PURPOSE: Urban water cycle construction processes are an important element to consider when assessing the sustainability of urban areas. The present study focuses on a structural and environmental ...analysis of cylindrical water tanks. The goal is to optimise cylindrical water tanks from both an environmental (environmental impacts due of life cycle assessment (LCA)) and a geometric perspective (building material quantities for construction purposes depending on the tank characteristics). METHODS: A sample of 147 cases was defined based on different positions (buried, superficial and partially buried), dimensions (combinations of heights and radii) and storage capacities (between 100 and 10,000 m³). A structural analysis was conducted for a defined set of cases to determine the quantities of steel and concrete required for its construction. The environmental impacts of the entire life cycle were assessed through a life cycle assessment (LCA). Additionally, environmental standards (the less impactful option for each dimension assessed: geometry, storage capacity and position) defined in the study were applied to realistic cases to evaluate potential environmental savings. RESULTS AND DISCUSSION: The LCA shows that materials are the main contributor to environmental impacts (more than transport, installation and end of life cycle stages). For this reason, the results of the structural and environmental assessments coincide. Taller water tanks have shown to be less impactful (60 to 70 % less impact for a 10.000-m³ tank). Regarding the position, superficial water tanks have shown to have between 15 and 35 % less impact than buried ones. The environmentally preferred water storage capacity is between 1000 and 2500 m³, being between 20 and 40 % less impact. For instance, an 8000-m³ tank would emit 1040 t of CO₂ eq. Applying the environmental standards 170.5 t of CO₂ eq could be saved (16 % of the total amount). CONCLUSIONS: The results of this study show that among the cases analysed, superficially positioned cylindrical water tanks of 8.5 m in height and of between 1000 and 2500 m³ in storage capacity present fewer impacts. The use of these standards in municipal water tanks construction projects may significantly reduce environmental impacts (10 to 40 %) in all impact categories.
There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding ...of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.
A multidisciplinary consensus following the Delphi methodology.
Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (<55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.
This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.
Actualmente, existe cierta divergencia entre las principales guías de práctica clínica sobre el manejo de los factores de riesgo de la enfermedad arterial periférica (EAP). El objetivo de este proyecto es conocer el manejo de los factores de riesgo de la EAP en la práctica clínica y alcanzar un consenso multidisciplinar sobre las estrategias que se tienen que seguir para optimizar su identificación, tratamiento y seguimiento.
Consenso multidisciplinar mediante metodología Delphi.
En la consulta participaron 130 profesionales con amplia experiencia en EAP. Los resultados sugieren que para optimizar el control de los factores de riesgo los esfuerzos deben dirigirse a: 1) promover la involucramiento y concienciación de todas las especialidades en la identificación y el cribado de la enfermedad; 2) garantizar la posibilidad de realizar el índice tobillo-brazo (ITB) en todas las especialidades implicadas; 3) fomentar estrategias de deshabituación del tabaquismo mediante el uso de fármacos, programas o derivaciones a unidades especializadas; 4) promover el seguimiento de una alimentación adecuada basada en la dieta mediterránea y la prescripción de ejercicio diario; 5) concienciar sobre la importancia de alcanzar unos valores de colesterol unido a lipoproteínas de baja densidad (cLDL) inferiores a 70 mg/dL especialmente en pacientes sintomáticos, pero también en asintomáticos (< 55 mg/dL tras la publicación de la guía ESC/EAS); 6) recomendar el uso de antiagregantes plaquetarios en pacientes asintomáticos con diabetes mellitus (DM) y/o ITB patológico, y 7) protocolizar la reevaluación del ITB anualmente en pacientes de alto riesgo.
Las 22 estrategias consensuadas en el presente documento pretenden ayudar a los profesionales a optimizar el manejo multidisciplinar de los factores de riesgo de la EAP.
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