Supplementary Measures Research Articles

Setting Measures for Tackling Agricultural Diffuse Pollution of Inland Surface Water Bodies: Towards Achieving Environmental Objectives in Turkey

We explained the methodology used in setting the basic and supplementary measures for diffuse pollutants at Küçük Menderes Basin. As the majority of diffuse pollutants arise from livestock breeding and agricultural activities, we focused to propose measures regarded with tackling the pollution from agricultural activities. The types and distribution of diffuse loads were expressed by total nitrogen and phosphorous parameters. We used the results of a yearlong surface water quality monitoring involving physico-chemical, chemical and biological parameters with specific pollutants and priority substances,set in the European Union Water Framework Directive as the AquaTool input data. The AquaTool model was run for attaining the outcomes of a series of measures determined according to the ecological sensitivity of each water body. The removal efficiency of pollution loads provided by the best management practices in agricultural activities and livestock breeding were compiled from literature,and typical removal rates were further determined for the basin. We produced nine alternative scenarios at first cycle for determining compliance measures for mitigating point and diffuse sources of pollution in surface water bodies, and water quality improvements observed in the Model were reported. A number of exemptions were defined for some of the water bodies that could not achieve the environmental objectives at the end of first implementation cycle. 759 proposed measures for tackling diffuse pollution were 81% of the total measures considered. Additionally, the measures for mitigating diffuse agricultural pollution were almost equal to half of the diffuse pollutant measures, and 40% of the overall measures listed

The BECCS Implementation Gap–A Swedish Case Study

The IPCC has assessed a variety of pathways that could still lead to achievement of the ambitious climate targets set in the Paris Agreement. However, the longer time that climate action is delayed, the more the achievement of this goal will depend on Carbon Dioxide Removal (CDR) technologies and practices. In the models behind these pathways, the main CDR technology is Bioenergy combined with Carbon Capture and Storage (BECCS). We review the role that BECCS could play in reaching net-zero targets based on the existing 1.5°C scenarios. Such scenarios presented in the literature typically have BECCS at a GtCO2per year scale. We also assess the potentials and obstacles for BECCS implementation at the national level, applying Sweden as a case study. Given that BECCS deployment has scarcely started and, thus, is far from capturing 1 GtCO2per year, with lead times on the scale of multiple years, we conclude that there will be a large implementation gap unless BECCS development is immediately intensified, emissions are reduced at a much faster pace or removals realized through other CDR measures. In the national case study, we show that Sweden has favorable conditions for BECCS in that it has large point sources of biogenic emissions, and that BECCS has been identified as one potential “supplementary measure” for reaching the Swedish target of net-zero emissions in 2045. Yet, work on planning for BECCS implementation has started only recently and would need to be accelerated to close the implementation gap between the present advancement and the targets for BECCS proposed in a recent public inquiry on the roles of supplementary measures. An assessment of two ramp-up scenarios for BECCS demonstrates that it should in principle be possible to reach the currently envisaged deployment scales, but this will require prompt introduction of political and economic incentives. The main barriers are thus not due to technological immaturity, but are rather of a socio-economic, political and institutional nature.

Performance comparison of various types of embankment dams in relation to the conditions of the Mullalakh HPP

Introduction. Several types of embankment dams are used in the hydraulic engineering practice. However, the choice of a dam is individual for each hydraulic engineering project, as it takes account of specific features and natural conditions. This paper compares two types of rockfill dams (the one having a concrete face and the other having an asphalt-concrete diaphragm) in relation to the Mullalakh HPP on the Pskem River in the Republic of Uzbekistan. The dam height is 85 m. The comparison was performed from the standpoint of the dam performance in case of exposure to static forces and high seismicity.
 Materials and methods. The analysis of (1) the stress-strain state (SSS), (2) the stability of slopes exposed to regular and irregular load combinations was conducted for two types of dams. All calculations were performed in the two-dimensional domain. The analysis of the stress-strain state took account of the non-linear behavior of the soil ground and the contact interaction between structural elements. Seismic loads, included into the scope of irregular loads, were identified using the response spectrum method applied to particular periods and self-oscillation modes. Slope stability was analyzed with regard for the stress state of soils identified in the course of SSS calculations.
 Results. Each type of embankment dams has its specific features. The asphalt diaphragm dam is worse at perceiving high seismic loads. Its SSS during an earthquake features strength loss and emergence of soil discontinuity zones. The disadvantage of a concrete face dam is the insufficient safety of its anti-seepage element. Supplementary measures are needed to ensure the appropriate stress state of the face. Another finding is that the slopes of both types of dam do not demonstrate a sufficient stability factor, if the slope ratio equals to 1.5 during a 9-point earthquake.
 Conclusions. In high seismicity regions, a concrete faced dam demonstrates better performance than the asphalt diaphragm dam if both are exposed to static and seismic forces.

Gestational Folate and Offspring Bone Health; The Vitamin D in Pregnancy Study.

Maternal nutritional intake, such as folate and folic acid supplementation, during pregnancy may affect offspring bone health during childhood. We aimed to determine the associations between maternal dietary and supplementary folate intake and offspring bone health measures, including fracture risk. Data were obtained from 160 of 475 mother-child pairs who had returned for the 11-year follow up of the Vitamin D in Pregnancy Study, an observational cohort study. Incident fractures were ascertained from radiological records and dual X-ray absorptiometry was used to measure bone mineral density and content at 11years of age. Maternal dietary folate intake during pregnancy was determined by Food Frequency Questionnaire and folate supplementation was determined through self-report. Both measures were undertaken at recruitment (before 16weeks gestation) and at 28-32weeks' gestation. Multivariable linear regression models and Cox regression models were used to examine associations. Results are presented as per 1000µg folate for dietary measures. There were significant associations between maternal folate supplementation in early pregnancy (< 16weeks gestation) and offspring spine bone mineral content (BMC) (β = 1.53, 95% CI 0.21, 2.86), spine area (β = 1.10, 95% CI 0.37, 1.82) and total body less head area (β = 329.30, 95% CI 3.50, 55.20) at the 11-year follow-up. The association between spine BMC was attenuated after adjustment for bone size (β = 0.13 95% CI - 0.85, 1.10). There was no association between maternal folate supplementation at 28-32weeks' or maternal dietary intake at either time point with any offspring bone outcome. These data suggest that folate supplementation in early pregnancy may be associated with offspring bone size, but not other bone measures.

Novel COVID-19 Intersections with Dentistry: Approaches to protection.

BackgroundCOVID-19 outbreak brought many challenges to the society and to health care systems. Health care professionals in dental practices are a high-risk population, due to close contact to saliva and aerosols. Specific guidance for those professionals is essential to control disease transmission and guarantee dentist’s health.Material and MethodsWe performed a literature review based on online search in Pubmed, Scientific Electronic Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde and Scopus databases. Included articles were fully read and analysed regarding infection control measurements, use of personal protective equipment (PPE), conditions for procedures and use of mouthrinse. ResultsNineteen articles were added to this review. The majority of them recommended maintaining only urgency treatments, with use of rubber dam and mouthrinse before procedures. ConclusionsThe data collected suggests dental care should be performed under strict protection measures such as a pre-check questionnaire prior to any dental procedure; postponing elective dental treatments and following infection control security procedures may be strategic at this point. The use of adequate PPE for procedures is recommended. Supplementary measures should rise from further understanding of the pandemics. Key words:COVID-19, dentistry, practice.

Cross-Border Transfers of Personal Data after Schrems II: Supplementary Measures and New Standard Contractual Clauses (SCCs)

Cross-Border Transfers of Personal Data after Schrems II: Supplementary Measures and New Standard Contractual Clauses (SCCs)

Study on the application of CAM techniques on CNC lathes with Y axis and driven tools

CNC lathes with Y axes and driven tools are machine-tools with complex kinematic. Using CAM techniques to program these machines is a cumbersome process and could easily lead to collisions. Collisions may occur not only between tools and workpiece but also between the mobile elements of the CNC lathe. While CAM software package can identify the first type of collisions, for the second type supplementary measures must be taken. This work presents the build of a kinematic model of such a CNC lathe and how can the CAM techniques be improved by using this model.

Restoring shallow lakes impaired by eutrophication: Approaches, outcomes, and challenges

Shallow lake ecosystems are widely impaired by eutrophication. Lake restoration projects frequently fail or are only partially successful, reflecting that environmental managers face difficult challenges in addressing this complex problem. Key uncertainties relate to selecting appropriate methods and predicting the resulting response trajectory, that is, “what should be done, how much improvement should be expected, and how long will it take?” This review critically evaluates approaches applied to address eutrophication in shallow lakes. A set of shallow lake restoration case studies from across the globe, involving moderate to high effort monitoring, was evaluated to determine common features and to identify advantages/disadvantages and drivers of successful restoration projects. Approaches are broadly grouped into four categories: 1) external nutrient load reductions, 2) internal nutrient load reductions, 3) biomanipulation, and 4) hydrological manipulations. Case studies highlight that external load reduction is an essential component of successful restoration, although supplementary measures can support restoration goals. To inform planning and help set realistic expectations, the following key challenges to the restoration of shallow lakes were identified: 1) insufficient reductions in external nutrient loads, 2) biogeochemical lags, 3) resistance of a stable, algal-dominated state due to hysteresis in the turbidity–nutrient load relationship, 4) delayed macrophyte reestablishment, 5) climate change, 6) need for lake-specific approaches, and 7) social and political shortcomings. Managing these challenges is crucial to the success of shallow lake restoration projects.

Preclinical studies of testicular ischemia-reperfusion treatment

Testicular torsion occurs annually in appr. 3.8/100.000 under the age of 18 years The condition has a bimodal incidence pattern with peaks in infancy and early adolescence [ [1] Zhao L.C. Lautz T.B. Meeks J.J. Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving of care. J Urol. 2011; 186: 2009-2013 Crossref PubMed Scopus (150) Google Scholar ]. If retorsion is performed within the first few hours, there might be a chance of preservation of testicular function, but when the time period from onset of symptoms exceeds 12 h, the testicular function is lost. So acute surgery is mandatory, but could it be possible to get a higher success rate with supplementary measures? This is the topic of the preclinical study by [ [2] Tanriverdi H.I. Senel U. Gevrek F. Akbas A. Protective effect of famotidine on ischemia-reperfusion injury following testicular torsion in rats. J Pediatr Urol. 2021; 17: 167 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ] where they explore the effect of famotidine, a competitive inhibitor of histamine H2 receptors, normally used to reduce gastric acid, to counteract the reperfusion damages to the testicular tissue? Protective effect of famotidine on ischemia–reperfusion injury following testicular torsion in ratsJournal of Pediatric UrologyVol. 17Issue 2PreviewIn testicular torsion, testicular blood flow is impaired, resulting in ischemic changes. Torsion must be corrected urgently with surgical treatment. Detorsioning and restoration of blood supply to the testis cause reperfusion injury. Full-Text PDF

Developing a Reliability Index of Low Impact Development for Urban Areas

A defining characteristic of the urbanization is the transformation of existing pervious areas into impervious areas during development. This leads to numerous hydrologic and environmental problems such as an increase in surface runoff due to excess rainfall, flooding, the deterioration of water quality, and an increase in nonpoint source pollution. Several studies propose supplementary measures on environmental change problems in development areas using the low impact development technique. This study investigated the reduction of nonpoint source pollutant loads and flooding in catchments through urban catchment rainfall–runoff management. For the quantitative assessment of flood disasters and water pollution problems, we propose a reliability evaluation technique. This technique refers to a series of analysis methods that determine the disaster prevention performance of the existing systems. As the two factors involve physical quantities of different dimensions, a reliability evaluation technique was developed using the distance measure method. Using the storm water management model, multiple scenarios based on synthetic rainfall in the catchment of the Daerim 2 rainwater pumping station in Seoul, South Korea, were examined. Our results indicate the need for efficient management of natural disaster risks that may occur in urban catchments. Moreover, this study can be used as a primary reference for setting a significant reduction target and facilitating accurate decision making concerning urban drainage system management.

Artificial intelligence technique in detection of early esophageal cancer.

Due to the rapid progression and poor prognosis of esophageal cancer (EC), the early detection and diagnosis of early EC are of great value for the prognosis improvement of patients. However, the endoscopic detection of early EC, especially Barrett's dysplasia or squamous epithelial dysplasia, is difficult. Therefore, the requirement for more efficient methods of detection and characterization of early EC has led to intensive research in the field of artificial intelligence (AI). Deep learning (DL) has brought about breakthroughs in processing images, videos, and other aspects, whereas convolutional neural networks (CNNs) have shone lights on detection of endoscopic images and videos. Many studies on CNNs in endoscopic analysis of early EC demonstrate excellent performance including sensitivity and specificity and progress gradually from in vitro image analysis for classification to real-time detection of early esophageal neoplasia. When AI technique comes to the pathological diagnosis, borderline lesions that are difficult to determine may become easier than before. In gene diagnosis, due to the lack of tissue specificity of gene diagnostic markers, they can only be used as supplementary measures at present. In predicting the risk of cancer, there is still a lack of prospective clinical research to confirm the accuracy of the risk stratification model.

Predictors of Health Utility in Relapsing-Remitting and Secondary-Progressive Multiple Sclerosis: Implications for Future Economic Models of Disease-Modifying Therapies.

BackgroundDecision-analytic models used in economic evaluations of disease-modifying therapies for relapsing–remitting multiple sclerosis (RRMS) have characterized disease progression and accrue quality-adjusted life-years from utility values based on the Expanded Disability Status Scale (EDSS), the occurrence of relapses, and progression to secondary-progressive multiple sclerosis (SPMS). The EDSS, used to characterize disability progression, has several limitations. If the EDSS is the only disability measure used in economic evaluations, the long-term clinical and economic implications of disease-modifying therapies may not be properly assessed.ObjectiveThe objective of this study was to explore if supplementary disability measures including the Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), and Paced Auditory Serial Addition Test (PASAT) significantly contribute additional information on health utility in RRMS and SPMS otherwise not captured by the EDSS and relapses and, therefore, should be considered in future economic evaluations of disease-modifying therapies.MethodsShort-Form Six-Dimension utility scores were derived from the RAND 36-Item Health Survey 1.0 individual-level data available in the Multiple Sclerosis Outcome Assessment Consortium (MSOAC) Placebo Database. Repeated-measures mixed-effects models were conducted to estimate the effects of EDSS, T25FW, 9HPT (dominant and non-dominant hand), PASAT, and relapses on changes in utility over time, controlling for demographics.ResultsA higher level of EDSS, longer time to complete the T25FW test, and a recent relapse were significant predictors of lower utility in people with RRMS and SPMS. 9HPT and PASAT were not significant predictors.ConclusionsThis study suggests that in addition to EDSS and recent relapses, T25FW significantly predicts utility in RRMS and SPMS. These findings support the use of T25FW to supplement the EDSS and the occurrence of relapses to characterize the course of disease progression and to more accurately accrue quality-adjusted life-years in future economic evaluations of disease-modifying therapies for the treatment of RRMS.Electronic supplementary materialThe online version of this article (10.1007/s40273-020-00964-w) contains supplementary material, which is available to authorized users.

Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations.

Economic evaluations of new youth mental health interventions require preference-based outcome measures that capture the broad benefits these interventions can have for adolescents. The Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI) was developed to meet the need for such a broader measure. It assesses self reported problems in seven important domains of adolescents' lives, including school performance and family relationships, and is intended for use in economic evaluations of relevant interventions. The aim of the current study was to present the ASC T-ASI and examine its validity as well as its ability to distinguish between adolescents with and without problems associated with substance use and delinquency. The validation study was conducted in a sample of adolescents (n = 167) aged 12-18 years, who received in- or outpatient care in a youth mental health and (enclosed) care facility in the Netherlands. To examine its feasibility, test-retest reliability, and convergent validity, respondents completed the ASC T-ASI, as well as the EQ-5D-3L and SDQ at baseline and after a two-week interval using a counterbalanced method. The ASC T-ASI descriptive system comprises seven domains: substance use, school, work, family, social relationships, justice, and mental health, each expressing self reported problems on a five-point Likert scale (ranging from having 'no problem' to having a 'very large problem'). The majority of respondents (>70%) completed the ASC T-ASI within 10 minutes and appraised the questions as (very) easy and (very) comprehensible. Test-retest reliability was adequate (Kw values 0.26-0.55). Correlations with the supplementary measures were moderate to high (rs 0.30-0.50), suggesting convergent validity. The ASC T-ASI is a promising and valid measure for assessing self reported problems in important domains in adolescents' lives, allowing benefits beyond health and health-related quality of life to be included in economic evaluations of youth mental health interventions. Future studies of the ASC T-ASI should consider the comprehensiveness of its domains and sensitivity to change.

Validation of the Severity of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Other Measures than History: Activity Bracelet, Cardiopulmonary Exercise Testing and a Validated Activity Questionnaire: SF-36.

Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe and disabling chronic disease. Grading patient’s symptom and disease severity for comparison and therapeutic decision-making is necessary. Clinical grading that depends on patient self-report is subject to inter-individual variability. Having more objective measures to grade and confirm clinical grading would be desirable. Therefore, the aim of this study was to validate the clinical severity grading that has been proposed by the authors of the ME International Consensus Criteria (ICC) using more standardized measures like questionnaires, and objective measures such as physical activity tracking and cardiopulmonary exercise testing. Methods and results: The clinical database of a subspecialty ME/CFS clinic was searched for patients who had completed the SF 36 questionnaire, worn a SensewearTM armband for five days, and undergone a cardiopulmonary exercise test. Only patients who completed all three investigations within 3 months from each other—to improve the likelihood of stable disease—were included in the analysis. Two-hundred-eighty-nine patients were analyzed: 121 were graded as mild, 98 as moderate and 70 as having severe disease. The mean (SD) physical activity subscale of the SF-36 was 70 (11) for mild, 43 (8) for moderate and 15 (10) for severe ME/CFS patients. The mean (SD) number of steps per day was 8235 (1004) for mild, 5195 (1231) for moderate and 2031 (824) for severe disease. The mean (SD) percent predicted oxygen consumption at the ventilatory threshold was 47 (11)% for mild, 38 (7)% for moderate and 30 (7)% for severe disease. The percent peak oxygen consumption was 90 (14)% for mild, 64 (8)% for moderate and 48 (9)% for severe disease. All comparisons were p < 0.0001. Conclusion: This study confirms the validity of the ICC severity grading. Grading assigned by clinicians on the basis of patient self-report created groups that differed significantly on measures of activity using the SF-36 physical function subscale and objective measures of steps per day and exercise capacity. There was variability in function within severity grading groups, so grading based on self-report can be strengthened by the use of these supplementary measures.

The medical insurance system’s weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study

ObjectivesLittle is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. MethodsData were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. ResultsThe incidence of CHE of China’s middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. ConclusionsThe health system needs to control the irrational growth of health expenses and reduce residents’ overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.

Mitigating Psychological Impact: The Experience of Korean Disaster Management.

The psychological impact of disasters has not been adequately addressed in Korea. This research aims to evaluate how Korea should improve its management of the psychological impact of disasters toward the ultimate goal of effective disaster management. Qualitative content analysis is the main method applied. Nonprofessional management is compared with professional management by considering governments, psychology specialists, disaster victims, and local communities. The main finding is that Korea must change its current management style from nonprofessional to professional. Neighboring nations need to implement supplementary measures toward adopting a systematic approach that considers all phases of the disaster management cycle, emergency planning, and a long-term approach. The value of this study lies in its comprehensive examination of the issue of psychological impact from the perspective of disaster management in Korea.

Measurement of team performance in air combat – have we been underperforming?

In air combat, a traditional way of evaluating team’s taskwork performance is to measure its performance output. However, it provides a narrow view about the team’s performance and potentially misses the complexity of air combat and the team’s taskwork when tactical operating procedures, teams’ competencies and applicability of aircraft systems are evaluated in live-, virtual- and live-virtual-constructive- simulations. This paper introduces a model of an air combat system, which explains the dynamically interacting elements relevant to the measurement of team performance in air combat. Shared situation awareness, mental workload, task performance and normative performance are proposed as supplementary measures for the performance output. Recommendations for the selection of measurement techniques are provided. The multidimensional measurement approach presented in this paper can prevent potential misunderstanding of team performance. The principles of the system model and the associated measuring techniques can be applied to the analysis of any military system where the objective is to achieve a holistic measure of team performance.

EARLY USE OF CONTINUOUS POSITIVE AIR WAY PRESSURE FOR PREVENTION AND TREATMENT OF RESPIRATORY DISTRESS SYNDROME IN PRETERM INFANTS

Respiratory support is the mainstay intervention for support of postnatal respiratory adaptation and treatment of preterm infants. There is no doubt today about the clinical benefits of early use of non-invasive respiratory support over traditional tracheal intubation and mechanical ventilation in the context of reducing the risk of death, lung injury, and long-term chronic morbidity. In particular, continuous positive airway pressure (CPAP) is the most commonly used method of initial non-invasive respiratory support (NRS) for spontaneously breathing preterm newborns. This method of NRS is preferred in practice because of its easy use, accessibility and effectiveness. Application of CPAP increases functional residual lung capacity and tidal volume, which is important for the prevention and treatment of respiratory distress- syndrome. However, significant proportion of preterm infants managed on CPAP require transfer to mechanical ventilation as NRS becomes ineffective ultimately. The requirement for tracheal intubationand initiation of mechanical ventilation increases the risk of complications and adverse outcomes in such infants. In particular, CPAP failure is associated with higher rate of intraventricular hemorrhages, bronchopulmonary dysplasia, and increases the risk of death. Therefore, the priority is to maximize effectiveness of CPAP application. This can be achieved by identifying a risk group, namely the infants, who have a high probability of this respiratory support type failure, and by timely adding supplementary measures that can increase the effectiveness of CPAP. This review substantiates the expediency of early CPAP use for treatment of preterm newborns, describes the risk factors of CPAP failure and ways to improve the effectiveness of this method of NRS.

Effects of Stellera chamaejasme removal on the nutrient stoichiometry of S. chamaejasme-dominated grasslands in the Qinghai-Tibetan plateau.

BackgroundStoichiometric relations drive powerful constraints in several fundamental ecosystem processes. However, limited studies have been conducted on the ecological stoichiometry of plants after the change of community composition induced by Stellera chamaejasme removal in alpine grassland in the Qinghai–Tibetan Plateau.MethodsWe investigated the effects of S. chamaejasme removal on ecological stoichiometry by estimating the C:N:P stoichiometry in species, functional group and community levels of the ecosystem. The interactions between different species, functional groups and correlation with soil nutrient, responding to S. chamaejasme removal were also analyzed.ResultsFor the plants that became dominant after S. chamaejasme removal (SR), N content decreased and their C:N increased. S. chamaejasme removal significantly affected the nutrient stoichiometry of different functional groups. Specifically, Gramineae in the SR sites had decreased N content and N:P, and increased C:N; however, forbs had increased N content, C:P and N:P and decreased P content and C:N. At the community level, N content was lower and C:N higher in SR communities compared to CK. The N content of the plant community was positively correlated with soil total N content. S. chamaejasme removal could change the nutrient balance from species level, to functional group level, and to community level. Thus, supplementary measures might be cooperated with S. chamaejasme removal for the recovery of S. chamaejasme-dominated degraded grassland. These results provide insight into the role of S. chamaejasme in ecological protection and conservation, and the conclusions from this study could be used to develop effective and sustainable measures for S. chamaejasme control in the Qinghai–Tibetan Plateau.

How does the EQ-5D-5L perform in asthma patients compared with an asthma-specific quality of life questionnaire?

BackgroundAsthma patients experience impairments in health-related quality of life (HRQL). Interventions are available to improve HRQL. EQ-5D-5L is a common generic tool used to evaluate health interventions. However, there is debate over whether the use of this measure is adequate in asthma patients.MethodsWe used data from 371 asthma patients participating in a pulmonary rehabilitation (PR) program from the EPRA randomized controlled trial. We used four time points: T0 randomization, T1 start PR, T2 end PR, T3 3 months follow-up. We calculated floor and ceiling effects, intra-class correlation (ICC), Cohen’s d, and regression analysis to measure the sensitivity to changes of EQ-5D-5 L (EQ-5D index and Visual Analog Scale (VAS)) and the disease-specific Asthma Quality of Life Questionnaire (AQLQ). Furthermore, we estimated the minimally important difference (MID). Based on the Asthma Control Test (ACT) scores, we defined three groups: 1. ACT-A (ACT> 19) controlled asthma, 2. ACT-B (14 < ACT≤19) not well-controlled asthma, and 3. ACT-C (ACT≤14) very poorly controlled asthma.ResultsOnly the EQ-5D index showed ceiling effects at T2 and T3 (32%). ICC (between T0 and T1) was moderate or good for all measures. Cohen’s d at T2 and T3 was better at differentiating between ACT-A and ACT-B than between ACT-B and ACT-C. The EQ-5D index showed moderate effect sizes (0.63–0.75), while AQLQ showed large effect sizes (0.74–1,48). VAS was responsive to pronounced positive and negative ACT changes in every period, and AQLQ mostly to the positive changes, whereas the EQ-5D index was less responsive. We estimated a MID of 0.08 for the EQ-5D index, 12.3 for VAS, and 0.65 for AQLQ.ConclusionAll presented HRQL tools had good discriminatory power and good reliability. However, EQ-5D-5 L did not react very sensitively to small changes in asthma control. Therefore, we would suggest using supplementary measures in addition to EQ-5D-5 L to evaluate asthma-specific interventions more comprehensively.Trial registrationGerman Clinical Trial Register, DRKS00007740 (date of registration: 05/15/2015), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007740. The registration took place prospectively.