Multi-level stratification of territories for waste composition analysis.

The fundamental knowledge at all levels of decision-making related to waste management is the quantity and composition of waste. Many articles deal with methods for estimating the composition of municipal waste, but most details are given as to how many categories should be chosen and what technical procedure should be followed. In order to obtain a broader view and a reasonable evaluation of the results, it is necessary to select the areas where the analyzes will be performed effectively. Current approaches have insufficiently addressed this issue at the regional and national levels. This paper presents a method that uses multi-level stratification to divide municipalities into similar groups to reduce the number of observations needed to obtain an estimate of the composition of waste in a selected area (region or state level). The method combines expert knowledge with statistical considerations and makes use of cluster analysis. Socio-economic and waste-related parameters are used within the individual steps. Regarding the available financial resources and the required accuracy of the results, the municipalities in which the analyzes should take place are selected. These representative municipalities represent other municipalities in the created groups, and thanks to them, it is possible to estimate the composition of waste in any municipality, region, or larger territory. Waste analysis planning is an essential procedure for waste management, but the respective costs represent a crucial factor at the national level and even more for individual municipalities. Estimating waste composition impacts the transition to sustainable waste management and is thus a key element for further development in this sector. The presented method demonstrates the selection of 10 representative municipalities from the Czech Republic, but an arbitrary number can be set respecting the financial resources. Estimating the composition of the mixed municipal waste for the Czech Republic should cost around 72,000 euros for ten representatives with different distribution of dwelling types. The method is described in general and can be applied to any territory/country in the world, considering local conditions and possibilities.

Antiplatelet efficacy of P2Y12 inhibitors (prasugrel, ticagrelor, clopidogrel) in patients treated with mild therapeutic hypothermia after cardiac arrest due to acute myocardial infarction.

Survivors after cardiac arrest (CA) due to AMI undergo PCI and then receive dual antiplatelet therapy. Mild therapeutic hypothermia (MTH) is recommended for unconscious patients after CA to improve neurological outcomes. MTH can attenuate the effectiveness of P2Y12 inhibitors by reducing gastrointestinal absorption and metabolic activation. The combined effect of these conditions on the efficacy of P2Y12 inhibitors is unknown. We compared the antiplatelet efficacies of new P2Y12 inhibitors in AMI patients after CA treated with MTH. Forty patients after CA for AMI treated with MTH and received one P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) were enrolled in a prospective observational single-center study. Platelet inhibition was measured by VASP (PRI) on days 1, 2, and 3 after drug administration. In-hospital clinical data and 1-year survival data were obtained. The proportion of patients with ineffective platelet inhibition (PRI > 50 %, high on-treatment platelet reactivity) for clopidogrel, prasugrel, and ticagrelor was 77 vs. 19 vs. 1 % on day 1; 77 vs. 17 vs. 0 % on day 2; and 85 vs. 6 vs. 0 % on day 3 (P < 0.001). The platelet inhibition was significantly worse in clopidogrel group than in prasugrel or ticagrelor group. Prasugrel and ticagrelor are very effective for platelet inhibition in patients treated with MTH after CA due to AMI, but clopidogrel is not. Using prasugrel or ticagrelor seems to be a more suitable option in this high-risk group of acute patients.

Evaluation of aspirin's effect on platelet function early after coronary artery bypass grafting.

OBJECTIVE: Aspirin therapy decreases mortality and ischemic complication rates after coronary artery bypass grafting (CABG). However, platelet inhibition after oral aspirin seems to be insufficient in the early postoperative period. There are incomplete data reporting aspirin efficacy early after CABG. The aim of this study was to assess the pharmacologic effect of aspirin on platelets in the first postoperative days using the most specific laboratory tests for the evaluation of aspirin efficacy. DESIGN: A prospective study. SETTING: A clinical study in one cardiac surgery center and measurements in two pharmacologic institutions. PARTICIPANTS: Thirty patients. INTERVENTIONS: Postoperative aspirin efficacy (200 mg/d) was assessed by the suppression of serum thromboxane B(2) (TxB(2)) and by arachidonic acid-induced aggregometry using the MULTIPLATE analyzer. Samples were collected before surgery and on postoperative days 1-5. METHODS AND MAIN RESULTS: The median baseline value (range) of serum TxB(2) was 1.6 ng/mL (1.4-1.9). The median TxB(2) inhibition >90% (the value required for full platelet inhibition) was not achieved until day 5 (-91%, 0.13 ng/mL [0.08-0.22], p < 0.001) and in only 55% of patients. The median baseline ASPI value was 805 (640-975) aggregation units (AU)*min. A significant decrease in aspirin insufficiency was not seen before postoperative day 5 (390 [243-621], p < 0.003) and only 34% of patients reached an effective platelet inhibition on day 5 (cutoff < 300 AU*min). CONCLUSIONS: The effect of aspirin on inhibition of TxB(2) production and arachidonic acid-induced platelet aggregation is impaired during the first postoperative days after CABG. A more effective antiplatelet strategy presumably could increase early graft patency and improve clinical outcomes after CABG.