Element partitioning and potential mobility within surface dusts on buildings in a polluted urban environment, Budapest.

A voluminous literature exists on the analysis of water-soluble ions extracted from gypsum crusts and patinas formed on building surfaces. However, less data is available on the intermediate dust layer and the important role its complex matrix and constituents play in crust/patina formation. To address this issue, surface dust samples were collected from two buildings in the city of Budapest. Substrate properties, different pollution levels and environmental variations were considered by collecting samples from a city centre granite building exposed to intense traffic conditions and from an oolitic limestone church situated in a pedestrian area outside and high above the main pollution zone. Selective extraction examines both water-soluble ions (Ca2+, Mg2+, Na+, K+, Cl-, NO3- SO42-) and selected elements (Fe, Mn, Zn, Cu, Cr, Pb, Ni) from the water-soluble, exchangeable/carbonate, amorphous Mn, amorphous Fe/Mn, crystalline Fe/Mn, organic and residual phases, their mobility and potential to catalyse heterogeneous surface reactions. Salt weathering processes are highlighted by high concentrations of water-soluble Ca2+, Na+, Cl- and SO42-- at both sites. Manganese, Zn and Cu and to a lesser extent Pb and Ni, are very mobile in the city centre dust, where 30%, 54%, 38%, 11% and 11% of their totals are bound by the water-soluble phase, respectively. Church dust shows a sharp contrast for Mn, Zn, Cu and Pb with only 3%, 1%, 12% and 3% of their totals being bound by the water-soluble phase respectively. This may be due to (a) different environmental conditions at the church e.g. lower humidity (b) continuous replenishment of salts under intensive city centre traffic conditions (c) enrichment in oxidisable organic carbon by a factor of 4.5 and a tenfold increase in acidity in the city centre dust.

Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study

Objective : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting : Acute district hospital, Northern Ireland. Participants : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in `real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305—312 Key Words: do not attempt resuscitation (DNAR) • end stage illness • inter-professional • policy • resuscitation decisions