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Wastewater Management Strategy for Resilient Cities—Case Study: Challenges and Opportunities for Planning a Sustainable Timor-Leste

High population growth, a lack of wastewater treatment plants and poor wastewater management are major challenges in wastewater management in Timor-Leste (East Timor). One of the approaches of the government of Timor-Leste is to separate wastewater into greywater and blackwater from domestic, commercial, residential, and industrial areas. Three methods were applied to obtain insight into the locations and discharge of grey- and blackwater to develop a cost-effective wastewater strategy: a field survey and data collection, interviews with over 130 participants from local authorities and communities, and the open-source mapping of locations of wastewater discharge. This research concluded that 47.7% of the grey wastewater is discharged into open sewers connected directly to the sea. Most communities discharge their wastewater directly due to the absence of wastewater management, policies and regulations, and lack of communities’ understanding of the possible health impacts of wastewater. The impact of poor wastewater management showed that most of the children in these communities have suffered from diarrhea (73.8%), and in the rainy season, there is a high possibility of infection with waterborne diseases. The literature review, field mapping, and interviews show that there is high demand for a cost-effective wastewater strategy for health improvement. Low-cost nature-based solutions such as constructed wetlands and bioswales can be implemented with local skills and materials to improve the wastewater situation and address other challenges such as biodiversity loss, heat stress, drought, and floodings. These installations are easier to rebuild than large-scale grey infrastructure given the multiple hazards that occur in Timor-Leste: landslides, earthquakes, strong wind, and pluvial and fluvial floodings, and they can serve as coastal protection.

Fundamentally shifting discharge planning and post-hospital care

Design of a Remote Coaching Program to Bridge the Gap From Hospital Discharge to Cardiac Rehabilitation: Intervention Mapping Study

Background: Remote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR).Objective: The goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support.Methods: We used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies.Results: Our exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program.Conclusions: This study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

Measuring compound flood potential from river discharge and storm surge extremes at the global scale

The interaction between physical drivers from oceanographic, hydrological, and meteorological processes in coastal areas can result in compound flooding. Compound flood events, like Cyclone Idai and Hurricane Harvey, have revealed the devastating consequences of the co-occurrence of coastal and river floods. A number of studies have recently investigated the likelihood of compound flooding at the continental scale based on simulated variables of flood drivers, such as storm surge, precipitation, and river discharges. At the global scale, this has only been performed based on observations, thereby excluding a large extent of the global coastline. The purpose of this study is to fill this gap and identify regions with a high compound flooding potential from river discharge and storm surge extremes in river mouths globally. To do so, we use daily time series of river discharge and storm surge from state-of-the-art global models driven with consistent meteorological forcing from reanalysis datasets. We measure the compound flood potential by analysing both variables with respect to their timing, joint statistical dependence, and joint return period. Our analysis indicates many regions that deviate from statistical independence and could not be identified in previous global studies based on observations alone, such as Madagascar, northern Morocco, Vietnam, and Taiwan. We report possible causal mechanisms for the observed spatial patterns based on existing literature. Finally, we provide preliminary insights on the implications of the bivariate dependence behaviour on the flood hazard characterisation using Madagascar as a case study. Our global and local analyses show that the dependence structure between flood drivers can be complex and can significantly impact the joint probability of discharge and storm surge extremes. These emphasise the need to refine global flood risk assessments and emergency planning to account for these potential interactions.

Planning nature-based solutions for urban flood reduction and thermal comfort enhancement

As a consequence of climate change and urbanization, many cities will have to deal with more flooding and extreme heat stress. This paper presents a framework to maximize the effectiveness of Nature-Based Solutions (NBS) for flood risk reduction and thermal comfort enhancement. The framework involves an assessment of hazards with the use of models and field measurements. It also detects suitable implementation sites for NBS and quantifies their effectiveness for thermal comfort enhancement and flood risk reduction. The framework was applied in a densely urbanized study area, for which different small-scale urban NBS and their potential locations for implementation were assessed. The overall results show that the most effective performance in terms of flood mitigation and thermal comfort enhancement is likely achieved by applying a range of different measures at different locations. Therefore, the work presented here shows the potential of the framework to achieve an effective combination of measures and their locations, which was demonstrated on the case of the Sukhumvit area in Bangkok (Thailand). This can be particularly suitable for assessing and planning flood mitigation measures in combination with heat stress reduction.

Development and evaluation of a fidelity tool in a post-discharge responsive parenting intervention program for very preterm born children

The TOP program is a fully implemented responsive parenting intervention for very preterm born infants. Fidelity monitoring of interventions is important for preserving program adherence, impact outcomes and to make evidence-based adaptations. The aim of this study was to develop a fidelity tool for the TOP program following an iterative and co-creative process and subsequently evaluate the reliability of the tool. Three consecutive phases were carried out. Phase I: Initial development and pilot testing two methods namely self-report and video based observation. Phase II: Adaptations and refinements. Phase III: Evaluation of the psychometric properties of the tool based on 20 intervention videos rated by three experts.The interrater reliability of the adherence and competence subscales was good (ICC.81 to .84) and varied from moderate to excellent for specific items (ICC between .51 and .98). The FITT displayed a high correlation (Spearman’s rho.79 to.82) between the subscales and total impression item. The co-creative and iterative process resulted in a clinical useful and reliable tool for evaluating fidelity in the TOP program. This study offers insights in the practical steps in the development of a fidelity assessment tool which can be used by other intervention developers.