| 1. |
- Cardoso Chrispim, Mariana, Postdoktor, 1990-, et al.
(författare)
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Biogas recovery for sustainable cities : A critical review of enhancement techniques and key local conditions for implementation
- 2021
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Ingår i: Sustainable cities and society. - Amsterdam : Elsevier. - 2210-6707. ; 72
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Forskningsöversikt (refereegranskat)abstract
- There is great potential to apply energy recovery from municipal wastewater treatment plants (WWTP) to achieve better energy efficiency and greenhouse gas emissions abatement. However, in most of the wastewater treatment plants that produce biogas through sludge digestion, there is no thermal energy recovery or electricity generation, and the biogas is flared and wasted, particularly in developing countries. This paper discusses the recent technological advances related to biogas recovery from wastewater treatment besides identifying research gaps and local conditions, which affect implementation. Techniques for enhancement of biogas production such as co-digestion and microalgae systems for energy recovery were reviewed in terms of performance and context for application. This paper provides an assessment of how local conditions promote or hinder biogas recovery from WWTP in megacities of developing countries. The lack of government subsidies and a biogas market that is not well developed and regulated hinder biogas recovery implementation in the studied megacities. Infrastructure and electricity prices are also discussed. Strategies to promote energy recovery are recommended based on successful examples of energy self-sufficient WWTP. The findings may not only support planning on energy recovery but also guide technological development and research on this topic, aligned with the sustainable development goals.
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| 2. |
- Cardoso Chrispim, Mariana
(författare)
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Resource recovery from wastewater treatment: challenges, opportunities and guidance for planning and implementation
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Considering the current resources scarcity, Wastewater Treatment Plants (WWTP) should be adapted to become more sustainable. For example, it is possible to recover resources present in municipal wastewater. However, regional studies about integration of resource recovery processes at different scales or about the main barriers to implementation in developing countries are missing in the literature. Also, there is a need for planning methodologies to identify the most sustainable solution in each context. Understanding the current situation is an essential step to support planning and accelerate resource recovery implementation. To address these issues this thesis aims to guide planning, technology and policy development towards resource recovery from municipal WWTP in large cities of developing countries. This thesis presents a comprehensive knowledge base for wastewater treatment plant managers and decision-makers leading to a better understanding of resource recovery solutions and the actions needed to facilitate implementation. The methodology comprised critical literature reviews and two case studies. Secondary data from literature and primary data (obtained through questionnaires) were collected and analysed. Megacities in developing countries are analysed in the papers, with the focus on the Macrometropolis of Sao Paulo, which is the most populous area in the Southern Hemisphere. The current situation shows a low implementation of resource recovery practices in the region, and local conditions affect the implementation of water reuse, and nutrients and energy recovery. A framework consisting of eleven steps is proposed to support planning and decision-making on resource recovery from wastewater. This new tool was tested and can be applied by decision-makers in wastewater sector for better operation and management. Market, legislation, local economic development, and cooperation with stakeholders are relevant aspects covered in the analysis. There is a great potential to expand wastewater treatment integrated with nutrient and energy recovery strategies in developing countries. Potentials for phosphorus and energy recovery were estimated and some recovery scenarios are recommended. In conclusion, the findings can help planning and elaboration of resource recovery projects in wastewater treatment in urban areas and stimulate creation of public policies. The main research gaps identified in this thesis can guide further research and technological development in this field.
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| 3. |
- Jacome, Cristina, et al.
(författare)
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Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study
- 2021
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Ingår i: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
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| 4. |
- Jacome, Cristina, et al.
(författare)
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Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App : Analysis of Real-World, Medium-Term Feasibility Studies
- 2021
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Ingår i: Frontiers in Medical Technology. - : Frontiers Media S.A.. - 2673-3129. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
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