Agent-based modeling in cancer biomedicine: applications and tools for calibration and validation

Computational models are not just appealing because they can simulate and predict the development of biological phenomena across multiple spatial and temporal scales, but also because they can integrate information from well-established in vitro and in vivo models and test new hypotheses in cancer biomedicine. Agent-based models and simulations are especially interesting candidates among computational modeling procedures in cancer research due to the capability to, for instance, recapitulate the dynamics of neoplasia and tumor - host interactions. Yet, the absence of methods to validate the consistency of the results across scales can hinder adoption by turning fine-tuned models into black boxes. This review compiles relevant literature that explores strategies to leverage high-fidelity simulations of multi-scale, or multi-level, cancer models with a focus on verification approached as simulation calibration. We consolidate our review with an outline of modern approaches for agent-based models' validation and provide an ambitious outlook toward rigorous and reliable calibration.

The Use of Osteobiologics in Single versus Multi-Level Anterior Cervical Discectomy and Fusion: A Systematic Review

STUDY DESIGN

Systematic literature review.

OBJECTIVES

In this study we assessed evidence for the use of osteobiologics in single vs multi-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spine degeneration. The primary objective was to compare fusion rates after single and multi-level surgery with different osteobiologics. Secondary objectives were to compare differences in patient reported outcome measures (PROMs) and complications.

METHODS

After a global team of reviewers was selected, a systematic review using different repositories was performed, confirming to PRISMA and GRADE guidelines. In total 1206 articles were identified and after applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Extracted data included fusion rates, definition of fusion, patient reported outcome measures, types of osteobiologics used, complications, adverse events and revisions.

RESULTS

Fusion rates ranged from 87.7% to 100% for bone morphogenetic protein 2 (BMP-2) and 88.6% to 94.7% for demineralized bone matrix, while fusion rates reported for other osteobiologics were lower. All included studies showed PROMs improved significantly for each osteobiologic. However, no differences were reported when comparing osteobiologics, or when comparing single vs multi-level surgery specifically.

CONCLUSION

The highest fusion rates after 2-level ACDF for cervical spine degeneration were reported when BMP-2 was used. However, PROMs did not differ between the different osteobiologics. Further blinded randomized trials should be performed to compare the use of BMP-2 in single vs multi-level ACDF specifically.

Developing Water-Stable Pore-Partitioned Metal-Organic Frameworks with Multi-Level Symmetry for High-Performance Sorption Applications

A new perspective is proposed in the design of pore-space-partitioned MOFs that is focused on ligand symmetry properties sub-divided here into three hierarchical levels: 1) overall ligand, 2) ligand substructure such as backbone or core, and 3) the substituent groups. Different combinations of the above symmetry properties exist. Given the close correlation between nature of chemical moiety and its symmetry, such a unique perspective into ligand symmetry and sub-symmetry in MOF design translates into the influences on MOF properties. Five new MOFs have been prepared that exhibit excellent hydrothermal stability and high-performance adsorption properties with potential applications such as C₃ H₆ /C₂ H₄ and C₂ H₂ /CO₂ selective adsorption. The combination of high stability with high benzene/cyclohexane selectivity of ≈13.7 is also of particular interest.

Transformation of Task Conflict Into Relational Conflict and Burnout: Enhancing Effect of Leader's Discriminatory Effect

Organizational conflict was proposed by dividing it into task conflict and relationship conflict. However, conflict is dynamic and therefor, the conflict transformation is recognized as an important topic in organizational conflict. In particular, task conflict can be easily transformed into relationship conflict due to emotional expression and misattribution in the process of conflict. In addition, task conflict can negatively affect employees' attitudes if it is transformed into relationship conflict even though task conflict can function properly. This transformation of conflict can become more active under certain conditions, and leaders play an important role in this transformation because leaders have an important influence on conflict management. Therefore, this study examined the effect of the transition from task conflict to relationship conflict on burnout and the moderating effect of leaders in the relationship between task and relationship conflict. To this end, surveying 721 employees in 15 departments, and multilevel mediation and moderation analysis were performed. As a result of analysis, employees' burnout increased when task conflict transformed into relationship conflict. In addition, greater the LMX differentiation of leader, greater the effect of task conflict on relationship conflict. Finally, theoretical and practical implications were discussed for leadership and conflict management.

Married women pre-marital HIV testing status in Ethiopia: Individual and community level factor analysis

Introduction

Marriage between serodiscordant individuals accounts for 65-85% of new infections. Pre-marital Human Immune Virus (HIV) testing opens the door for HIV infection prevention and control. There are no studies that have evaluated the coverage and factors influencing pre-marital HIV testing at the community level in Ethiopia.

Methods

This study was conducted using 10,008 samples of data extracted from Ethiopian demographic and health surveys (EDHS), 2016. To identify individual and community level factors a multi-level binary logistic regression model was used. Among fitted models, "full" model was taken as the best model. To declare the presence or absence of significant association with pre-marital HIV testing, a p-value < 0.05 with confidence interval (CI) was used.

Results

In Ethiopia, 21.4% (95% CI: 20.6, 22.2%) of study participants had pre-marital HIV testing. Age 35-49 years (AOR = 0.25; 95% CI: 0.09, 0.66), educated (AOR = 1.76; 95% CI: 1.17, 2.79), rich (AOR = 1.95; 95% CI: 1.13, 3.55), having media exposure (AOR = 1.54; 95% CI: 1.30, 4.71), and high community level literacy (AOR = 0.38; 95% CI: 0.22, 0.66) were factors significantly associated with pre-marital HIV testing.

Conclusion

The low coverage of pre-marital HIV testing in Ethiopia is insufficient to have a significant influence on the HIV/Acquired Immune Deficiency Syndrome (AIDS) epidemic. Information dissemination to create awareness about human rights and public health implications of pre-marital HIV testing áre necessary while it is made mandatory.

MSLF-Net: A Multi-Scale and Multi-Level Feature Fusion Net for Diabetic Retinopathy Segmentation

Diabetic Retinopathy (DR) is a diabetic complication that predisposes patients to visual impairments that could lead to blindness. Lesion segmentation using deep learning algorithms is an effective measure to screen and prevent early DR. However, there are several types of DR with varying sizes and high inter-class similarity, making segmentation difficult. In this paper, we propose a supervised segmentation method (MSLF-Net) based on multi-scale-multi-level feature fusion to achieve accurate end-to-end DR lesion segmentation. MSLF-Net builds a Multi-Scale Feature Extraction (MSFE) module to extract multi-scale information and provide more comprehensive features for segmentation. This paper further introduces the Multi-Level Feature Fusion (MLFF) module to improve feature fusion using a cross-layer structure. This structure only fuses low- and high-level features of the same class based on category supervision, avoiding feature contamination. Moreover, this paper produces additional masked images for the dataset and performs image enhancement operations to ensure that the proposed method is trainable and functional on small datasets. The extensive experiments are conducted on public datasets IDRID and e_ophtha. The results showed that our proposed feature enhancement method can perform feature fusion more effectively. Therefore, In the end-to-end DR segmentation neural network model, MSLF Net is superior to other similar models in segmentation, and can effectively improve the DR lesion segmentation performance.

Influence of furrow irrigation regime on the yield and water consumption indicators of winter wheat based on a multi-level fuzzy comprehensive evaluation

Irrigation regimes should be chosen to maximize crop yield and water use efficiency. To realize high yield and efficient water use with the appropriate furrow irrigation regime, the effects of two regimes (alternate furrow irrigation and conventional furrow irrigation) and three lower soil moisture limits (60, 70, and 80%) were studied on winter wheat yield and water consumption using a multi-level fuzzy comprehensive evaluation method. The results show that under the two regimes, alternate furrow irrigation and conventional furrow irrigation, when the lower limit of the soil moisture is 70%, the harvest index (0.45 and 0.39, respectively) and crop water productivity of winter wheat (1.86 and 1.90 kg m⁻³, respectively) are highest. The comprehensive fuzzy evaluation model considers multiple measures, including yield, harvest indices, irrigation volume, total water consumption, and crop water productivity – the index values are highest at the 70% condition, which are 0.3468 and 0.3432, respectively. Therefore, it can be concluded that a moderate water deficit is conducive to saving water resources and improving water use efficiency. In conclusion, a multi-level and multi-factor indices system of furrow irrigation regime was constructed based on ensuring winter wheat production. Conventional furrow irrigation is recommended in areas with sufficient irrigation water, while alternating furrow irrigation, which can reduce the total amount of irrigation required, is suitable for areas with water shortages.

Multi-level classroom learning prepares nurses for future collaboration in palliative care: an educational initiative

BACKGROUND

Palliative care (PC) education should be an important part of both the graduate and undergraduate nursing curriculum. Nursing's philosophy of holistic care, which aims to improve the quality of life of patients and families, aligns with the primary objective of PC, positioning nurses to take the lead in expanding and improving PC delivery to all patients with a life-threatening diagnosis. The best way to facilitate this level of care is when staff nurses and advanced practice nurses work collaboratively.

AIM

To establish a new standard for nursing education that emphasises intradisciplinary care.

METHODS

To fill the gap in PC education for nursing students, a dedicated elective PC class was developed for undergraduate and graduate students at a large midwestern University in the United States.

FINDINGS

Through an interactive approach to learning, both groups were able to experience and more fully understand how they would work collaboratively with each other to provide high-quality PC.

CONCLUSIONS

Intradisciplinary PC education is an opportunity for students to learn the precepts of PC in an environment that will mirror their post-graduation practice environment.

Short-term post-operative complications in 207 patients with multi-level degenerative cervical myelopathy: the effect of surgical approach

INTRODUCTION

Degenerative cervical myelopathy (DCM) is a common condition often treated by surgical decompression and fusion. The objective of this paper was to compare short-term post-operative complication rates of patients with multi-level DCM treated with decompression and fusion using either an anterior or a posterior cervical approach.

MATERIAL AND METHODS

A retrospective evaluation of patients' charts, imaging studies and operative reports of patients operated for multilevel subaxial DCM from 2011 to 2016 at a single institution was performed. Patients who were operated upon for the treatment of three stenosed spinal levels or above and who underwent anterior cervical discectomy and fusion, or anterior cervical corpectomy and fusion, or posterior cervical laminectomy and fusion, were included. Short-term post-operative complications were compared between the anterior and posterior approaches.

RESULTS

Overall, 207 patients were included in this study. 156 were operated via an anterior approach and 51 via a posterior approach. The mean number of treated levels was 3.4 and 4.3 for the anterior and posterior approach groups, respectively (p < 0.001). In the posterior approach group, the proportion of stenosed spinal levels within all operated levels was significantly lower than in the anterior approach group (p = 0.025). Early post-operative neurological status change was favourable for both groups. Deep wound infection rate was significantly higher in the posterior approach group (7.8% vs. none; p = 0.001).

CONCLUSIONS

Posterior cervical laminectomy and fusion is significantly associated with an increased rate of deep wound infection and wound revision surgery compared to the anterior approach. We recommend the anterior approach as the valid option in treating multi-level DCM.

Wearable RGO/MXene Piezoresistive Pressure Sensors with Hierarchical Microspines for Detecting Human Motion

Flexible piezoresistive pressure sensors may exhibit excellent sensing performances to be applied in wearable electronics, medical diagnosis, and electronic skin. Herein, we report a multi-layer and phased-responsive reduced graphene oxide/MXene-based piezoresistive pressure sensor with hierarchical microspines constructed by sandpaper as the template. Thanks to the multi-level and multi-layer structure, the obtained sensor realized phased response and showed wide detection range (up to 70 kPa), fast response (response/recovery time of 40/80 ms), and excellent working stability (1000 fatigue cycles). Furthermore, the sensor was successfully applied for detecting various human motions including pulse beats, cheek bulging, nodding, finger bending, speech recognition, handwriting, and other pressure signals. Besides, a 6 × 6 sensing matrix integrated by the sensors was able to sensitively perceive the distribution of plane pressure. The findings in this work conceivably stand out as a new strategy to fabricate high-performance piezoresistive pressure sensors in the fields of intelligent healthcare and medical diagnosis, wearable electronic devices, electronic skin, and human-machine interaction.

The Multilevel Study on the Impact of High-Performance Human Resource Practices on Employees' Voice Behavior: A Moderated Mediation Model

Based on the social identity theory, the relationship and influencing mechanism between high-performance human resource practices (HPHRPs) and employees’ voice behavior were explored by constructing a moderated mediation model, and the relationship between the field of human resources and the field of organizational behavior was also established. Through 1,178 paired samples of supervisor-employee survey and multilevel linear model analysis technology, it was found that (1) HPHRPs had a positive impact on employees’ voice behavior; (2) perceived insider status played a mediating role between HPHRPs and voice behavior; (3) voice efficacy played a moderating role between perceived insider status and voice behavior; and (4) voice efficacy played a mediating role in the relationship between “HPHRPs-perceived insider status-voice behavior.”

[Predictors Of The Use Of Prenatal Care Among Women Who Have Given Birth In Burundi: A Multilevel Analysis]

OBJECTIVE

Identify the predictors of the use of antenatal care in Burundi.

DATA AND METHODS

This were an analysis of secondary data from the 2016 - 2017 demographic and health surveys in Burundi. The survey population was women who gave birth in the last five (05) years prior to the survey and gave their informed consent. Our sample consisted of 7,372 women. The data were analyzed with Stata 15.1 software. In bivariate analysis, the Chi-2 test, and simple logistic regression allowed us to identify the candidate variables for modelling at the 20% threshold. Multilevel ordinal logistic regression identified individual and contextual predictors of prenatal care use.

RESULTS

The use of antenatal care by women who gave birth in Burundi was influenced by the area of residence (rural area : OR=1.25; 95% CI [1.05 - 1.49]), level of education (secondary level: OR=1.36; 95% CI [1.12 - 1.65]), parity (OR=0.77; 95% CI [0.68 - 0.87]), HIV transmission during pregnancy (OR=1.22; 95% CI [1.06 - 1.41]) and internet use frequency (OR=1.60; 95% CI [1.16 - 2.20]). The intraclass correlation coefficient was (Ii 3 = 0.0050083).

CONCLUSION

Consideration of these determinants in the development of strategies to improve antenatal care utilization is necessary.

The Demand Supply Steady-State Process-Based Multi-Level Spare Parts Optimization

Spare parts are one of the important components of the equipment comprehensive support system. Spare parts management plays a decisive role in achieving the desired availability with the minimum cost. With the equipment complexity increasing, the price of spare parts has risen sharply. The traditional spare parts management makes the contradiction between fund shortage and spare parts shortage increasingly prominent. Based on the analysis of the multi-echelon and multi-indenture spare parts support model VARI-METRIC (vary multi-echelon technology for recoverable item control, VARI-METRIC), which is widely used by troops and enterprises in various countries, the model is mainly used in high system availability scenarios. However, in the case of low equipment system availability, the accuracy and cost of model inventory prediction are not ideal. This paper proposed the multi-level spare parts optimization model, which is based on the demand-supply steady-state process. It is an analytical model, which is used to solve the low accuracy problem of the VARI-METRIC model in the low equipment system availability. The analytical model is based on the multi-level spare parts support process. The article deduces methods for solving demand rate, demand–supply rate, equipment system availability, and support system availability. The marginal analysis method is used in the model to analyze the spare parts inventory allocation strategy’s current based cost and availability optimal value. Finally, a simulation model is established to evaluate and verify the model. Then, the simulation results show that, when the low availability of equipment systems are 0.4, 0.6, the relative errors of the analytical model are 3.54%, 3.86%, and its costs are 0.52, 1.795 million ¥ RMB. The experiment proves that the inventory prediction accuracy of the analytical model is significantly higher than that of the VARI-METRIC model in low equipment system availability. Finally, the conclusion and future research directions are discussed.

Perceptions of Customer Incivility, Job Satisfaction, Supervisor Support, and Participative Climate: A Multi-Level Approach

Perceived customer incivility can be a significant day-to-day demand that affects frontline service employees’ job satisfaction. The current research focuses on job resources on multiple levels that serve as buffers in the face of this demand. We tested a multi-level model in which supervisor support (at the employee level) and participative climate (at the work-unit level) moderate the negative relationship between perceived customer incivility and job satisfaction. We used multi-level analysis with self-reported cross-sectional data collected from 934 employees nested in 107 work units of a large clothing shop chain in Belgium. The results showed that both supervisor support and participative climate moderate the negative relationship between perceived customer incivility and job satisfaction. The theoretical contribution of this study resides in an extension of the JD-R theory to simultaneously conceptualize resources on multiple levels. In the meantime, we focus on practical, hands-on resources that organizations can implement to protect service employees from the adverse effects of perceived customer incivility.

A Low-Power RRAM Memory Block for Embedded, Multi-Level Weight and Bias Storage in Artificial Neural Networks

Pattern recognition as a computing task is very well suited for machine learning algorithms utilizing artificial neural networks (ANNs). Computing systems using ANNs usually require some sort of data storage to store the weights and bias values for the processing elements of the individual neurons. This paper introduces a memory block using resistive memory cells (RRAM) to realize this weight and bias storage in an embedded and distributed way while also offering programming and multi-level ability. By implementing power gating, overall power consumption is decreased significantly without data loss by taking advantage of the non-volatility of the RRAM technology. Due to the versatility of the peripheral circuitry, the presented memory concept can be adapted to different applications and RRAM technologies.

The Influence of Nursing Home, Ward, and Eldercare Workers on the Number of Resident Handlings Performed per Shift in Eldercare

The purpose of our study was to investigate which organizational levels and factors determine the number of resident handlings in eldercare. We conducted a multi-level study, stratified on day and evening shifts, including information on four levels: nursing homes (n = 20), wards within nursing homes (day, n = 120; evening, n = 107), eldercare workers within wards (day, n = 619; evening, n = 382), and within eldercare workers (i.e., days within eldercare workers; day, n = 5572; evening, n = 2373). We evaluated the influence of each level on the number of resident handlings using variance components analysis and multivariate generalized linear mixed models. All four levels contributed to the total variance in resident handlings during day and evening shifts, with 13%/20% at “nursing homes”, 21%/33% at “wards within nursing homes”, 25%/31% at “elder-care workers within wards”, and 41%/16% “within eldercare workers”, respectively. The percentage of residents with a higher need for physical assistance, number of residents per shift, occupational position (only within day shifts), and working hours per week (only within day shifts) were significantly associated with the number of resident handlings performed per shift. Interventions aiming to modify number of resident handlings in eldercare ought to target all levels of the eldercare organization.

The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion. Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.

Nitrogen Fertilisation Increases Specific Root Respiration in Ectomycorrhizal but Not in Arbuscular Mycorrhizal Plants: A Meta-Analysis

Plants spend a high proportion of their photosynthetically fixed carbon (C) belowground to support mycorrhizal associations in return for nutrients, but this C expenditure may decrease with increased soil nutrient availability. In this study, we assessed how the effects of nitrogen (N) fertiliser on specific root respiration (SRR) varied among mycorrhizal type (Myco type). We conducted a multi-level meta-analysis across 1,600 observations from 32 publications. SRR increased in ectomycorrhizal (ECM) plants with more than 100 kg N ha^-1 applied, did not change in arbuscular mycorrhizal (AM) and non-mycorrhizal (NM) plants, but increased in plants with a dual mycorrhizal association in response to N fertilisation. Our results suggest that high N availability (>100 kg N ha^-1) could disadvantage the growth of ECM plants because of increased C costs associated with maintaining higher root N concentrations, while the insensitivity in SRR by AM plants to N fertilisation may be because AM fungi are more important for phosphorus (P) uptake.

The Impact of Osteobiologic Subtype Selection on Perioperative Complications and Hospital-Reported Charges in Single- and Multi-Level Lumbar Spinal Fusion

BACKGROUND

Over the last several decades, various osteobiologics including allograft, synthetics, and growth factors have been used for lumbar spinal fusion surgery. However, the data on these osteobiologic products remain controversial with conflicting evidence in the literature. This study evaluates the influence of osteobiologic type selection on perioperative complications and hospital-reported charges in single-level and multilevel lumbar fusion.

METHODS

Using the 2016 and 2017 Nationwide Readmission Database, we conducted a retrospective cohort analysis of 125,143 patients who received lumbar fusion with either autologous tissue substitute, nonautologous tissue substitute, or synthetic substitute. This cohort was split into single-level and multilevel fusion procedures, and one-to-one age and sex propensity score matching was implemented. This resulted in cohorts each consisting of 1967 patients for single-level fusion, and cohorts each consisting of 1657 patients for multilevel fusion. Statistical analysis included one-way analysis of variance and Tukey multiple comparisons of means.

RESULTS

Autologous single-level fusion resulted in significantly more postoperative pain at 30-, 90-, and 180-day follow-up compared to fusion with nonautologous graft (P < .05). Multilevel fusion with autologous graft had higher rates of acute postsurgical anemia compared with synthetic (P = .021) and nonautologous (P = .016) alternatives, and less postsurgical infection when compared with nonautologous fusion (P = .0020). In addition, procedures using autologous osteobiologics were associated with significantly more neurological complications at 30 days (P = .049) and 90 days (P = .048) for multi-level fusion and at 30 days (P = .044) for single-level fusion compared with the nonautologous group. Lastly, for both cohorts, the total accrued inpatient hospital charges during admission for patients receiving nonautologous grafts were the most expensive and those for patients receiving autologous grafts were the least expensive.

CONCLUSION

Significant differences were found between the groups with respect to rates of complications, including infection, postoperative pain, and neurologic injury. Furthermore, the hospital-reported charges of each procedure varied significantly. As the field of biologics continues to expand, it is important to continually evaluate the safety, efficacy, and cost-effectiveness of these novel materials and techniques.

LEVEL OF EVIDENCE

3 CLINICAL RELEVANCE: With increased utilization of osteobiologics and spinal fusion being a common procedure, longitudinal data on readmissions, and post-operative complications are critical in guiding evidence-based practice.

Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50 years and older in 22 countries

BACKGROUND AND AIMS

Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50 years and older.

DESIGN

Cross-sectional observational study using previously harmonized survey data.

SETTING

Twenty-two countries surveyed in 2010 or the closest available year.

PARTICIPANTS

A total of 106 180 adults aged 50 years and over.

MEASUREMENTS

Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking.

FINDINGS

Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P-value < 0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross-country variability in SDUs (LR test P-value < 0.001) but did not explain cross-country variability in the prevalence of heavy drinkers.

CONCLUSIONS

Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

Multi-Level Neuromorphic Devices Built on Emerging Ferroic Materials: A Review

Achieving multi-level devices is crucial to efficiently emulate key bio-plausible functionalities such as synaptic plasticity and neuronal activity, and has become an important aspect of neuromorphic hardware development. In this review article, we focus on various ferromagnetic (FM) and ferroelectric (FE) devices capable of representing multiple states, and discuss the usage of such multi-level devices for implementing neuromorphic functionalities. We will elaborate that the analog-like resistive states in ferromagnetic or ferroelectric thin films are due to the non-coherent multi-domain switching dynamics, which is fundamentally different from most memristive materials involving electroforming processes or significant ion motion. Both device fundamentals related to the mechanism of introducing multilevel states and exemplary implementations of neural functionalities built on various device structures are highlighted. In light of the non-destructive nature and the relatively simple physical process of multi-domain switching, we envision that ferroic-based multi-state devices provide an alternative pathway toward energy efficient implementation of neuro-inspired computing hardware with potential advantages of high endurance and controllability.

Contributions of Individual, Family, and School Characteristics to Chilean Students' Social Well-Being at School

Schools are an essential part of students’ lives and can promote and facilitate their well-being. Although research on well-being among school-aged children and adolescents has distinguished subjective well-being from social well-being, very few studies examined student’s social well-being at school (SWS). SWS is understood as students’ valuation of the circumstances and functioning of their school. This framework posits that the context of the schools can shape students’ perception of feeling integrated and making significant contributions to their schools. However, not much is known regarding the joint contribution of individual, family, and school characteristics to students’ SWS. This study analyzed these joint contributions in a nationally representative sample of 6,389 children and adolescents enrolled in 5th–11th grades. Findings show that being female and younger were individual predictors of SWS. Students’ satisfaction with their family and fewer changes of schools were also significant contributors. When students’ perceptions of their schools were incorporated, the individual and family characteristics decreased or lost significance. In the full model, the highest contribution to SWS was explained by the school-level aggregated perception of school climate. These findings call for integrated policies and practices to foster students’ sense of belonging, feeling integrated, and contribution to their schools, with a focus on school-level interventions to improve SWS through positive and engaging school climates that foster students’ sense of agency.

Inculcation of Green Behavior in Employees: A Multilevel Moderated Mediation Approach

In this era of globalization, preventing organizations from undermining and degrading the environment has become a great challenge, especially when considering that organizations are among the major contributors to environmental deterioration. As a result, scholars have recently begun to focus on understanding the key determinants of employee green behavior (EGB), a nascent field within the area of sustainable development and organizational behavior. This study extends the emerging discussion over EGB by investigating how green behavior can be inculcated into employees’ mindsets and under what conditions this can best be accomplished. The present research examines the relationship between ethical leadership and EGB by the mediating mechanisms of green psychological climate, employees’ harmonious environmental passion, and employees’ environmental commitment, through the underpinnings of social learning theory. Further, the study examines the contingency effects of leaders’ pro-environmental attitudes to determine how leaders with ethical attributes and pro-environmental attitudes can create a green psychological climate that ultimately leads to EGB through employees’ harmonious environmental passion and employees’ environmental commitment. The approach to implementing theory development is deductive as the research employed a quantitative research design and survey administration with a time-lagged approach. Multi-level data were collected from 400 respondents working in public and private sector hospitals and universities in Pakistan. The analysis was conducted in MPlus. The results show positive and statistically significant effects of ethical leadership on EGB through the serial mediations of a green psychological climate and employees’ harmonious environmental passion, and a green psychological climate and employees’ environmental commitment. Moreover, the leaders’ pro-environmental attitude contingency strengthens the indirect impact of ethical leadership on EGB. This research provides several managerial implications through which organizations can strategically concentrate on EGB, including saving energy by turning off unused lights, reducing waste, and recycling.

Does the Number of Levels Fused Affect Spinopelvic Parameters and Clinical Outcomes Following Posterolateral Lumbar Fusion for Low-Grade Spondylolisthesis?

STUDY DESIGN

Retrospective cohort.

OBJECTIVES

To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis.

METHODS

This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale [VAS]-back, VAS-leg, Oswestry Disability Index [ODI]), and postoperative complications were compared.

RESULTS

Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions.

CONCLUSIONS

Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.

Insights from a Multi-Level Mathematical Model Approach

Bacterial pneumonia is one of the most prevalent infectious diseases and has high mortality in sensitive patients (children, elderly and immunocompromised). Although an infection, the disease alters the alveolar epithelium homeostasis and hinders normal breathing, often with fatal consequences. A special case is hospitalized aged patients, which present a high risk of infection and death because of the community acquired version of the Streptococcus pneumoniae pneumonia. There is evidence that early antibiotics treatment decreases the inflammatory response during pneumonia. Here, we investigate mechanistically this strategy using a multi-level mathematical model, which describes the 24 first hours after infection of a single alveolus from the key signaling networks behind activation of the epithelium to the dynamics of the local immune response. With the model, we simulated pneumonia in aged and young patients subjected to different antibiotics timing. The results show that providing antibiotics to elderly patients 8 h in advance compared to young patients restores in aged individuals the effective response seen in young ones. This result suggests the use of early, probably prophylactic, antibiotics treatment in aged hospitalized people with high risk of pneumonia.

Associations between neighborhood-level factors and opioid-related mortality: A multi-level analysis using death certificate data

AIM

To identify associations between opioid-related mortality and neighborhood-level risk factors.

DESIGN

Cross-sectional study.

SETTING

Massachusetts, USA.

PARTICIPANTS

Using 2011-14 Massachusetts death certificate data, we identified opioid-related (n = 3089) and non-opioid-related premature deaths (n = 8729).

MEASUREMENTS

The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment and (4) health-related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status and nativity. The primary outcome of interest was opioid-related mortality.

FINDINGS

Multi-level models identified number of social associations per 10 000 [odds ratio (OR) = 0.84, P = 0.002, 95% confidence interval (CI) = 0.75-0.94] and number of hospital beds per 10 000 (OR = 0.78, P < 0.001, 95% CI = 0.68-0.88) to be inversely associated with opioid-related mortality, whereas the percentage living in poverty (OR = 1.01, P = 0.008, 95% CI = 1.00-1.01), food insecurity rate (OR = 1.21, P = 0.002, 95% CI = 1.07-1.37), number of federally qualified health centers (OR = 1.02, P = 0.028, 95% CI = 1.02-1.08) and per-capita morphine milligram equivalents of hydromorphone (OR = 1.05, P = 0.003, 95% CI = 1.01-1.08) were positively associated with opioid-related mortality.

CONCLUSIONS

Opioid-related deaths between 2011 and 2014 in the state of Massachusetts appear to be positively associated with the percentage living in poverty, food insecurity rate, number of federally qualified health centers and per-capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10 000 and number of hospital beds per 10 000.

Effect of light pollution on self-reported sleep quality and its components: Comparative assessment among healthy adult populations in a rural and an Urban area of West Bengal, India

Background

Light pollution is inappropriate or excessive use of artificial light. Nighttime sky radiance is an effective measure to study its effects on individual sleep quality.

Objectives

The study is aimed to measure the effect of light pollution on the sleep quality and compare among people residing in selected rural and urban areas of West Bengal, India.

Methods

A comparative cross-sectional study was conducted during September-October 2018 in 10 villages of Barasat II block and 10 wards of Kolkata Municipal Corporation. Two hundred and sixty-three participants from urban and 249 participants from rural areas were selected through multi-stage sampling. Data regarding sleep quality and other selected factors were geotagged along with the radiance data. Multi-level linear regression models were built.

Results

The mean age of the participants from rural and urban areas were respectively 37.65 (±10.77) years and 38.10 (±11.02) years. Gender-wise the participants were distributed almost evenly in urban and rural areas. Among the urban and rural population, the observed mean global Pittsburgh Sleep Quality Index scores were 12.63 (±3.04) and 9.23 (±2.27), respectively. Poorer sleep quality was observed to be statistically significant with increasing level of exposure. Multi-level models show that, at an exposure of >40.0 nW/cm²/sr the adjusted coefficient was 11.52 (95% confidence interval [CI]: 9.65, 13.40) in the overall model and 12.84 (95% CI: 12.31, 13.37) for urban participants.

Conclusion

The disturbance in sleep is associated with higher levels of night-time radiance of the sky strongly observed among the urban population.

Engaging Leadership and Its Implication for Work Engagement and Job Outcomes at the Individual and Team Level: A Multi-Level Longitudinal Study

The current study investigates how supervisors’ engaging leadership, as perceived by their employees, increases employees’ job outcomes at the individual and team level, as mediated by (team) work engagement. Job outcome indicators at the team level are team performance, team learning, and team innovation; and at the individual level, job performance, employee learning, and innovative work behavior. The novel concept of engaging leadership is presented as the specific type of leadership to foster (team) work engagement. A multi-level longitudinal study is conducted among 224 blue collar employees nested in 54 teams in an Indonesian state-owned holding company in the agricultural industry using a one-year time lag. The findings show, as expected, that at the team level, engaging leadership at time 1 predicted team learning and team innovation (but not team performance) at time 2, via team work engagement at time 2. Additionally, an expected cross-level effect was observed from engaging leadership at the team level at time 1 predicting individual job performance (but not employee learning and innovative work behavior) at time 2, via team work engagement at time 2. Finally, an expected second cross-level effect was observed for engaging leadership at the team level at time 1, which predicted individual job performance, employee learning, and innovative work behavior at time 2, via work engagement at time 2.

Multi-Level Features Extraction for Discontinuous Target Tracking in Remote Sensing Image Monitoring

Many techniques have been developed for computer vision in the past years. Features extraction and matching are the basis of many high-level applications. In this paper, we propose a multi-level features extraction for discontinuous target tracking in remote sensing image monitoring. The features of the reference image are pre-extracted at different levels. The first-level features are used to roughly check the candidate targets and other levels are used for refined matching. With Gaussian weight function introduced, the support of matching features is accumulated to make a final decision. Adaptive neighborhood and principal component analysis are used to improve the description of the feature. Experimental results verify the efficiency and accuracy of the proposed method.

A cross-level moderating effect of team trust on the relationship between transformational leadership and cohesion

We draw on the concept of the shared mental model to explain the cross-level direct and moderating effects of team trust on the relationship between coach transformational leadership and cohesion. Using hierarchical linear modelling, we analysed 597 national level high school and university volleyball players to test our research model. Our results revealed that, (a) at the individual level, coach transformational leadership has a positive effect on athletes' perceptions on cohesion and (b) team trust, a group-level construct, is positively related to social cohesion and moderates the coach transformational leadership-cohesion relationship. The moderating effect demonstrates that the positive effect of coach transformational leadership on cohesion could be enhanced when high levels of team trust are shared within the group. Implications for coach education and sport psychology in terms of theory and research are discussed.

Hierarchical social modularity in gorillas

Modern human societies show hierarchical social modularity (HSM) in which lower-order social units like nuclear families are nested inside increasingly larger units. It has been argued that this HSM evolved independently and after the chimpanzee–human split due to greater recognition of, and bonding between, dispersed kin. We used network modularity analysis and hierarchical clustering to quantify community structure within two western lowland gorilla populations. In both communities, we detected two hierarchically nested tiers of social structure which have not been previously quantified. Both tiers map closely to human social tiers. Genetic data from one population suggested that, as in humans, social unit membership was kin structured. The sizes of gorilla social units also showed the kind of consistent scaling ratio between social tiers observed in humans, baboons, toothed whales, and elephants. These results indicate that the hierarchical social organization observed in humans may have evolved far earlier than previously asserted and may not be a product of the social brain evolution unique to the hominin lineage.

The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.

Risk factors associated with clinical adjacent segment pathology following multi-level cervical fusion surgery

Few clinical studies investigate risk factors associated with clinical adjacent segment pathology (CASP) following multi-level cervical fusion surgery. The aim is to record the incidence of postoperative CASP in patients after at least 2 years' follow-up and to identify possible risk factors that may be associated with the CASP after multi-level cervical surgery.We retrospectively reviewed patients who underwent multi-level cervical surgery in our hospital from January 2004 to February 2016. All patients underwent more than 2 years' follow-up. The diagnosis of CASP is according to clinical symptoms as well as image findings. Potential risk factors were collected from demographic data and radiographic images.A total of 301 patients after multi-level cervical surgery were analyzed. During follow-up, 28 patients (9.3%) were diagnosed as having CASP. Among these patients, 7 showed symptoms of CASP within 3 years after surgery, 6 showed symptoms between 3 and 5 years, 14 showed symptoms between 5 and 10 years, and the last one showed symptoms more than 10 years later. In the multivariate analysis, degeneration of adjacent segment (OR, 1.592; 95% CI, 1.113-2.277), decreased Cobb angle in fused vertebrae (OR, 2.113; 95% CI, 1.338-3.334) and decreased Cobb angle in cervical spine (OR, 1.896; 95% CI, 1.246-2.886) were correlated with the incidence of CASP during follow-up.The incidence of CASP following multi-level cervical surgery was 9.3% with a mean of about 70 months' follow-up. Patients with preoperative degeneration of adjacent segment and postoperative imbalance of sagittal alignment have a higher risk of developing CASP after multi-level cervical surgery.

Development of a Conjunctivitis Outpatient Rate Prediction Model Incorporating Ambient Ozone and Meteorological Factors in South Korea

Ozone (O₃) is a commonly known air pollutant that causes adverse health effects. This study developed a multi-level prediction model for conjunctivitis in outpatients due to exposure to O₃ by using 3 years of ambient O₃ data, meteorological data, and hospital data in Seoul, South Korea. We confirmed that the rate of conjunctivitis in outpatients (conjunctivitis outpatient rate) was highly correlated with O₃ (R² = 0.49), temperature (R² = 0.72), and relative humidity (R² = 0.29). A multi-level regression model for the conjunctivitis outpatient rate was well-developed, on the basis of sex and age, by adding statistical factors. This model will contribute to the prediction of conjunctivitis outpatient rate for each sex and age, using O₃ and meteorological data.

Neighbourhood deprivation and lung cancer risk: a nested case-control study in the USA

OBJECTIVES

To examine the association between neighbourhood deprivation and lung cancer risk.

DESIGN

Nested case-control study.

SETTING

Southern Community Cohort Study of persons residing in 12 states in the southeastern USA.

PARTICIPANTS

1334 cases of lung cancer and 5315 controls.

PRIMARY OUTCOME MEASURE

Risk of lung cancer.

RESULTS

After adjustment for smoking status and other confounders, and additional adjustment for individual-level measures of socioeconomic status (SES), there was no monotonic increase in risk with worsening deprivation score overall or within sex and race groups. There was an increase among current and shorter term former smokers (p=0.04) but not among never and longer term former smokers. There was evidence of statistically significant interaction by sex among whites, but not blacks, in which the effect of worsening deprivation on lung cancer existed in males but not in females.

CONCLUSIONS

Area-level measures of SES were associated with lung cancer risk in current and shorter term former smokers only in this population.

Unemployment and the Division of Housework in Europe

Unemployment, especially in insecure times, has devastating effects on families, but it is not clear what happens to domestic work. On the one hand, unemployment frees up time for more housework by both men and women. On the other hand, once unemployed, women may take on more additional housework than men do, either because they capitalize on their time to act out traditional gender roles or because unemployment compounds women's general disadvantage in household bargaining. Multi-level analyses based on the European Social Survey show that both men and women perform more housework when unemployed. However, the extra domestic work for unemployed women is greater than for unemployed men. They also spend more time on housework when their husband is unemployed. Compared to their employed counterparts, unemployed women, but not men, perform even more housework in a country where the unemployment rate is higher.

A joint model for recurrent events and a semi-competing risk in the presence of multi-level clustering

Clinical trial designs often include multiple levels of clustering in which patients are nested within clinical sites and recurrent outcomes are nested within patients who may also experience a semi-competing risk. Traditional survival methods that analyze these processes separately may lead to erroneous inferences as they ignore possible dependencies. To account for the association between recurrent events and a semi-competing risk in the presence of two levels of clustering, we developed a semi-parametric joint model. The Gaussian quadrature with a piecewise constant baseline hazard was used to estimate the unspecified baseline hazards and the likelihood. Simulations showed that the proposed joint model has good statistical properties (i.e. <5% bias and 95% coverage) compared to the shared frailty and joint frailty models when informative censoring and multiple levels of clustering were present. The proposed method was applied to data from an AIDS clinical trial to investigate the impact of antiretroviral treatment on recurrent AIDS-defining events in the presence of a semi-competing risk of death and multi-level clustering and showed a significant dependency between AIDS-defining events and death at the patient level but not at the clinic level.

Modeling Community Discharge of Medicaid Nursing Home Residents: Implications for Money Follows the Person

OBJECTIVE

To build and test a model that predicts community discharge probabilities for Medicaid-eligible nursing home (NH) residents who remain in the nursing home at 90 days after admission and, thus, would be candidates for the Money Follows the Person (MFP) program.

DATA SOURCE

The Minimum Data Set, Medicaid Management Information Systems, and Minnesota Vital Statistics file.

DATA

Cohort of 33, 590 nursing home stays that qualified for Medicaid by the 90th day of their stay from 383 Minnesota nursing homes from July 2011 to June 2013.

STUDY DESIGN

Mixed effects logistic regression model to predict community discharge.

PRINCIPAL FINDINGS

The scoring system had a high level of accuracy in predicting community discharge for both the fitting and validation cohorts. Subpopulations with severe mental illness or intellectual disability were well represented across the entire score range.

CONCLUSIONS

Findings are being applied in the Minnesota's MFP initiative (Moving Home Minnesota) to target Medicaid-eligible NH residents for transitioning to the community. This approach could be applied to MFP in other states.

Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol

The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.

The Emergence of Family-specific Support Constructs: Cross-level Effects of Family-supportive Supervision and Family-Supportive Organization Perceptions on Individual Outcomes

Implicit to the definitions of both family-supportive supervision (FSS) and family-supportive organization perceptions (FSOP) is the argument that these constructs may manifest at a higher (e.g. group or organizational) level. In line with these conceptualizations, grounded in tenants of conservation of resources theory, we argue that FSS and FSOP, as universal resources, are emergent constructs at the organizational level, which have cross-level effects on work-family conflict and turnover intentions. To test our theoretically derived hypotheses, a multilevel model was examined in which FSS and FSOP at the unit level predict individual work-to-family conflict, which in turn predicts turnover intentions. Our hypothesized model was generally supported. Collectively, our results point to FSOP serving as an explanatory mechanism of the effects that mutual perceptions of FSS have on individual experiences of work-to-family conflict and turnover intentions. Lagged (i.e. overtime) cross-level effects of the model were also confirmed in supplementary analyses. Our results extend our theoretical understanding of FSS and FSOP by demonstrating the utility of conceptualizing them as universal resources, opening up a variety of avenues for future research. Copyright © 2015 John Wiley & Sons, Ltd.

Overweight and obesity in India: policy issues from an exploratory multi-level analysis

This article analyses a nationally representative household dataset-the National Family Health Survey (NFHS-3) conducted in 2005 to 2006-to examine factors influencing the prevalence of overweight/obesity in India. The dataset was disaggregated into four sub-population groups-urban and rural females and males-and multi-level logit regression models were used to estimate the impact of particular covariates on the likelihood of overweight/obesity. The multi-level modelling approach aimed to identify individual and macro-level contextual factors influencing this health outcome. In contrast to most studies on low-income developing countries, the findings reveal that education for females beyond a particular level of educational attainment exhibits a negative relationship with the likelihood of overweight/obesity. This relationship was not observed for males. Muslim females and all Sikh sub-populations have a higher likelihood of overweight/obesity suggesting the importance of socio-cultural influences. The results also show that the relationship between wealth and the probability of overweight/obesity is stronger for males than females highlighting the differential impact of increasing socio-economic status on gender. Multi-level analysis reveals that states exerted an independent influence on the likelihood of overweight/obesity beyond individual-level covariates, reflecting the importance of spatially related contextual factors on overweight/obesity. While this study does not disentangle macro-level 'obesogenic' environmental factors from socio-cultural network influences, the results highlight the need to refrain from adopting a 'one size fits all' policy approach in addressing the overweight/obesity epidemic facing India. Instead, policy implementation requires a more nuanced and targeted approach to incorporate the growing recognition of socio-cultural and spatial contextual factors impacting on healthy behaviours.

Social network analysis of multi-level linkages: a Swedish case study on Northern Forest-Based sectors

Forest use in Northern Sweden is being influenced both by global trends and local situations. This results in interactions between numerous groups that may impact local forest governance. Social network analysis can here provide insight into the total pattern of positive, negative, and cross-level interactions within user group community structure (within and among groups). This study analyses interactions within selected renewable resource sectors in two northern Swedish municipalities, both with regard to whether they are positive, neutral, or negative, as well as with regard to how local actors relate to actors across levels, e.g., with regional, national, and international actors. The study illustrates that many interactions both within and outside a given sector are seen as neutral or positive, and that considerable interaction and impact are defined as national and in some cases even international. It also indicates that the impact of Sweden's only existing Model Forest may to some extent constitute a bridge between different sectors and levels, in comparison with the interactions between sectors in a municipality where such a cooperation mechanism does not exist.

Multi-level functionality of social media in the aftermath of the Great East Japan Earthquake

This study examines the multi-level functionalities of social media in the aftermath of the Great East Japan Earthquake of 11 March 2011. Based on a conceptual model of multi-level story flows of social media (Jung and Moro, 2012), the study analyses the multiple functionalities that were ascribed to social media by individuals, organisations, and macro-level social systems (government and the mass media) after the earthquake. Based on survey data, a review of Twitter timelines and secondary sources, the authors derive five functionalities of social media: interpersonal communications with others (micro level); channels for local governments; organisations and local media (meso level); channels for mass media (macro level); information sharing and gathering (cross level); and direct channels between micro-/meso- and macro-level agents. The study sheds light on the future potential of social media in disaster situations and suggests how to design an effective communication network to prepare for emergency situations.

Images from a jointly-arousing collective ritual reveal affective polarization

Collective rituals are biologically ancient and culturally pervasive, yet few studies have quantified their effects on participants. We assessed two plausible models from qualitative anthropology: ritual empathy predicts affective convergence among all ritual participants irrespective of ritual role; rite-of-passage predicts emotional differences, specifically that ritual initiates will express relatively negative valence when compared with non-initiates. To evaluate model predictions, images of participants in a Spanish fire-walking ritual were extracted from video footage and assessed by nine Spanish raters for arousal and valence. Consistent with rite-of-passage predictions, we found that arousal jointly increased for all participants but that valence differed by ritual role: fire-walkers exhibited increasingly positive arousal and increasingly negative valence when compared with passengers. This result offers the first quantified evidence for rite of passage dynamics within a highly arousing collective ritual. Methodologically, we show that surprisingly simple and non-invasive data structures (rated video images) may be combined with methods from evolutionary ecology (Bayesian Generalized Linear Mixed Effects models) to clarify poorly understood dimensions of the human condition.

A latent-variable marginal method for multi-level incomplete binary data

Incomplete multi-level data arise commonly in many clinical trials and observational studies. Because of multi-level variations in this type of data, appropriate data analysis should take these variations into account. A random effects model can allow for the multi-level variations by assuming random effects at each level, but the computation is intensive because high-dimensional integrations are often involved in fitting models. Marginal methods such as the inverse probability weighted generalized estimating equations can involve simple estimation computation, but it is hard to specify the working correlation matrix for multi-level data. In this paper, we introduce a latent variable method to deal with incomplete multi-level data when the missing mechanism is missing at random, which fills the gap between the random effects model and marginal models. Latent variable models are built for both the response and missing data processes to incorporate the variations that arise at each level. Simulation studies demonstrate that this method performs well in various situations. We apply the proposed method to an Alzheimer's disease study.

Effects of state-level public spending on health on the mortality probability in India

This study uses the second National Family Health Survey of India to estimate the effect of state-level public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state's gross fiscal deficit as an instrument for its health spending. Our study shows a 10% increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities.

Social Connections in the Inner City: Examination across the Life Course

Social connectedness has been shown to be related to health and well-being, yet there is little knowledge about its developmental and intergenerational origins. We examine the childhood, family, and neighbourhood origins of social connectedness in young adulthood in a cohort of African American children (N=1242) from Chicago followed since 1966. The five measures of social connections are: political involvement, organizational membership, church involvement, family ties, and friend ties. In multivariate analyses, predictors of social connectedness were found across the life course: first grade social adaptation to school, childhood family resources, family social participation, adult neighbourhood characteristics, social class, and marital status. We conclude that adult social connections have roots in childhood behaviour and social involvement, family resources and family social connections as well as one's own resources and the neighbourhood where one lives.

Review: the wider social environment and schizophrenia

Rates of schizophrenia differ significantly between groups defined at the social level, eg, urban/rural comparisons, neighborhoods, and ethnic minority status. While earlier studies were not able to determine if the social environment influenced the development of schizophrenia (causation) or whether individuals at risk aggregated in adverse social environments (selection), the recent development of multilevel modeling should inform this debate. To date, there are few examples of multilevel analyses in schizophrenia research; however, the small number of studies suggest that there may be a neighborhood social contextual effect that influences rates of schizophrenia and other psychotic disorders. Further research is urgently required to progress our knowledge of how individuals, their genes, and the neighborhoods they live in, interact with each other. Studies need to use well-specified multilevel models, and until then, we should remain cautious in our interpretation of such findings.