A world avoided: impacts of changes in anthropogenic emissions on the burden and effects of air pollutants in Europe and North America.

Emissions from anthropogenic activity are known to have deleterious impacts on human and ecosystem health and as such a significant amount of time, effort and money has been spent developing legislation to minimise their effects. Here we use a state of the art coupled chemistry-climate model HadGEM2-ES, with extended tropospheric chemistry, to assess the impacts that changes in emissions from anthropogenic activity have had on the burden and impacts of air pollutants over the last three decades. We use HadGEM2-ES to assess an alternative trajectory in air pollutant emissions to that which we have seen, with a regional focus on the contiguous United States and areas of Western Europe. This alternative trajectory can be considered to reflect a world avoided. In this world avoided, the significant levels of air pollution legislation imposed over the last three decades are simulated to not have come into effect in the contiguous United States and Western Europe. Rather a business as usual emission scenario is followed from 1970 to the present day. By combining the results of simulations of the world avoided with a base case present day atmosphere our model runs demonstrate that as a result of air pollution legislation, over 500 000 early mortalities a year have been mitigated owing to extensive reduction in sulfate aerosol and up to 8000 early mortalities a year have been mitigated as a result of improvements in ozone and nitrogen dioxide pollution. These results highlight the important role of legislation in reducing air pollution related mortality in these areas of the globe and highlight a compelling case for developing regions to follow.

Prescreening cardiothoracic surgical patient population for post acute care services.

For the postoperative cardiothoracic patient, the first 2 weeks during recovery is the most difficult time. Initiating discharge planning at the earliest opportunity aids in identifying those patients at risk for functional status disability. The purpose of this study was to examine the results of a pilot preadmission screening program to determine whether cardiothoracic surgical patients could be accurately identified for postoperative needs during preadmission testing.

The impact of compliance on quality outcomes in the home infusion population.

Home intravenous therapy is a standard form of treatment for many recipients of healthcare in the United States. The use of intravascular devices can, however, be complicated by a variety of local or systemic infectious complications. A study was undertaken to address the role that patient noncompliance with infusion protocols plays in the complication rate of those receiving infusion therapy in the home. This article examines the compliance of patients involved in the self-administration of home infusion products, their compliance with the protocols set forth by the home infusion provider, and the resultant infection rates. Home infusion patients at risk for infection should be prospectively monitored in a quality management program. On the basis of our findings, this program should be expanded to include surveillance for patient adherence to standards of treatment. Education and reinforcement of protocols, combined with a sound monitoring program, will decrease infection rates and improve patient outcomes.