Longitudinal brain volumetrics in glioma survivors

OBJECTIVE

Radiation therapy (RT) is used selectively for patients with low-grade glioma (LGG) given the concerns for potential cognitive effects in survivors, but prior cognitive outcome studies among LGG survivors have had inconsistent findings. Translational studies that characterize changes in brain anatomy and physiology after treatment of LGG may help to both contextualize cognitive findings and improve the overall understanding of radiation effects in normal brain tissue. This study aimed to investigate the hypothesis that patients with LGG who are treated with RT will experience greater brain volume loss than those who do not receive RT.

METHODS

This retrospective longitudinal study included all patients with WHO grade 2 glioma who received posttreatment surveillance MRI at the University of Alabama at Birmingham. Volumetric analysis of contralateral cortical white matter (WM), cortical gray matter (GM), and hippocampus was performed on all posttreatment T1-weighted MRI sequences using the SynthSeg script. The effect of clinical and treatment variables on brain volumes was assessed using two-level hierarchical linear models.

RESULTS

The final study cohort consisted of 105 patients with 1974 time points analyzed. The median length of imaging follow-up was 4.6 years (range 0.36-18.9 years), and the median number of time points analyzed per patient was 12 (range 2-40). Resection was performed in 79 (75.2%) patients, RT was administered to 61 (58.1%) patients, and chemotherapy was administered to 66 (62.9%) patients. Age at diagnosis (β = -0.06, p < 0.001) and use of RT (β = -1.12, p = 0.002) were associated with the slope of the contralateral cortical GM volume model (i.e., change in GM over time). Age at diagnosis (β = -0.08, p < 0.001), midline involvement (β = 1.31, p = 0.006), and use of RT (β = -1.45, p = 0.001) were associated with slope of the contralateral cortical WM volume model. Age (β = -0.0027, p = 0.001), tumor resection (β = -0.069, p < 0.001), use of chemotherapy (β = -0.0597, p = 0.003), and use of RT (β = -0.0589, p < 0.001) were associated with the slope of the contralateral hippocampus volume model.

CONCLUSIONS

This study demonstrated volume loss in contralateral brain structures among LGG survivors, and patients who received RT experienced greater volume loss than those who did not. The results of this study may help to provide context for cognitive outcome research in LGG survivors and inform the design of future strategies to preserve cognition.

Religiosity, sexual behaviors, sexual motivations, and gender: A three-year longitudinal study

Longitudinal data are critical for examining associations of religiosity with sexual behaviors and motivations during college. We use hierarchical linear modeling on five semesters of data from a diverse sample of college students (N = 735) to examine within- and between-person associations between religious service attendance and importance of religion and sexual behaviors and motivations for and against sex and consider gender as a moderator. Between-person religiosity was associated with sexual behaviors and motivations whereas within-person religiosity was not. Students' sexual motivations co-varied across semesters with their religious service attendance and importance of religion. Our results indicated more restrictive associations between religiosity and sexual motivations for women than for men.

What Matters More in Explaining Drug Court Graduation and Rearrest: Program Features, Individual Characteristics, or Some Combination

This study examines the program- and individual-level factors that impact the success of drug court clients in terms of: (1) graduation; and (2) not being arrested while participating in the court program. The data consist of 848 individuals in nine drug courts. This paper discusses how different individual- and program-level factors impact the success of drug court participants. The findings suggest that individual- and program-level factors are both important in predicting program graduation and arrest during drug court participation, while controlling for participant demographics. Clients' education, drug/alcohol usage, program staffing, and clinical standards impact program graduation while criminal history, drug/alcohol usage, number of program hours offered, program staffing, and use of rewards and sanctions predict in-program arrest. Models combining both program- and individual-level factors performed better than either alone, leading to recommendations that agencies should emphasize improving program quality while targeting clients' needs to achieve greater success.

The Effect of Downward Social Comparison on Creativity in Organizational Teams, with the Moderation of Narcissism and the Mediation of Negative Affect

Employee creativity has become an essential element for the survival and success of contemporary organizations in the fast-changing business environment. The increased importance of team systems in the flood of information has increased the attention given to creativity in social relationships. This study adopts social comparison theory to propose a framework that shows how social comparisons of creative ability between team members influence individual creativity. In particular, this study focuses on the downward social comparison that individuals frequently experience in real team situations. We adopted multi-source field data collected from 130 employees and supervisors working in a manufacturing company in South Korea. The moderated mediation hypotheses were tested using hierarchical linear modeling to address the dependence of employees rated by the same supervisor, given that employees are nested within supervisors. The effect of downward social comparison on creativity, as mediated by negative affect, is positively moderated by narcissism. Specifically, the conditional indirect effects of downward social comparison on creativity through negative affect were significant and negative when narcissism was high but insignificant when it was low. This research provides novel insights for researchers and practitioners by offering a theoretical elaboration of the effects of social comparison processes on creativity and providing unique empirical validation for the model in the context of teams in actual organizations.

How students' writing motivation, teachers' personal and professional attributes, and writing instruction impact student writing achievement: a two-level hierarchical linear modeling study

Student motivation to write is a pivotal factor influencing their writing achievement. However, individual motivation to write is not independent of the learning environment. It also is crucial for teachers to develop their own efficacy, knowledge, and ability in writing and writing instruction to help them utilize effective instructional methods that stimulate students' motivation to write and further promote their writing achievement. Given these considerations, we utilized a two-level hierarchical linear model to examine the relationships among student motivation, teacher personal and professional traits, teacher writing instruction, and writing achievement at student and teacher levels. Our analysis of the dataset, which included 346 fourth and fifth graders nested within 41 classrooms, found that motivation had a positive predictive effect on writing ability at both student and teacher levels. Moreover, female students, fifth graders, and typically achieving students demonstrated higher writing achievement than their counterparts. While there were no significant effects of teacher efficacy, knowledge, ability, or professional development on student writing achievement, we observed that higher frequency of classroom management practices during writing instruction had a significant negative effect on student writing achievement. Our full model revealed that the relationship between student motivation and achievement was negatively moderated by teachers' increased use of instructional practices related to process features and using writing instruction materials, but positively moderated by increased use of varied teaching tactics. Overall, our findings emphasize the importance of contextual factors in understanding the complexity of student writing achievement and draw attention to the need for effective instructional practices to support students' writing development.

R-squared Measures for Multilevel Models with Three or More Levels

Applications of multilevel models (MLMs) with three or more levels have increased alongside expanding software capability and dataset availability. Though researchers often express interest in R-squared measures as effect sizes for MLMs, R-squareds previously proposed for MLMs with three or more levels cover a limited subset of choices for how to quantify explained variance in these models. Additionally, analytic relationships between total and level-specific versions of MLM R-squared measures have not been clarified, despite such relationships becoming increasingly important to understand when there are more levels. Furthermore, the impact of predictor centering strategy on R-squared computation and interpretation has not been explicated for MLMs with any number of levels. To fill these gaps, we extend the Rights and Sterba two-level MLM R-squared framework to three or more levels, providing a general set of measures that includes preexisting three-level measures as special cases and yields additional results not obtainable from existing measures. We mathematically and pedagogically relate total and level-specific R-squareds, and show how all total and level-specific R-squared measures in our framework can be computed under any centering strategy. Finally, we provide and empirically demonstrate software (available in the r2mlm R package) to compute measures and graphically depict results.

The Influence of Parent- and Adult Child-level Factors on Intergenerational Relationship Quality: A Study of Chinese Families with Multiple Children in Hong Kong

Intergenerational relationships have become increasingly crucial for maintaining well-being in aging families. Under a changing sociocultural background, families in Hong Kong increasingly exhibit diverse intergenerational relationships and functioning. Focusing on families with mutiple children, this study investigated how the characteristics of parents and their adult children jointly affect different domains of intergenerational relationship quality. A two-stage stratified random sampling design was adopted. Face-to-face questionnaire interviews were conducted between November 2016 and March 2017 with 1,001 Hong Kong residents aged ≥ 50 years. Data of 612 parents and 1,745 adult children were included for analysis. Hierarchical linear modeling was performed to examine child- and parent-level correlates of intergenerational relationship quality. Parents who were female, were married, had higher self-perceived economic status, owned a house, and had fewer depressive symptoms, exhibited higher intergenerational relationship quality. Parents' age was positively related to affectual closeness, whereas their educational level was negatively related to both affectual closeness and conflict. More favorable intergenerational relationships were reported by aging parents whose adult children were younger, female, and married. Children with higher educational levels exhibited higher levels of both affectual closeness and conflict with their parents. Moreover, affectual closeness was found to be transmitted between generations. The findings can help improve awareness of the factors affecting the different domains of intergenerational relationships, thus informing the development of targeted services and interventions to promote family relationships and well-being.

The Impacts of Three Educational Technologies on Algebraic Understanding in the Context of COVID-19

The current study investigated the effectiveness of three distinct educational technologies-two game-based applications (From Here to There and DragonBox 12+) and two modes of online problem sets in ASSISTments (an Immediate Feedback condition and an Active Control condition with no immediate feedback) on Grade 7 students' algebraic knowledge. More than 3,600 Grade 7 students across nine in-person and one virtual schools within the same district were randomly assigned to one of the four conditions. Students received nine 30-minute intervention sessions from September 2020 to March 2021. Hierarchical linear modeling analyses of the final analytic sample (N = 1,850) showed significantly higher posttest scores for students who used From Here to There and DragonBox 12+ compared to the Active Control condition. No significant difference was found for the Immediate Feedback condition. The findings have implications for understanding how game-based applications can affect algebraic understanding, even within pandemic pressures on learning.

Source of perceived social support and cognitive change: an 8-year prospective cohort study

OBJECTIVES

This study explored the longitudinal association between overall and individual sources of social support and global cognitive function in older adults.Methods:Data were drawn from three waves (2006, 2010 and 2014) of the Health and Retirement Study (HRS). The analytic sample included participants aged 65 and above who were married and had at least one child (N = 1319). Global cognitive function was measured through a 35-point Telephone Interview Cognitive Screen (TICS). Perceived social support was measured via questions across four sources of support (spouse, child, other family members, and friends). Analyses were conducted using Hierarchical Linear Modeling (HLM) with the addition of a cross-lagged panel model (CLPM).

RESULTS

There was no significant association between perceived overall social support and global cognitive function over time (β=-0.02, p=0.19). However, changes in perceived support from children were positively associated with changes in global cognition (β=0.05,p<0.01). In contrast, changes in perceived support from other family members were negatively associated with changes in cognitive function (β=-0.07,p<0.01).

CONCLUSIONS

Our findings highlight the importance of examining perceived social support from specific elements of one's social networks, rather than in an aggregated variable. Although the positive effect of perceived support from children may be small to moderate, the findings could provide a target for interventions to protect the cognitive function of older adults.

How Daily Mindfulness Predicts Life Satisfaction: From the Perspective of Mindfulness Coping Model

Previous studies have explored the effect of mindfulness on life satisfaction, but the mechanism has not been explored in terms of daily mindfulness. Therefore, based on the mindfulness coping model, this study uses a daily diary method to examine whether individuals' daily mindfulness could predict life satisfaction and whether this relationship was mediated by rumination. In this study, 178 adults who had not received mindfulness training completed the same diary for continuous 14 days, in which their mindfulness and rumination at state level were measured. Besides, mindfulness, rumination, and life satisfaction at dispositional level were measured before and after the daily reporting process. Hierarchical linear models showed that daily mindfulness is a significant predictor of daily rumination. In addition, both the latent growth curve model and structural equation model showed that the change of daily mindfulness can influence life satisfaction through the change of rumination, and this relationship was also confirmed at the dispositional level. These findings are not only valuable for understanding how mindfulness is linked to rumination and life satisfaction according to the mindfulness coping model, but also contribute to the development of psychological intervention programs aimed at improving individual life satisfaction.

The Effect of Shadow Education on Hong Kong Student Wellbeing: Evidence From PISA 2018

This study investigates the effect of shadow education on Hong Kong student wellbeing. The data were extracted from PISA 2018 (Programme For International Student Assessment 2018) of Hong Kong, and HLM analysis was conducted with student and school dimensions as the independent variables and student wellbeing as the dependent variable. The results in the student dimension showed that students attending shadow education had a significantly higher level of wellbeing than students who did not attend, and in the school dimension, that school competition climate had a significant impact on students' wellbeing; however, shadow education caused by schoolwork pressure and shadow education support appeared to have no significant impact on wellbeing. Furthermore, there was an interactive effect between competition climate and shadow education time which negatively affected wellbeing.

Effects of Compounded Nonnormality of Residuals in Hierarchical Linear Modeling

While hierarchical linear modeling is often used in social science research, the assumption of normally distributed residuals at the individual and cluster levels can be violated in empirical data. Previous studies have focused on the effects of nonnormality at either lower or higher level(s) separately. However, the violation of the normality assumption simultaneously across all levels could bias parameter estimates in unforeseen ways. This article aims to raise awareness of the drawbacks associated with compounded nonnormality residuals across levels when the number of clusters range from small to large. The effects of the breach of the normality assumption at both individual and cluster levels were explored. A simulation study was conducted to evaluate the relative bias and the root mean square of the model parameter estimates by manipulating the normality of the data. The results indicate that nonnormal residuals have a larger impact on the random effects than fixed effects, especially when the number of clusters and cluster size are small. In addition, for a simple random-effects structure, the use of restricted maximum likelihood estimation is recommended to improve parameter estimates when compounded residuals across levels show moderate nonnormality, with a combination of small number of clusters and a large cluster size.

Power of the Curriculum: Content, Context, and Learning in Physical Education

Purpose: It is argued that the constructivist physical education has the potential to overcome socioeconomic (SES) constraints and promote learning. The purpose of this study was to determine the extent to which school SES-related class environmental factors influenced student learning in a constructivist physical education context. Methods: Students in 8th grade (N = 1,256) from 10 middle schools with varied SES were tested on exercise knowledge before and after a constructivist physical education intervention. School SES was determined using free and reduced meal ratio (FARM) and physical education related factors. Data on lesson frequency, length, facilities, equipment, and class size were collected from teachers. Results: Hierarchical linear model analyses reveal that SES is not predictive of intervention induced learning (γ = 0.73, t =.91, p =.37). Lesson frequency (γ 02 =.52, t =.31, p =.06), length (γ 03 = -.03, t = -1.82, p =.07), facilities (γ 04 = -.11, t = -.49, p =.63), equipment (γ 05 = -.36, t = -1.36, p =.18), and class size (γ 06 = -.05, t = -1.36, p =.18) are not predictive of learning. Student prior knowledge (γ = -.59, t = -18.37, p <.001) and teacher factor (γ =.04, t = 3.72, p <.001) are predictive of learning. Conclusion: The findings suggest that school SES's detrimental impact on learning in physical education could be overcome by the power of a constructivist curriculum.

Random Forests Approach for Causal Inference with Clustered Observational Data

There is a growing interest in using machine learning (ML) methods for causal inference due to their (nearly) automatic and flexible ability to model key quantities such as the propensity score or the outcome model. Unfortunately, most ML methods for causal inference have been studied under single-level settings where all individuals are independent of each other and there is little work in using these methods with clustered or nested data, a common setting in education studies. This paper investigates using one particular ML method based on random forests known as Causal Forests to estimate treatment effects in multilevel observational data. We conduct simulation studies under different types of multilevel data, including two-level, three-level, and cross-classified data. Our simulation study shows that when the ML method is supplemented with estimated propensity scores from multilevel models that account for clustered/hierarchical structure, the modified ML method outperforms preexisting methods in a wide variety of settings. We conclude by estimating the effect of private math lessons in the Trends in International Mathematics and Science Study data, a large-scale educational assessment where students are nested within schools.

Self-efficacy remains a vital factor in reducing the risk of dialysis in type 2 diabetes care

Studies have provided promising outcomes of the pay-for-performance (P4P) program or with good continuity of care levels in diabetes control.We investigate the different exposures in continuity of care (COC) with their providers and those who participate in the P4P program and its effects on the risk of diabetes diabetic nephropathy in the future.We obtained COC and P4P information from the annual database, to which we applied a hierarchical linear modeling (HLM) in 3 levels adjusted to account for other covariates as well as the effects of hospital clustering and accumulating time.Newly diagnosed type 2 diabetes in 2003At the individual level, those with a higher Diabetes Complications Severity Index (DCSI) score have a higher likelihood of diabetic nephropathy than those with a lower DCSI (OR, 1.46), whereas contrasting results were obtained for the Charlson Comorbidity Index (CCI) (odds ratio[OR], 0.88). Patients who visited family physicians, endocrinologists, and gastroenterologists showed a lower likelihood of diabetic nephropathy (OR, 0.664, 0.683, and 0.641, respectively), whereas those who continued to visit neurologists showed an increased risk of diabetic nephropathy by 4 folds. At the hospital level, patients with diabetes visiting primary care clinics had a lower risk of diabetic nephropathy with an OR of 0.584 than those visiting hospitals of other higher levels. Regarding the repeat time level, the patients who had a higher COC score and participated in the P4P program had a reduced diabetic nephropathy risk with an OR of 0.339 and 0.775, respectively.Diabetes control necessitates long-term care involving the patients' healthcare providers for the management of their conditions to reduce the risk of diabetic nephropathy. Indeed, most contributing factors are related to patients, but we cannot eliminate the optimal outcomes related to good relationships with healthcare providers and participation in the P4P program.

Consultation Pricing of the Online Health Care Service in China: Hierarchical Linear Regression Approach

BACKGROUND

Online health care services are a possible solution to alleviate the lack of medical resources in rural areas, and further understanding of the related medical service pricing system would contribute to improvement of the online health care community (OHC). Although many studies have investigated the OHC, the impact of physicians' reputations and wage levels on consulting prices in the OHC has rarely been discussed in the literature.

OBJECTIVE

This study was designed to explore the determinants of consulting prices in the OHC. We addressed the following questions: (1) Are the prices of online health consultation services affected by wage levels at the doctor's location? (2) How does a physician's online and offline reputation affect their consulting prices?

METHODS

Employing a large-scale sample of 16,008 doctors in China, we first used descriptive statistics to investigate the determinants of consulting prices in their entirety. Hierarchical linear modeling was then used to investigate the determinants of consulting prices in the OHC.

RESULTS

The empirical results led to the conclusion that if doctors have more elevated clinic titles, work in higher-level hospitals, have better online reputations, and/or have made more past sales, their consulting prices will be higher. Additionally, the wage level in the city in which the doctor is working determines their opportunity cost and therefore also affects consulting prices.

CONCLUSIONS

The findings indicate that the characteristics of the doctor, the doctor's online reputation, and past sales affect the consulting price. In particular, the wage level in the city affects the price of the consultation. These findings highlight that the OHC is important because it can indeed break through geographical restrictions and give rural residents the opportunity to obtain medical service from doctors in big cities. However, doctors from cities often charge higher fees because of their higher opportunity cost. The results reveal that one of the most important functions of the OHC is to reduce the medical disparity between urban and rural areas; however, planners appear to ignore the possibility that rural residents with lower incomes may not be able to afford such high medical consultation costs. Therefore, the government should consider providing incentives to encourage urban doctors to provide discounts to rural residents or directly offer appropriate subsidies.

Accentuated Eccentric Loading in the Bench Press: Considerations for Eccentric and Concentric Loading

This study examined the effects of accentuated eccentric loading (AEL) on bench press velocities across a spectrum of concentric and eccentric loads. Ten strength trained men (bench press one-repetition maximum (1-RM): 124.3 ± 19.4 kg; relative strength ratio: 1.5 ± 0.2 kg∙body mass^-1) participated. Subjects completed bench press repetitions using concentric loads from 30% to 80% 1-RM in 10% increments in each experimental session. The AEL protocols were implemented using 100% (AEL100) and 110% 1-RM (AEL110) loads during the eccentric action, while the eccentric load remained the same as the concentric for traditional loading (TRAD). Multilevel models analyzed the effects of each AEL protocol on concentric velocities across concentric loads (p < 0.05). Faster concentric velocities were observed at 30% 1-RM and 80% 1-RM with AEL100 compared to TRAD (p ≤ 0.05) but this effect was reduced for individuals moving the barbell through a greater displacement. Additionally, AEL110 presented a greater change in velocity from 30% to 80% 1-RM than TRAD (p ≤ 0.05). The AEL100 protocol resulted in faster concentric velocities throughout concentric loads of 30-80% 1-RM, but AEL110 may have been too great to elicit consistent performance enhancements. Thus, the efficacy of AEL at various concentric loads is dependent on the eccentric loading and barbell displacement.

The influence of extra-therapeutic social support on the association between therapeutic bond and treatment outcome

Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeutic bond, because a well-formed bond can partly substitute relationship needs. This study replicates former research (main effects of bond and social support) and investigates the hypothesized interaction between both constructs. Method: Data from 1206 adult patients receiving cognitive-behavioral outpatient therapy were analyzed. Patients rated early therapeutic bond, their impairment, as well as their social support. Multilevel regression analyses were applied to test for main effects and interactions between bond and social support predicting therapy outcome post treatment. Results: Consistent with prior research, both therapeutic bond and social support predicted therapy outcome. Among patients with high social support, the impact of the therapeutic bond was minimal, while patients with low social support benefited most from a good therapeutic bond. Conclusions: Results suggest that both the therapeutic bond and social support play a role in therapy outcomes and that good therapeutic bond quality might be especially important if a patient lacks social support.

The danger of conflating level-specific effects of control variables when primary interest lies in level-2 effects

In the multilevel modelling literature, methodologists widely acknowledge that a level-1 variable can have distinct within-cluster and between-cluster effects, and that failing to disaggregate these can yield a slope estimate that is an uninterpretable, conflated blend of the two. Methodologists have stated, however, that including conflated slopes of level-1 variables in a model is not problematic if substantive interest lies only in effects of level-2 predictors. Researchers commonly follow this advice and use methods that do not disaggregate effects of level-1 control variables (e.g., grand mean centering) when examining effects of level-2 predictors. The primary purpose of this paper is to show that this is a dangerous practice. When level-specific effects of level-1 variables differ, failing to disaggregate them can severely bias estimation of level-2 predictor slopes. We show mathematically why this is the case and highlight factors that can exacerbate such bias. We corroborate these findings with simulations and present an empirical example, showing how such distortions can severely alter substantive conclusions. We ultimately recommend that simply including the cluster mean of the level-1 variable as a control will alleviate the problem.

The Parent-Child Relationship and Posttreatment Child Outcomes Across Two Treatments for Oppositional Defiant Disorder

This study examined the degree to which the parent-child relationship uniquely predicted clinical outcomes in externalizing problems and adaptive skills in children meeting diagnostic criteria for oppositional defiant disorder and whether facets of this relationship moderated the effects of two unique psychosocial treatments. We recruited 134 children and their parents (38.06% female; M age = 9.52 years, range = 7-14; 83.58% White). Families were randomly assigned to 1 of 2 treatments: Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). We formed principal components from pretreatment reports and behaviors of the parent-child relationship to predict within- and between-family outcomes in children's externalizing problems and adaptive skills. Four principal components were supported (parental warmth, parental monitoring, family hostility, and family permissiveness). Parental monitoring predicted fewer externalizing problems, whereas family permissiveness predicted more externalizing problems. Parental warmth predicted greatest improvements in children's adaptive skills among families receiving PMT. Family hostility predicted more externalizing problems and poorer adaptive skills for children; however, families receiving CPS were buffered from the negative effect of family hostility on adaptive skills. The parent-child relationship can uniquely inform posttreatment outcomes following treatment for oppositional defiant disorder. Certain treatment approaches may better fit unique relationships that emphasize warmth and/or hostility, allowing clinicians to anticipate and tailor treatments to families.

How Schools Affect Student Well-Being: A Cross-Cultural Approach in 35 OECD Countries

A common approach for measuring the effectiveness of an education system or a school is the estimation of the impact that school interventions have on students' academic performance. However, the latest trends aim to extend the focus beyond students' acquisition of knowledge and skills, and to consider aspects such as well-being in the academic context. For this reason, the 2015 edition of the international assessment system Programme for International Student Assessment (PISA) incorporated a new tool aimed at evaluating the socio-emotional variables related to the well-being of students. It is based on a definition focused on the five dimensions proposed in the PISA theoretical framework: cognitive, psychological, social, physical, and material. The main purpose of this study is to identify the well-being components that significantly affect student academic performance and to estimate the magnitude of school effects on the well-being of students in OECD countries, the school effect being understood as the ability of schools to increase subjective student well-being. To achieve this goal, we analyzed the responses of 248,620 students from 35 OECD countries to PISA 2015 questionnaires. Specifically, we considered non-cognitive variables in the questionnaires and student performance in science. The results indicated that the cognitive well-being dimension, composed of enjoyment of science, self-efficacy, and instrumental motivation, as well as test anxiety all had a consistent relationship with student performance across countries. In addition, the school effect, estimated through a two-level hierarchical linear model, in terms of student well-being was systematically low. While the school effect accounted for approximately 25% of the variance in the results for the cognitive dimension, only 5-9% of variance in well-being indicators was attributable to it. This suggests that the influence of school on student welfare is weak, and the effect is similar across countries. The present study contributes to the general discussion currently underway about the definition of well-being and the connection between well-being and achievement. The results highlighted two complementary concerns: there is a clear need to promote socio-emotional education in schools, and it is important to develop a rigorous framework for well-being assessment. The implications of the results and proposals for future studies are discussed.

Flow States and Associated Changes in Spatial and Temporal Processing

Improved perception during high performance is a commonly reported phenomenon. However, it is difficult to determine whether these reported changes experienced during flow states reflect veridical changes in perceptual processing, or if instead are related to some form of memory or response bias. Flow is a state in which an individual experiences high focus and involvement in a specific task, and typically experiences a lack of distractibility, a disordered sense of time, great enjoyment, and increased levels of performance. The present pre-registered study investigated 27 athletes and musicians using a temporal order judgement (TOJ) task before and after a sports or music performance over three sessions. Participants' flow experiences were surveyed in order to measure how modulations of flow over successive performances potentially modulates spatiotemporal perception and processing. Hierarchical linear modeling showed a positive moderation of subjectively experienced flow and performance on post-measures of a TOJ task. Specifically, the higher the subjective flow experience of the sport or music performance was rated, the better the participant performed in the post-performance TOJ task compared to the pre-performance TOJ task. The findings of the present study provide a more comprehensive explanation of human perception during flow at high level performances and suggest important insights regarding the possibility of modulated temporal processing and spatial attention.

Neuropsychological Symptoms and Intrusive Thoughts Are Associated With Worse Trajectories of Chemotherapy-Induced Nausea

CONTEXT

Although chemotherapy-induced vomiting is well controlled with evidence-based antiemetic regimens, chemotherapy-induced nausea (CIN) remains a significant clinical problem.

OBJECTIVES

Study purposes, in a sample of outpatients with breast, gastrointestinal, gynecological, or lung cancer who received two cycles of chemotherapy (CTX, n = 1251), were to evaluate for interindividual differences in the severity of CIN and to determine which demographic, clinical, symptom, and stress characteristics are associated with higher initial levels as well as with the trajectories of CIN.

METHODS

Patients were recruited during their first or second cycle of CTX. Patients completed self-report questionnaires a total of six times over two cycles of CTX. Hierarchical linear modeling was used to evaluate for interindividual differences in and characteristics associated with the severity of CIN.

RESULTS

Across the two cycles of CTX, higher levels of sleep disturbance, depression, and morning fatigue, as well as higher levels of intrusive thoughts, were associated with higher initial levels of CIN. In addition, lower functional status scores and shorter cycle lengths were associated with higher initial levels of CIN, and younger age and higher emetogenicity of the CTX regimen were associated with both higher initial levels as well as worse trajectories of CIN severity.

CONCLUSION

These findings suggest that common symptoms associated with cancer and its treatment are associated with increased severity of CIN. Targeted interventions for these symptoms may reduce the burden of unrelieved CIN.

The thinner the better: Evidence on the internalization of the slimness ideal in Chinese college students

Internalization of the "thin ideal" is a risk factor for eating pathology. It is unclear how pervasive the thin ideal is among young Chinese. In the current study, 97 participants reported their subjective willingness to be thin and their eating-disorder-related weight-controlling behaviors, and then finished a picture judgment task to implicitly detect their perception of the importance of thinness to attractiveness. Hierarchical linear modeling was used to analyze the data. Among female participants, 79.59% wanted a thinner body. Participants' level of willingness to be thin correlated positively with frequency of eating-disorder-related weight-controlling behaviors, r = .47, p < .05. In the implicit task, the judgment of others' attractiveness correlated negatively with body mass index (BMI) evaluation, and this relationship was stronger for women's pictures than for men's pictures. Additionally, an individual's willingness to be thin enhanced the relationship between BMI evaluation and attractiveness judgment. The notion "the thinner the better" seems to be widely accepted among young Chinese.

A Longitudinal Study of Predictors of Constipation Severity in Oncology Outpatients With Unrelieved Pain

CONTEXT

Although constipation is a common symptom in oncology patients, it often goes unrecognized and untreated. In addition, little is known about characteristics associated with interindividual differences in constipation severity.

OBJECTIVES

To describe prevalence, characteristics, and management of constipation; evaluate interindividual differences in constipation severity over 10 weeks; and identify demographic, clinical, and symptom characteristics associated with higher constipation severity scores.

METHODS

In this prospective, longitudinal study, 175 oncology patients with unrelieved pain were recruited from eight outpatient cancer settings in the U.S. Patients completed demographic and symptom questionnaires at enrollment. Constipation severity was evaluated over 10 weeks using the Constipation Assessment Scale (CAS). Hierarchical linear modeling was used to identify characteristics associated with higher CAS scores.

RESULTS

At enrollment, 70.1% of the patients reported constipation [i.e., CAS score of >2; mean CAS score: 3.72 (±3.11)]. While over the first week of the study patients used one to two constipation treatments per day, a large amount of interindividual variability was found in CAS scores. Higher percentage of days with no bowel movement, higher number of constipation treatments, higher state anxiety scores, and higher analgesic side effects scores were associated with higher CAS scores at enrollment. Higher percentage of days with no bowel movement was associated with interindividual differences in the trajectories of constipation.

CONCLUSION

Our findings underscore the high prevalence of and large amount of interindividual variability in constipation severity. The characteristics associated with worse CAS scores can assist clinicians to identify high-risk patients and initiate prompt interventions.

The Influence of Workplace Incivility on Employees' Emotional Exhaustion in Recreational Sport/Fitness Clubs: A Cross-Level Analysis of the Links between Psychological Capital and Perceived Service Climate

The aim of this study was to explore the influence of workplace incivility on the emotional exhaustion of recreational sport/fitness club providers through a cross-level analysis. A total of 200 recreational sport/fitness club providers from Taiwan were selected for the repeated collection of measures and a 10-day diary method was used. The effect of workplace incivility on recreational sport/fitness club employees' emotional exhaustion on a daily basis was analyzed at the intra-personal level, and the relationship between psychological capital and perceived service climate was studied at the inter-personal level. Five hypotheses were developed and tested using hierarchical linear modeling. The results found that employees' emotional exhaustion and burnout highly correlated with workplace incivility and service climate. Based on the results, recommendations for employees and sport/fitness centers are proposed. Furthermore, research limitations and future directions are discussed.

Effect Partitioning in Cross-Sectionally Clustered Data Without Multilevel Models

Effect partitioning is almost exclusively performed with multilevel models (MLMs) - so much so that some have considered the two to be synonymous. MLMs are able to provide estimates with desirable statistical properties when data come from a hierarchical structure; but the random effects included in MLMs are not always integral to the analysis. As a result, other methods with relaxed assumptions are viable options in many cases. Through empirical examples and simulations, we show how generalized estimating equations (GEEs) can be used to effectively partition effects without random effects. We show that more onerous steps of MLMs such as determining the number of random effects and the structure for their covariance can be bypassed with GEEs while still obtaining identical or near-identical results. Additionally, violations of distributional assumptions adversely affect estimates with MLMs but have no effect on GEEs because no such assumptions are made. This makes GEEs a flexible alternative to MLMs with minimal assumptions that may warrant consideration. Limitations of GEEs for partitioning effects are also discussed.

Employees' Environmental Protection and Charitable Donation and Ethical Leadership: An Empirical Study

The sustainable development of the environment and society depends not only on firms’ social responsibility initiatives, but also on employees’ socially responsible behavior during their daily work life. Hence, it is important to study why and how employees go about the socially responsible behaviors (SRB), such as environmental protection and charitable donations. Although research has been done on the antecedents of employees’ SRB from personal, contextual and leadership perspectives, little is known about the mechanism through which they affect these behaviors. Moreover, compared with the other two perspectives, research from the leadership perspective is relatively scarce. In this paper, we aim to fill these research gaps. Based on 936 respondents from 109 corporations, we empirically test the cross-level direct effect of ethical leadership on employees’ SRB and the cross-level mediating effect of perceived organizational virtuousness. In our empirical analyses, we adopt statistical methodologies such as hierarchical linear modeling and multilevel mediation analysis. Our results show that perceived organizational virtuousness partly mediates the influence of ethical leadership on employees’ environmental protection and charitable donation. In other words, ethical leadership enables employees to form the perception of organizational virtuousness, and therefore employees are more engaged in environmental protection and charitable donations. This research provides important insights for firms and their employees to become more socially and environmentally responsible.

Do Factors from Admissions and Dental School Predict Performance on National Board Exams? A Multilevel Modeling Study

The aim of this study was to assess the association among admissions variables, dental school performance, and licensing exam performance for six cohorts of graduates of one dental school. Data from all dental school graduates of Schulich School of Medicine & Dentistry, Western University, Canada, from 2009 to 2014 who had matching National Dental Examining Board of Canada (NDEB) data (N=298) were analyzed. In the results, significant differences between cohorts were found on both the NDEB objective structured clinical examination (OSCE) and written scores. Approximately 18% of the variation in OSCE scores was attributable to cohort differences and 82% to student differences. Approximately 10% of the variation in written scores was attributable to cohort differences and 90% to student differences. Several multilevel models were conducted. The final predictive model for NDEB OSCE scores consisted of age, Canadian Dental Aptitude Test (DAT) reading comprehension scores, year 2 average, and year 4 average. For predicting NDEB written exam scores, the final model consisted of DAT chemistry and year 1, 2, and 4 averages. The findings of this study showed that academic performance on admissions variables and in training predicted performance on dental licensing exams, whereas variables that captured noncognitive or interpersonal skills, such as interview scores, were not predictive. This difference may be due to construct mismatch, such that the outcome variables had no theoretical association with the predictors. Additional outcome measures (including noncognitive) are needed that have greater ecological validity in predicting potential for competence in practice.

Validating the SEDA Measures of District Educational Opportunities via a Common Assessment

The Stanford Educational Data Archive (SEDA) is the first data set to allow comparisons of district academic achievement and growth from Grades 3 to 8 across the United States, shining a light on the distribution of educational opportunities. This study describes a convergent validity analysis of the SEDA growth estimates in mathematics and English Language Arts (ELA) by comparing the SEDA estimates against estimates derived from NWEA's MAP Growth assessments. We find strong precision-adjusted correlations between growth estimates from SEDA and MAP Growth in math (.90) and ELA (.82). We also find that the discrepancy between the growth estimates in ELA is slightly more pronounced in high socioeconomic districts. Our analyses indicate a high degree of congruence between the SEDA estimates and estimates derived from the vertically scaled MAP Growth assessment. However, small systematic discrepancies imply that the SEDA growth estimates are less likely to generalize to estimates obtained through MAP Growth in some states.

Exploring Path Models of Disablement in Residential Care and Assisted Living Residents

This study examined the relationships between individual and environmental factors and physical activity, and between physical activity and functional limitations and disability in residential care/assisted living (RC/AL) residents. Participants completed questionnaires and physical performance tests, and wore the Fitbit Motion Tracker® to capture physical activity. Model fit was analyzed using two-level path models with residents nested within RC/AL settings. Model parameters were estimated using the MPlus robust maximum likelihood method. A multilevel model with good fit (root mean square error of approximation = 0.07, comparative fit index [CFI] = 0.91) showed that persons with greater exercise self-efficacy were more physically active, and persons who were more physically active had better physical function and less disability. Setting-level factors did not significantly correlate with physical activity or disability. Although environmental factors may influence physical activity behavior, only individual factors were associated with physical activity in this sample of RC/AL residents.

Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy

CONTEXT

Studies on physical function trajectories in older adults during chemotherapy remain limited.

OBJECTIVES

The objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ≥65 years with breast, gastrointestinal, gynecological, or lung cancer.

METHODS

Older adults with cancer (n = 363) who had received chemotherapy within the preceding four weeks were assessed six times over two cycles of chemotherapy using the Short Form-12 Physical Component Summary (PCS) score. Hierarchical linear modeling was used to evaluate for interindividual variability in initial levels and trajectories of PCS scores.

RESULTS

Mean age was 71.4 years (SD 5.5). Mean PCS score at enrollment was 40.5 (SD .45). On average, PCS scores decreased slightly (i.e., 0.21 points) at each subsequent assessment. Lower PCS scores at enrollment were associated with older age, greater comorbidity, being unemployed, lack of regular exercise, higher morning fatigue, lower evening energy, occurrence of pain, lower trait anxiety, and lower attentional function. Only higher morning fatigue and lower enrollment PCS scores were associated with decrements in physical function over time.

CONCLUSION

While several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.

Meta-Analysis of Single-Case Research via Multilevel Models: Fundamental Concepts and Methodological Considerations

Multilevel modeling is an approach that can be used to summarize single-case experimental design (SCED) data. Multilevel models were developed to analyze hierarchical structured data with units at a lower level nested within higher level units. SCEDs use time series data collected from multiple cases (or subjects) within a study that allow researchers to investigate intervention effectiveness at the individual level and also to investigate how these individual intervention effects change over time. There is an increased interest in the field regarding how SCEDs can be used to establish an evidence base for interventions by synthesizing data from a series of intervention studies. Although using multilevel models to meta-analyze SCED studies is promising, application is often hampered by being potentially excessively technical. First, this article provides an accessible description and overview of the potential of multilevel meta-analysis to combine SCED data. Second, a summary of the methodological evidence on the performance of multilevel models for meta-analysis is provided, which is useful given that such evidence is currently scattered over multiple technical articles in the literature. Third, the actual steps to perform a multilevel meta-analysis are outlined in a brief practical guide. Fourth, a suggestion for integrating the quantitative results with a visual representation is provided.

CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS

The current study addressed whether two institution-wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.

The Impact of Partial Measurement Invariance on Testing Moderation for Single and Multi-Level Data

Moderation effect is a commonly used concept in the field of social and behavioral science. Several studies regarding the implication of moderation effects have been done; however, little is known about how partial measurement invariance influences the properties of tests for moderation effects when categorical moderators were used. Additionally, whether the impact is the same across single and multilevel data is still unknown. Hence, the purpose of the present study is twofold: (a) To investigate the performance of the moderation test in single-level studies when measurement invariance does not hold; (b) To examine whether unique features of multilevel data, such as intraclass correlation (ICC) and number of clusters, influence the effect of measurement non-invariance on the performance of tests for moderation. Simulation results indicated that falsely assuming measurement invariance lead to biased estimates, inflated Type I error rates, and more gain or more loss in power (depends on simulation conditions) for the test of moderation effects. Such patterns were more salient as sample size and the number of non-invariant items increase for both single- and multi-level data. With multilevel data, the cluster size seemed to have a larger impact than the number of clusters when falsely assuming measurement invariance in the moderation estimation. ICC was trivially related to the moderation estimates. Overall, when testing moderation effects with categorical moderators, employing a model that accounts for the measurement (non)invariance structure of the predictor and/or the outcome is recommended.

Education and Health across Lives and Cohorts: A Study of Cumulative (Dis)advantage and Its Rising Importance in Germany

Research from the United States has supported two hypotheses. First, educational gaps in health widen with age-the cumulative (dis)advantage hypothesis. Second, this relationship has intensified across cohorts-the rising importance hypothesis. In this article, we used 23 waves of panel data (Socio-Economic Panel Study, 1992-2014) to examine both hypotheses in the German context. We considered individual and contextual influences on the association between education and health, and we assessed gender differences in health trajectories over the life course (ages 23 to 84) and across cohorts (born between 1930 and 1969). For women, we found no support for either hypothesis, as educational gaps in self-rated health remained stable with age and across cohorts. Among men, we found support for both hypotheses, as educational gaps in self-rated health widened with age and increasingly in newer cohorts.

The convergence and divergence of impulsivity facets in daily life

OBJECTIVE

Impulsivity appears to be best conceptualized as a multidimensional construct. For example, the UPPS-P model posits that there are five underlying facets of impulsivity. The present study examined the expression of the UPPS-P facets in daily life using experience sampling methodology. A specific goal of the study was to examine positive urgency, a facet added to the original UPPS model, and its convergence and divergence from the negative urgency facet.

METHOD

A large nonclinical sample of young adults (n = 294) completed the UPPS-P scale and was signaled to complete questionnaires assessing daily affect, cognitions, sense of self, and impulsive behaviors eight times a day for 7 days.

RESULTS

Results indicated that the UPPS-P facets are associated with disruptions in affect, cognitions, and behavior in daily life. Furthermore, all of the UPPS-P facets were associated with impulsivity in daily life. Contrary to expectation, positive urgency was associated with negative affect rather than positive affect and had a profile indistinguishable from negative urgency.

CONCLUSIONS

These results generally support a four-factor model of multidimensional impulsivity with a general overall urgency factor instead of separate positive and negative urgency facets.

Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy

CONTEXT

Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment.

OBJECTIVES

The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy.

METHODS

Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data.

RESULTS

A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time.

CONCLUSION

Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.

Changes in health behaviors and the trajectory of body mass index among older Japanese: A 19-year longitudinal study

AIM

Although the modification of lifestyle factors might facilitate weight control, the effects of health behaviors on the trajectory of bodyweight among older adults have been understudied. We examined the effect of changes in smoking, alcohol use and physical activity on the long-term trajectory of body mass index (BMI) among older Japanese adults.

METHODS

Data came from a national sample of 4869 Japanese adults aged 60 years and older at baseline, with up to seven repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI trajectory.

RESULTS

The average BMI among older Japanese adults was 22.3 at baseline, and decreased with an accelerating rate over time. Smoking was significantly associated with lower BMI over time, whereas smoking cessation was associated with higher BMI. Drinking and physical activity were not associated with BMI. We found significant interactions between age and smoking status, and between sex and physical activity, on BMI trajectory: the association between smoking and lower BMI was stronger in younger participants compared with older participants. The association between physical activity and higher BMI was more pronounced among men compared with women.

CONCLUSION

The present findings yield important new information regarding the complex dynamics underlying the linkage between lifestyles factors and BMI trajectory among older Japanese, and suggest that there might be cross-cultural differences in these linkages. Geriatr Gerontol Int 2017; 17: 2008-2016.

Centering Predictor Variables in Three-Level Contextual Models

Hierarchical data are becoming increasingly complex, often involving more than two levels. Centering decisions in multilevel models are closely tied to substantive hypotheses and require researchers to be clear and cautious about their choices. This study investigated the implications of group mean centering (i.e., centering within context; CWC) and grand mean centering (CGM) of predictor variables in three-level contextual models. The goals were to (a) determine equivalencies in the means and variances across the centering options and (b) use the algebraic relationships between the centering choices to clarify the interpretation of the estimated parameters. We provide recommendations to assist the researcher in making centering decisions for analysis of three-level contextual models.

Policy Implications of Achievement Testing Using Multilevel Models: The Case of Brazilian Elementary Schools

Large-scale educational assessment has been established as source of descriptive, evaluative and interpretative information that influence educational policies worldwide throughout the last third of the twentieth century. In the 1990s the Brazilian Ministry of Education developed the National Basic Education Assessment System (SAEB) that regularly measures management, resource and contextual school features and academic achievement in public and private institutions. In 2005, after significant piloting and review of the SAEB, a new sampling strategy was taken and Prova Brasil became the new instrument used by the Ministry to assess skills in Portuguese (reading comprehension) and Mathematics (problem solving), as well as collecting contextual information concerning the school, principal, teacher, and the students. This study aims to identify which variables are predictors of academic achievement of fifth grade students on Prova Brasil. Across a large sample of students, multilevel models tested a large number of variables relevant to student achievement. This approach uncovered critical variables not commonly seen as significant in light of other achievement determinants, including student habits, teacher ethnicity, and school technological resources. As such, this approach demonstrates the value of MLM to appropriately nuanced educational policies that reflect critical influences on student achievement. Its implications for wider application for psychology studies that may have relevant impacts for policy are also discussed.

The relationship between multilevel models and non-parametric multilevel mixture models: Discrete approximation of intraclass correlation, random coefficient distributions, and residual heteroscedasticity

Multilevel data structures are common in the social sciences. Often, such nested data are analysed with multilevel models (MLMs) in which heterogeneity between clusters is modelled by continuously distributed random intercepts and/or slopes. Alternatively, the non-parametric multilevel regression mixture model (NPMM) can accommodate the same nested data structures through discrete latent class variation. The purpose of this article is to delineate analytic relationships between NPMM and MLM parameters that are useful for understanding the indirect interpretation of the NPMM as a non-parametric approximation of the MLM, with relaxed distributional assumptions. We define how seven standard and non-standard MLM specifications can be indirectly approximated by particular NPMM specifications. We provide formulas showing how the NPMM can serve as an approximation of the MLM in terms of intraclass correlation, random coefficient means and (co)variances, heteroscedasticity of residuals at level 1, and heteroscedasticity of residuals at level 2. Further, we discuss how these relationships can be useful in practice. The specific relationships are illustrated with simulated graphical demonstrations, and direct and indirect interpretations of NPMM classes are contrasted. We provide an R function to aid in implementing and visualizing an indirect interpretation of NPMM classes. An empirical example is presented and future directions are discussed.

Integrating developmental theory and methodology: Using derivatives to articulate change theories, models, and inferences

Matching theories about growth, development, and change to appropriate statistical models can present a challenge, which can result in misuse, misinterpretation, and underutilization of different analytical approaches. We discuss the use of derivatives --- the change of a construct with respect to changes in another construct. Derivatives provide a common language linking developmental theory and statistical methods. Conceptualizing change in terms of derivatives allows precise translation of theory into method and highlights commonly overlooked models of change. A wide variety of models can be understood in terms of the level, velocity and acceleration of constructs: the 0th, 1st, and 2nd derivatives, respectively. We introduce the language of derivatives, and highlight the conceptually differing questions that can be addressed in developmental studies. A substantive example is presented to demonstrate how common and unfamiliar statistical methodology can be understood as addressing relations between differing pairs of derivatives.

Leveling Mountains: Purpose Attenuates Links Between Perceptions of Effort and Steepness

People tend to overestimate the steepness of slopes, especially when they appraise the effort necessary to ascend them as greater. Recent studies, however, suggest the way individuals perceive visual stimuli may rely heavily on their personal motivations. In four studies (N = 517), purpose in life was tested as a motivational framework influencing how appraised effort relates to slope perception. Studies 1 and 2 found the amount of effort participants appraised necessary to ascend several virtual slopes was related to greater overestimation of their steepness. Yet, this relationship was attenuated by purpose assessed both as a disposition and experimental manipulation. Studies 3 and 4 replicated these findings using actual hills, again showing links between the amount of effort thought required to ascend them and their perceived angle were diminished by greater purpose. The discussion addresses implications of purpose as a broad motivational framework that shapes how individuals see their environment.

Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

CONTEXT

Fatigue is the most common symptom in oncology patients during chemotherapy. Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients.

OBJECTIVES

An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on evening fatigue.

METHODS

A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (n = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives.

RESULTS

A large amount of interindividual variability was found in the morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index, who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance, and depressive symptoms reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients' ethnicity and younger age.

CONCLUSION

The modifiable risk factors that were associated with only morning fatigue were body mass index, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Adolescent Attachment Trajectories with Mothers and Fathers: The Importance of Parent-Child Relationship Experiences and Gender

This longitudinal study investigated how attachment with mothers and fathers changes during adolescence, and how gender and parent-child relationship experiences are associated with attachment trajectories. The relative importance of specific positive and negative relationship experiences on attachment trajectories was also examined. An initial sample of 223 adolescents reported on relationship experiences and attachment avoidance and anxiety with mothers and fathers in grades 6, 8, 10, and 12 (final N=110; Mage=11.90 years at onset, SD=.43). Mothers and fathers reported on relationship experiences with adolescents. Hierarchical linear modeling showed that security with parents increased during adolescence. Positive relationship experiences (companionship, satisfaction, approval, support) predicted increases in security and negative experiences (pressure, criticism) predicted decreases in security. Females reported less avoidance than males.

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

CONTEXT

Fatigue is a distressing persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. Although significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy.

OBJECTIVES

To determine whether demographic, clinical, and symptom characteristics were associated with initial levels and the trajectories of evening fatigue.

METHODS

A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives.

RESULTS

A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were white, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, childcare responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment.

CONCLUSION

This study identified both nonmodifiable (e.g., ethnicity) and modifiable (e.g., childcare responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Effects of Individual and School-Level Characteristics on a Child's Gross Motor Coordination Development

The aim of this study was to identify child and school-level characteristics that explained inter-individual differences in gross motor coordination (GMC). Participants (n = 390), recruited from 18 Portuguese primary schools, were aged 6 to 10 years of age. Birth weight, body fat (BF), physical activity (PA), physical fitness (PF) and GMC were assessed. School size, setting, infrastructure and physical education classes were considered as school context markers. A multilevel modeling approach was used to identify hierarchical effects (child and school levels). It was found that children-level variables (sex, PF, and BF) significantly explained 63% of the 90% variance fraction at the individual level; boys outperformed girls (p < 0.05), individuals with higher BF were less coordinated (p < 0.05), and those with higher PF were more coordinated (p < 0.05). School-variables (e.g. school size and playing surface) explained 84% of the 10% variation fraction. These findings confirm the roles of sex, PFS and BF. Interestingly they also suggest that the school environment plays a minor but significant role in GMC development. However, it is important to stress that the school context and conditions can also play an important role in a child's motor development, providing adequate and enriching motor opportunities.

Trajectories of fear of recurrence in women with breast cancer

PURPOSE

Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery.

METHODS

Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months.

RESULTS

From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time.

CONCLUSIONS

These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.

Multilevel analyses of school and children's characteristics associated with physical activity

BACKGROUND

Children spend most of their awake time at school, and it is important to identify individual and school-level correlates of their physical activity (PA) levels. This study aimed to identify the between-school variability in Portuguese children PA and to investigate student and school PA correlates using multilevel modeling.

METHODS

The sample included 1075 Portuguese children of both sexes, aged 6-10 years, from 24 schools. Height and weight were measured and body mass index (BMI) was estimated. Physical activity was estimated using the Godin and Shephard questionnaire (total PA score was used); cardiorespiratory fitness was estimated with the 1-mile run/walk test. A structured inventory was used to access information about the school environment. A multilevel analysis (level-1: student-level; level-2: school-level) was used.

RESULTS

Student-level variables (age, sex, 1-mile run/walk test) explained 7% of the 64% variance fraction of the individual-level PA; however, school context explained approximately 36% of the total PA variance. Variables included in the model (school size, school setting, playground area, frequency and duration of physical education class, and qualification of physical education teacher) are responsible for 80% of the context variance.

CONCLUSIONS

School environment is an important correlate of PA among children, enhancing children's opportunities for being active and healthy.