Pluralizing the urban waste economy: insights from community-based enterprises in Ahmedabad (India) and Kampala (Uganda)

The delivery of urban basic infrastructure services is often guided by the modern infrastructure ideal, which aims for technical innovation, economic efficiency and uniformity through long-term, centralized management approaches. In rapidly growing urban centres of the global South, however, heterogeneous infrastructure configurations have long involved multiple systems in varying degrees of coexistence. This paper explores how community-based enterprises – organizations that aim not to turn a profit but rather to generate human well-being – contribute to, complement or conflict with wider municipal solid waste management strategies. It does so through two case studies, focused on Luchacos, a local enterprise turning waste into briquettes in an informal settlement of Kampala, Uganda; and the Self Employed Women’s Association (SEWA), a cooperative of waste pickers in Ahmedabad, India. Drawing on empirical data and policy analysis, the research finds that, given the necessary state support, community-based enterprises can contribute to a range of sustainability and development objectives.Urban Development ManagementManagement in the Built Environmen

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

A corpus-assisted discourse analysis of sustainability transitions in urban basic infrastructure services

Basic infrastructure services – water and sanitation, waste collection and management, transport, energy, and housing – form the foundation upon which cities are built. Sustainable and equitable provision of services is key to combating climate change, eradicating poverty and meeting targets set out in international sustainability agendas. However, even as the language of the sustainability transitions literature is being appropriated by governments, social movements and practitioners, the concepts of sustainability and sustainability transitions remain ill-defined and often narrowly applied. We conduct a corpus-assisted discourse analysis of the sustainability transitions literature on urban basic infrastructure services to tap into prevailing representations and conceptions. Findings show that the delivery of sustainable urban services is discursively framed as a predominantly institutional and economic challenge, favouring a top-down techno-managerial approach to transitions that applies technical fixes to environmental problems at the expense of social dimensions of sustainability. While some studies, such as those with a focus on the Global South and/or water and sanitation services, engage to a greater degree with issues such as justice and equality, they still tend towards technical and economic solutions. An integrated approach encompassing all dimensions of sustainability and a broader understanding of infrastructure services not as separate, single-purpose technologies but as part of interconnected systems with multiple social, economic and environmental objectives is needed if we are to transition to a more sustainable urban future

Metadata of literature review belonging to the publication: A corpus-assisted discourse analysis of sustainability transitions in urban basic infrastructure services

This file includes the metadata of 107 articles that were included in a systematic literature review and subsequent corpus-based discourse analysis.</p

Metadata of literature review belonging to the publication: A corpus-assisted discourse analysis of sustainability transitions in urban basic infrastructure services

This file includes the metadata of 107 articles that were included in a systematic literature review and subsequent corpus-based discourse analysis.</p