A Note on Modelling Bidirectional Feedback Loops in Mendelian Randomization Studies.

Structural equation models (SEMs) involving feedback loops may offer advantages over standard instrumental variables estimators in terms of modelling causal effects in the presence of bidirectional relationships. In the following note, we show that in the case of a single "exposure" and "outcome" variable, modelling relationships using a SEM with a simple bidirectional linear feedback loop offers no advantage over traditional instrumental variables estimators in terms of consistency (i.e. both approaches yield consistent estimates of the causal effect, provided that causal estimates are obtained in both directions). In the case of finite samples, traditional IV estimators and SEM exhibited similar power across many of the conditions we examined, although which method performed best depended on the residual correlation between variables and the strength of the instruments. In particular, the power of SEM was insensitive to the residual correlation between variables, whereas the power of the Wald estimator/2SLS improved (deteriorated) relative to SEM as the magnitude of the residual correlation increased (decreased) assuming a positive causal effect of the exposure on the outcome. The power of SEM improved relative to the Wald estimator/2SLS as the instruments explained more residual variance in the "outcome" variable.

Developing a community-responsive research model in the healthcare system: a mixed-method study.

BACKGROUND: Responsiveness to the population's non-clinical needs encompasses various dimensions, including responsive research and an educational outreach plan at the community level. This study aims to develop a community-responsive research model in the healthcare system to ensure the connection between community-identified health priorities and research funds, as well as capacity-building efforts. METHODS: A mixed-methods research study was conducted in three main phases, including a comprehensive literature review, a qualitative analysis of an expert panel's points of view, and the developing of a model using the Equation Modeling (SEM) technique. R software version 3.2.4 was used to conduct statistical analysis, considering a significance level of 0.05. RESULTS: Based on the literature review, 41 responsiveness components were identified from sixteen relevant studies conducted between 2000 and 2022. Ten sub-themes in four major themes, including planning, implementation, monitoring and evaluation, and action, were identified through qualitative content analysis. Standardized coefficients revealed that components such as dissemination of results to all stakeholders, research prioritization aligned with community needs, commitment to implement research findings, and collaborative learning had statistically significant effects on the community-responsive research model. CONCLUSION: It is essential to identify community health priorities by following a community-focused, priority-setting process based on the principles of community engagement to develop a community-responsive research model. Afterward, dissemination of research findings to all stakeholders, commitment to apply the obtained results in the real world, and promotion of shared learning among research partners have been proven to facilitate collaborative investigation and mutual understanding between the community and academic partners.

Quantifying reciprocal relationships between poverty and health: combining a causal loop diagram with longitudinal structural equation modelling.

BACKGROUND: This study takes on the challenge of quantifying a complex causal loop diagram describing how poverty and health affect each other, and does so using longitudinal data from The Netherlands. Furthermore, this paper elaborates on its methodological approach in order to facilitate replication and methodological advancement. METHODS: After adapting a causal loop diagram that was built by stakeholders, a longitudinal structural equation modelling approach was used. A cross-lagged panel model with nine endogenous variables, of which two latent variables, and three time-invariant exogenous variables was constructed. With this model, directional effects are estimated in a Granger-causal manner, using data from 2015 to 2019. Both the direct effects (with a one-year lag) and total effects over multiple (up to eight) years were calculated. Five sensitivity analyses were conducted. Two of these focus on lower-income and lower-wealth individuals. The other three each added one exogenous variable: work status, level of education, and home ownership. RESULTS: The effects of income and financial wealth on health are present, but are relatively weak for the overall population. Sensitivity analyses show that these effects are stronger for those with lower incomes or wealth. Physical capability does seem to have strong positive effects on both income and financial wealth. There are a number of other results as well, as the estimated models are extensive. Many of the estimated effects only become substantial after several years. CONCLUSIONS: Income and financial wealth appear to have limited effects on the health of the overall population of The Netherlands. However, there are indications that these effects may be stronger for individuals who are closer to the poverty threshold. Since the estimated effects of physical capability on income and financial wealth are more substantial, a broad recommendation would be that including physical capability in efforts that are aimed at improving income and financial wealth could be useful and effective. The methodological approach described in this paper could also be applied to other research settings or topics.

Assessing the effects of climate and human activity on vegetation change in Northern China.

Fractional vegetation cover (FVC) has changed significantly under various disturbances over northern China in recent decades. This research examines the dynamics of FVC and how it is affected by climate and human activity during the period of 1990-2018 in northern China. The effects of climate change (i.e., temperature, precipitation, solar radiation, and soil moisture) and human activity (socioeconomic data and land use) on vegetation coverage change in northern China from 1990 to 2018 were quantified using the Sen + Mann-Kendall test, partial correlation analysis, and structural equation modelling (SEM) methods. The findings of this research indicate the following: (1) From 1990 to 2018, the overall trend in FVC in northern China was increased. The areas with obvious increases were mainly situated on the northern slope of Tianshan Mountains, Xinjiang, the Loess Plateau, the Northeast China Plain, and the Sanjiang Plain, while the areas with distinct degradation were located in the Inner Mongolia Plateau, the Changbai Mountain and the eastern part of north China. (2) In the past 29 years, the FVC in northern China has been mainly affected by precipitation and soil moisture. (3) Based on structural equation modelling, we discovered that certain variables impacted the main factors influencing the amount of FVC in northern China. Human activity has had a larger impact on FVC than climate change. Our findings can accelerate the comprehension of vegetation dynamics and their underlying mechanisms and provide a theoretical basis for regional ecological environmental protection.

Neurogenetic and multi-omic sources of overlap among sensation seeking, alcohol consumption, and alcohol use disorder.

Sensation seeking is bidirectionally associated with levels of alcohol consumption in both adult and adolescent samples, and shared neurobiological and genetic influences may in part explain these associations. Links between sensation seeking and alcohol use disorder (AUD) may primarily manifest via increased alcohol consumption rather than through direct effects on increasing problems and consequences. Here the overlap among sensation seeking, alcohol consumption, and AUD was examined using multivariate modelling approaches for genome-wide association study (GWAS) summary statistics in conjunction with neurobiologically informed analyses at multiple levels of investigation. Meta-analytic and genomic structural equation modelling (GenomicSEM) approaches were used to conduct GWAS of sensation seeking, alcohol consumption, and AUD. Resulting summary statistics were used in downstream analyses to examine shared brain tissue enrichment of heritability and genome-wide evidence of overlap (e.g., stratified GenomicSEM, RRHO, genetic correlations with neuroimaging phenotypes), and to identify genomic regions likely contributing to observed genetic overlap across traits (e.g., H-MAGMA and LAVA). Across approaches, results supported shared neurogenetic architecture between sensation seeking and alcohol consumption characterised by overlapping enrichment of genes expressed in midbrain and striatal tissues and variants associated with increased cortical surface area. Alcohol consumption and AUD evidenced overlap in relation to variants associated with decreased frontocortical thickness. Finally, genetic mediation models provided evidence of alcohol consumption mediating associations between sensation seeking and AUD. This study extends previous research by examining critical sources of neurogenetic and multi-omic overlap among sensation seeking, alcohol consumption, and AUD which may underlie observed phenotypic associations.

Exploring socioeconomic status, lifestyle factors, and cardiometabolic disease outcomes in the United States: insights from a population-based cross-sectional study.

BACKGROUND: Cardiometabolic diseases are a major global health concern. This study aims to identify areas for targeted interventions and investigate the impact of socioeconomic status and lifestyle as a potential mediator in the context of the US. METHODS: Our study analyzed data from the Health Information National Trends Survey 5, a nationwide survey by the National Cancer Institute. Using standardized scales and questions, we examined cardiometabolic disease outcomes, lifestyle factors, and socioeconomic status of non-institutionalized civilians aged 18 + in the US. We analyzed the data using structural equation modelling. RESULTS: Our findings show that socioeconomic status and lifestyle significantly predict cardiometabolic disease outcomes. However, our analysis did not support lifestyle as the primary mediating factor in the association between socioeconomic status and cardiometabolic diseases, suggesting that other factors may significantly influence this relationship. CONCLUSIONS: Cardiometabolic diseases require lifestyle and structural interventions addressing socioeconomic factors. Policymakers must consider multifaceted factors to prevent, detect, and manage these diseases effectively and equitably.

Outcomes of a homestead food production program on nutritional knowledge, dietary diversity, food security and empowerment of rural women in Tehran province, Iran.

BACKGROUND: Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province. METHODS: The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software. RESULTS: The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05). CONCLUSION: Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program.

Breaking down barriers: rationalisations and motivation to stop among Chinese male smokers under cigarette dependence.

BACKGROUND: Smoking rationalisation beliefs are a huge barrier to quitting smoking. What types of rationalisations should be emphasised in smoking cessation interventions? Although past literature has confirmed the negative relationship between those beliefs and motivation to stop smoking, little is known regarding the importance and performance of those beliefs on motivation with varying cigarette dependence. The study aimed to ascertain rationalisations that are highly important for motivation yet perform poorly in different cigarette dependence groups. METHODS: The cross-sectional study was conducted from November 19 to December 9, 2023 in Guiyang City, China. Adult male current smokers were enrolled. Partial least squares structural equation modelling was used to test the hypothesis. The multi-group analysis was used to determine the moderating effect of cigarette dependence, and the importance-performance map analysis was utilised to assess the importance and performance of rationalisations. RESULTS: A total of 616 adult male current smokers were analysed, and they were divided into the low cigarette dependence group (n = 297) and the high cigarette dependence group (n = 319). Except for risk generalisation beliefs, smoking functional beliefs (H1: -ß = 0.131, P < 0.01), social acceptability beliefs (H3: ß = -0.258, P < 0.001), safe smoking beliefs (H4: ß = -0.078, P < 0.05), self-exempting beliefs (H5: ß = -0.244, P < 0.001), and quitting is harmful beliefs (H6: ß = -0.148, P < 0.01) all had a significant positive influence on motivation. Cigarette dependence moderated the correlation between rationalisations and motivation. In the high-dependence group, the social acceptability beliefs and smoking functional beliefs were located in the "Concentrate Here" area. In the low-dependence group, the social acceptability beliefs were also situated in there. CONCLUSIONS: Social acceptability beliefs and smoking functional beliefs showed great potential and value for improvement among high-dependence smokers, while only social acceptability beliefs had great potential and value for improvement among low-dependence smokers. Addressing these beliefs will be helpful for smoking cessation. The multi-group analysis and the importance-performance map analysis technique have practical implications and can be expanded to other domains of health education and intervention practice.

Procrastination, depressive symptomatology, and loneliness in later life.

OBJECTIVES: Procrastination is an almost universal behaviour and yet little research to date has focused on procrastination among older adults. The purpose of this study was to explore the potential association between age and procrastination, and the potential mediating roles of depressive symptomatology and loneliness. METHOD: Structural equation modelling was applied to data from 1309 participants (aged 29-92) from two waves United States Health and Retirement Study (2016-2020). Within the model, sex, education, marital status, and job status were added as covariates. RESULTS: There was no statistically significant direct effect between age and procrastination (ß = 0.06, p = 0.106). However, an indirect effect was present via depressive symptomatology (ß = -0.40, p < 0.001). No mediating effect of loneliness was observed (ß = - 0.01, p = 0.371). Subsequent analysis revealed that the symptoms, fatigue, loneliness, and lack of motivation significantly predicted procrastination. CONCLUSION: While age was not directly associated with procrastination, increasing age was associated with a decreased likelihood of depressive symptomatology, which was in turn associated with an increased likelihood of procrastination. Such findings indicates that age demonstrates no association with procrastination because of the suppressing effect of depressive symptomatology.

Parental mental health and reporting of their child's behaviour: measurement invariance of the French version of the parental strengths and difficulties questionnaire.

Symptomatic effects of mental disorders in parents could bias their reporting on their child's mental health. This study aimed to investigate the measurement invariance of the French version of the parental Strengths and Difficulties Questionnaire (SDQ) across parental mental health in a sample (N = 20,765) of parents of children aged 3 to 17 years in France. Confirmatory factor analysis (CFA) and Exploratory Structural Equation Modelling (ESEM) were used to evaluate the fit of three known alternative SDQ factor structures (five, three, or second-order factor structures). Invariance was tested across parental mental health (present anxiety and depressive symptoms, psychiatric history) and across socio-demographic characteristics (child's age, child's gender, parent's gender, parent's educational level). CFA models showed a poor fit, while all ESEM models achieved acceptable or good fit, with the five-factor model presenting the best fit. Invariance was observed for all characteristics tested, indicating that the SDQ can be used to study the links between parental mental health and their child's mental health without bias. However, ESEM showed that the hyperactivity/inattention and conduct problems dimensions were not well differentiated in the French version of the SDQ.

The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis.

OBJECTIVES: The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN: Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS: We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS: The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS: Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.

Associations of nature contact with emotional ill-being and well-being: the role of emotion regulation.

Nature contact has associations with emotional ill-being and well-being. However, the mechanisms underlying these associations are not fully understood. We hypothesised that increased adaptive and decreased maladaptive emotion regulation strategies would be a pathway linking nature contact to ill-being and well-being. Using data from a survey of 600 U.S.-based adults administered online in 2022, we conducted structural equation modelling to test our hypotheses. We found that (1) frequency of nature contact was significantly associated with lesser emotional ill-being and greater emotional well-being, (2) effective emotion regulation was significantly associated with lesser emotional ill-being and greater emotional well-being, and (3) the associations of higher frequency of nature contact with these benefits were partly explained via emotion regulation. Moreover, we found a nonlinear relationship for the associations of duration of nature contact with some outcomes, with a rise in benefits up to certain amounts of time, and a levelling off after these points. These findings support and extend previous work that demonstrates that the associations of nature contact with emotional ill-being and well-being may be partly explained by changes in emotion regulation.

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study.

AIM: To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure. DESIGN: A cross-sectional study. METHODS: An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure. RESULTS: Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure. CONCLUSION: Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure. IMPACT: This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses. REPORTING METHOD: We have followed the STROBE checklist in reporting this study. PATIENT OR PUBLIC CONTRIBUTION: No Patient or public contribution.

Perceived stress, positive psychological capital and health literacy in patients with multiple chronic conditions: A structural equation modelling.

AIM: To investigate the structural relationships among perceived stress (PS), positive psychological capital (PsyCap) and health literacy (HL) in patients with multiple chronic conditions (MCC) and construct a model to explore the relationships of PS and PsyCap on HL. BACKGROUND: HL is critical in the rehabilitation and management of patients with MCC. Extensive understanding of the relationships between research variables can help nursing staff to implement effective programmes that improve the level of HL of patients. However, currently there is no research that has evaluated the structural relationships among these variables using a single model. METHODS: This study adhered to the STROBE guidelines for reporting cross-sectional studies. The Health Literacy Scale for Chronic Patients, Chinese Perceived Stress Scale (CPSS) and Positive Psychological Capital Questionnaire were used to assess HL, PS and PsyCap, respectively. Questionnaires were distributed to 317 patients with MCC attending a tertiary general care hospital in China from February to May 2023, using convenience sampling approach. Structural equation modelling was used to validate the proposed model. RESULTS: The findings showed that PS has a negative relationship with HL and PsyCap. PS was indirectly associated with HL through PsyCap. The results indicated that PsyCap was positively associated with HL. The PS and PsyCap explained 64% of the variance in HL. CONCLUSIONS: The findings showed that the proposed model had high validity and structural relationships between chosen variables were observed for MCC patients. RELEVANCE TO CLINICAL PRACTICE: These results may help nursing staff develop strategies to improve the HL of patients with MCC, which should focus on reducing PS and enhancing PsyCap to improve HL. Nursing staff can provide targeted psychological counselling and health guidance for patients to alleviate negative emotions and further promote their HL. PATIENT OR PUBLIC CONTRIBUTION: Participate in research and fill out questionnaires.

Multi-layered physical factors govern mercury release from soil: Implications for predicting the environmental fate of mercury.

Despite the recognised risks of human exposure to mercury (Hg), the drivers of gaseous elemental mercury (GEM) emissions from the soil remain understudied. In this study, we aimed to identify the environmental parameters that affect the GEM flux from soil and derive the correlations between environmental parameters and GEM flux. Principal component analysis (PCA), factor analysis (FA), and structural equation modelling (SEM) were performed on samples from forest and non-forest sites. The associated results revealed the impact of each environmental parameter on GEM flux, either due to the interaction between the parameters or as a coherent set of parameters. An introductory correlation matrix examining the relationship between two components showed a negative correlation between GEM flux and atmospheric pressure at the two sites, as well as strong correlations between atmospheric pressure and soil temperature. In cases of non-forest open sites with no trees, the PCA and FA results were consistent, indicating that atmospheric pressure, solar irradiance, and soil moisture-defined as primary causality-are largely independent drivers of GEM flux. In contrast, the PCA and FA results for the forest areas with high humidity, tree coverage, and shade were inconsistent, confirming the hypothesis that primary causality affects GEM flux rather than consequent parameters driven by primary causality, such as air and soil temperature and atmospheric humidity. The SEM results provided further evidence for primary and consequent causality as crucial drivers of the GEM flux. This study demonstrates the importance of key primary parameters, such as atmospheric pressure, solar irradiance, and soil moisture content, that can be used to predict mercury release from soils, as well as the importance of consequent parameters, such as air and soil temperature and atmospheric humidity. Monitoring the magnitude of these environmental parameters alone may facilitate the estimation of mercury release from soils and be useful for detailed modelling of soil-air Hg exchange.

Investigating the relationship between individualized care, patient satisfaction and trust in nurses through structural equation modelling.

INTRODUCTIONS: The aim of this study was to demonstrate the impact of individualized nursing care on patient satisfaction and trust in nurses through structural equation modelling in patients receiving treatment in internal clinics. METHODS: The study is a descriptive, exploratory and cross-sectional research conducted with patients receiving treatment in the internal admission services of an educational research hospital between January and April 2023. According to sample calculations, it was determined that a minimum of 238 patients needed to be included in the study, and 286 patients who met the inclusion criteria and agreed to participate in the research formed the study sample. Data were collected using the 'Patient Identification Form', 'Individualized Care Scale-Patient Version', 'Newcastle Nursing Care Satisfaction Scale' and the 'Trust in Nurses Scale'. RESULTS: The level of awareness of nursing actions supporting individuality was found to be 2.71 ± 0.99, the level of perceiving individuality was 2.88 ± 0.99, the average level of nursing care satisfaction measured 77.17 ± 12.67 and the average level of trust in nurses was 21.92 ± 3.04. It was determined that as patients' awareness of nursing actions supporting individuality and their perception of individuality in care increased, they remained more satisfied with their care and had greater trust in nurses. CONCLUSIONS: Patients who perceived receiving individualized care were found to have higher levels of patient satisfaction and trust in nurses. Additionally, it was observed that as participants' satisfaction with their care increased, their trust in nurses also increased.

Influence of vegetation pattern and aridity on soil properties related soil available water in the Mediterranean regions.

Grassland ecology is deteriorating along with a fall in biodiversity and ecosystem services as a result of climate change in the Mediterranean regions. Understanding the mechanism of feedback between soil properties related to available water and increasing aridity is a key component of preserving grassland ecosystems. Structural equation modelling was used to explore a deep understanding of the underlying mechanisms of the feedback between soil properties related to available water and increasing aridity. In most cases, vegetation patches had significantly higher soil properties related to available water than inter-patches. Compared to inter-patches, the fine fractions of silt and clay content, soil organic carbon, saturated hydraulic conductivity, and available water under vegetation patches increased by 3.79%-7.64%, 31.08%-37.64%, 96.65%-141.14%, and 2.63%-9.21%, respectively, under limestone and mica schist lithologies. The fine fractions of silt and clay content, soil organic carbon, and available water were more responsive to the aridity index than the vegetation patch, while saturated hydraulic conductivity was more responsive to the vegetation patch than the aridity index. These complex relationships demonstrated that the available water was significantly positively affected by the vegetation pattern (0.09) and the aridity index (0.21-0.38). Soil texture had a significantly direct effect (0.43-0.53) on available water. Increasing aridity would strengthen the contrast in soil water availability while weakening the contrast in saturated hydraulic conductivity between vegetation patches and inter-patches. Available water was controlled by many aspects except vegetation pattern and aridity index. Understanding these relationships helped in predicting and mitigating the impacts of climate change on soil properties related to available water. The study offered fresh perspectives on the mechanism of vegetation pattern and aridity index on the various soil properties related to available water in arid and semiarid grasslands ecosystems under climate change.

Investigating important and necessary conditions to analyse traffic noise levels at intersections in mid-sized cities.

Traffic noise is a major problem for urban residents, especially near intersections. In order to effectively manage and control traffic noise, there is a need for a better understanding of noise-influencing variables at intersections. In this way, the study aims to identify and distinguish the important and necessary conditions corresponding to the particular traffic noise level. Using 342 h of field data from 19 intersections in Kanpur, the current research has used the Partial Least Square-Structural Equation Modelling (PLS-SEM) and Necessary Condition Analysis (NCA). The study determines that traffic volume, honking, speed, and median width are important factors. Traffic volume and honking are positively affecting traffic noise level, while speed and median width have a negative effect. Further investigation reveals that only traffic volume and honking are necessary to achieve a particular traffic noise level. Policymakers can use these findings to manage and control traffic noise at intersections.

Behavioral factors driving farmers' intentions to adopt spot spraying for sustainable weed control.

Smart Farming Technologies enable plant-specific agrochemical applications which can increase the efficiency and reduce the environmental impacts of agriculture. However, the uptake of Smart Farming Technologies remains slow despite their potential to enhance sustainable transformation of food systems. The design of policies to promote sustainable agricultural technologies requires a holistic understanding of the complex set of factors driving the adoption of innovations at farm level. This study has a focus on behavioral factors, such as pro-environmental attitude, personal innovativeness and moral norms. Based on an online study conducted in Germany, structural equation modelling is applied to test the predictions of an extended version of the Theory of Planned Behavior, using spot spraying, a smart weeding technology, as an example. The results confirm theoretical predictions and show that indicators of attitude, subjective norms, and perceived behavioral control have relevant effects on farmers' adoption intentions. The extended model revealed a medium-sized (small) direct effect of moral norms on the attitude towards spot spraying (adoption intention). Personal innovativeness had a small effect on adoption intention, whereas pro-environmental attitude did not exhibit a clear direction of impact. Methodological and policy implications derived from the results are discussed noting that the inclusion of indicators for moral norms can improve the predictive power of models used in future research in this field. Overall, initiatives aimed at facilitating the exchange of opinions and related moral norms as well as collaboration among peers may contribute to voluntary sustainable innovation as it enhances adoption intentions among farmers.

Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey.

BACKGROUND: It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS: We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS: The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (ß1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS: The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.