in counting data analysis that both violation of distributional assumption and large-scale over-dispersion substantially impair the validity of the methods for multiple comparisons. For over-dispersed data fitting to the generalized linear models, we describe the simultaneous inference method in assessing a sequence of estimable functions based on the root using the quasi-likelihood estimation of the regression coefficients. A new method for deriving the limiting distributions of the score function and the root under a list of mild regularity conditions is presented. This approach has a close connection to the asymptotic normality of the root in general linear models that it provides a heuristic analogy for classroom presentation. Hence, researchers can routinely estimate quantiles based on the limiting distribution of the root for simultaneous inference. We apply the percentile bootstrap method to estimate the quantiles as a resampling-based alternative. As will be shown, the simultaneous test based on both the approximation methods above is anti-conservative in designs with small sample sizes. We propose the simultaneous testing method using Efron's bias-corrected percentile bootstrapping procedure as an improvement. In small-sample designs, we demonstrate through the simulation study that the proposed method provides a viable alternative to the large-sample and the percentile bootstrap approximation methods. Moreover, the proposed method persists in controlling the familywise error rate in simultaneous testing for highly over-dispersed data from substantially small-sample designs, where the percentile-t bootstrap method provides a liberal test.

The Effect of Shared Decision-Making by Mental Health Nurses on Medication Adherence in Patients with Alcohol Use Disorders: Provider-Patient Communication Pathway Model

The involvement of patients with mental health issues in their own treatment decision-making has often been overlooked. This study aimed to investigate the impact of shared decision-making between mental health nurses and patients with alcohol use disorders (AUD) on medication adherence. The provider-patient communication pathway model was utilized to examine the ways in which therapeutic communication strategies employed by mental health nurses positively influence medication adherence. The study employed a percentile bootstrap method and pairwise comparison tests in structural equation modeling. The results revealed that shared decision-making between AUD patients and mental health nurses directly enhanced medication adherence, as well as indirectly influenced adherence through the mediating factors of therapeutic alliance and alcohol abstinence self-efficacy. These findings hold both theoretical and practical implications for involving patients with AUD in therapeutic decision-making within psychiatric and mental health nursing settings, as well as for improving medication adherence among this patient population.

Path Analysis of Self-Efficacy, Coping Style and Resilience on Depression in Patients with Recurrent Schizophrenia.

Based on the two mediating variables of self-efficacy and coping style, a multiple mediating model was constructed to explore the mechanism by which psychological resilience affects depression in patients with recurrent schizophrenia. A total of 210 patients with recurrent schizophrenia who were hospitalized in a tertiary hospital in Hunan Province, China, were enrolled. The Connor Davidson Resilience Scale (CD-RISC), Self-rating Depression Scale (SDS), General Self-Efficacy Energy Scale (GSES) and Simplified Coping Style Questionnaire (SCSQ) were used to evaluate resilience, self-efficacy, coping style and depression. Path analysis was performed by constructing a structural equation model, and the mediating effect between variables was verified by the bias-corrected nonparametric percentile bootstrap method. Resilience, self-efficacy and positive coping together explained 53.2% of the variance in depression. (1) The total scores of self-efficacy, coping style, resilience and depression in patients with recurrent schizophrenia were 2.54±0.61, 31.73±9.62, 58.06±17.26 and 50.48±12.55, respectively. (2) Pearson analysis showed that the scores of self-efficacy, positive coping, resilience and depression were significantly correlated with depression (r=-0.24-0.51, P<0.01). (3) The path analysis showed that resilience directly affects depression (β=-0.401); additionally, resilience indirectly affects depression through self-efficacy (β=-0.179) and through the chain mediating effect of self-efficacy and positive coping style (β=-0.024). There is a high incidence of depression in patients with recurrent schizophrenia in China, and intervention is needed. This research revealed that resilience directly affects depression in patients with recurrent schizophrenia and that self-efficacy and positive coping play a part in mediating resilience and depression in patients with recurrent schizophrenia in China. Implementing targeted interventions based on action paths to improve the level of resilience and reduce the incidence of depression has guiding significance in the field of occupational rehabilitation of patients with recurrent schizophrenia.