Although low vegetation productivity has been observed in karst regions, whether and how bedrock geochemistry contributes to the low karstic vegetation productivity remain unclear. In this study, we ...address this knowledge gap by exploring the importance of bedrock geochemistry on vegetation productivity based on a critical zone investigation across a typical karst region in Southwest China. We show silicon and calcium concentrations in bedrock are strongly correlated with the regolith water loss rate (RWLR), while RWLR can predict vegetation productivity more effectively than previous models. Furthermore, the analysis based on 12 selected karst regions worldwide further suggest that lithological regulation has the potential to obscure and distort the influence of climate change. Our study implies that bedrock geochemistry could exert effects on vegetation growth in karst regions and highlights that the critical role of bedrock geochemistry for the karst region should not be ignored in the earth system model.
Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing ...interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST).
Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively.
The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 2
fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components.
We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.
Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take ...medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability.
This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs).
According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice.
In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended.
We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence.
Abstract
Background
Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence.
Purpose
...To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs.
Methods
We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet.
Results
There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = −0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = −0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component.
Conclusions
The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.
Lay Summary
Adjuvant endocrine therapy (AET) is a medication given to women to stop breast cancer from returning. Many women do not take AET every day or stop taking it before they should. Some women do not take AET because they do not believe it will help them, or they have concerns about the side effects. We ran an online study aiming to create the best information leaflet to help women understand how AET is helpful and to reduce their concerns. The leaflet had five sections; diagrams explaining how AET works, visual pictures of the benefits of AET, information about the side effects, answers to common concerns, and quotes from other women with breast cancer. 1,604 healthy women filled in a questionnaire before and after looking at an information leaflet about AET. Women received different combinations of the five sections of the information leaflet. We found quotes from other women with breast cancer led to more positive beliefs about AET. Some sections of the leaflet worked better in combination, while other sections were worse in combination. Our results led us to remove the detailed side effect information from the leaflet, as in combination with the other sections this negatively affected women’s beliefs about AET.
Factorial experimental designs are an efficient way to optimize the content of information leaflets. Optimizing an information leaflet to support beliefs about a medication prescribed to women with breast cancer led enhanced information about side-effects to be screened out.
Marine spatial planning and conservation need underpinning with sufficiently detailed and accurate seabed substrate and habitat maps. Although multibeam echosounders enable us to map the seabed with ...high resolution and spatial accuracy, there is still a lack of fit-for-purpose seabed maps. This is due to the high costs involved in carrying out systematic seabed mapping programmes and the fact that the development of validated, repeatable, quantitative and objective methods of swath acoustic data interpretation is still in its infancy. We compared a wide spectrum of approaches including manual interpretation, geostatistics, object-based image analysis and machine-learning to gain further insights into the accuracy and comparability of acoustic data interpretation approaches based on multibeam echosounder data (bathymetry, backscatter and derivatives) and seabed samples with the aim to derive seabed substrate maps. Sample data were split into a training and validation data set to allow us to carry out an accuracy assessment. Overall thematic classification accuracy ranged from 67% to 76% and Cohen׳s kappa varied between 0.34 and 0.52. However, these differences were not statistically significant at the 5% level. Misclassifications were mainly associated with uncommon classes, which were rarely sampled. Map outputs were between 68% and 87% identical. To improve classification accuracy in seabed mapping, we suggest that more studies on the effects of factors affecting the classification performance as well as comparative studies testing the performance of different approaches need to be carried out with a view to developing guidelines for selecting an appropriate method for a given dataset. In the meantime, classification accuracy might be improved by combining different techniques to hybrid approaches and multi-method ensembles.
•We investigate four mapping approaches in their ability to map seabed substrates.•We assess classification accuracy and similarity of map outputs.•Differences in accuracy are not statistically significant at the 5% level.•Map agreement ranged from 68% to 87%.•We propose strategies to increase classification accuracy.
Understanding the impacts of climate change and human activities on vegetation is of great significance to the sustainable development of terrestrial ecosystems. However, most studies focused on the ...overall impact over a period and rarely examined the time-lag effect of vegetation's response to climatic factors when exploring the driving mechanisms of vegetation dynamics. In this study, we identified key areas driven by either positive or negative human activities and climate change. Taking the three karst provinces of southwest China as the case study area, a Leaf Area Index (LAI)-climate model was constructed by quantifying the time-lag effect. Then the associated residual threshold was calculated to identify the vegetation change areas dominated by human activities and climate change. The results showed that, during the implementation period of ecological restoration projects from 1999 to 2015, positive impact areas of human activities were mainly distributed among the implementation areas of ecological restoration projects, accounting for 5.61% of the total area. For another, the negative impact areas were mainly distributed across the mountainous area of Yunnan Province, accounting for 1.30% of the total area. Karst landform had the greatest influence on the areas dominated by positive human activities, whereas both topography and karst landform significantly affected the areas dominated by negative human activities. Urban development level had the greatest impact on the areas dominated by climate change. The outcomes of this study provided scientific supports for the sustainable development of ecological restoration projects in China's karst region.
Display omitted
•The time-lag effect was considered to establish the LAI-climate model.•Residual threshold was used to separate the impacts of climate and human activities.•LAI dynamics changed significantly during the two stages of 1983-1998 and 1999-2015.•Dominant impact areas of climate change and human activities were identified.•Karst landform significantly affected the distribution of human positive impact area.
Purpose
Side-effects of adjuvant endocrine therapy (AET) are common in breast cancer survivors, and can affect adherence to treatment. We synthesised the evidence for strategies to self-manage these ...side-effects.
Methods
We searched for systematic reviews and clinical guidelines on self-management strategies for AET side-effects (arthralgia, fatigue, hot flashes, gastrointestinal discomfort, nausea, vulvovaginal symptoms, and sleep disturbance). We searched oncology organisation’s websites and eight databases (Inception-November 2020). Screening, data extraction and quality assessment were completed independently in duplicate. PROSPERO: 2019CRD4201914001.
Results
We identified 33 systematic reviews and 18 clinical guidelines. 21% of reviews were high quality, and the average quality score for guidelines was 44%. Evidence for most strategies was absent or weak. There was consensus from a low-quality review and multiple guidelines to recommend moisturisers, gels and lubricants for vulvovaginal symptoms. Evidence was weak for physical activity for self-managing most symptoms, although two high-quality reviews indicated yoga and aerobic exercise could reduce fatigue. Primary research was often biased by weak and underpowered study designs. Eleven reviews did not report information on adverse events.
Conclusions
Most self-management strategies for breast cancer survivors experiencing side-effects from AET lack evidence. Primary research is needed using high-quality well-powered designs focusing on implementable strategies.
Implications for Cancer Survivors
Patients and clinicians should be aware that although the risk of harm is low for these self-management strategies, the likelihood of benefit is often unclear. Women should consider moisturisers, gels or lubricants for self-managing vulvovaginal symptoms, and yoga or aerobic exercise for alleviating fatigue.
Carbon sequestration is a key soil function, and an increase in soil organic carbon (SOC) is an indicator of ecosystem recovery because it underpins other ecosystem services by acting as a substrate ...for the soil microbial community. The soil microbial community constitutes the active pool of SOC, and its necromass (microbial residue carbon, MRC) contributes strongly to the stable SOC pool. Therefore, we propose that the potential for restoration of degraded karst ecosystems lies in the abundance of soil microbial community and the persistence of its necromass, and may be measured by changes in its contribution to the active and stable SOC pools during recovery. We investigated changes in SOC stocks using an established space-for-time chronosequence along a perturbation gradient in the subtropical karst ecosystem: sloping cropland < abandoned cropland < shrubland < secondary forest < primary forest. Microbial biomarkers were extracted from soil profiles from surface to bedrock and used to measure the contributions of the soil microbial community composition (using phospholipid fatty acids, PLFAs) and MRC (using amino sugars) to SOC stocks at each recovery stage. The results showed that the SOC stocks ranged from 10.53 to 31.77 kg m−2 and increased with recovery stage, with total MRC accounting for 17–28% of SOC. Increasing PLFAs and MRC abundances were positively correlated with improved soil structure (decreased bulk density) and organic carbon, nitrogen and phosphorus nutrient. Bacterial MRC contributes more to SOC stocks than fungal residue carbon during vegetation recovery. The PLFA analysis indicated that Gram positive bacteria were the largest microbial group and were relatively more abundant in deeper soils, and biomarkers for saprophytic and ectomycorrhizal fungi were more abundant in soils under woody vegetation. In conclusion, this study suggests that the soil microbial community in karst soils have the potential to adapt to changing soil conditions and contribute substantially to building SOC stocks after abandonment of agriculture in degraded karst landscapes.
Display omitted
•Fungal and bacterial residue carbon increased with vegetation recovery in karst landscape.•Bacterial residue carbon contributes more to SOC stocks than fungal residue carbon.•Gram positive bacteria PLFA has the largest abundance in microbial community composition.•Gram positive bacteria increased in relative abundance with depth to the bedrock at all stages.
The study of the critical zones (CZs) of the Earth link the composition and function of aboveground vegetation with the characteristics of the rock layers, providing a new way to study how the unique ...rock and soil conditions in karst regions affect the aboveground vegetation. Based on survey results of the rocks, soils and vegetation in the dolomite and limestone distribution areas in the karst area of central Guizhou, it was found that woody plant cover increases linearly with the number of cracks with a width of more than 1 mm, while the cover of herbaceous plants shows the opposite trend (
p
<0.01). The dolomite distribution area is characterized by undeveloped crevices, and the thickness of the soil layer is generally less than 20 cm, which is suitable for the distribution of herbaceous plants with shallow roots. Due to the development of crevices in the limestone distribution area, the soil is deeply distributed through the crevices for the deep roots of trees, which leads to a diversified species composition and a complicated structure in the aboveground vegetation. Based on moderate resolution imaging spectroradiometer (MODIS) remote sensing data from 2001 to 2010, the normalized differentiated vegetation index (NDVI) and annual net primary productivity (NPP) results for each phase of a 16-day interval further indicate that the NDVI of the limestone distribution area is significantly higher than that in the dolomite distribution area, but the average annual NPP is the opposite. The results of this paper indicate that in karst CZs, the lithology determines the structure and distribution of the soil, which further determines the cover of woody and herbaceous plants in the aboveground vegetation. Although the amount of soil in the limestone area may be less than that in the dolomite area, the developed crevice structure is more suitable for the growth of trees with deep roots, and the vegetation activity is strong. At present, the treatment of rocky desertification in karst regions needs to fully consider the rock-soilvegetation- air interactions in karst CZs and propose vegetation restoration measures suitable for different lithologies.
PDF
