Long-term Improvement In Quality Research Articles

Preface: advances in hypolimnetic oxygenation

Wagner KJ. 2019. Preface: advances in hypolimnetic oxygenation. Lake Reserv Manage. 35:225–228. Hypolimnetic oxygenation systems (HOS, here taken to mean techniques that add oxygen to the bottom layer of a lake or reservoir without disrupting stratification) have been in use for over half a century. However, issues of theoretical understanding, equipment, implementation, monitoring, and cost have limited widespread application of what is a potentially very effective means of improving water quality. Advances of the last two decades have pushed HOS to the forefront of water supply management, with some application in recreational lakes as well. Key advances include demonstration of long-term improvement of water quality, including higher concentrations of oxygen and lower concentrations of reduced compounds and algae, better predictability of results, including greater understanding of oxygen demand and its expression, and characterization of capital and operational costs, including likely changes over time as oxygen demand is satisfied. The application of additional management techniques in many cases limits our ability to ascribe all positive results to HOS alone, but the value of HOS as a lake management tool has been clearly demonstrated. More applications with careful monitoring and documentation of results are expected to advance this approach further.

Hypolimnetic oxygenation 3: an engineered switch from eutrophic to a meso-/oligotrophic state in a California reservoir

Horne AJ, Beutel M. 2019. Hypolimnetic oxygenation 3: an engineered switch from eutrophic to a meso-/oligotrophic state in a California reservoir. Lake Reserv Manage. 35:338–353. A long-term improvement in water quality due to a hypolimnetic oxygenation system (HOS) used without other management actions was shown for Camanche Reservoir in California (volume = 514 million m3). Prior to oxygenation, the reservoir was eutrophic with low water clarity, high chlorophyll a (Chl-a), and blooms of cyanobacteria primarily caused by internal nutrient loading from anoxic sediments. All 4 trophic state indicators showed major improvement, most pointing to a new oligotrophic state. Days after HOS startup in July 1993, hypolimnion soluble phosphate and ammonium concentrations declined and, unexpectedly, nitrate remained low. This report covers pre-HOS (1988 to mid-1993) and 12 yr of post-HOS measurements (mid-1993 to mid-2005). For surface waters during the growth season (Apr–Oct) after HOS, average Chl-a decreased 79% (14.6–3.1 μg/L) and peak Chl-a decreased sixfold (from 49 to 8 μg/L). Average Secchi depth increased 10-fold (0.47 to 4.9 m) and peak Secchi depth doubled (4.2–8 m). Cyanobacteria (Aphanizomenon and Dolichospermum, formerly Anabaena) decreased >95% while the previously absent Merismopedia, an indicator of clean water, appeared. The large colonial diatom Fragilaria also decreased by >90%. Zooplankton (rotifers and crustaceans) appeared unchanged. After HOS, late winter surface nutrients prior to the next spring bloom were much reduced (total phosphorus, TP, by 58%, total inorganic nitrogen, TIN, by 88%). The TIN:TP ratio dropped from 6 to 1.6. In 2004, the last full year of measurements, further declines were found for nitrate nitrogen (42–3 μg/L) and Chl-a (3.1–2.8 μg/L) while TP was unchanged (14 μg/L).

Optimising the safety of road transport workers on IBS building construction projects: a review

PurposeThe purpose of this study is to develop a new information and communication technology (ICT)-based approach for optimising safety transportation according to the needs of the current industrialised building system (IBS) building construction schemes. The improper handling and information management of road transport workers appears to be a major problem in the safety of the IBS building construction industry. Transportation activity is particularly problematic for IBS building construction projects in which traffic incident and safety management level are not in good condition to match with construction specification.Design/methodology/approachA new ICT-based approach is suggested for optimising safety transportation in accordance with the needs of the current IBS building construction schemes. As a precursor to this work, the concept of road transport workers practices is reviewed and the main features of ICT tools and techniques currently being used on such projects are presented.FindingsThe sophisticated road transport workers system solutions is described as an essential component of this optimisation to promote long-term safety and quality improvements of IBS building construction projects.Originality/valueFinally, the potential for a research framework for developing such a system in the future is presented.

Total Knee Arthroplasty: Fitness, Heart Disease Risk, and Quality of Life.

Total knee arthroplasty (TKA) may decrease coronary heart disease (CHD) risk in patients with advanced osteoarthritis by reducing pain and allowing for a more active lifestyle. We examined cardiovascular fitness, CHD risk factors, and quality of life in patients for 1 year after TKA compared with matched controls who did not undergo surgery. A total of 14 patients, 7 surgery patients and 7 matched controls, were tested for measurements of body composition, knee range of motion, resting blood pressure, strength testing, a maximal exercise test, quality-of-life questionnaires (Medical Outcomes Study Short Form-36 and Knee Osteoarthritis Outcome Score [KOOS]), and activity monitoring, fasting blood glucose, and lipids at 0, 3, 6, and 12 months after surgery or baseline testing. Comparison between the two groups was analyzed. Twelve months after surgery, patients with TKA had significantly (p < 0.05) lower pain scores, increased fat free mass, lower resting mean arterial pressure, and improved scores on the KOOS for pain, symptoms, activities of daily living, and quality of life. Initially, total cholesterol, high-density lipoprotein cholesterol, triglycerides, and body fat percentage were reduced in the TKA group but returned to baseline at 12 months. The results of this study indicate that there are immediate and long-term improvements in pain and quality of life in patients with TKA, but physical function, exercise capacity, leg strength, and some lipid profiles may take longer than 12 months to improve. This is a level II, prospective, Therapeutic study, comparative study.

Advances in stem cell-based regenerative medicine: Despite setbacks and failures, therapies to replace damaged tissue are making their way into the clinic.

EMBO Reports (2019) e48172 Stem cell‐based regenerative medicine has experienced turbulent times in recent years that have involved several scandals implicating prominent institutions and numerous retractions of papers from leading journals. But it has also seen real progress being made on the way to the clinic. It reflects the tension between human ambition and hope on one side and the need for hard evidence and solid data on the other side in a field where early expectations ran far ahead of reality. This tension may help explain the recent scandal involving stem cell surgeon Paolo Macchiarini, who was found guilty of scientific misconduct regarding an article in The Lancet , which has since been retracted. It is an ongoing saga as Macchiarini is still publishing in leading journals, even though his reputation as a surgeon and stem cell researcher has been compromised. > … the whole field of regenerative medicine had been tainted by a number of cases where […] researchers had taken short cuts and neglected basic science. The story dates back to 2004, when Macchiarini's team extracted some pig intestine and removed the cells to leave a collagen matrix that was then repopulated with muscle and fibroblasts to generate connective epidermal tissue. The patch was implanted in the airway of a 58‐year‐old patient suffering from respiratory problems after surgery for lung cancer [1]. Macchiarini then expanded this technique to whole tracheas using plastic scaffolds in addition to natural tissue from human donors. In another clinical case, the bare plastic scaffold was populated with stem cells taken from the patient's own bone marrow and implanted in a young female patient in 2008. This propelled Macchiarini almost to rock star status and an appointment by the Karolinska Institute, where he refined his technique by replacing donor windpipes with plastic …

PS-086-Sustained virologic response in patients with cirrhosis from chronic hepatitis C leads to sustained and long-term improvement of health-related quality of life, fatigue, and work productivity

PS-086-Sustained virologic response in patients with cirrhosis from chronic hepatitis C leads to sustained and long-term improvement of health-related quality of life, fatigue, and work productivity

126 Brief Motivational Interviewing Increases Participation in the Take Charge of Burn Pain Self- Management Program

Burn related pain is a common experience post‐injury impacting physical, psychological and social recovery, and reducing long‐term function and community participation. The Take Charge of Burn Pain online self-management program (www.takechargeofburnpain.org) is a cognitive-behavioral based, 7 session, interactive program that utilizes the principles of self-management to provide knowledge, self-monitoring, pain coping skill development and practice. In the parent RCT study, initial efficacy data indicates program completers have significant benefits. However, there are significant numbers of individuals who initially enroll in the program and do not start or complete the program. This paper reports on the impact of a brief motivational interviewing (MI) intervention to increase program utilization and completion. A matched cohort series design was used. Eligibility criteria are: 18 to 70 years of age, having experienced a burn injury requiring hospitalization at least 6 months prior to enrollment; 2) Reporting a pain severity score on the Brief Pain Inventory of 4 (0‐10) or higher; 3) Reporting pain of at least 3 months duration; 4) English speaking; and 5) Did not log on in within one week of enrollment, or became inactive (no program usage for 21 days). 66 participants in the initial cohort received a series of electronic reminders to re-engage. In the second cohort, 20 individuals in the second cohort who did not respond to the standard reminders, received a single, brief MI- based phone intervention to promote re-engagement. The outcome measures were log on and program completion rates. The 86 participants are 55% female, 60% white, 8% Latino/Hispanic, 55% have more than high school education, and a mean age of 41. The standard reminder cohort had a log on rate of 43%, completed 3 lessons on average and had and program completion rate of 30%. The brief MI- based phone intervention cohort had a log on rate of 53%, completed 4 lessons on average and had and program completion rate of 40%. Standard electronic reminders yield less than optimal utilization of the online pain self-management program. Addition of a single MI-based phone call modestly increased log on rates and program completion rates. Additional research is needed to determine if additional MI-based contacts would further increased utilization and lead to long-term improvements in pain, psychological distress and quality of life. Poor participant engagement undermines the potential benefit of online resources to address the pain and psychosocial sequelae of burn injury. There is a need to identify strategies to increase participant engagement and improve effectiveness of online resources.

The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study

BackgroundInferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad.MethodsA retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children’s center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children’s Benefit Inventory (GCBI) was administered by phone to assess QOL improvement.ResultsOne hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication.ConclusionsThis study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

Function and Strength after Free Abdominally Based Breast Reconstruction: A 10-Year Follow-Up.

The long-term impact of abdominally based free flap breast reconstruction is incompletely understood. The aim of this study is to provide long-term, subjective and objective health data on abdominally based free flap breast reconstruction patients, with specific attention to the effects of laterality, flap type, and obesity. Patients were enrolled in this prospective study between 2005 and 2010 and completed preoperative, early (<1 year), and long-term (5 to 10 years) evaluations. Objective examination included an assessment of upper and lower abdominal function and a functional independence measure. Patient-reported outcomes included the 36-Item Short-Form Health Survey and the BREAST-Q abdominal well-being module. Scores were compared by laterality (unilateral versus bilateral), flap type (muscle-sparing free transverse rectus abdominis musculocutaneous versus deep inferior epigastric artery perforator), and presence of obesity. Fifty-one patients were included, with an average 8.1-year follow-up. Overall, 78.8 percent of patients had stable or improved scores across the upper and lower abdominal function and functional independence measures, and minimal objective differences across flap laterality or types were observed. Postoperative scores improved for 36-Item Short-Form Health Survey physical health (p < 0.001) and mental health (p < 0.001), and did not differ based on laterality or flap type. Obesity negatively impacted physical health (p = 0.002) and mental health (p = 0.006). Abdominally based autologous breast reconstruction is associated with significant improvements in long-term quality of life across key domains of physical and mental health with little functional impairment and no long-term differences across flap type or laterality. Obese patients, however, may be at risk for subjective physical and mental health impairment, perhaps unrelated to the surgery itself.

Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs

Long-Term Outcomes and Improvements in Quality of Life in Patients with Atrial Fibrillation Treated with Catheter Ablation vs. Antiarrhythmic Drugs

Implementation of a care coordination system for chronic diseases.

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

Healthcare Experience and their Relationship with Demographic, Disease and Healthcare-Related Variables: A Cross-Sectional Survey of Patients with Chronic Diseases Using the IEXPAC Scale.

BackgroundPatient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes.ObjectivesOur objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences.MethodsA cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience).ResultsOf the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases.ConclusionsThrough IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality.Electronic supplementary materialThe online version of this article (10.1007/s40271-018-0345-1) contains supplementary material, which is available to authorized users.

PHP222 - IDENTIFYING THE KEY DRIVERS AFFECTING THE REIMBURSEMENT OF THERAPEUTIC VACCINES IN EU5 COUNTRIES USING A WEB-BASED PORTAL TO ENGAGE PAYERS

The global market for therapeutic vaccines has witnessed significant growth in the last decade (e.g. anti-cancer, hepatitis B); however, the overall cost, stringent regulatory policies and initial capital investment associated with therapeutic vaccines present a challenge to payers. This research was completed to understand the key drivers affecting reimbursement for therapeutic vaccines in EU5 countries and potential solutions to current challenges. A web-based survey was administered through the Rapid Payer Response™ online portal (RPR®) to 25 payers with experience in HTA and reimbursement decision-making for vaccines in France, Germany, Italy, Spain and the UK, 5 payers per country. Payer profiles included former members of the department of Health and JCVI (Joint Committee of Vaccine and Immunization) in the UK, ex-CEPS and ex-TC payers in France, ex-GBA and SHI payers in Germany and both national and regional level payers in Italy and Spain. Responses were collected through RPR® in 5 days and analysed via Microsoft™ Excel. Cost-effectiveness studies, use of biomarkers and real world evidence demonstrating patient outcomes in clinical practice were identified as being highly supportive in facilitating successful reimbursement outcomes alongside clinical drivers such as the magnitude of efficacy benefit, long-term safety data and improvement in quality of life. With recent approvals of therapeutic vaccines, payers are concerned about the potentially high cost of treatment, therefore identifying the most appropriate patient population for vaccination is likely to become increasingly important to payers in order to reduce the overall budget impact and ensure favourable HTA and formulary outcomes.

The experience of 70 heart transplants in a multidisciplinary medical care facility

Introduction.The total number of patients with chronic heart failure in Russia had reached 15 million by 2016, including 6 million of those with the end-stage heart failure. Currently, heart transplantation (HT) provides the only possible method of a definite treatment of the disease, which allows a significant steady and long-term improvement of patient's quality of life. The purpose of this article was to review the experience of heart transplantation in a multidisciplinary medical institution over an 8-year period.Material and methods. Since September 2009, more than 300 patients have been studied for the presence of indications for heart transplantation in the Department of Urgent Cardiology, Assisted Circulation and Heart Transplantation of the Sklifosovsky Research Institute for Emergency Medicine. Eighty of all the screened potential recipients were included in the waiting list, and by the end of 2017, heart transplantations had been performed in 70 of them; the mean waiting time for transplantation was 93 ± 79 days.Results.The graft ischemia time averaged 174 ± 28 minutes (97 to 250 minutes). The graft ischemia time was 187 ± 36 minutes with the biatrial technique and 169 ± 24 minutes with bicaval technique. That parameter made 184 ± 23 minutes for a distant organ retrieval, while for a local organ retrieval it was 155 ± 29 minutes. By the end of 2017, of 70 cardiac transplant recipients enrolled in the analyzed group, 31 patients (44%) had died, 12 of whom during their hospital stay (hospital mortality was 18%). The main cause of death was the multiple organ failure syndrome in the early postoperative period, and infectious complications in the later period.Conclusion.The advantage of establishing the organ transplantation center (particularly for heart transplantation) in a multidisciplinary medical care facility lies in reduced donor organ ischemia time and starting treatment of complications without delay. The number of infectious complications, as well as complications associated with acute cellular rejection and coronary artery disease of the transplanted heart can be reduced by creating a regional system ensuring the targeted work with post transplant patients.

Selecting rootstocks to improve vine performance and vineyard sustainability in deficit irrigated Monastrell grapevines under semiarid conditions

Regulated deficit irrigation (RDI) and partial root zone irrigation (PRI) were compared for five years, in field-grown mature Monastrell grapevines grafted on five different rootstocks (140Ru, 1103 P, 41B, 110R, and 161-49C), in the semiarid winegrowing region of D.O. Bullas, South Eastern Spain. Vines grafted on invigorating rootstocks (140Ru or 1103 P) showed the highest vigor, water productivity, and productive water use efficiency (WUEyield), but at the expense of berry quality (lower berry quality indices, QI), compared to those on rootstocks of medium-low vigor (41B, 110R, and 161-49C). Vines grafted on 41B showed a moderate vigor-yield-efficiency-quality response, and this did not improve substantially the final berry quality. The least vigorous rootstocks (161-49C and 110R) gave lower yield, WUEyield, and productivity ratios, but a significant improvement in long-term final berry quality. The PRI increased the yield and/or berry quality attributes, especially in low vigor rootstocks (161-49C, 110R) and high vigor rootstocks (140Ru, 1103 P), but not in the medium vigor rootstock 41B. In addition, PRI produced a beneficial increase in the nutraceutical potential for practically all rootstocks. The PRI vines grafted on 161-49C gave the lowest yield and WUEyield, but the highest QI scores and the highest nutraceutical value, while PRI vines grafted on 110R had enhanced long-term yield, WUEyield, and amino acid and resveratrol contents, with similar berry quality (QI) indices, compared to RDI vines. Both 161-49C and 110R seem good options to achieve a compromise between long-term yield-quality-efficiency and returns for the grower. The application of low water volumes (85-90 mm year−1) with well-designed DI strategies was enough to maintain the vines in an optimum physiological state, obtaining moderate yields (7,400–9,900 kg ha−1, for 161-49C and 110R) with high berry quality and nutraceutical potential for premium red wine production. Such an approach can serve as an adaptation measure in the face of climate change, to improve vine performance and enhance Monastrell vineyard sustainability under semiarid and water limiting conditions.

Patient Profiling Can Identify Spondylolisthesis Patients at Risk for Conversion from Nonoperative to Operative Treatment.

Background:Factors that are relevant to the decision regarding the use of surgical treatment for degenerative spondylolisthesis include disease-state severity and patient quality-of-life expectations. Some factors may not be easily appraised by the surgeon. In prospective trials involving patients undergoing nonoperative and operative treatment, there are instances of crossover in which patients from the nonoperative group undergo surgery. Identifying and understanding patient characteristics that may influence crossover from nonoperative to operative treatment will aid understanding of what motivates patients toward pursuing surgery.Methods:Patients with degenerative spondylolisthesis who were randomized to nonoperative care in a prospective, multicenter study were evaluated over 8 years of enrollment. Two cohorts were defined: (1) the surgery cohort (patients who underwent surgery at any point) and (2) the nonoperative cohort (patients who did not undergo surgery). A Cox proportional hazards model, modeling time to surgery, was used to explore demographic data, clinical diagnoses, and patient expectations and attitudes after adjusting for other variables. A subanalysis was performed on surgery within 6 months after enrollment and surgery >6 months after enrollment.Results:One hundred and forty-five patients who had been randomized to nonoperative treatment, 80 of whom crossed over to surgery, were included. In analyzing baseline differences between the 2 cohorts, patients who underwent surgery were younger; however, there were no significant difference between the cohorts in terms of race, sex, or comorbidities. Treatment preference, greater Oswestry Disability Index score, marital status, and no joint problems were predictors of crossover to surgery. Clinical factors, including stenosis, neurological deficits, and listhesis levels, did not show a significant relationship with crossover. At the time of long-term follow-up, the surgery cohort showed significantly greater long-term improvement in health-related quality of life (p < 0.001). The difference was maintained throughout follow-up.Conclusions:Neurological symptoms and diagnoses, including listhesis and stenosis severity, did not predict crossover from nonoperative care to surgery. Attitudes toward surgery, greater Oswestry Disability Index score, marital status, and no joint problems were independent predictors of crossover from nonoperative to operative care. Certain demographic characteristics were associated with higher rates of crossover, although they were connected to patient attitudes toward surgery.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Long-term quality of life improvement for chronic intractable back and leg pain patients using spinal cord stimulation: 12-month results from the SENZA-RCT

PurposeChronic axial low-back pain is a debilitating disorder that impacts all aspects of an afflicted individual’s life. Effective, durable treatments have historically been elusive. Interventional therapies, such as spinal cord stimulation (SCS), have shown limited efficacy at best. Recently, a novel treatment, 10 kHz SCS, has demonstrated superior pain relief compared with traditional SCS in a randomized controlled trial (RCT). In this manuscript, we report on the long-term improvements in quality of life (QoL) outcomes for subjects enrolled in this study.MethodsA prospective, multicenter, randomized controlled trial (SENZA-RCT) was conducted. Patients with both chronic back and leg pain were enrolled and randomized (1:1) into 10 kHz SCS or traditional SCS treatment groups. A total of 171 subjects received a permanent SCS device implant. QoL and functionality measures were collected up to 12 months. The device remote control utilization, which is an indication of patient interaction with the device for adjustments, was collected at 24-month post-implantation.ResultsAt 12 months, a higher proportion of 10 kHz SCS subjects had marked improvement of their disability (Oswestry Disability Index) to a “moderate” or “minimal” impact on their daily function versus the control group. The subjects also reported better improvement in the Global Assessment of Functioning, Clinician Global Impression of Change, Pittsburgh Sleep Quality Index, and short-form McGill Pain Questionnaire, compared to traditional SCS subjects. The 10 kHz SCS subjects also reported far higher rates of both driving and sleeping with their device turned on, as well as reduced reliance on their programmers to adjust therapy settings.ConclusionsIn addition to superior pain relief, 10 kHz SCS provides long-term improvements in quality of life and functionality for subjects with chronic low-back and leg pain. Trial registration: ClinicalTrials.gov (NCT01609972).

IDO: modelling a serious educational game based on hands on approach for training dementia carers

Dementia is one of the burdensome diseases in older age for which there is no cure known. The demand for carers of dementia patients is growing as the population ages. We analyse serious games as an approach to provide dementia carers with training on care related problem solving and modelling real-world cases. We present the behaviour model of improved care process by applying serious games, describe the design of the interactive serious game, its game mechanics, game environment, game actors and the motivation reinforcement mechanisms. The results of the initial evaluation performed by surveying the people caring for their elderly parents and elderly persons themselves, both healthy and showing early signs of dementia, and using the System Usability Score (SUS) questionnaire provided favourable response to the game. The use of an ICT-based gamification approach as part the training package for dementia care will be beneficial for direct care workers leading to long-term improvement of dementia care quality.

Air pumping for alleviation of heavy smog in Beijing

Beijing often suffers under heavy smog. During such events which occur mostly in autumn and winter, people are desperate for fresh air. The formation of heavy smog is due to foremost human induced air pollution, but geographic and meteorological conditions, especially below a surface inversion, play an important role. We propose to destroy the inversion by pumping air from above the inversion layer to the surface layer to alleviate the severity of the smog. While long-term air quality improvement depends on the reduction of air pollution emission, air pumping may provide relief in the interim for the Beijing citizens. We estimate that an air pumping at a rate 2×107 m3 s–1 can lead to significantly improved air quality in Beijing, due to (1) direct clean air input; (2) increased instability and vertical mixing and (3) a positive radiation-mixing feedback. The pumping requires an energy input of 10 GW, comparable with the energy consumption in Beijing for air conditioning in summer. We propose to use wind energy from Inner Mongolia for the pumping, which has currently an installed wind energy capacity of 70 GW.

A Gardener's Influence on Urban Soil Quality

Gardens are hot spots for urban biodiversity and provide habitats for many plant and animal spe- cies, both above- and below-ground. Furthermore, gardens provide a wide range of ecosystem services, including carbon (C) storage and nutrient cycling. Although the soil is the foundation of sustainable gardens providing those ecosystem services, very little is known about the conseque- nces of garden management on soil quality. Here we present a comprehensive assessment of urban garden soil quality, including biotic and abiotic site characteristics combined with land-use history and garden management information in a multivariate evaluation. A set of 44 soil quality indicators was measured at 170 sites of 85 gardens in the city of Zurich, Switzerland, comprising contrastingly managed garden habitats along a gradient of urban density. Taken together, our results show that garden management was the driving factor that influenced soil quality and soil functions. Eco-physiological soil quality indices were useful to identify differences in disturbance and intensity of soil use, showing highest microbial (microbial biomass (Cmic)/soil organic carbon (SOC)) and lowest metabolic (qCO2) quotients in perennial grass sites compared to annual vegetable sites. Despite the intensity of soil disturbance in annual vegetable and flower beds, the highest endogeic earthworm biomass and diversity were found in those habitats. Whereas decomposition of green tea bags was higher in grass sites. Soil heavy metal contents varied considerably and could not be linked with garden management practices, but with spatial patterns of industry and traffic. We conclude that understanding soil quality in urban ecosystems needs multi-indicator frameworks to capture the complexity of soil characteristics and the influencing factors in space and time. This study contributes to a better understanding of urban gardens and enhances the development of sustainable soil management strategies aimed at long-term improvement of soil quality and related ecosystem services in cities.