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A major strength of this study would lie in the large number of patients involved (over 100,000 patients for each of the incident prescription/de-escalation analyses), from a cohort of over 500,000 patients from the UK primary care system over 17 years. To the best of our knowledge, there exists no prior study of comparable scale on the impacts of stepping-down asthma medication. Therefore, this study may have significant potential to affect health policy on asthma management, especially with an observed increase in the prescription of higher level medication, and purported insufficient evidence about stepping-down ICS medication as a factor in increased risk of future asthma attacks (e.g. from page 33 of the BTS/SIGN 2019 guidelines).

Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: A population-based observational study

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These findings will be of interest to the general microbial and specific desert ecology fields, along with those studying Mars analog extreme environments. The results and discussion sections were clear and interesting, with some fascinating points. I really enjoyed reading the paper- well done!

Life under quartz: Hypolithic mosses in the Mojave Desert

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