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Airtightness refers to the amount of air leakage through a building’s envelope. This uncontrolled exchange of air between inside and outside, either infiltration or exfiltration, may lead to therma...

The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss the new definition of ARDS, its risk factors and pathophysiology, and current evidence regarding ventilation management, adjunctive therapies, and intervention required in refractory hypoxemia.

Massive hemoptysis can have a rapid and potentially fatal clinical course. A 68-year-old woman presented with recurrent hemoptysis complicated by refractory hypoxemia and shock despite aggressive intervention. The use of veno-venous extracorporeal membrane oxygenation was a nontraditional intervention that ultimately proved to be lifesaving, but is by no means recommended for routine use in this setting.

Hospital-acquired pneumonia is a common complication that continues to have a poor cure rate in some patients with intravenous therapy alone. Aerosolized antibiotics are theoretically attractive in an attempt to optimize lung concentrations of antibiotics. Limited data suggest that aerosolized aminoglycosides or colistin in addition to intravenous therapy results in good response rates in patients with multidrug-resistant organisms or nonresponding pneumonia. Adverse events can occur, especially with colistin. When used, care should be taken to properly compound and administer aerosolized antibiotics to ensure tolerability and good drug delivery.

Short M., Jones C., Carter J., Baker M. and Wood C. (2004) Current practice in the strategic environmental assessment of development plans in England, Reg. Studies 38, 177–190. In the UK, strategic environmental assessment has been applied to the full hierarchy of development plans in the form of environmental appraisal. Government guidance in England contains a forceful recommendation to local planning authorities to assess the environmental effects of proposed development plans by carrying out an environmental appraisal of their policies and proposals. This advice has grown in importance with the adoption of the European Directive on strategic environmental assessment. Research undertaken into current appraisal practice provides a context for the implementation of the Directive in England. The results show a broadly positive outlook towards strategic environmental assessment and a move towards using sustainability appraisal. Furthermore, they show other benefits from the process additional to assessing ...

The Countryside Agency has recommended that national park authorities (NPAs) undertake an environmental appraisal of their national park management plans. A study of the appraisal practices of the NPAs of England and Wales has shown that, despite this guidance, the practice of environmental appraisal is uncommon but that a culture of applying sustainability appraisal is evolving. It is argued that the most likely explanation for this situation is the increasing influence of the concept of sustainable development on the workings of the national park management system. This broad policy development has manifested itself in a variety of ways, including the production of government guidance relating to sustainability appraisal and changes in best practice, each of which have influenced appraisal procedures in national parks. The wider implications of, and drivers behind, the evolution of appraisal procedure towards sustainability appraisal are thus identified and then discussed.

The high-voltage distribution and transmission of electricity are associated with a range of environmental effects that are increasingly contentious and are leading to difficult land-use planning issues. In the UK, local planning authorities have been taking an anticipatory approach to such efforts by the formation of policy in statutory land-use plans; this seeks to set constraints on the location and form of high-voltage installations and nearby development. This emerging body of policy reveals a number of consistently occurring themes that focus explicitly on the protection of local environmental conditions. This is indicative of broader trends apparent throughout plan-making in the last decade, in which environmental emphases have become more central, but the policy area also indicates that local authorities are responding to structural changes in the electricity industry and to changing patterns of energy generation. Copyright © 2002 John Wiley & Sons, Ltd.

This paper presents the results from a post-auditing study-a comparison of the predictions of environmental impacts of projects made in environmental statements prior to developmentwith those that actually occurred upon or after development. The purpose of post-auditing is to provide an analysis of prediction performance in environmental impact assessment and thus to improve future practice by learning from experience. By means of a combination of site visits, interviews and document scrutiny, 865 predictions from 28 UK projects granted planning permission were examined. Of these, 488 (56%) were auditable, of which 383 (79%) were deemed 'accurate' or 'nearly accurate' and 105 (21%) 'inaccurate'. The remaining 377 (44%) predictions were not auditable, the main reasons being lack of data, vague or ambiguous predictions and time dependency.There were only six unpredicted impacts. The study reveals some encouraging findings, but also a number of discouraging ones, which indicate the need to increase both enth...

(1997). The Effect of Environmental Assessment on UK Infrastructure Project Planning Decisions. Planning Practice & Research: Vol. 12, No. 3, pp. 223-238.

This article reports the findings of an investigation of the practice of environmental impact assessment (EIA) for wastewater treatment plants in the United Kingdom and Germany. It demonstrates that both EIA systems have a number of common deficiencies but that the differences between the practice of EIA in Britain and Germany are considerable. These indicate that one of the objectives of the European Directive—to harmonize environmental controls—has not been met. The differences can be explained by examining: (1) the context in which EIAs for wastewater treatment plants take place in both countries; (2) the ways in which EIA procedures are implemented in both countries; and (3) the attitudes of the competent authorities in both countries to EIA.

The National Health Service in England is running out of money. With demand increasing all the time, by 2021 the NHS in England will be £30 billion short of what it needs to provide an effective se...

The Commonwealth of Australia, Victoria, Western Australia and New Zealand have some legal provisions, of a permissive nature, relating to SEA within their ELA requirements. Despite this, and a recent growth in interest in such provisions, very few SEA reports have been submitted to date. Victoria (on one occasion), New Zealand (on one occasion) and Western Australia (on two or three occasions) have required and assessed SEA reports. Experience in these four jurisdictions suggests that SEA will rarely be undertaken where the environmental authority can evaluate the activities of other, frequently more powerful, government departments only by invitation. For SEA to be undertaken, it appears that there needs to exist a specific requirement upon the proponent and an environmental authority with the power to ensure compliance.

This paper describes the Polish requirements for environmental impact assessment (EIA) and discusses procedures and practice in relation to screening, scoping environmental impact statement (EIS) preparation, EIS review, decision-making and monitoring. It is concluded that there is little information available about EIA practice in Poland, that there are confusions of nomenclature, that developers have insufficient choice of consultant, that EIA consultants often prepare weak EISs, that delays in reviewing EISs are common and that public participation is unsatisfactory. A number of reforms are planned which should lead to real improvement in EIA practice and meet the requirements of the European Directive.

(1992). STRATEGIC ENVIRONMENTAL ASSESSMENT: EA OF POLICIES, PLANS AND PROGRAMMES. Impact Assessment: Vol. 10, No. 1, pp. 3-22.

Studies of two samples of 24 selected local planning authorities (LPAs) in the UK were undertaken to determine the effect of environmental assessment (EA) regulations on planning practice during their first 18 months of operation. EA has been integrated into the UK planning system without significant recourse to the courts and many LPAs regarded EA as a worthwhile and helpful procedure. However, several LPAs did not consider whether to request EA for projects that might be likely to have significant impacts and some LPAs did not follow statutory and recommended consultation procedures. LPAs did not evaluate environmental statements systematically and their quality was often unsatisfactory. However, mitigation of environmental impacts took place in many cases though two‐fifths of the 20 determined applications involving EA were refused. Half the decisions took longer than the 16‐week time limit. While practice is evolving as experience is gained, there is obvious scope for further improvement and ...

Environmental assessment became mandatory in the UK under a European directive in July 1988; between then and the end of December 1990, 472 environmental statements (ESs) are known to have been submitted to competent authorities by developers. The distribution of ESs by type of regulation under which they were submitted, and by type of project for which they were prepared, is examined. The numbers and types of developers and consultancies involved in preparing, and the numbers of competent authorities involved in reviewing, a 50% sample of 236 ESs are analysed. The length and price of these 236 ESs are discussed, together with the content of 100 ESs known to have been submitted by July 1989. Recommendations relating to the listing, to the availability and to the content analysis, of ESs are made which are intended to assist in improving UK environmental assessment practice.

(1973). Community, culture and social work. Journal of Ethnic and Migration Studies: Vol. 2, No. 3, pp. 278-282.