MEDIATION ANALYSIS TO INFORM POLICY ON CORONARY REVASCULARIZATION BY EXPECTED TIME TO TREATMENT: ANALYTICAL FRAMEWORK

Objectives Clinical guidelines favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) for patients with stable complex coronary disease. Yet the benefit of CABG as established in trials may not be generalizable to populations in which treatment method determines time to treatment, typically being longer for CABG. For cases in which the cardiac anatomy is suitable for either treatment, it is unclear whether it is appropriate to recommend CABG, which is likely to be delayed, if PCI can be performed sooner. This paper outlines an analytical framework for a policy analysis of the timing of coronary revascularization. Methods We constructed a thought experiment to examine whether time to treatment will influence the advantage of CABG. We substantiated the use of mediation analysis to estimate the extent to which differences in outcomes between CABG and PCI would change if times to CABG were the same as times to PCI. Results We designed a study that uses data from a population-based patient registry to obtain effect measures of mediation analysis: the total effect, the natural indirect effect, and the natural direct effect. The partitioning of the total effect will allow us to estimate the proportional reduction in the risk of an outcome if the time to CABG was similar to that of PCI. Interpretation Treatment recommendation, resource allocation and scheduling benchmarks will be guided by understanding the extent to which the time to treatment mediates the relation between revascularization method and outcome.

The Relationships Amongst Pediatric Nurses' Work Environments, Work Attitudes, and Experiences of Burnout

Background: Pediatric nurses care for some of the most vulnerable patients in our healthcare system. Research on health care provider organizational behavior shows that the quality of care nurses provide is directly related to their well-being, influenced by Burnout and job stress, in the workplace. However, most of the research conducted on nursing populations neglects to separately study nurses who care for children. In a resource limited system where health care provider well-being is recognized as a priority, it is important for administrators to understand the environmental and attitudinal work factors most influential to pediatric nurse work outcomes in order to target optimization strategies. The aim of the study was to identify which modifiable work environment factors, e.g., [Incivility, Perceived Organizational Support, Quality of Work-life] make the greatest contribution to the work outcome of Burnout (i.e., Personal Accomplishment, Emotional Exhaustion, Depersonalization) in pediatric nurses.Methods: A cross-sectional survey design was used at a large quaternary care pediatric hospital in Toronto, Canada. We administered a survey to a convenience sample of all registered nurses with >3 months experience in the Pediatric, Cardiac, and Neonatal Intensive Care Units from January 2021–March 2021. Path analysis was used to test our proposed model which was specified a priori based on a review of the literature.Results: 143 nurses completed the survey. Path analysis of the tested model resulted in good fit. Quality of Work-life had the largest direct effect on Work Engagement (β = 0.582, S.E. = 0.111, p < 0.001). Work Engagement had the largest direct effect on Personal Accomplishment (β = 0.68, S.E. = 0.53, p < 0.001). Quality of Work-life had the largest indirect effect on Personal Accomplishment (β = 0.4, S.E. = 0.65, p < 0.001), Emotional Exhaustion (β = −0.33, S.E. = 0.87, p < 0.001), and Depersonalization (β =−0.17, S.E. = 0.41, p = 0.006), respectively. Work Engagement had the largest total effect on Personal Accomplishment (β = 0.68, S.E. = 0.64, p < 0.001) and the third largest total effect on Emotional Exhaustion (β = −0.57, S.E. = 0.83, p < 0.001). Quality of Work-life had the second largest total effect on Work Engagement (β = 0.58, S.E. = 0.11, p < 0.001) indicating that Quality of Work-life is mediated through Work Engagement for its effect on Burnout.Conclusions: Our results indicate work environment and work attitude factors that can provide organizational leadership with a targeted focus to reduce pediatric critical care nurse Burnout, and thus improve provider well-being, in a resource limited system.

COMPARISON BETWEEN DIFFERENT SURVIVABILITY MEASURES ON A GENERIC FRIGATE

Choosing suitable survivability measures is a demanding task that has to start early in the ship design process. Throughout the design process there is a need for compromises that will define and sometimes limit future operations or capabilities. In this study generic survivability measures are compared. The study also examines the sensitivity of the calculated probabilities to changes in the threat description. The result shows that it is important to investigate the total effect of a hit over a set of relevant ship functions defined for example by survivability levels. The calculations for different threat definitions show that the changes in survivability are substantial when the threat definition is changed. Moreover, the effects of different hit assumptions differ between weapon types. This must be treated as an uncertainty which also should be reflected in the output and weighted into the decisions made, based on the survivability analysis.

Relationship Among Physical Literacy, Mental Health, and Resilience in College Students

Objectives: The objective of the study is to examine the relationship among physical literacy, mental health, and resilience in college students.Methods: The study is a cross-sectional study. Participants (N = 5,265; 46.6% males) completed perceived physical literacy instruments, mental health continuum short forms, and the 12-item child and youth resilience measures. Mediation models were applied to explore the association among three concepts.Results: Physical literacy, resilience, and mental health were significantly linked with each other. In the mediation model, the direct effect of physical literacy on mental health was 0.49. The indirect effect of physical literacy on mental health through the mediation of resilience was 0.97. The mediating effect of resilience accounts for 66.30% of the total effect, indicating the partial mediating effect of resilience in the relationship between physical literacy and mental health. In more detailed models, resilience was found to mediate the relationship between physical literacy and social and psychological wellbeing, accounting for 61.02% and 56.92% of the total effect, respectively. In addition, resilience acted as full mediator in the relationship between physical literacy and emotional wellbeing (>100%). These findings suggest that physical literacy increases mental health by improving resilience.Conclusions: This is the first time to connect physical literacy with mind factors. The mediating effect of resilience on the relationship between physical literacy and mental health was found. Our findings support the development of physical literacy in universities as part of a holistic approach to supporting the wellbeing and mental health of undergraduates. This study provides a new perspective for the development of large-scale interventions in the health of body and mind in college students.

P-tau and neurodegeneration mediate the effect of β-amyloid on cognition in non-demented elders

Background There are many pathological changes in the brains of Alzheimer’s disease (AD) patients. For many years, the mainstream view on the pathogenesis of AD believes that β-amyloid (Aβ) usually acts independently in addition to triggering functions. However, the evidence now accumulating indicates another case that these pathological types have synergies. The objective of this study was to investigate whether effects of Aβ pathology on cognition were mediated by AD pathologies, including tau-related pathology (p-tau), neurodegeneration (t-tau, MRI measurements), axonal injury (NFL), synaptic dysfunction (neurogranin), and neuroinflammation (sTREM2, YKL-40). Methods Three hundred seventy normal controls (CN) and 623 MCI patients from the ADNI (Alzheimer’s Disease Neuroimaging Initiative) database were recruited in this research. Linear mixed-effects models were used to evaluate the associations of baseline Aβ with cognitive decline and biomarkers of several pathophysiological pathways. Causal mediation analyses with 10,000 bootstrapped iterations were conducted to explore the mediation effects of AD pathologies on cognition. Results Tau-related pathology, neurodegeneration, neuroinflammation are correlated with the concentration of Aβ, even in CN participants. The results show that age, gender, and APOE ε4 carrier status have a moderating influence on some of these relationships. There is a stronger association of Aβ with biomarkers and cognitive changes in the elderly and females. In CN group, Aβ pathology is directly related to poor cognition and has no mediating effect (p < 0.05). In mild cognitive impairment, tau-related pathology (26.15% of total effect) and neurodegeneration (14.8% to 47.0% of total effect) mediate the impact of Aβ on cognition. Conclusions In conclusion, early Aβ accumulation has an independent effect on cognitive decline in CN and a tau, neurodegeneration-dependent effect in the subsequent cognitive decline in MCI patients.

Association Between Dehydroepiandrosterone Sulphate Levels at 7 Years Old And Bone Mineral Density At 10 Years Old – a Prospective Cohort Study

We aimed to explore the effect of dehydroepiandrosterone sulphate (DHEAS) at age 7 on areal bone mineral density (aBMD) at age 10, and to distinguish the direct and indirect effects (explained by sexual maturity and by aBMD at age 7), for each sex, after adjustment for body mass index z-score (BMI). In a subsample of 274 children (139 girls, 135 boys) from the Generation XXI cohort, aBMD was assessed with dual-energy x-ray absorptiometry (DXA) scan at age 7 and age 10. The increase in aBMD at age 10 for each 10 µg/dL increase in DHEAS levels at age 7 was estimated using path analysis. Both the direct and the indirect effects were calculated.In girls, higher DHEAS levels at age 7 were associated with higher aBMD at age 10. No direct effect was observed. The indirect effect via higher aBMD at age 7 explained 61% of the total effect, and the indirect effect via higher Tanner stage explained 21%. After adjustment for BMI, the total effect remained statistically significant, explained in 33% by the indirect effect of DHEAS on Tanner stage and Tanner stage on aBMD. In boys, no effect of DHEAS on aBMD was observed.Conclusion: An indirect effect of DHEAS at age 7 on aBMD at age 10 was found in girls, but not in boys, as higher DHEAS levels were associated with more advanced sexual maturity at age 10, and more advanced sexual maturity to higher aBMD. No direct effect of DHEAS on aBMD was observed.

Factors associated with using the internet for medical information based on the doctor-patient trust model: a cross-sectional study

Background Internet medical care has been advancing steadily, especially during the coronavirus disease 2019 pandemic, the development momentum of Internet medical care in China is more vigorous. This study aimed to explore the factors associated with using the Internet for medical information, to examine the popularisation and implementation of Internet medical treatment and feasible strategies, and promote the further development of Internet medical treatment. Methods A cross-sectional study was conducted on 408 medical patients who had used online medical services. The one-way analysis of variance or independent samples t-test was used to compare the differences in the influence of demographic characteristics on behavioural intentions of different people seeking medical care. Pearson’s correlation was used to evaluate the correlation between different measurement variables. A mediation regression analysis was used to explore the mediating role of trust in Internet medical care. Results The difference in the influence of Internet medical use frequency on the behavioural intention of different participants was statistically significant (F = 3.311, P = 0.038). Among the influencing factors, personal trust propensity (r = 0.387, P < 0.01), website credibility (r = 0.662, P < 0.01), hospital credibility (r = 0.629, P < 0.01), doctor’s credibility (r = 0.746, P < 0.01), and online patient trust (r = 0.874, P < 0.01) were positively correlated with patients’ behavioural intentions. In the analysis of intermediary factors, the total effect of the credibility of the diagnosis and treatment website on the behavioural intention of patients was 0.344. The total effect of the credibility of the diagnosis and treatment hospital on the behavioural intention of patients was 0.312; the total effect of the service doctor’s credibility on the patient’s behavioural intention was 0.385; the total effect of the personal trust tendency on the patient’s behavioural intention was 0.296. Conclusions This study found defects in various factors that produce distrust in Internet medical treatment. It also reveals the positive effect of trust factors on the development and implementation of Internet medical treatment and provides some ideas for improving the use of Internet medical treatment by the masses.

Factors Influencing Urban Residents’ Intention of Garbage Sorting in China: An Extended TPB by Integrating Expectancy Theory and Norm Activation Model

With the deepening of the garbage classification policy strength, making urban household garbage sorting mandatory in China, it is imperative to clarify the key factors affecting the urban residents’ intention to behave in garbage classification. Though it has attracted the attention of researchers, there are still several aspects that need to be supplemented and improved. Thus, this study aims to investigate the critical factors affecting the urban residents’ intention of garbage sorting and develop an extended model of planned behavior by integrating expectancy theory (ET) and norm activation model (NAM). Given the positive externalities of urban residents’ garbage sorting behaviors, awareness of consequences and attribution of responsibility are correspondingly interpreted as environmental benefits (EB) and environmental concerns (EC). The sample data of 668 urban residents who lived in four pilot cities of garbage classification in China were collected and adopted to the structural equation modeling (SEM) with bootstrapping estimation method to assess the causal relationship between variables. The results indicated that the expectation (Exp) was a significant positive predictor of garbage sorting intention. Attitude (AT), perceived behavior control (PBC) and subjective norm (SN) positively affected urban residents’ expectation of garbage sorting, with SN having the most significant direct impact. The results also found that the EB has significant influences EC, which strongly influences urban residents’ expectation of garbage sorting. Furthermore, the total effect of EC on Exp is higher than other paths, and the mediating effect of SN on Exp by AT and PBC is greater than other indirect paths, which accounted for about 27.1% of the total effect. Finally, we discuss both theoretical and practical implications, along with recommendations for future research.

Influence of Sport Motivation on Sport Mental Fatigue: Mediating Effect of Coping Style

In order to explore the relationship between sport motivation sport mental fatigue, as well as the mediating effect of coping style, a sample of 523 active athletes were recruited to complete sport motivation questionnaire, sport mental fatigue questionnaire and coping inventory for competitive sports. The result indicated that sport motivation negatively predicted the sport mental fatigue. Coping style partially mediated the relationship between sport motivation and sport mental fatigue. The mediating effect accounted for 65% of total effect. Sport motivation and coping style explain the 35% variation of sport mental fatigue. The harm effect of sport mental fatigue on sport motivation could be reduced while the coping style could be improved.