Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis

IntroductionPain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS.Methods and materialsWe convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice.ResultsThirteen assessment and treatment recommendations were produced regarding pain in children with MS.DiscussionFuture studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting

Assessing land use and flood management impacts on ecosystem services in a river landscape (Upper Danube, Germany)

Rivers and floodplains provide many regulating, provisioning and cultural ecosystem services (ES) such as flood risk regulation, crop production or recreation. Intensive use of resources such as hydropower production, construction of detention basins and intensive agriculture substantially change ecosystems and may affect their capacity to provide ES. Legal frameworks such as the European Water Framework Directive, Bird and Habitats Directive and Floods Directive already address various uses and interests. However, management is still sectoral and often potential synergies or trade‐offs between sectors are not considered. The ES concept could support a joint and holistic evaluation of impacts and proactively suggest advantageous options. The river ecosystem service index (RESI) method evaluates the capacity of floodplains to provide ES by using a standardized five‐point scale for 1 km‐floodplain segments based on available spatial data. This scaling allows consistent scoring of all ES and their integration into a single index. The aim of this article is to assess ES impacts of different flood prevention scenarios on a 75 km section of the Danube river corridor in Germany. The RESI method was applied to evaluate scenario effects on 13 ES with the standardized five‐point scale. Synergies and trade‐offs were identified as well as ES bundles and dependencies on land use and connectivity. The ratio of actual and former floodplain has the strongest influence on the total ES provision: the higher the percentage and area of an active floodplain, the higher the sum of ES. The RESI method proved useful to support decision‐making in regional planning.BMBF, 033W024A, ReWaM - Verbundprojekt RESI: River Ecosystem Service Index, Teilprojekt

Florix, an index to assess plant species in floodplains for nature conservation : developed and tested along the river Danube

Natural floodplains are ecosystems with a diverse mosaic of habitats and site conditions, but also highly threatened due to anthropogenic pressures. Plant species occur in all habitat types and can indicate their value for nature conservation. To improve sustainable management of rivers and floodplains, several indices such as the River Ecosystem Service Index (RESI) have been developed. However, there are so far no assessment schemes for the entire range of floodplain plants. The common assessment approaches like biological integrity, achievement rates or threatened species (Red list), applying to other species groups or other ecosystems, are not appropriate in floodplains. Legal obligations and the need to restore floodplains clearly call for an index assessing the ecological value in a reference area which can be combined with a 5-scale assessment in accordance to established assessments like RESI or the Water Framework Directive. Five typical characteristics describing vascular plants’ adaptation to floodplain habitats were identified. These can be derived from published data sets available for all species in Germany. We checked these indicators for multicollinearity and selected three of them: species number, hydrodynamic indicators, nature conservation indicators. Species number highly correlate with habitat indicators and geographic occurrence. For the selected three indicators we determined thresholds to group habitats and their indicator rate to five classes (very low to very high value for nature conservation). These thresholds are valid for the river Danube and for the habitat types scrutinized in this study. The Florix approach was sensitive in data sets testing active against former floodplains and protected against unprotected areas: For the entire reference region ‘Danube floodplain’, Florix values were higher in the active floodplain and in the protected areas. Only the habitat type ‘water bodies’ showed better scores for habitats in the former floodplain, for ‘softwood forests’ the status of being part of a protected area had no effect. Florix results were validated in two case studies differing in land use intensity. The region with dominant agricultural use showed significantly lower values than that with a higher portion of forests and grasslands. Florix can be used for a floristic conservation status assessment at single habitat level or for the entity of a study region in comparison to a reference region. It allows to identify main pressures and to complement a habitat-type based evaluation. To achieve higher comparability, we should strive for a generalized monitoring in Europe like it is common in aquatic ecosystem monitoring

The "habitat provision" index for assessing floodplain biodiversity and restoration potentials as an ecosystem service-method and application

River floodplains provide a large number of ecosystem services (ESSs) for human societies. However, human manipulations of rivers and floodplains have led to the loss of many ESSs, including the provision of habitats for typical floodplain flora and fauna. To quantify such losses, we present a new index, which incorporates the functional and structural quality of riverine and alluvial habitats and their communities. The assessment is based on publicly available biotic and abiotic data at a local scale (e.g., habitat type mapping, species data). The new evaluation method consists of three steps: First, an evaluation at habitat type level is done by using well-established assessment criteria (e.g., groundwater dependence, legal protection status, regenerability). Secondly, the individual habitats are assessed based on specific quality characteristics (e.g., presence of protected birds or backwater influence). Finally, these values are aggregated within 1-km floodplain compartments weighted by their spatial expansion. The index uses a five-step value to describe the importance of a floodplain area for typical species and habitats from “very high” (=5) to “very low” (=1). The aim of this “habitat provision index” is to provide a tool for planners and decision makers to compare and analyze the effects of past or future measures. The methodical approach is tested for two rivers: the Nahe and the Rhine. The performance of the index is analyzed by comparing the current conditions (status quo) against two different scenarios. The index is validated and shown to be sensitive to different water management scenarios (river restoration and technical polder scenario for flood risk enhancement), with both scenarios showing an improvement in the habitat provision value