Hierarchical Regression Research Articles

Pre-disaster income inequality and post-disaster mental health: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami

BackgroundWe sought to test the hypothesis that communities with a high degree of income inequality are ill-equipped to deal with crises. Specifically, we tested whether pre-disaster higher income inequality increases the risk of worse mental health conditions in the aftermath of disaster. MethodsWe examined the association between pre-disaster community income inequality and post-disaster mental health outcomes in a prospective cohort study of older adults (≥65 years) who survived the 2011 Great East Japan Earthquake. The baseline survey of participants (completed in 2010) predated the disaster by seven months. Survivors completed three waves of post-disaster surveys in 2013, 2016, and 2019. To assess the level of income inequality, the Gini index was calculated using individual income data in 2010 aggregated to 98 communities (range 0.05–0.50: median = 0.32) and categorized into tertiles (low, middle, high). Depressive symptoms and post-traumatic stress symptoms (PTSS) were assessed in the three post-disaster surveys using validated instruments. Multilevel analysis was conducted adjusting for pre-disaster characteristics. ResultsHigher levels of community income inequality were associated with higher PTSS scores across time (2013: β = 0.14, 95%CI = −0.01, 0.29; 2016: β = 0.16, 95%CI = 0.03, 0.29; 2019: β = 0.12, 95%CI = −0.01, 0.24). The association between income inequality and mental health was partly attenuated by adding the change in social capital to the model (2013: β = 0.14, 95%CI = -0.01, 0.29; 2016: β = 0.15, 95%CI = 0.03, 0.28; 2019: β = 0.11, 95%CI = -0.01, 0.22). ConclusionOur findings suggest that pre-disaster income inequality may explain PTSS symptoms in the aftermath of a disaster, and the relation may be mediated by disaster-related change. Further study to reveal its mechanism is needed for the policy recommendation.

Do nurse spiritual responses to trauma explain nurse outcomes? A correlational observational study

BackgroundVarious facets of spirituality are associated with wellbeing. Given the current urgency to promote nurse wellbeing, nurse spirituality merits exploration. PurposeTo investigate how spiritual distress and growth (i.e., spiritual/religious struggle, moral injury, post-traumatic growth) contributed to nurse outcomes (i.e., burnout, job satisfaction, intent to leave). MethodsRNs providing direct patient care in three Southern California hospitals completed an online survey that included psychometrically robust measures. Hierarchical multiple regression analyses were used to test spiritual variables as predictors of nurse outcomes after accounting for demographic and work-related factors. FindingsIn this sample of 531 demographically diverse RNs, spiritual struggle contributed to burnout and turnover intention; posttraumatic growth and employer respect for nurse wellbeing contributed to all three nurse outcomes. DiscussionSpiritual distress and growth are understudied but potentially important influences on job outcomes for nurses. Results here suggest that continued development of interventions to address spiritual health is worth investment.

The relationships among family function, psychological resilience, and social network of patients with chronic disease in the community

This study aimed to examine the relationships among family function, psychological resilience, and social network of patients with chronic disease in the community and to further identify whether psychological resilience played a mediating role in the relationship between family function and social network. A cross-sectional survey including 460 convenient samples of patients with chronic disease in four Chinese communities was conducted using a general characteristics questionnaire, the Family APGAR Index, the Connor-Davidson Resilience Scale, and the Lubben Social Network Scale 6. Data were analyzed using descriptive analysis, Student's t-test, one-way ANOVA, Pearson/Spearman correlation, hierarchical multiple regression analysis, and mediation analysis using the PROCESS macro. Family function, psychological resilience, and social network were significantly related. Psychological resilience partially mediated the relationship between family function and social network. Interventions designed to enhance family function and psychological resilience may improve social network among patients with chronic disease in the community.

Multilevel hybrid handcrafted feature extraction based depression recognition method using speech

Background and purposeDiagnosis of depression is based on tests performed by psychiatrists and information provided by patients or their relatives. In the field of machine learning (ML), numerous models have been devised to detect depression automatically through the analysis of speech audio signals. While deep learning approaches often achieve superior classification accuracy, they are notably resource-intensive. This research introduces an innovative, multilevel hybrid feature extraction-based classification model, specifically designed for depression detection, which exhibits reduced time complexity. Materials and methodsMODMA dataset consisting of 29 healthy and 23 Major depressive disorder audio signals was used. The constructed model architecture integrates multilevel hybrid feature extraction, iterative feature selection, and classification processes. During the Hybrid Handcrafted Feature (HHF) generation stage, a combination of textural and statistical methods was employed to extract low-level features from speech audio signals. To enhance this process for high-level feature creation, a Multilevel Discrete Wavelet Transform (MDWT) was applied. This technique produced wavelet subbands, which were then input into the hybrid feature extractor, enabling the extraction of both high and low-level features. For the selection of the most pertinent features from these extracted vectors, Iterative Neighborhood Component Analysis (INCA) was utilized. Finally, in the classification phase, a one-dimensional nearest neighbor classifier, augmented with ten-fold cross-validation, was implemented to achieve detailed, results. ResultsThe HHF-based speech audio signal classification model attained excellent performance, with the 94.63 % classification accuracy. ConclusionsThe findings validate the remarkable proficiency of the introduced HHF-based model in depression classification, underscoring its computational efficiency.

Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke.

Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations. To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke. This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables. Community. 39 people with stroke. We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities). We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = -0.05 to -0.07, p < .001) and satisfaction (β = -0.04 to -0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = -0.01, p < .001) and emotion regulation (β = -0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke. Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

The effects of family, culture and sex on linguistic development across 20 languages.

Languages vary in their complexity; caregivers vary in the way they structure their communicative interactions with children; and boys and girls can differ in their language skills. Using a multilevel modelling approach, we explored how these factors influence the path of language acquisition for young children growing up around the world (mean age 2-years 9-months; 56 girls). Across 43 different sites, we analysed 103 mother-child pairs who spoke 3,170,633 utterances, 16,209,659 morphemes, divided across 20 different languages: Afrikaans, Catalan, Cantonese, Danish, Dutch, English, Farsi, French, German, Hebrew, Icelandic, Irish, Italian, Japanese, Mandarin, Norwegian, Portuguese, Spanish, Swedish and Turkish. Using mean length of utterance (MLU) as a measure of language complexity and developmental skill, we found that variation in children's MLU was significantly explained by (a) between-language differences; namely the rate of child MLU growth was attuned to the complexity of their mother tongue, and (b) between-mother differences; namely mothers who used higher MLUs tended to have children with higher MLUs, regardless of which language they were learning and especially in the very young (<2.5 years-old). Controlling for family and language environment, we found no evidence of MLU sex differences in child speech nor in the speech addressed to boys and girls. By modelling language as a multilevel structure with cross-cultural variation, we were able to disentangle those factors that make children's pathway to language different and those that make it alike. RESEARCH HIGHLIGHTS: The speech of 103 mother-child pairs from 20 different languages showed large variation in the path of early language development. Language, family, but not the sex of the child, accounted for a significant proportion of individual differences in child speech, especially in the very young. The rate at which children learned language was attuned to the complexity of their mother tongue, with steeper trajectories for more complex language. Results demonstrate the relative influence of culture, family, and sex in shaping the path of language acquisition for different children.

Multidimensional structural racism and estimated cancer risk from traffic-related air pollution.

Traffic-related air pollutants have been associated with a variety of adverse human health impacts, including cancers. In the United States, numerous studies have documented racial inequities in neighborhood exposures to traffic-related air pollution. Emerging evidence suggests that structural racism may influence neighborhood exposures to air pollutants. However, existing research has largely focused on residential racial segregation, one indicator of structural racism. This study developed a multidimensional measure of structural racism to examine the relationship between structural racism and estimated cancer risk from air pollutants in Georgia. Carcinogenic air toxics data were obtained from the US Environmental Protection Agency's 2019 Air Toxics Screening Assessment and sociodemographic data from the American Community Survey. Guided by stakeholder input, county-level data on residential segregation, education, employment, incarceration, economic status, political participation, and homeownership were used to create a multidimensional county-level structural racism index. Relative risks (RRs) were estimated for associations between structural racism and elevated (top 10% in Georgia) estimated cancer risk from air toxics. Multilevel analyses revealed a significant association between multidimensional structural racism and exposure to carcinogenic traffic-related air pollutants. Neighborhoods in the highest quartile of structural racism exhibited an elevated cancer risk from traffic-related air pollutants (RR,7.84; 95% CI,5.11-12.05) compared to neighborhoods with lower levels of structural racism. Multidimensional structural racism was associated with estimated cancer risk from traffic-related air pollution in Georgia. Findings can inform future studies and policy interventions that address racial inequalities in exposure to traffic-related air pollution.

Factors Influencing Radiation Protection Behavior of Nurses in Intensive Care Units

Purpose : The purpose of this study was to identify the factors that influence the behavior of intensive care unit (ICU) nurses regarding radiation protection, and to provide basic data to improve radiation protection educational programs. Methods : This descriptive research study included 143 nurses working in ICUs. Data were collected through a self-reported structured questionnaire and analyzed using t-test, Pearson’s correlation coefficients, and hierarchical multiple regression analysis. Results : Radiation protection environment (&lt;i&gt;β&lt;/i&gt;=.35, &lt;i&gt;p&lt;/i&gt;=.001), radiation protection self-efficacy (&lt;i&gt;β&lt;/i&gt;=.25, &lt;i&gt;p&lt;/i&gt; =.002), type of hospital (&lt;i&gt;β&lt;/i&gt;=-.25, &lt;i&gt;p&lt;/i&gt;=.002) and experience in ICU (&lt;i&gt;β&lt;/i&gt;=-.18, &lt;i&gt;p&lt;/i&gt;= .022) affected the radiation protection behavior of ICU nurses. The total explanatory power of model was 60.0% (R&lt;sup&gt;2&lt;/sup&gt;=.64, Adj. R&lt;sub&gt;2&lt;/sub&gt;=.60, F=17.71, &lt;i&gt;p&lt;/i&gt;＜.001). Conclusion : In order to enhance the standards of radiation protection behavior among intensive care unit nurses and improve radiation protection self-efficacy, educational and training programs should be developed. Additionally, administrative support should be considered to create environments with better radiation protection at the organizational level.

Multilevel analysis of factors affecting the interhospital transfer of high-acuity pediatric patients: a focus on severe pediatric emergency patients

Purpose: The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED).Methods: Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable.Results: A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%).Conclusion: This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts.

The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self-reported health problems of midlife adults with and without a history of PAE to describe these outcomes. Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol-exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors. Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol-exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS). Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors.

Do commitment and asset specificity serve as the double-edged sword to assist co-production in enhancing value co-creation? A dyadic approach in Taiwan

PurposeValue, also known as co-creation, is recognized as the outcome of collaborative efforts between both parties. However, knowledge is currently limited regarding the motivations and mechanisms driving customers to engage in co-production and value co-creation. Therefore, the current study aims to investigate co-production in enhancing value co-creation. Previous research has predominantly explored the linear effects of commitment and asset specificity on co-production. To expand on this foundation, our study goes a step further by including the potential quadratic effects of commitment and asset specificity on co-production. Although moderate levels of commitment and asset specificity may enhance co-production, higher levels are implied to possibly impede it. Considering that co-production requires collaboration between customers and service employees, this study includes the characteristics of service employees, such as self-monitoring and self-efficacy, identifying their moderating roles in aiding active co-production and ultimately enhancing the value co-creation.Design/methodology/approachWe employed linear, nonlinear and hierarchical moderated regression analysis to test our hypotheses.FindingsOur findings provide evidence for the positive linear effects and negative quadratic effects between commitment, asset specificity and co-production. The inverted-U relationships suggest an existing optimal commitment and asset specificity that maximize co-production. Results also suggest that co-production influences value co-creation and self-efficacy and self-monitoring positively moderates the relationship between co-production and value co-creation.Originality/valueBy applying the core provisions of S-D logic, this study contributes to marketing literature by analyzing the dyadic process of co-production. Dyadic data collection from both customers and service employees provides a comprehensive understanding of the co-production process, allowing academics to recognize service employees’ self-efficacy and self-monitoring that contribute to effective co-production and value co-creation in service processes.

Regional distribution and factors associated with early marriage in Ghana: a cross-sectional study

BackgroundEarly marriage, the formal or informal union before age 18, remains a critical challenge in several low-and middle-income countries. It has adverse health and education-related implications on child brides. This study examined the regional distribution of early marriage and its associated factors in Ghana.MethodsWe performed a cross-sectional analysis of data extracted from the 2022 Ghana Demographic and Health Survey. Our study comprised 10,098 ever married/cohabiting aged 15 to 49. Regional variations in the prevalence of child marriage were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with early marriage. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of early marriage was 29.2% [27.9, 30.6] in Ghana. Women in the North East 38.2% [33.4, 43.2], Western North 36.7% [32.1, 41.5] and Ahafo regions 35.8% [32.0, 39.8] had the highest prevalence of early marriage, whilst women in the Western 22.2% [18.4, 26.5] and Greater Accra 19.7% [15.8, 24.3 regions] had the lowest prevalence of early marriage in Ghana. The odds of early marriage was lower among women aged 20-49 compared to those aged 15-19. Women with secondary [aOR = 0.40; 95% CI 0.33, 0.48] and higher education [aOR = 0.07; 95% CI 0.04, 0.12], those who belonged to the Gurma ethnic group [aOR = 0.59; 95% CI 0.41, 0.84], and women from richer [aOR = 0.64; 95% CI: 0.47, 0.87] and richest [aOR = 0.42; 95% CI 0.28, 0.64] households were less likely to be married early compared to those with no education, those belonging to the Akan ethnic group, and those from the poorest wealth quintile households, respectively. The odds of early marriage was higher among women whose family size was five or more [aOR = 1.50; 95% CI 1.31, 1.72] and women living in the Central [aOR = 1.72; 95% CI 1.16, 2.54], Volta [aOR = 1.97; 95% CI 1.17, 3.30], Eastern [aOR = 1.53; 95% CI 1.01, 2.29], Ashanti [aOR = 1.98; 95% CI 1.33, 2.97], Western North [aOR = 1.77; 95% CI 1.18, 2.65], and Ahafo regions [aOR = 1.74; 95% CI 1.18, 2.56].ConclusionAbout one in three marriages were early in Ghana, with variations across the regions. Age, wealth index, ethnicity, level of education, family size, and region were identified as factors associated with early marriages. The government and policymakers in Ghana should increase access to and completion of secondary education for girls, as it is crucial in reducing early marriage. Providing programmes that economically empower women and girls can decrease their vulnerability to early marriage. More vigorous enforcement of laws against early marriage is necessary. Engaging with communities, including tribal leaders, is essential to shift cultural attitudes toward early marriage.

Correlates of Emotional and Tangible Reciprocity in Adult Siblings of Individuals With Autism.

Sibling relationships often involve exchanges of emotional and tangible support. When one sibling has a disability, the nature of the reciprocity of such support may differ from sibling pairs wherein no disability is present. Specifically, when an individual has autism, the nature of emotional and tangible reciprocity is unclear given the potential for a supportive or caregiving role of the sibling without autism. In this study, 256 adult siblings of autistic individuals completed a national survey. Analyses included descriptive statistics describing the nature of reciprocity and hierarchical regressions to identify the correlates of emotional and tangible reciprocity. Overall, participants often reported not giving or receiving much tangible support to/from their autistic sibling while they often gave and, to some extent received, emotional support from their autistic sibling. When the autistic sibling had more asocial behaviors, participants were more likely to provide emotional support than receive it. When participants engaged in more caregiving, they both gave and received more emotional and tangible support. Implications for research and practice are discussed.

Cultural Conversations in Therapy: How Often Clients Talk About Their Identities.

The purpose of this study was to examine how often clients report discussing cultural identities during counseling sessions; the extent to which discussion of cultural identities during treatment varies across therapists; whether identifying as BIPOC (Black, Indigenous, and people of color) predicts clients' discussion of cultural identities in sessions; and whether differences in the frequency of cultural conversations (i.e., dialogue that focuses on client cultural identities) across client groups depend on the therapist. This study examined variation in reports of engagement in cultural conversations during sessions (N=10,731) with 1,997 clients and 72 therapists from a university counseling center. Data were analyzed by using Bayesian multilevel models. Overall, clients reported having cultural conversations in 48.4% of sessions. Cultural conversations were much more likely to occur in sessions with BIPOC clients than with White clients: 66.2% of sessions with BIPOC clients involved conversations about cultural identities, compared with only 39.8% of sessions with White clients. Of note, the magnitude of this difference varied by therapist. Cultural conversations were more likely to occur in treatment with BIPOC clients than with White clients, and the presence of cultural conversations in treatment varied by therapist.

A Multi-level Reference Model and a Dedicated Method for Cyber-Security by Design

AbstractThe increased reliance of organizations on information technology inherently increases their vulnerability to cyber-security attacks. As a response, a host of cyber-security approaches exists. While useful, these approaches exhibit shortcomings such as an inclination to be fragmented, not accounting for up-to-date organizational data, focusing on singular vulnerabilities only, and being reactive, i.e., focusing on patching up vulnerabilities in current systems. The paper presents and evaluates a modeling method aiming to address those shortcomings and to support security by design with a focus on the electricity sector. The proposed modeling method encompasses a multi-level reference model reconstructing and integrating existing initiatives and supporting top-down and bottom-up analyses. Compared to earlier work, the paper contributes (1) a process model for cyber-security by design, which proactively considers security as a first-class citizen during the design process, (2) a complete coverage of the multi-level model, in terms of three views complementing the introduced process model, (3) an elaborated evaluation, in terms of reporting on an additional design science cycle.

The Impact of OER’s Continuous Improvement Cycles on Students’ Performance: A Longitudinal Analysis of the RISE Framework

Open educational resources (OER) have been praised for revolutionizing education. However, practitioners and instructors battle keeping OER updated and measuring their impact on students’ performance. Few studies have analyzed the improvement of OER over time in relation to achievement. This longitudinal study uses learning analytics through the open-source Resource Inspection, Selection, and Enhancement (RISE) analysis framework to assess the impact of continuous improvement cycles on students’ outcomes. Panel data (i.e., performance and use) from 190 learning objectives of OER of an introductory sociology course were analyzed using a hierarchical linear model. Results show that more visits to an OER do not improve student achievement, but continuous improvement cycles of targeted OER do. Iterative implementation of the RISE analysis for resource improvement in combination with practitioners’ expertise is key for students’ learning. Given that the RISE classification accounted for 65% of the growth of students’ performance, suggesting a moderate to large effect, we speculate that the RISE analysis could be generalized to other contexts and result in greater student gain. Institutions and practitioners can improve the OER’s impact by introducing learning analytics as a decision-making tool for instructional designers. Yet, user-friendly implementation of learning analytics in a “click-and-go” application is necessary for generalizability and escalation of continuous improvement cycles of OER and tangible improvement of learning outcomes. Finally, in this article, we identify the need for efficient applications of learning analytics that focus more on “learning” and less on analytics.

Pitfalls in the assessment of higher education learning gains in Brazil through multilevel regression: handling the ceiling effect.

This work assesses the validity of the Brazilian Indicator of the Difference between Observed and Expected Performances (IDD), which applies a multilevel regression model to rank university courses. It proposes a methodology to test for inconsistencies and research for the causes. With this objective, we develop an experimental methodology, applied to a database with 4,432 production engineering students distributed over 329 undergraduate courses, from the government’s National Institute for Educational Studies and Research. We display a graphical analysis of the expected and achieved grades in final graduation exams, the gap in which determines the learning gains for every course. Then we apply the multilevel linear regression model of the IDD in a particular scenario, to test for consistency in value-added learning measurements using the technique reductio ad absurdum. The result reveals that the present methodology for the calculation of the IDD is inadequate and inconsistent, and that this can be explained by the ceiling effect. It needs to be radically revised to prevent unfair judgements. Finally, we propose and implement a production frontier technique to correct for the ensuing ceiling effect, namely a variable returns to scale data envelopment analysis model for adjusting the measurements using evidence based benchmarks.

Revisiting happiness at work within the hospitality sector: revealing the power of ethical leadership and group diversity

PurposeIndividual happiness at the workplace allows hospitality organizations to foster an optimistic work environment and endorse the well-being of their employees, which is essential for achieving long-term success. While ethical leadership has been verified as an interpreter of happiness, however, enhancing employee happiness at work remains a gap. The current study seeks to fill this gap by utilizing a multilevel model of the direct and indirect relationship between ethical leadership and happiness at work and also the mediation of group diversity in this relationship.Design/methodology/approachThe study involved a cross-sectional study with a quantitative methodology. The authors collected data from 36 Jordanian hospitality teams. A total number of 960 participants were selected using the convenience sampling method. The model of the study was validated by multilevel structural equation modeling, and the hypothesized relationships were tested using SPSS 26.FindingsResults showed that ethical leadership directly promoted happiness and indirectly through group diversity. Moreover, group diversity was found to mediate this relationship.Practical implicationsFindings propose that leaders within hospitality organizations can attain happiness at work by showing more ethical leadership. Practitioners within the hospitality industry likewise ought to recognize that promoting altruistic attitudes among followers is capable of guiding ethical leadership into happiness at work. Moreover, building a developmental culture is crucial for hospitality teams to reinforce the impact of ethical leadership on happiness at work.Originality/valueThe current study magnifies the leadership-happiness research by unlocking both the direct as well as indirect links, the mediation effect, between ethical leadership and happiness at work.

Territorial health inequalities in breast cancer mortality across France from 1968 to 2017

Abstract Background Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, until 2016, included up to 8 departments. In this study, we analyze the evolution of between and within-region territorial inequalities in breast cancer mortality over 50 years. Methods We used direct and indirect standardization to analyze trends in breast cancer mortality for women aged 25 to 74 years between 1968 and 2017 in each department of metropolitan France. We analyzed the evolution of relative inequalities over time using standard errors of age-adjusted rates. We used multilevel Poisson regression to estimate how much the regional level contributed to territorial variation. Results Over the period 1968 to 1992, breast cancer standardized mortality ratios (SMRs) increased (+16%) while relative territorial inequalities decreased (-21%). After 1997, SMRs decreased (-23%) but territorial inequalities remained unchanged. In 18 out of 22 regions, inequalities were lower at the end than at the start of the study period. Period proved to be the most important determinant of variation in mortality. However, multilevel models also suggested that the regional level explained most of the remaining variation in each period (from 50% to over 80%). Conclusions Over the study period in most French regions, breast cancer mortality has decreased, and so have relative inequalities. Nevertheless, there is evidence that regions have performed differently. The proportion of variation explained by the regional level suggests the continued relevance of the health system on breast cancer mortality. Key messages • Territorial inequality in breast cancer mortality has decreased in France over the 1968-2017 period. • In most regions, disparities between departments have decreased.

Psychological Distress Changes During COVID-19: A Belgian Cohort Study On Psychosocial Factors

Abstract Longitudinal studies have identified an increase in psychological distress across the general population during the COVID-19 pandemic. Nevertheless, the trajectories of mental health outcomes exhibit variations, suggesting potential associations with psychosocial individual factors. This paper identifies the factors of this individual trajectory of psychological distress during the COVID-19 pandemic. Five waves of a prospective cohort survey were conducted with a convenience sample of the general population in Belgium between March 2020 and November 2021 (n = 4,550). Psychological distress was measured using the GHQ-12. Individual covariates included socioeconomic factors (age, gender, level of education), psychological factors (loneliness, social support, and social activities), and factors related to the virus and the lockdown measures (exposure to COVID-19 and survey wave). Multilevel models were used for analysis. Women and young people experienced more pronounced fluctuations in their risk of psychological distress across study waves, experiencing both increases and decreases. We found that individual variance in psychological distress breaks down into two components, respectively 43% for psychosocial factors (time-invariant) and 57% for the survey waves (time-variant) variation. A significant share of the time-invariant difference in psychological distress over COVID-19 is associated with loneliness, social support, and social activities. Loneliness emerged as the most important interpersonal factor associated with psychological distress. The change in psychological distress was mainly associated with psychosocial factors rather than with pandemic-related dynamics (e.g. survey waves). These findings suggest that mitigation policies aiming at controlling the pandemic should focus more on addressing specific individual vulnerabilities rather than solely responding to the fluctuations within pandemic waves to decrease their detrimental impact on mental health.