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Background: To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated.
Methods: Using Zelen’s design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff’s Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool).
Results: Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline.
Conclusions: After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
Background: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages.
Objective: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain.
Methods: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts.
Results: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients’ own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8–10 points and 26% for the DK cohort and 6–8 points and 29% for the UK cohort.
Conclusions: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.
Since operational managers often monitor large numbers of wind turbines (WTs), they depend on a toolset to provide them with highly condensed information to identify and prioritize low performing WTs or schedule preventive maintenance measures. Power curves are a frequently used tool to assess the performance of WTs. The power curve health value (HV) used in this work is supposed to detect power curve anomalies since small deviations in the power curve are not easy to identify. It evaluates deviations in the linear region of power curves by performing a principal component analysis. To calculate the HV, the standard deviation in direction of the second principal component of a reference data set is compared to the standard deviation of a combined data set consisting of the reference data and data of the evaluated period. This article examines the applicability of this HV for different purposes as well as its sensitivities and provides a modified HV approach to make it more robust and suitable for heterogeneous data sets. The modified HV was tested based on ENGIE's open data wind farm and data of on- and offshore WTs from the WInD-Pool. It proved to detect anomalies in the linear region of the power curve in a reliable and sensitive manner and was also eligible to detect long term power curve degradation. Also, about 7 % of all corrective maintenance measures were preceded by high HVs with a median alarm horizon of three days. Overall, the HV proved to be a promising tool for various applications.
Thailand’s power system has been facing an energy transition due to the increasing amount of Renewable Energy (RE) integration, prosumers with self-consumption, and digitalization-based business models in a Local Energy Market (LEM). This paper introduces a decentralized business model and a possible trading platform for electricity trading in Thailand’s Micro-Grid to deal with the power system transformation. This approach is Hybrid P2P, a market structure in which sellers and buyers negotiate on energy exchanging by themselves called Fully P2P trading or through the algorithm on the market platform called Community-based trading. A combination of Auction Mechanism (AM), Bill Sharing (BS), and Traditional Mechanism (TM) is the decentralized price mechanism proposed for the Community-based trading. The approach is validated through a test case in which, during the daytime, the energy import and export of the community are significantly reduced when 75 consumers and 25 PV rooftop prosumers participate in this decentralized trading model. Furthermore, a comparison analysis confirms that the decentralized business model outperforms a centralized approach on community and individual levels.
This study introduced an automated long-term fermentation process for fungals grown in pellet form. The goal was to reduce the overgrowth of bioreactor internals and sensors while better rheological properties in the fermentation broth, such as oxygen transfer and mixing time, can be achieved. Because this could not be accomplished with continuous culture and fed-batch fermentation, repeated-batch fermentation was implemented with the help of additional bioreactor internals (“sporulation supports”). This should capture some biomass during fermentation. After harvesting the suspended biomass, intermediate cleaning was performed using a cleaning device. The biomass retained on the sporulation support went through the sporulation phase. The spores were subsequently used as inocula for the next batch. The reason for this approach was that the retained pellets could otherwise cause problems (e.g., overgrowth on sensors) in subsequent batches because the fungus would then show undesirable hyphal growth. Various sporulation supports were tested for sufficient biomass fixation to start the next batch. A reproducible spore concentration within the range of the requirements could be achieved by adjusting the sporulation support (design and construction material), and an intermediate cleaning adapted to this.
Irrigated paddy rice agriculture accounts for a major share of Asia Pacific’s total water withdrawal. Furthermore, climate change induced water scarcity in the Asia-Pacific region is projected to intensify in the near future. Therefore, methods to reduce water consumption through efficiency measures are needed to ensure the long-term (water) sustainability. The irrigation systems, subak of Karangasem, Indonesia, and the tameike of Kunisaki, Japan, are two examples of sustainable paddy rice irrigation. This research, through interviews and an extensive survey, comparatively assessed the socio-environmental sustainability of the two irrigation management systems with special reference to the intensity and nature of social capital, equity of water distribution, water demand, water footprint, and water quality, etc. The prevailing social capital paradigm of each system was also compared to its overall managerial outcomes to analyze how cooperative action contributes to sustainable irrigation management. Both systems show a comparable degree of sustainable irrigation management, ensuring an equitable use of water, and maintain relatively fair water quality due to the land-use practices adapted. However, the systems differ in water demand and water efficiency principally because of the differences in the irrigation management strategies: human and structural. These findings could help devise mechanisms for transitioning to sustainable irrigation management in the commercially-oriented paddy rice agricultural systems across the Asia-Pacific region.
Issues on climate change have been recognized as serious challenges for regional sustainable development both at a global and local level. Given the background that most of the artificial carbon emissions are resulted from the energy consumption sector and the energy is also the key element resource for economic development, this paper investigated the relationship between CO2 emission, fossil energy consumption, and economic growth in the period 1970–2008 of nine European countries, based on the approach of Granger Causality Test, followed by the risk analysis on impacts of CO2 reduction to local economic growth classified by the indicator of causality degree. The results show that there are various feedback causal relationships between carbon emission, energy consumption and economic growth, with both unidirectional and dual-directional Granger causality. The impact of reducing CO2 emission to economic growth varies between countries as well.
Integrated analysis on socio-economic metabolism could provide a basis for understanding and optimizing regional sustainability. The paper conducted socio-economic metabolism analysis by means of the emergy accounting method coupled with data envelopment analysis and decomposition analysis techniques to assess the sustainability of Qingyang city and its eight sub-region system, as well as to identify the major driving factors of performance change during 2000–2007, to serve as the basis for future policy scenarios. The results indicate that Qingyang greatly depended on non-renewable emergy flows and feedback (purchased) emergy flows, except the two sub-regions, named Huanxian and Huachi, which highly depended on renewable emergy flow. Zhenyuan, Huanxian and Qingcheng were identified as being relatively emergy efficient, and the other five sub-regions have potential to reduce natural resource inputs and waste output to achieve the goal of efficiency. The results of decomposition analysis show that the economic growth, as well as the increased emergy yield ratio and population not accompanied by a sufficient increase of resource utilization efficiency are the main drivers of the unsustainable economic model in Qingyang and call for polices to promote the efficiency of resource utilization and to optimize natural resource use.
This paper analyzed the characteristic of the tourism destination ecosystem from perspective of entropy in Dunhuang City. Given these circumstances, an evaluation index system that considers the potential of sustainable development was formed based on dissipative structure and entropy change for the tourism destination ecosystem. The sustainable development potential evaluation model for tourism destination ecosystem was built up based on information entropy. Then, we analyzed each indicator impact for the sustainable development potential and proposed some measures for the tourism destination ecosystem. The conclusions include: (a) the requirements of Dunhuang tourism destination ecosystem on the natural ecosystem continuously grew between 2000 and 2012; (b) The sustainable development potential of the Dunhuang tourism destination ecosystem was on an oscillation upward trend during the study period, which is dependent on government attention, and pollution problems were improved.
With less than 6% of total global water resources but one fifth of the global population, China is facing serious challenges for its water resources management, particularly in rural areas due to the long-standing urban-rural dualistic structure and the economic-centralized developmental policies. This paper addresses the key water crises in rural China including potable water supply, wastewater treatment and disposal, water for agricultural purposes, and environmental concerns, and then analyzes the administrative system on water resources from the perspective of characteristics of the current administrative system and regulations; finally, synthetic approaches to solve water problems in rural China are proposed with regard to institutional reform, regulation revision, economic instruments, technology innovation and capacity-building. These recommendations provide valuable insights to water managers in rural China so that they can identify the most appropriate pathways for optimizing their water resources, reducing the total wastewater discharge and improving their water-related ecosystem.