Effects of home-based exercise with telehealth guidance in lymphoma cancer survivors entering cardio-oncology rehabilitation: rationale and design of the tele@home study.

BACKGROUND: Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed. OBJECTIVES: To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness. DESIGN: This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT05779605.

Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis.

PURPOSE: Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS: PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS: A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION: This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.

Co-composting of sewage sludge as an effective technology for the production of substrates with reduced content of pharmaceutical residues.

Sewage sludge is a valuable source of elements such as phosphorus and nitrogen. At the same time, heavy metals, emerging organic compounds, micropollutants (pharmaceuticals, pesticides, PCPs, microplastics), or some potentially dangerous bacteria can be present. In this study, the sewage sludge was aerobically treated by composting with other materials (co-composted), and the resulting substrate was tested for suitability of its use in agriculture. Closer attention was focused on the pharmaceuticals (non-steroidal antiphlogistics, sartanes, antiepileptics, caffeine, and nicotine metabolites) content and ecotoxicity of the resulting substrates in the individual phases of sludge co-composting. It has been verified that during co-composting there is a potential for reduction of the content of pharmaceutical in the substrates up to 90 %. The course of the temperature in the thermophilic phase is decisive. Growth and ecotoxicity experiments demonstrated that with a suitable co-composting procedure, the resulting stabilized matter is suitable as a substrate for use in plant production, and the risk of using sewage sludge on agricultural land is substantially reduced.

Fungal pretreatment parameters for improving methane generation from anaerobic digestion of corn silage.

Corn silage was treated by white rot fungi (WRF) to investigate the effect of pretreatment on material's ability to produce methane in anaerobic digestion (AD). The selective fungi Pleurotus ostreatus and Dichomitus squalens promoted biogas generation, whereas the non-selective Trametes versicolor and Irpex lacteus had negative effect. Cumulative methane production after 10-day pretreatment with P. ostreatus at 28 °C rose 1.55-fold. The longer pretreatments of 30 and 60-days had smaller effect. When the pretreatment with P. ostreatus was carried out at 40 °C a high H2S release affected the AD process. Effect of WRF action dependent on the type of corn silage. With typical corn silage, the lignin depolymerisation raised the methane generation from 0.301 to 0.465 m3kgVS-1. In contrast, extensive decomposition of hemicellulose in hybrid corn silage deteriorated the effect of pretreatment on methane production.

Dry anaerobic digestion of the fine particle fraction of mechanically-sorted organic fraction of municipal solid waste in laboratory and pilot reactor.

High-solid anaerobic digestion of the very small particle fraction of mechanically-sorted organic fraction of municipal solid waste (OFMSW) was examined in mesophilic digestion tests in a conventional laboratory (0.013 m3) and a pilot (0.300 m3) reactor. The non-biodegradable and recalcitrant molecules together with the low protein and starch contents of the small-particles of OFMSW limited the methane generation potential of substrate. In the conventional AD system, methane yields remained low at 0.139 m3kgVS-1 due to formation of a non-reacting layer on digestate surface, which restricted utilization of the available in OFMSW digestible organics. The absence of surface solid crust in the pilot unit favoured consumption of a greater proportion of volatile solids of the OFMSW. Dry AD was remarkably stable over the entire period and negligibly effected by the toxic H2S yields. Methane generation (0.167 m3kgVS-1) was increased 1.2-fold compared to the conventional system due to a better mixing of substrate and microorganisms achieved inside the pilot reactor, which led to an increase of the digested volatile organics. Digestate presented low stability and high heavy metal content, both of which restrain its implementation as soil conditioner or fertilizer in agriculture. A secondary co-digestion treatment may be required for the neutralization of digestate.

Two-stage psychrophilic anaerobic digestion of food waste: Comparison to conventional single-stage mesophilic process.

Food waste collected exclusively from University restaurant was tested under anaerobic digestion (AD) conditions to determine its biomethane generation potential. The digestion characteristics of food waste were evaluated in BMP tests and in a conventional single-stage mesophilic CST Reactor. The suitability of psychrophilic two-stage AD to convert food waste was investigated by using a novel two-stage psychrophilic semi-continuous reactor, consisted of a vertically-oriented cylindrical reactor and a coaxially incorporated vertical tube able to spatially separate acidification from methanogenesis. Food waste presented significant methane generation performance under mesophilic conditions. Relatively high amounts of H2S released during process evolution did not have a significant effect on biogas production. For psychrophilic two-stage AD, H2S generated during start-up provoked reactor's instability only for a few days. The system was stable and operated at steady-state conditions over the course of the main AD. Higher amount of biogas was produced by the two-stage psychrophilic reactor (0.800 m3 kgVS-1) than the mesophilic single-stage system (0.751 m3 kgVS-1). However, the average methane quantities generated by the two systems were remarkably similar (0.444 and 0.440 m3 kgVS-1). Psychrophilic process was more efficient in utilizing higher proportions of volatile organics contained in substrate for methane generation than mesophilic operation. The low-temperature two-stage reactor was more energy-efficient than the mesophilic CSTR for digestion of food waste. Two-stage anaerobic digestion system operating under psychrophilic conditions might be an economically feasible option for efficiently digesting food waste.

Assessment of high-solid mesophilic and thermophilic anaerobic digestion of mechanically-separated municipal solid waste.

Mechanically-sorted organic fraction of municipal solid waste (OFMSW) was tested to determine its biogas and biomethane generation efficiency. Methane production capability of OFMSW was examined in biochemical methane potential (BMP) tests. The factors affecting the high-solid anaerobic digestion (AD) of feedstock were investigated in a series of long-term semi-continuous digestion tests performed at dry mesophilic and thermophilic conditions in a continuously rotating drum reactor with working volume of 0.013 m3. OFMSW presented low biogas and methane generation capacity due to its contained non-biodegradable components and the low proteins and starch proportions. Dry mesophilic AD allowed only a relatively limited fraction of OFMSW volatile solids to be consumed for biogas and methane production. Reducing particle size favoured utilization of higher proportions of the available digestible organic substances, and concurrently promoted biogas and biomethane generation rate. Stability of methane generation was also significantly improved by particle downsizing. Small particles compensated the limited mass transfer and restricted distribution of methane production intermediate metabolites caused by water absence in the dry AD system. Dry thermophilic AD converted sufficient quantity of OFMSWs biodegradable content. The average methane released from dry thermophilic AD (0.176 m3kgVS-1) was higher than that of dry mesophilic AD of fine particles (0.148 m3kgVS-1) and much higher than that of dry mesophilic AD of same grain size (0.114 m3kgVS-1). High temperature proved more suitable for anaerobically digesting mechanically-sorted OFMSW.