Respiratory physiotherapy interventions focused on exercise training and enhancing physical activity levels in people with chronic obstructive pulmonary disease are likely to be cost-effective: a systematic review

Question: What is the cost-effectiveness of respiratory physiotherapy interventions for people with chronic obstructive pulmonary disease? Design: Systematic review of full economic evaluations alongside clinical trials published between 1997 and 2021. Reviewers independently screened studies for inclusion, extracted data and assessed methodological quality. Participants: People with chronic obstructive pulmonary disease. Intervention: Respiratory physiotherapy interventions as defined in the respiratory physiotherapy curricu- lum of the European Respiratory Society. Outcome measures: Costs expressed in monetary units, effect sizes expressed in terms of disease-specific quality of life (QOL), quality-adjusted life years (QALYs) or monetary units. Results: This review included 11 randomised trials with 3,261 participants. The interventions were pulmonary rehabilitation, airway clearance techniques, an integrated disease-management program and an early assisted discharge program, including inpatient respiratory physiotherapy. Meta-analysis was consid- ered irrelevant due to the extensive heterogeneity of the reported interventions. A total of 45 incremental cost-effectiveness ratios (ICERs) were extracted. Regardless of the economic perspectives, 67% of all QOL- related ICERs and 71% of all QALY-related ICERs were situated in the north-east or south-east quadrants of the cost-effectiveness plane. Six studies could be seen as cost-effective when compared with a specified cost- effectiveness threshold per QALY gained. Conclusion: Respiratory physiotherapy interventions focusing on exercise training in combination with enhancing physical activity levels are likely to be cost-effective in terms of costs per unit QOL gained and QALYs. Some uncertainty still exists on the various estimates of cost- effectiveness due to differences in the content and intensity of the type of interventions, outcome measures and comparators. Registration: PROSPERO CRD42018088699

Monitoring the world's agriculture

Agriculture must be transformed. Although global food production is increasing, today's farming systems undermine the well-being of communities in many ways. For instance, farming has destroyed huge regions of natural habitat and caused an untold loss of ecosystem services, and it is responsible for about 30% of greenhouse-gas emissions. Already, about 1 billion people are undernourished. Yet to feed the global population expected by 2050, more than 1 billion hectares of wild land will need to be converted to farmland if current approaches continue to be used

Effective monitoring of agriculture: a response

The development of effective agricultural monitoring networks is essential to track, anticipate and manage changes in the social, economic and environmental aspects of agriculture. We welcome the perspective of Lindenmayer and Likens (J. Environ. Monit., 2011, 13, 1559) as published in the Journal of Environmental Monitoring on our earlier paper, “Monitoring the World's Agriculture” (Sachs et al., Nature, 2010, 466, 558–560). In this response, we address their three main critiques labeled as ‘the passive approach’, ‘the problem with uniform metrics’ and ‘the problem with composite metrics’. We expand on specific research questions at the core of the network design, on the distinction between key universal and site-specific metrics to detect change over time and across scales, and on the need for composite metrics in decision-making. We believe that simultaneously measuring indicators of the three pillars of sustainability (environmentally sound, social responsible and economically viable) in an effectively integrated monitoring system will ultimately allow scientists and land managers alike to find solutions to the most pressing problems facing global food security

Spatio-temporal development of forests - Current trends in field methods and models

We present a critical review of current trends in research of spatio-temporal development of forests. The paper addresses (1) field methods for the development of spatially-explicit models of forest dynamics and their integration in models of forest dynamics, (2) strengths and limitations of traditional patch models versus spatially-explicit, individual-based models, and (3) the potential for moment-based methods in the analysis of forest dynamics. These topics are discussed with reference to their potential for solving open questions in the studies of forest dynamics. The study of spatio-temporal processes provides a link between pattern and process in plant communities, and plays a crucial role in understanding ecosystem dynamics. In the last decade, the development of spatially-explicit, individual-based models shifted the focus of forest dynamics modelling from the dynamics of discrete patches to the interactions among individual organisms, thus encapsulating the theory of "neighbourhood" dynamics. In turn, the stochastic properties and the complexity of spatially-explicit, individual-based models gave rise to the development of a new suite of so-called moment-based models. These new models describe the dynamics of individuals and of pairs of individuals in terms of their densities, thus directly capturing second-order information on spatial structure. So far, this approach has not been applied to forests; we indicate extensions needed for such applications. Moment-based models may be an important complement to spatially explicit individual-based models in developing a general spatial theory of forest dynamics. However, both kinds of models currently focus on fine scales, whereas a critical issue in forest dynamics is to understand the interaction of fine-scale processes with coarser-scale disturbances. To obtain a more complete picture of forest dynamics, the relevant links and interactions between fine-, intermediate-, and coarse-scale processes ought to be identified. Intensive links between modelling work and field studies designed across different scales are a promising means to create a new perspective on forest dynamics

Low carbon stations for low carbon cities – Final report 2015

1. svensk text Våra stationssamhällen är viktiga för städers och regioners utveckling. En utveckling av dessa samhällen kan möjliggöra en transportsnål samhällsplanering, hållbar ekonomisk utveckling och en attraktiv region. Att förtäta i stationsnära lägen är en gemensam utmaning för många aktörer och intressenter. Mistra Urban Futures driver tillsammans med en rad partners, även Trafikverket, ett projekt om urbana stationssamhällen. Projektet vill öka kunskapen om det komplexa i stationsnära planering och skapa förutsättningar för utveckling av stationssamhällen. Projektet fokuserar på att vitalisera och stötta planeringsprocesser i kommuner för att kunna bygga transporteffektiva region med attraktiva och täta stationssamhällen. Flera delprojekt genomförs för att öka kunskapen och Low carbon stations for low carbon cities är ett delprojekt. Mistra Urban Futures anser att utformningen av kollektivtrafiknoder är en viktig parameter för att öka resandet med kollektivtrafiken och minska utsläppen av koldioxid. Utformningen av stationslägen är en globalt viktig fråga och detta projekt kan tillföra viktig kunskap till plattformarna inom Mistra Urban Futures. Trafikverket har finansierat det europeiska forskarteamet YDF för arbetet med "Low carbon stations for low carbon cities" - en forskning om stationsområden och hur man genom en effektivare utformning och planering av flöden för resor och transporter kan minska koldioxidutsläppen. Syftet med forskningen har varit att få fram generella rekommendationer som kan användas vid utformning av stationsområden och dess flöden. Med syfte att få underlag för en generaliserbar kunskap med rekommendationer som kan användas i alla länder, har YDF undersökt och jämfört stationsområdens utformning, funktioner och möjligheter i flera världsdelars städer. I Sverige har YDF undersökt stationsområdena i Stockholm, Malmö och Göteborg. Projektets ena rapportdel innehåller övergripande frågeställningar om energieffektivitet kopplat till resor, transporter och design för hållbarhet i storstadsregioner utifrån ett stationsperspektiv. Projektets andra rapportdel innehåller konkreta råd och rekommendationer om metoder och utformning med användbar kunskap som efterfrågas allt mer. Anne Leemans, generalsekreterare i stiftelsen YDF: ” Som medborgare och formgivare känner vi ansvar att göra vad vi kan för att mildra klimatförändringarna. Vi började forska ur resenärsperspektivet och kopplingen mellan upplevd säkerhet och design av urbana transporter och utvecklade en metod för att förbättra den upplevda tryggheten i och omkring stationerna. Det har visat sig vara viktigt att inte bara öka antalet passagerare och användare av stationen men också för att öka detaljhandeln på stationen. Hur kan vi påverka kollektivtrafikens attraktion hos resenärerna? Hur kan vi öka tilliten för kollektivtrafiken? Nästa fråga var, med tanke på behovet av tillgänglighet, lokalisering och minskad klimatpåverkan, hur kan vi bidra till en bättre integrering av stationer i stadens urbana struktur i olika delar av världen.” 2. English The future role of station communities is crucial for urban and regional development. A development of these communities can enable a transport-efficient urban planning, a sustainable economic development and an attractive region. Densifying station neighborhoods is a common challenge for many actors and stakeholders. Mistra Urban Futures are therefore along with several partners, Swedish Transport Administration is one of them, in the process of developing a project about urban station communities. The project will increase knowledge about the complexity in planning station near locations and create conditions for development of station communities. The project focuses on revitalizing and supporting municipalities regular planning processes to stimulate the building of an efficient transport region with attractive and dense station communities. Mistra Urban Futures think that the design of public transport nodes is an important parameter to increase travel by public transport and reduce emissions of carbon dioxide. The design of the station locations is a globally important issue and the project can bring important knowledge to the platforms in Mistra Urban Futures. The Swedish Transport Administration has funded the European research team YDF for the work of the "Low Carbon station for low carbon cities" - a research of station areas and how, through effective design and planning of flows for travel and transport can reduce carbon emissions. Purpose of the research has been to develop general recommendations that can be used in the design of the station areas and its flows. To get a basis for a generalizable knowledge with recommendations that can be used in all countries, has YDF examined and compared station areas design, features and capabilities in several continents cities. In Sweden has the station areas in Stockholm, Malmö and Gothenburg been examined. The first part of the project’s report contains general questions about the energy efficiency linked to the travel, transportation and design for sustainability in metropolitan regions from a station perspective. The project's second part of the report contains advice and recommendations on methods, the design of useful knowledge that are increasingly in demand. Anne Leemans , Secretary General of the Foundation YDF: “As citizens and design professionals we moreover feel we have an obligation to undertake what is within our power and capacity to help mitigate climate change. We started doing research from the perspective of passengers on the link between perceived security and design of urban public transport stations and developed a methodology to improve perceived security in and around stations. It has proved to be important not only to increase the number of passengers and users of the station but also to boost the turn-over of retailers in the station. How can we positively influence the attraction of public transport to passenger? How can we make sure more people trust public transport? The next question was, considering the need for accessible mobility is location and climate independant, how can we contribute to a better integration of stations in the urban tissue both in the global South and North.”Mistra Urban Future