Pulmonary telerehabilitation vs. conventional pulmonary rehabilitation - a secondary responder analysis.

Home-based pulmonary telerehabilitation (PTR) has been proposed to be equivalent to supervised outpatient pulmonary rehabilitation (PR) but available randomised trials have failed to reach the minimal important changes (MIC). The purpose of this study was to analyse the proportion of MIC responders and non-responders on short-term (10 weeks from baseline) and long-term (62 weeks from baseline) in total and between groups in 134 patients with COPD randomised (1:1) to either home-based PTR or traditional hospital-based outpatient PR. Difference between PTR and PR on 6MWD response proportion could not be shown at 10 (OR=0.72, CI=0.34 to 1.51, p=0.381) or 62 weeks (OR=1.12, CI=0.40 to 3.14, p=0.834). While the evidence and knowledge of PTR accumulate, outpatient supervised PR for now remains the standard of care, with home-based PTR as a strong secondary option for those unable to attend out-patient programmes.

A multi-criteria decision framework for circular wastewater systems in emerging megacities of the Global South.

Lima faces increasing water stress due to demographic growth, climate change and outdated water management infrastructure. Moreover, its highly centralized wastewater management system is currently unable to recover water or other resources. Hence, the primary aim of this study is to identify suitable wastewater treatment alternatives for both eutrophication mitigation and indirect potable reuse (IPR). For eutrophication mitigation, we examined MLE, Bardenpho, Step-feed, HF-MBR, and FS-MBR. For IPR, we considered secondary treatment+UF + RO + AOP or MBR + RO + AOP. These alternatives form part of a WWTP network at a district level, aiding Lima's pursuit of a circular economy approach. This perspective allows reducing environmental impacts through resource recovery, making the system more resilient to disasters and future water shortages. The methods used to assess these scenarios were Life Cycle Assessment for the environmental dimension; Life Cycle Costing for the economic perspective; and Multi-Criteria Decision Analysis to integrate both the quantitative tools aforementioned and qualitative criteria for social and techno-operational dimensions, which combined, strengthen the decision-making process. The decision-making steered towards Bardenpho for eutrophication abatement when environmental and economic criteria were prioritized or when the four criteria were equally weighted, while HF-MBR was the preferred option when techno-operational and social aspects were emphasized. In this scenario, global warming (GW) impacts ranged from 0.23 to 0.27 kg CO2eq, eutrophication mitigation varied from 6.44 to 7.29 g PO4- equivalent, and costs ranged between 0.12 and 0.17 €/m3. Conversely, HF-MBR + RO + AOP showed the best performance when IPR was sought from the outset. In the IPR scenario, GW impacts were significantly higher, at 0.46-0.51 kg CO2eq, eutrophication abatement was above 98 % and costs increased to ca. 0.44 €/m3.

Wastewater treatment decentralization: Is this the right direction for megacities in the Global South?

The centralization-decentralization dichotomy in wastewater treatment management has been a recurrent topic of discussion in the urban context. The escalation of environmental hazards linked to increasing mismanaged wastewater flows in emerging or developing cities has vivified this conundrum. It is argued that there is a wide range of parameters to identify the optimal level of centralization-decentralization that must be implemented. In many cases, this prevents decision-makers from having a clear picture of the most appropriate management choices that must be undertaken. Hence, the main objective of the current discussion consists of an in-depth comparison between centralized wastewater treatment systems and decentralized systems with source separation in urban environments of the Global South. Moreover, a set of actions that should be considered in order to upgrade wastewater treatment systems amidst the existence of numerous economic, social and environmental constraints are analyzed. Considering the constraints of megacentralization as a preferred option, we argue that decision-makers should restrain from entering a centralization-decentralization dichotomy, seeing the process as a gradient between the two concepts. In fact, we advocate combining the benefits of each of the two perspectives to generate an adaptive management, site-specific solution for urban environments. For this, the inclusion of quantitative management tools, such as life-cycle environmental or cost management methodologies, in multi-objective optimization models, constitutes an interesting path forward towards fostering comprehensive policy support.

Identifying and measuring land-use and proximity conflicts: methods and identification.

ABSTRACT: This text aims to present the methodology of study of land-use conflicts performed in recent years by a multidisciplinary team, and to reveal the methods of survey and data collection, as well as the structure of the resulting database. We first define the scope of our study by providing a definition of these conflicts, of their characteristics and motives, of the ways they manifest themselves and of the actors involved (I). We then present the methodology we have used to identify conflicts; it is based on a spatial analysis and the combined use of different data collection methods including surveys conducted by experts, analyses of the regional daily press and of data from the administrative litigation courts (II). Finally we present the resulting Conflicts © data base, with its tables and nomenclatures, in which the data collected in different fields are reconciled and analyzed (III), before providing a few examples of how this method can be used to analyze case studies in developed and developing countries (IV). JEL CODES: D74; C83; K41.