Kernel Density Plots Research Articles

Preoperative embolization in surgical treatment of spinal metastases originating from non–hypervascular primary tumors: a propensity score matched study using 495 patients

BACKGROUND CONTEXTPreoperative embolization (PE) reduces intraoperative blood loss during surgery for spinal metastases of hypervascular primary tumors such as thyroid and renal cell tumors. However, most spinal metastases originate from primary breast, prostate, and lung tumors and it remains unclear whether these and other spinal metastases benefit from PE. PURPOSETo assess the (1) efficacy of PE on the amount of intraoperative blood loss and safety in patients with spinal metastases originating from non–hypervascular primary tumors, and (2) secondary outcomes including perioperative allogeneic blood transfusion, anesthesia time, hospitalization, postoperative complication within 30 days, reoperation, 90-day mortality, and 1-year mortality. STUDY DESIGNRetrospective propensity-score matched, case-control study at 2 academic tertiary medical centers. PATIENT SAMPLEPatients 18 years of age or older undergoing surgery for spinal metastases originating from primary non–thyroid, non–renal cell, and non–hepatocellular tumors between January 1, 2002 and December 31, 2016 were included. OUTCOME MEASURESThe primary outcomes were estimated amount of intraoperative blood loss and complications attributable to PE, such as neurologic injury, wound infection, thrombosis, or dissection. The secondary outcomes included perioperative allogeneic blood transfusion, anesthesia time, hospitalization, postoperative complication within 30 days, reoperation, 90-day mortality, and 1-year mortality. METHODSIn total, 495 patients were identified, of which 54 (11%) underwent PE. After propensity score matching on 21 variables, including primary tumor, number of spinal levels, and surgical treatment, 53 non–PE patients were matched to 53 PE patients. Matching was adequate measured by comparing the matched variables, testing the standardized mean differences (<0.25), and inspecting Kernel density plots. The degree of embolization was noted to be complete, until stasis, or successful in 43 (80%) patients. RESULTSIntraoperative blood loss did not differ between both groups with a median blood loss in liters of 0.6 (IQR, 0.4–1.2) for non–PE patients and 0.9 (IQR, 0.6–1.2) for PE patients (p=.32). No complications occurred during embolization or the time between embolization and surgery. No differences were found in terms of the secondary outcomes. CONCLUSIONSOur data suggest that, although no complications occurred and the embolization procedure can be considered safe, patients with non–hypervascular spinal metastases might not benefit from PE. A larger, prospective study could confirm or refute these study findings and aid in elucidating a subset of spinal metastases that might benefit from PE.

Varying degrees of spatio-temporal partitioning among large carnivores in a fenced reserve, South Africa

Context The spatio-temporal partitioning of large carnivores is influenced by interspecific competition and coexistence within small, enclosed reserves. Lions (Panthera leo), spotted hyaenas (Crocuta crocuta) and leopards (Panthera pardus) are the three largest African carnivores and have the greatest potential for intra-guild competition, particularly where space is limited. Aim To investigate the spatio-temporal partitioning between lions, spotted hyaenas and leopards in a small (~75 000 ha), enclosed nature reserve, Madikwe Game Reserve (Madikwe), South Africa. Methods We deployed 110 camera traps (baited n = 55 and unbaited n = 55) across Madikwe from 26 August 2019 until 6 May 2020. Von Mises kernel density plots were used to investigate daily temporal partitioning among the three species. A multiple-species, single-season occupancy model was used to investigate daily space use patterns. Key results We found both temporal and spatial exclusion between lions and spotted hyaenas on Madikwe. However, no evidence was found of spatio-temporal partitioning between lions and leopards, and spotted hyaenas and leopards. Conclusions Exploitative and interference competition on Madikwe might be high enough to warrant spatio-temporal partitioning between lions and spotted hyaenas to avoid the negative effects of intra-guild competition. Contrastingly, patterns observed between leopards and both lions and spotted hyaenas preclude the possibility of top-down control by superior carnivores. Implication These findings call for an adaptive management approach, where both carnivore and prey species compositions are constantly monitored. Management strategies such as these will allow for the conservation of valuable resources (i.e. prey species) to ensure the persistence of large carnivore populations across African ecosystems.

Technical efficiency and inefficiency: Reliability of standard SFA models and a misspecification problem

It is formally proven that if inefficiency (u) is modelled through its variance, considered as a function of exogenous variables z, then the marginal effects of z on technical inefficiency (TI) and technical efficiency (TE) have opposite signs in the typical setup with a normally distributed random error and an exponentially or half-normally distributed u. This is true for both conditional and unconditional TI and TE. An example is provided to show that the signs of the marginal effects of z on TI and TE may coincide for some ranges of z. If the real data comes from a bimodal distribution of u, and a model is estimated with an exponential or half-normal distribution for u, the estimated efficiency and the marginal effect of z on TE could be wrong. Moreover, the rank correlations between the true and the estimated values of TE could be small and even negative for some subsamples of the data. This is a warning that in the case when the true (real life) distribution of the inefficiency is bimodal, commonly used standard SFA models could lead to wrong policy recommendations. The kernel density plot of the residuals is suggested as a diagnostic plot. The results are illustrated by simulations.

Progress in child stunting across the world from 1990 to 2015: testing the global convergence hypothesis.

This study has two-fold objectives: first, to test the global convergence hypothesis in the progress of child stunting across 174 countries over the period 1990-2015; second, to identify factors determining the process of convergence or divergence. The study design comprises macro-level cross-country analyses. Our empirical strategy uses parametric convergence models such as absolute and conditional β-convergence models, while non-parametric convergence models such as Kernel density plots serve as robustness checks. The study uses a global setting comprising child stunting information from 174 countries. The participants for this study are 174 countries. The information on child stunting prevalence for most countries is available from the UNICEF-WHO-WB Joint Child Malnutrition Estimates Expanded Database (April-2019), while national-level surveys are used for those countries where UNICEF-WHO-WB Database is not available. The data for socio-economic variables are taken from the World Bank's data bank (1990-2015). Findings from the absolute β-convergence model estimates show that progress in child stunting has diverged over the entire period (1990-2015). However, the speed of divergence has reduced for the recent period (2010-2015). The conditional β-convergence model estimates show that cross-country heterogeneity in GDP per capita, poverty and health care expenditure are significant factors explaining divergence in child stunting. For replacing current divergence with convergence in child stunting worldwide, the study demonstrates the critical role of economic factors and public spending on health care to reduce child stunting, particularly in countries where progress is slow.

Abstract P164: Understanding The Health Of Mothers Of A Child With Congenital Heart Disease Utilizing Electronic Health Record Data

Introduction: With improved survival of children with congenital heart disease (CHD), more parents are managing medical care for their child into adulthood, which can negatively affect parental health. The prevalence of mental and physical health conditions in affected mothers are not well quantified. Hypothesis: Mothers of a child with CHD (excluding mild CHD) have increased odds of being diagnosed with mental and physical health conditions compared to mothers of a child without CHD. Methods: A retrospective study with linked maternal-child EHR data was conducted. Kernel density plots, two sample Kolmogorov Smirnov test, and Bayesian networks were used for analyses. Results: A total of 3,480 mothers of a child with CHD and 252,206 mothers without a child with CHD were identified. Densities significantly differed between groups for most diagnoses and often occurred earlier for mothers with a child with CHD. Mothers of child with CHD (≤40 years) had increased odds of having a mental or physical health diagnosis (Figure &amp; Table). Conclusion: Understanding how to support mothers of a child with CHD and improve engagement in preventive health behaviors is critical.

Image analysis method for heterogeneity and porosity characterization of biomimetic hydrogels

This work presents an image processing procedure for characterization of porosity and heterogeneity of hydrogels network mainly based on the analysis of cryogenic scanning electron microscopy (cryo-SEM) images and can be extended to any other type of microscopy images of hydrogel porous network. An algorithm consisting of different filtering, morphological transformation, and thresholding steps to denoise the image whilst emphasizing the edges of the hydrogel walls for extracting either the pores or hydrogel walls features is explained. Finally, the information of hydrogel porosity and heterogeneity is presented in form of pore size distribution, spatial contours maps and kernel density dot plots. The obtained results reveal that a non-parametric kernel density plot effectively determines the spatial heterogeneity and porosity of the hydrogel.

Release the Pressure! Does Jugular Venous Pressure Predict Rejection in Cardiac Biopsy?

<h3>Purpose</h3> Rejection in heart transplant recipients is often diagnosed by surveillance biopsies as most patients are asymptomatic. Nevertheless, rejection, if left untreated, can produce progressive diastolic dysfunction followed by systolic heart failure. This in turn will cause an increase in central venous pressure due to decreased ventricular compliance. With this in mind we sought out to determine if elevated central venous pressures measured invasively at the time of the biopsy correlated with the presence of rejection. <h3>Methods</h3> Patients undergoing an endomyocardial biopsy between June and October 2020 were included. The invasive JVP was measured before and after the procedure by measuring the height of the blood column in the side port of the sheath open to the atmospheric pressure. The biopsy results were reported according to the 2004 ISHLT revision. Differences in median JVP for each biopsy result group (0, 1R, 2R, 3R) were compared using a Mann-Whitney test. The histogram density for each biopsy group was graphed using a Kernel density plot. <h3>Results</h3> Eighty-four patients underwent one or more endomyocardial biopsies, with a total of 374 biopsies performed. Of all procedures, 187 were grade 0 for rejection, 168 were grade 1R and 18 were grade 2R. One patient had Grade 3R rejection (not shown in illustration) The median JVP was not statistically different between the three groups and the numerical difference was not clinically meaningful (figure 1 A). The Kernel density plot (figure 1 B) demonstrates the similarities between the groups. The lack of correlation between invasive JVP and rejection persists if data from the first 2 weeks post heart transplant are excluded. <h3>Conclusion</h3> In our dataset, there was no clinical or statistical difference in median invasive JVP and rejection grade between the biopsy result groups. One limitation is that we only had one patient with severe rejection (3R). Overall, our findings reinforce the need for surveillance biopsies.

Monitoring of Rainfall and Soil Moisture at the Rebaixader Catchment (Central Pyrenees)

ABSTRACT The instrumental monitoring of torrential catchments is a fundamental research task that provides necessary information to improve our understanding of the mechanisms of debris flows. While most monitoring sites include meteorological sensors and analyze the critical rainfall conditions, very few contain soil moisture measurements. In our monitoring site, the Rebaixader catchment, 11 debris flows and 24 debris floods were detected during the last 9 years. Herein, the initiation mechanisms of these torrential flows were analyzed, focusing on the critical rainfall conditions and the soil water dynamics. Comparing the temporal distribution of both rainfall episodes and torrential flows, the Kernel density plots showed maximum values for rainfalls at the beginning of June, while the peak for torrential flows is on July 20. Thus, the antecedent rainfall, and especially the soil moisture conditions, may influence the triggering of torrential flows. In a second step, a new updated rainfall threshold was proposed that included total rainfall duration and mean intensity. The analysis of soil moisture data was more complicated, and no clear trends were observed in the data set. Therefore, additional data have to be recorded in order to quantitatively analyze the role of soil moisture on the triggering of torrential flows and for the definition of thresholds. Some preliminary results show that the soil moisture at the beginning of a rainfall event affects the maximum increase of soil moisture, while a slight trend was visible comparing the initial soil moisture with the necessary rainfall amount to trigger a torrential flow.

Image analysis method for heterogeneity and porosity characterization of biomimetic hydrogels.

This work presents an image processing procedure for characterization of porosity and heterogeneity of fully hydrated hydrogels based on the analysis of cryogenic scanning electron microscopy (cryo-SEM) images. An algorithm consisting of different filtering, morphological transformation, and thresholding steps to denoise the image whilst emphasizing the hydrogel fibres edges for extracting the pores features is explained. Finally, the information of hydrogel porosity and heterogeneity is presented in form of pore size distribution, spatial contours maps and kernel density dot plots. The obtained results reveal that a non-parametric kernel density plot effectively determines the spatial heterogeneity and porosity of the hydrogel.

Maternal Hypertensive Disorders in Pregnancy and Postpartum Plasma B Vitamin and Homocysteine Profiles in a High-Risk Multiethnic U.S., Population.

Background: Hypertensive disorders of pregnancy are a recognized risk factor of a woman's future cardiovascular risk. The potential role of micronutrients in mitigating hypertensive disorders is not fully understood. This study examined maternal postpartum plasma B vitamin profiles by hypertensive disorders of pregnancy in a high-risk multiethnic U.S. population. Materials and Methods: The analyses included 2584 mothers enrolled within 3 days postpartum at the Boston Medical Center. Hypertensive disorders of pregnancy included gestational hypertension and pre-eclampsia disorders (pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes, and/or low platelets syndrome) as documented in the medical records. Plasma folate, vitamin B12, and homocysteine levels were measured in blood samples collected at enrollment. Kernel density plots and multivariable regressions were used to examine the relationship between hypertensive disorders and postpartum B vitamin profiles. Results: Of the 2584 mothers, 10% had pre-eclampsia disorders that were associated with significantly lower plasma folate (adjusted beta coefficient (aβ): -0.10; 95% CI: -0.22 to -0.06) and increased homocysteine (aβ: 0.08; 95% CI: 0.04-0.13), but not with vitamin B12 concentrations. These associations remained robust after adjusting for a range of pertinent covariables and were more pronounced in non-Hispanic Black women compared with other groups. However, gestational hypertension was not significantly associated with any postpartum biomarker. Conclusions: We found that pre-eclampsia disorders, but not gestational hypertension, was associated with lower folate and higher homocysteine levels postpartum, especially among Black mothers. This finding, if further confirmed, may have implications for postpartum care, including attention to maternal micronutrient status to reduce and prevent hypertensive disorders in pregnancy-associated consequences in subsequent pregnancies and lifespan. Registration date: July 25, 2017; Registry website: https://clinicaltrials.gov/ct2/show/NCT03228875.

Testing the regional Convergence Hypothesis for the progress in health status in India during 1980-2015.

The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981-2015), National Family Health Survey (NFHS, 1992-2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981-2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.

Investigating Regional Inequalities in India: Are Indian Districts Converging?

AbstractThe study examines the regional inequalities in India across 315 districts during 1999/2000–2010/2011. For examining convergence, parametric and non‐parametric tests are employed. Findings reveal that absolute and conditional convergences hold for the entire time period. Analysis of intra‐period convergence reveals an overall divergence during 1999–2005 and convergence during 2005–2011. Conditional variables included the number of bank branches, literacy rate and pupil–teacher ratio. Results for σ convergence reveal a higher level of dispersion during 1999–2005 and a sharp decline thereafter. These results are supported by Kernel density plots. The study reveals that Indian districts exhibited convergent behaviour only after 2005. © 2020 John Wiley &amp; Sons, Ltd.

Testing the Regional Convergence Hypothesis for the Progress in Health Status in India During 1980–2015

The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981–2015), National Family Health Survey (NFHS, 1992–2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981–2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.

Poor allocation concealment methods are associated with heterogeneity in age and statistical significance of the primary outcome: Review of recent trials published in four general medical journals.

To assess the association of the quality of allocation concealment with heterogeneity in age, the P value of the primary outcome and statistical significance of the primary outcome. We extracted data from articles published in four major medical journals in 2017 and 2018 that reported the results of randomized controlled trials. The outcome measures were the quality of allocation concealment used in the trial, the P value of the primary outcome, whether the P value of the primary outcome was statistically significant and the level of heterogeneity in age between the treatment groups (measured using the I2 statistic). The association between the quality of allocation concealment and the P value of the primary outcome was assessed using a kernel density plot, while the association between the quality of allocation concealment and whether the P value was statistically significant was assessed using logistic regression. Trials that used inadequate concealment methods were more likely to report statistically significant findings than trials that used good or adequate methods (OR 1.90; 95% CI: 0.91 to 3.95; P = .09). The values of I2 for trials that used good, adequate, inadequate and unclear concealment methods were 0%, 1.0%, 32.6%, and 93.8%, respectively. There is evidence of an association between poor allocation concealment methods and statistical significance of the primary outcome. Trials that use inadequate allocation concealment methods are more likely to have statistically significant P values compared with trials using good or adequate allocation concealment methods.

Potential Cluster Regions for Manufacturing Small and Medium Enterprises in Khulna City of Bangladesh: A Spatial Examination

Industrialization is considered as the main path towards urbanization and economic development. Small and medium enterprises (SMEs) are the major contributor to the industrialization in many countries across the world. Cluster approach has gained extensive acceptance among academics and policy makers as an effective development strategy both for an industry and a region. This study thus aims to identify the potential cluster regions (PCRs) for manufacturing SMEs in Khulna city of Bangladesh since such identification is an important first step for cluster-based development strategy. Locating and mapping key manufacturing SMEs and exploring their spatial pattern are the major objectives of the study. The study concentrates on applying geo-statistical analysis such average nearest neighbour index, kernel density plot and SME distribution mapping using GIS to find the spatial pattern of the industries in the study area. The study depicted a clustered spatial pattern and uneven distribution of the SMEs across different wards of the city.

Building the Wutai arc: Insights into the Archean – Paleoproterozoic crustal evolution of the North China Craton

The Wutai complex is located within the Trans–North China Orogen (TNCO) which marks the collision zone between the Eastern and Western Blocks of the North China Craton (NCC). Here we investigate the timings and mechanisms of Precambrian arc building in Wutai from a suite of newly identified greenstone – felsic tuff – Banded Iron Formation (BIF) – phyllite sequence. Zircon grains from the felsic tuff layer intercalated within the greenstones provide robust constraints on the timing of BIF deposition. Geochemical features of the greenstones and felsic tuff suggest E - MORB and volcanic arc affinity, whereas the BIFs are of submarine hydrothermal origin. Zircon grains in the greenstones define an upper intercept age of 2951 ± 41 Ma and a lower intercept age of 1845 ± 190 Ma. Those from the felsic tuff show 207Pb/206Pb weighted mean age of 2557 ± 10 Ma, whereas those from the BIF intercalated with felsic tuff shows an age of 2585 ± 14 Ma. Metamorphic zircon grains in the BIF define two age populations of ca. 2471 and 1906 Ma. Zircon grains in the phyllite yield an age of 2594 ± 14 Ma. Kernel density plots define age peaks at 2873 and 2578 Ma marking the major phase of arc building in Wutai. Zircon εHf (t) values are mostly positive, in the range of 3.15–7.72, suggesting new crustal growth from juvenile/depleted mantle components. Our study provides insights into the Mesoarchean to Neoarchean crust building through subduction-related arc magmatism, followed by Paleoproterozoic metamorphism in the North China Craton.

DO MANUFACTURING SMALL AND MEDIUM ENTERPRISES CLUSTER GEOGRAPHICALLY IN KHULNA CITY? – A SPATIAL ANALYSIS

DO MANUFACTURING SMALL AND MEDIUM ENTERPRISES CLUSTER GEOGRAPHICALLY IN KHULNA CITY? – A SPATIAL ANALYSIS

Agglomeration effect of CO2 emissions and emissions reduction effect of technology: A spatial econometric perspective based on China's province-level data

To clarify the spatial characteristics of CO2 emissions, economic externalities of spatial units are transplanted into CO2 emissions research. Furthermore, to identify emissions reduction pathways, spatial econometric models are constructed based on the patent data about energy conservation and emissions reduction. The key results are: (1) The kernel density plot of China's CO2 emissions shows an obvious right-averse state, and the peak is getting lower. Therefore, we can conclude that CO2 emissions in China are increasing, and polarisation of CO2 emissions is serious; (2) Due to the similarity and connectivity exist in spatial units, China's CO2 emissions have shown a stable spatial agglomeration effect from global and local perspectives; (3) Based on adjacent, geographic, and economic distance matrices, energy technological progress has played a positive emissions reduction role on China's CO2 emissions from the perspective patent data about energy saving and emissions reduction. Finally, on the basis of the above conclusions, some policy implications have been proposed accordingly.

Re-assessment of South African juvenile facial soft tissue thickness data for craniofacial approximation: A comparative analysis using central tendency statistics

Facial soft tissue thickness (FSTT) data form the basis of craniofacial identification methods such as facial approximation in cases where unknown skeletal remains lack unique identifiers such as fingerprints, DNA and dental records. Appropriate FSTT data are said to be required to produce accurate facial approximations that may be recognised by relatives. This view led to a vast number of studies considering subdivisions of FSTT data according to ancestry, age and sex. The paucity of South African juvenile FSTT standards of particular age groups, sex and ancestry is therefore problematic as “accurate” facial approximations cannot be produced. However, the use of pooled datasets and central tendency statistics offers a unique opportunity to circumvent the problem of small or absent FSTT datasets. The aim of this study was to use central tendency statistics of previously published South African data in order to assess whether it is necessary to subdivide FSTT datasets into different subgroups. In addition, a meta-analysis using central tendency statistics of 11 datasets within the C-table repository using the free open source TDStats programme (available through CRANIOFACIALidentification.com) for midfacial landmarks was performed. These datasets comprised of raw juvenile and adult FSTT data gathered from 1895 to 2015 as measured by a variety of methods Scatter plots showed that FSTT correlation with age is rather weak, while Kernel density plots of FSTT by sex and landmark indicated no difference between South African juvenile males and females. In order to test the practical application of FSTT data, two facial approximations were constructed — one based on the shorth from South African data and C-tables and one based on an American dataset. When comparing the two facial approximations based on different datasets, geometric deviation indicated differences at midline and bilateral landmarks, but the visual presentation of the facial approximations was similar. Therefore it is suggested that differences of less than 3mm at any landmark do not result in profound practical differences in the juvenile face. Subcategorizing juvenile data is not necessary as the same result can be achieved by weighted means as presented in the sub-adult C-tables.

Application of accelerometers to record drinking behaviour of beef cattle

Accelerometers have been used to record many cattle postures and behaviours including standing, lying, walking, grazing and ruminating but not cattle drinking behaviour. This study explores whether neck-mounted triaxial accelerometers can identify drinking and whether head-neck position and activity can be used to record drinking. Over three consecutive days, data were collected from 12 yearling Brahman cattle each fitted with a collar containing an accelerometer. Each day the cattle were herded into a small yard containing a water trough and allowed 5 min to drink. Drinking, standing (head up), walking and standing (head down) were recorded. Examination of the accelerometer data showed that drinking events were characterised by a unique signature compared with the other behaviours. A linear mixed-effects model identified two variables that reflected differences in head-neck position and activity between drinking and the other behaviours: mean of the z- (front-to-back) axis and variance of the x- (vertical) axis (P &amp;lt; 0.05). Threshold values, derived from Kernel density plots, were applied to classify drinking from the other behaviours using these two variables. The method accurately classified drinking from standing (head up) with 100% accuracy, from walking with 92% accuracy and from standing (head down) with 79% accuracy. The study shows that accelerometers have the potential to record cattle drinking behaviour. Further development of a classification method for drinking is required to allow accelerometer-derived data to be used to improve our understanding of cattle drinking behaviour and ensure that their water intake needs are met.