Paul S Phillips

Clinical and angiographic implications of coronary stenting in thrombus-containing lesions.

OBJECTIVES This study sought to determine the results of coronary stenting in thrombus-laden lesions. BACKGROUND The angiographic evidence of intracoronary thrombus has classically been considered a formal contraindication to stent implantation. However, with increasing use of stenting, the indications for this technique have widened to include treatment of patients who have an acute coronary syndrome or lesions with adverse anatomic features. METHODS We studied 86 consecutive patients (mean age +/- SD 61 +/- 11 years, 14 women) undergoing coronary stenting of a thrombus-containing lesion; the procedure was performed electively in 39% and after angioplasty failure in 61%. Sixty-four patients (75%) were treated for unstable angina, and 19 (22%) underwent the procedure during an acute myocardial infarction. A specific protocol that included clinical and late angiographic follow-up was used. RESULTS Angiographic success was obtained in 83 patients (96%). Five patients (6%) died during the hospital stay despite angiographic success; four of these had cardiogenic shock, and one (1%) had subacute stent thrombosis. Non-Q wave myocardial infarction developed in five additional patients (6%), and four of these five had data consistent with distal embolization. Of the 78 patients discharged with angiographic success, 67 (86%) were event-free and clinically improved at last follow-up visit (12 +/- 11 months). During the follow-up period, eight patients required repeat angioplasty, one patient required heart transplantation, and two patients died. Quantitative angiography demonstrated excellent angiographic results after stenting (minimal lumen diameter 0.31 +/- 0.4 vs. 2.77 +/- 0.6 mm). Late angiographic follow-up (5.5 +/- 1 months) was obtained in 50 patients with 54 lesions (93% of eligible), revealing a minimal lumen diameter of 2.0 +/- 1 mm and restenosis (lumen narrowing > 50%) in 18 lesions (33%). CONCLUSIONS Coronary stenting constitutes an effective therapeutic strategy for patients with thrombus-containing lesions, either after failure of initial angioplasty or electively as the primary procedure. Coronary stenting in this adverse anatomic setting results in a high degree of angiographic success, a low incidence of subacute thrombosis and an acceptable restenosis rate.

The successful demonstration of aerobic landfilling: The potential for a more sustainable solid waste management approach?

Abstract Municipal solid waste (MSW) landfills worldwide are experiencing the consequences of conventional landfilling techniques, whereby anaerobic conditions are created within the landfilled waste. Under anaerobic conditions within a landfill site slow stabilization of the waste mass occurs, producing methane, (an explosive ‘green house’ gas) and leachate (which can pollute groundwater) over long periods of time. As a potential solution, it was demonstrated that the aerobic degradation of MSW within a landfill can significantly increase the rate of waste decomposition and settlement, decrease the methane production and leachate leaving the system, and potentially increase the operational life of the site. Readily integrated into the existing landfill infrastructure, this approach can safely and cost-effectively convert a MSW landfill from anaerobic to aerobic degradation processes, thereby effectively composting much of the organic portions (one of the potentially polluting elements in a conventional landfill site) of the waste. This paper summarizes the successful results of two separate aerobic landfill projects located in Georgia (USA) and discusses the potential, economic and environmental impacts to worldwide solid waste management practices.

UK waste minimisation clubs: a contribution to sustainable waste management

The UK waste strategy is based upon the central concept of the hierarchy of preferable options for the treatment and disposal of waste. Minimisation is placed at the top of the hierarchy and the Government seeks to encourage its uptake by industry and commerce as well as householders. It has been accepted that previous waste management policy and practice have not delivered the hoped for movement up the hierarchy. Within the UK, landfill still predominates as the option most commonly used to deal with waste. Movement towards more sustainable waste management practice has been identified as a priority, in the UK, by the present Labour Government. To that end, they have recently produced a series of consultation papers on sustainable issues that set out their vision and confirm waste minimisation as a key strategy for the future. In an attempt to stimulate the uptake of minimisation methodology by industry, waste minimisation clubs have been developed across the UK. There have been around 60 such clubs and they receive support and guidance from a range of organisations, including the Environment Agency and the ETBPP. These clubs have demonstrated that a significant reduction in waste arisings can occur when minimisation methodology is applied. Minimisation strategies often lead to improved resource efficiency and this is reflected in clear financial savings, e.g. the Leicester Waste Minimisation Initiative recorded mean savings, at the end of year one, of 0.26% of joint turnover. The median, however, better reflects the actual savings and it is apparent that even within a successful club there can be a wide range of performance by companies. Not all clubs have been successful and there has been little attention to the causes of failure in the UK. There are marked regional variations in club distribution and the proposed Regional Development Agencies, working with the Environment Agency, need to quickly establish strategies for minimisation uptake.

Radon in the Creswell Crags permian limestone caves

An investigation of radon levels in the caves of Creswell Crags, Derbyshire, an important Site of Special Scientific Interest (SSSI) shows that the Lower Magnesian Limestone (Permian) caves have moderate to raised radon gas levels (27-7800 Bq m(-3)) which generally increase with increasing distance into the caves from the entrance regions. This feature is partly explained in terms of cave ventilation and topography. While these levels are generally below the Action Level in the workplace (400 Bq m(-3) in the UK), they are above the Action Level for domestic properties (200 Bq m(-3)). Creswell Crags has approximately 40,000 visitors per year and therefore a quantification of effective dose is important for both visitors and guides to the Robin Hood show cave. Due to short exposure times the dose received by visitors is low (0.0016 mSv/visit) and regulations concerning exposure are not contravened. Similarly, the dose received by guides is fairly low (0.4 mSv/annum) due in part to current working practice. However, the risk to researchers entering the more inaccessible areas of the cave system is higher (0.06 mSv/visit). This survey also investigated the effect of seasonal variations on recorded radon concentration. From this work summer to winter ratios of between 1.1 and 9.51 were determined for different locations within the largest cave system.

Waste management issues for the UK ready-mixed concrete industry

The UK government has recognised the vital contribution that the construction industry has to play in contributing towards sustainable development. While the issue of hardened concrete waste has received considerable attention, process waste arising from the manufacture of ready-mixed concrete is relatively unexplored. It is apparent that initiatives such as the landfill tax have encouraged UK ready-mixed concrete manufacturers to reduce substantially the amount of waste they produce. Environmental pressures continue to increase and ready-mixed concrete producers are being forced towards a closed loop production system.

The UK Landfill Tax: an analysis of its contribution to sustainable waste management

Abstract The UK Government in October 1996 introduced a Landfill Tax to ensure that landfill waste disposal is properly priced so as to reflect its environmental cost and to help promote a more sustainable approach to waste management in which less waste is produced, reused or recycled. The UK Customs and Excise have recently reviewed the tax and the report indicates that there has been a modest reduction in waste going to landfill by industry but not households. It is submitted that for there to be a significant move towards a more sustainable approach to waste management to meet the targets set in the National Strategy the tax should be higher and the money raised by the tax should be invested to make alternatives to landfill cheaper and more readily available. It is also submitted that the Tax Credit Scheme, introduced as a means of enabling some of the tax to be invested to promote better waste management, is inadequately funded and the money is inappropriately focused. Following an examination of the projects and contributions made under the Scheme it is found that most of the contributions are not made towards projects which will fulfil the UK Governments perceived purposes. It is further submitted that there needs to be a more rational approach to waste management and legislation in Philadelphia forms a good case study of such an approach

Higher education partnerships: Creating new value in the environment sector

Outlines some of the benefits that can arise through partnership working between higher education institutions and other local organisations in the environment sector. Aims to contribute to the debate on sustainability by highlighting the capacity for partnerships to “unlock” value retained within single organisations. Argues for the need for more creativity in the ways in which HEIs interact with other organisations in the environment sector, in order to harness mutually‐advantageous opportunities. The situation in Northamptonshire (central England) is described and case studies are included to demonstrate some local successful partnership‐based projects and to highlight the wider approach. Suggests this approach can offer considerable scope for the personal development of academics and to benefit HEIs, the local communities they serve and the economies they operate within. States, in addition, that partnership working can significantly contribute to the process of sustainable management within HEIs and external organisations by promoting the effective use of human resources, information and finance for environmentally beneficial activity.

Sustainable waste management in the food and drink industry

In moving towards sustainable wastes management, the UK Government has adopted a wastes hierarchy. This hierarchy sets out clearly the priorities for sustainable resource use and wastes management: it ought to be the guiding principle of private and public policy, with the emphasis placed strongly on reducing the amount of raw material used. The House of Commons Environment, Transport & Regional Affairs Committee has noted a pressing need to promote wastes minimisation within industrial and commercial sectors and has recommended the introduction of penalties and incentives to encourage industrial wastes minimisation. Despite this, in the food and retailing sector only around 25 per cent of companies were found to operate wastes minimisation programmes. This paper aims to demonstrate the benefits of wastes minimisation, in both financial and environmental terms, for the food and drink sector. Large multiprocess food and drink companies have found they can make annual savings of greater than one per cent of turnover by implementing wastes minimisation strategies.

An analysis of UK waste minimization clubs: key requirements for future cost effective developments.

The UK waste strategy is based upon use of the best practicable environmental option (BPEO), by those making waste management decisions. BPEO is supported by the use of the waste hierarchy, with its range of preferable options for dealing with waste, and the proximity principle, where waste is treated/disposed of as close to its point of origin as possible. The national waste strategy emphasizes the key role of waste minimization and encourages industry, commerce and the public to move towards sustainable waste management practice for economic and environmental reasons. Waste minimization clubs have been used, since the early 1990s, to demonstrate to industry/commerce that reducing waste production can lead to significant financial savings. There have been around 75 such clubs in the UK and they receive support from a wide range of agencies, including the Environmental Technology Best Practice Program. The early Demonstration Clubs had significant savings to cost ratios, e.g. Aire and Calder at 8.4, but had very high costs, e.g. Aire and Calder at 400,000 pounds. It is acknowledged that the number of clubs will have to be approximately doubled in the next few years so as to have an adequate coverage of the UK. There are at present, marked regional variations in club development and cognizance needs to be taken, by facilitators, of the need for extensive coverage of the UK. Future clubs will probably have to operate in a financially constrained climate and they need to be designed to deliver significant savings and waste reduction at low cost. To aid future club design, final reports of all projects should report in a standard manner so that cost benefit analysis can be used to inform facilitators about the most effective club type. rights reserved.

A review of the cost effectiveness of radon mitigation in domestic properties in Northamptonshire

The costs of remedial work, and the radon level reduction achieved, have been studied in a series of domestic properties in Northamptonshire, which is a radon affected area. The cost-effectiveness of the series is similar to published theoretical estimates for proposed national remediation programmes, and five times more effective than our similar analysis for the National Health Service workplace, if it is assumed that 100% of householders discovering levels above 300 Bq m-3 implement remediation. In practice, in the UK, far fewer of those who arrange an initial radon test proceed to remediation, but this domestic programme could be cost effective if more than 5% carry out remediation. Our series confirms that a considerable number of householders with radon levels in the 200 to 300 Bq m-3 range do not seek or implement remediation work.