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This study delved into socio-psychological determinants driving residential water curtailment actions, an area relatively overlooked in the existing literature. The theory of planned behavior was innovatively expanded with moral norms, perceived expectations, self-identity, and risk-related components. The proposed framework was empirically examined by conducting an online self-administered survey of 343 citizens residing in Isfahan, Iran. What sets this research apart is introducing a new multi-analytical hybrid approach integrating linear and non-linear techniques to leverage their respective strengths. Artificial neural network (ANN), coupled with Sobol sensitivity analysis, was employed to robustly validate structural equation modeling (SEM) results regarding the framework's explanatory power and predictors' ranking. Through providing reliable performance, the ANN analysis confirmed SEM findings, revealing that the significant influences of moral norms and self-identity on intention are mediated by attitude and perceived behavioral control. Moreover, self-identity and attitude were the strongest direct predictors of behavior and intention. Several policy recommendations were proposed, with the following highlighted as crucial: (1) fostering favorable water conservation attitudes, which entails targeting individuals' moral considerations and inducing self-reward feelings within the community; (2) cultivating a sense of water conservation identity among citizens; and (3) boosting individuals’ self-confidence and facilitating their engagement in water conservation behaviors.

OBJECTIVES: To describe the clinical phenotype and prognosis of people in the Australian Scleroderma (SSc) Cohort Study with pulmonary arterial hypertension (PAH) with or without interstitial lung disease (ILD). METHODS: Participants meeting ACR/EULAR criteria for SSc were divided into four mutually exclusive groups: those meeting criteria for PAH (PAH-only), ILD (ILD-only), concurrent PAH and ILD (PAH-ILD) or neither PAH nor ILD (SSc-only). Logistic or linear regression analyses were used for associations between clinical features, health-related quality of life (HRQoL) and physical function. Survival analysis was performed using Kaplan-Meier estimates and Cox-regression modelling. RESULTS: Of 1561 participants, 7% fulfilled criteria for PAH-only, 24% ILD-only, 7% PAH-ILD and 62% SSc-only. People with PAH-ILD were more frequently male, with diffuse skin involvement, higher inflammatory markers, older age of SSc onset and higher frequency of extensive ILD than the cohort overall (p < 0.001). People of Asian race more frequently developed PAH-ILD (p < 0.001). People with PAH-ILD or PAH-only had worse WHO functional class and 6-min-walk-distance than ILD-only (p < 0.001). HRQoL scores were worst in those with PAH-ILD (p < 0.001). Survival was reduced in the PAH-only and PAH-ILD groups (p < 0.01). Multivariable hazard modelling demonstrated the worst prognosis in extensive ILD and PAH (HR = 5.65 95% CI 3.50-9.12 p < 0.01), followed by PAH-only (HR = 4.21 95% CI 2.89-6.13 p < 0.01) and PAH with limited ILD (HR = 2.46 95% CI 1.52-3.99 p < 0.01). CONCLUSIONS: The prevalence of concurrent PAH-ILD in the ASCS is 7%, with poorer survival in those patients with PAH-ILD compared to ILD or SSc alone. The presence of PAH confers a poorer overall prognosis than even extensive ILD; however, further data are required to better understand the clinical outcomes of this high-risk patient group.

As concerning with water insecurity driven by water scarcity threatens the lives and livelihoods of humanity worldwide, urban water demand management is focused on promoting residential water conservation behaviors (WCBs) as a critical policy response to water scarcity. However, urban water conservation initiatives cannot be successful unless households involve in residential WCBs voluntarily by adopting water curtailment and/or water-efficiency actions. Thus, understanding motivations and mechanisms underlying accepting these two types of WCBs and interpreting their distinctions are primary policy considerations to make sustainable water consumption behaviors. Hence, the purpose of this research was twofold: (1) To explore intentions to household adoption of water curtailment and water-efficiency actions, key corresponding determinants, and distinctions between them; and (2) To evaluate the capability and robustness of the Health Belief Model (HBM) to explain residential WCBs. The present research design was a cross-sectional survey conducted in Tehran, Iran. The outcomes from structural equation modeling indicated that: (1) Water curtailment intention was solely determined by self-efficacy and perceived benefits; (2) In addition to self-efficacy and perceived benefits, perceived severity, cues to action, and perceived barriers were significantly related to water-efficiency intention; (3) While only perceived susceptibility was not a significant determinant for water-efficiency intention, perceived susceptibility, perceived severity, perceived barriers, and cues to action could not significantly explain water curtailment intention; (4) Self-efficacy also emerged as the strongest predictive variable behind intentions to adopt both WCBs; (5) The perceived barriers had a negative significant relationship only with water-efficiency intention; and (6) The HBM could explain 72% and 61% of the variance in households' intentions to adopt water curtailment and water-efficie

OBJECTIVE: This study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals. DESIGN: A cross-sectional study. SETTING: Data obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019. PARTICIPANTS: Heterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview. PRIMARY AND SECONDARY OUTCOME MEASURES: Univariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming). RESULTS: There were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25-34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth. CONCLUSION: Older heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.

AIM: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. METHODS: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. RESULTS: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: -0.5 to -0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. CONCLUSIONS: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.

BACKGROUND: The aim of this study was to evaluate the association between type 2 diabetes and disability in Mauritius and to assess the extent to which the effect of diabetes is explained by diabetes risk factors and concomitant complications. METHODS: Data from a national survey in the multiethnic nation of Mauritius, which comprises South Asians and African Creoles, were analyzed. Disability was measured using the Katz activities of daily living questionnaire in participants aged >50 years. RESULTS: Among 3692 participants, 487 (13.2%) had some level of disability. Diabetes was associated with significantly higher risk of disability (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.34-2.08). After adjusting for demographic, behavioral, and metabolic factors, as well as comorbidities, disability was significantly associated with diabetes among African Creoles (OR 2.03; 95% CI 1.16-3.56), but not South Asians (OR 1.27; 95% CI 0.98-1.66). Obesity explained much of the association between diabetes and disability (excess percentage of risk: 26.3% in South Asians and 12.1% in African Creoles). Obesity, history of cardiovascular disease (CVD), asthma-like symptoms, and depression together explained 46.5% and 29.0% of the excess risk in South Asians and African Creoles, respectively. CONCLUSIONS: Diabetes is associated with a 67% increased risk of disability. Diabetes risk factors and comorbidities explain more of the association between diabetes and disability among South Asians than Africans. Obesity and history of CVD explained the largest percentage of the relationship between diabetes and disability, indicating that weight and CVD management may be helpful in controlling disability related to diabetes.

AIMS: To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. METHODS: Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c , blood pressure and LDL cholesterol. RESULTS: In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. CONCLUSIONS: In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.

Climate change occasioned by the accumulation of greenhouse gases (GHGs) is now widely accepted as an issue which mankind needs to address. The starting point is necessarily the determination of all the sources of emissions during the life-cycles of the studied components. Post-calculation, the results ought to be presented to decision-makers in a clear manner so as to provide the basis on which corrective actions could be considered. This paper calculates the GHGs emissions during the life-cycle of wastewater pipelines and introduces a different approach to communicate information about GHGs released, to decision-makers. Different diameters of concrete and high-density polyethylene (HDPE) wastewater pipes are compared in a case study. Results show that the total CO 2-equivalent (CO2-eq) emissions attributed to concrete pipes are greater than HDPE pipes. Hence, the equivalent bio-productive area of forest required to sequester the CO2 (the major GHG) and its corresponding costs will be greater for the former.

BACKGROUND: Vitamin D deficiency is highly prevalent and associated with increased risk of a number of chronic health conditions including cardiovascular disease, poor bone and muscle health, poor mental health, infection, and diabetes. Vitamin D deficiency affects millions of Australians, potentially causing considerable suffering, economic loss, and mortality. OBJECTIVE: To measure the effectiveness of a (1) mobile-based app (behavioral) and (2) pharmacological intervention to increase circulating 25-hydroxyvitamin D (serum 25 OHD) levels and health outcomes over 4 months of intervention compared with usual care in a cohort of young women with suboptimal serum 25 OHD levels (25-75 nmol/L). METHODS: Participants with 25 OHD levels 25 to 75 nmol/L are invited to participate in this study. Participants are randomized to one of three groups in 1:1:1 ratio: a mobile phone-based application, vitamin D supplementation (1000 IU/day), and a control group. Data collection points are at baseline, 4, and 12 months post baseline with the major endpoints being at 4 months. A wide-range of information is collected from participants throughout the course of this study. General health, behavioral and demographic information, medications, smoking, alcohol and other substance use, health risk factors, nutrition, eating patterns and disorders, and mental health data are sourced from self-administered, Web-based surveys. Clinical data include anthropometric measurements, a silicone skin cast of the hand, cutaneous melanin density, bone mineral density, and body composition scans obtained through site visits. Main analyses will be conducted in two ways on an intention-to-treat (ITT) basis using the last observation carried forward approach as an imputation for missing data, and on a per protocol basis to compare the intervention arms against the control group at 4 and 12 months. RESULTS: Publication of trial results is anticipated in 2017. CONCLUSIONS: The study will allow assessment o

A mathematical model is presented for shovel and truck allocation, with the aims of maximising production and minimising deviations from target head grade, tonnage fed to the plant, and operating cost. The two main modelling components are a mixed integer linear goal programming model to allocate trucks and shovels to mining faces over a shift-by-shift basis, and a discrete-event simulation model to investigate the behaviour of a truck-and-shovel haulage system in the presence of uncertainty within mining operations. The simulation model was verified using key performance indicators from a large-scale oil sands open pit mine using truck-and-shovel operations, with a simulation run of 3 months. When compared with the actual operating data the simulation showed promising results for modelling the highly uncertain mining environment., A mathematical model is presented for shovel and truck allocation, with the aims of maximising production and minimising deviations from target head grade, tonnage fed to the plant, and operating cost. The two main modelling components are a mixed integer linear goal programming model to allocate trucks and shovels to mining faces over a shift-by-shift basis, and a discrete-event simulation model to investigate the behaviour of a truck-and-shovel haulage system in the presence of uncertainty within mining operations. The simulation model was verified using key performance indicators from a large-scale oil sands open pit mine using truck-and-shovel operations, with a simulation run of 3 months. When compared with the actual operating data the simulation showed promising results for modelling the highly uncertain mining environment.