The impact of atmospheric deposition of non-acidifying substances on the quality of European forest soils and the North Sea

In the pilot study ESQUAD the impact of atmospheric deposition of three heavy metals (cadmium, copper and lead) and two persistent organic pollutants (benzo(a)pyrene and lindane) on the quality of European soils and seawater has been calculated. Calculations have been made of atmospheric transport and deposition using a detailed emissions database for Europe. This enabled deposition maps to be produced to a resolution of approximately 50 km. The distribution of pollutant concentrations in forest soils was calculated for each grid cell using a database of soil property parameters in Europe. For the North Sea, a model was used to map long-term concentrations in water and sediment, which are due to atmospheric deposition and other, non-atmospheric sources. The model calculations allowed detailed comparisons of deposition fluxes and concentrations of the substances studied with critical loads and environmental quality threshold values, including critical loads. Although significant uncertainties were identified, the study gives insight in how threshold exceedance rates in Europe relate to pollutant type, threshold type, environmental compartment and chemophysical phase (adsorbed, dissolved). For all pollutants and for all compartments exceedances were calculated for at least some of the quality thresholds that were chosen

Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

BACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown. METHODS: In a large, randomized trial, we assigned 1800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxeleluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status). RESULTS: The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P = 0.04 and P = 0.03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%, P = 0.05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period. CONCLUSIONS: Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.). Copyrigh