NSR&D Program Fiscal Year (FY) 2015 Call for Proposals Mitigation of Seismic Risk at Nuclear Facilities using Seismic Isolation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coleman, Justin

2015-02-01

Seismic isolation (SI) has the potential to drastically reduce seismic response of structures, systems, or components (SSCs) and therefore the risk associated with large seismic events (large seismic event could be defined as the design basis earthquake (DBE) and/or the beyond design basis earthquake (BDBE) depending on the site location). This would correspond to a potential increase in nuclear safety by minimizing the structural response and thus minimizing the risk of material release during large seismic events that have uncertainty associated with their magnitude and frequency. The national consensus standard America Society of Civil Engineers (ASCE) Standard 4, Seismic Analysismore » of Safety Related Nuclear Structures recently incorporated language and commentary for seismically isolating a large light water reactor or similar large nuclear structure. Some potential benefits of SI are: 1) substantially decoupling the SSC from the earthquake hazard thus decreasing risk of material release during large earthquakes, 2) cost savings for the facility and/or equipment, and 3) applicability to both nuclear (current and next generation) and high hazard non-nuclear facilities. Issue: To date no one has evaluated how the benefit of seismic risk reduction reduces cost to construct a nuclear facility. Objective: Use seismic probabilistic risk assessment (SPRA) to evaluate the reduction in seismic risk and estimate potential cost savings of seismic isolation of a generic nuclear facility. This project would leverage ongoing Idaho National Laboratory (INL) activities that are developing advanced (SPRA) methods using Nonlinear Soil-Structure Interaction (NLSSI) analysis. Technical Approach: The proposed study is intended to obtain an estimate on the reduction in seismic risk and construction cost that might be achieved by seismically isolating a nuclear facility. The nuclear facility is a representative pressurized water reactor building nuclear power plant (NPP) structure. Figure 1: Project activities The study will consider a representative NPP reinforced concrete reactor building and representative plant safety system. This study will leverage existing research and development (R&D) activities at INL. Figure 1 shows the proposed study steps with the steps in blue representing activities already funded at INL and the steps in purple the activities that would be funded under this proposal. The following results will be documented: 1) Comparison of seismic risk for the non-seismically isolated (non-SI) and seismically isolated (SI) NPP, and 2) an estimate of construction cost savings when implementing SI at the site of the generic NPP.« less

Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities

PubMed Central

Caljouw, Monique A A; van den Hout, Wilbert B; Putter, Hein; Achterberg, Wilco P; Cools, Herman J M; Gussekloo, Jacobijn

2014-01-01

Objectives To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. Design Double-blind randomized placebo-controlled multicenter trial. Setting Long-term care facilities (LTCFs). Participants LTCF residents (N = 928; 703 women, median age 84). Measurements Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. Results In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57–0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68–1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). Conclusion In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. PMID:25180378

Hanford Site Asbestos Abatement Plan. Revision 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mewes, B.S.

The Hanford Site Asbestos Abatement Plan (Plan) lists priorities for asbestos abatement activities to be conducted in Hanford Site facilities. The Plan is based on asbestos assessment information gathered in fiscal year 1989 that evaluated all Hanford Site facilities for the presence and condition of asbestos. Of those facilities evaluated, 414 contain asbestos-containing materials and are classified according to the potential risk of asbestos exposure to building personnel. The Plan requires that asbestos condition update reports be prepared for all affected facilities. The reporting is completed by the asbestos coordinator for each of the 414 affected facilities and transmitted tomore » the Plan manager annually. The Plan manager uses this information to reprioritize future project lists. Currently, five facilities are determined to be Class Al, indicating a high potential for asbestos exposure. Class Al and B1 facilities are the highest priority for asbestos abatement. Abatement of the Class A1 and Bl facilities is scheduled through fiscal year 1997. Removal of asbestos in B1 facilities will reduce the risk for further Class ``A`` conditions to arise.« less

Risk-based decision making for terrorism applications.

PubMed

Dillon, Robin L; Liebe, Robert M; Bestafka, Thomas

2009-03-01

This article describes the anti-terrorism risk-based decision aid (ARDA), a risk-based decision-making approach for prioritizing anti-terrorism measures. The ARDA model was developed as part of a larger effort to assess investments for protecting U.S. Navy assets at risk and determine whether the most effective anti-terrorism alternatives are being used to reduce the risk to the facilities and war-fighting assets. With ARDA and some support from subject matter experts, we examine thousands of scenarios composed of 15 attack modes against 160 facility types on two installations and hundreds of portfolios of 22 mitigation alternatives. ARDA uses multiattribute utility theory to solve some of the commonly identified challenges in security risk analysis. This article describes the process and documents lessons learned from applying the ARDA model for this application.

The impact of transportation infrastructure on bicycling injuries and crashes: a review of the literature

PubMed Central

2009-01-01

Background Bicycling has the potential to improve fitness, diminish obesity, and reduce noise, air pollution, and greenhouse gases associated with travel. However, bicyclists incur a higher risk of injuries requiring hospitalization than motor vehicle occupants. Therefore, understanding ways of making bicycling safer and increasing rates of bicycling are important to improving population health. There is a growing body of research examining transportation infrastructure and the risk of injury to bicyclists. Methods We reviewed studies of the impact of transportation infrastructure on bicyclist safety. The results were tabulated within two categories of infrastructure, namely that at intersections (e.g. roundabouts, traffic lights) or between intersections on "straightaways" (e.g. bike lanes or paths). To assess safety, studies examining the following outcomes were included: injuries; injury severity; and crashes (collisions and/or falls). Results The literature to date on transportation infrastructure and cyclist safety is limited by the incomplete range of facilities studied and difficulties in controlling for exposure to risk. However, evidence from the 23 papers reviewed (eight that examined intersections and 15 that examined straightaways) suggests that infrastructure influences injury and crash risk. Intersection studies focused mainly on roundabouts. They found that multi-lane roundabouts can significantly increase risk to bicyclists unless a separated cycle track is included in the design. Studies of straightaways grouped facilities into few categories, such that facilities with potentially different risks may have been classified within a single category. Results to date suggest that sidewalks and multi-use trails pose the highest risk, major roads are more hazardous than minor roads, and the presence of bicycle facilities (e.g. on-road bike routes, on-road marked bike lanes, and off-road bike paths) was associated with the lowest risk. Conclusion Evidence is beginning to accumulate that purpose-built bicycle-specific facilities reduce crashes and injuries among cyclists, providing the basis for initial transportation engineering guidelines for cyclist safety. Street lighting, paved surfaces, and low-angled grades are additional factors that appear to improve cyclist safety. Future research examining a greater variety of infrastructure would allow development of more detailed guidelines. PMID:19845962

Chemical facility vulnerability assessment project.

PubMed

Jaeger, Calvin D

2003-11-14

Sandia National Laboratories, under the direction of the Office of Science and Technology, National Institute of Justice, conducted the chemical facility vulnerability assessment (CFVA) project. The primary objective of this project was to develop, test and validate a vulnerability assessment methodology (VAM) for determining the security of chemical facilities against terrorist or criminal attacks (VAM-CF). The project also included a report to the Department of Justice for Congress that in addition to describing the VAM-CF also addressed general observations related to security practices, threats and risks at chemical facilities and chemical transport. In the development of the VAM-CF Sandia leveraged the experience gained from the use and development of VAs in other areas and the input from the chemical industry and Federal agencies. The VAM-CF is a systematic, risk-based approach where risk is a function of the severity of consequences of an undesired event, the attack potential, and the likelihood of adversary success in causing the undesired event. For the purpose of the VAM-CF analyses Risk is a function of S, L(A), and L(AS), where S is the severity of consequence of an event, L(A) is the attack potential and L(AS) likelihood of adversary success in causing a catastrophic event. The VAM-CF consists of 13 basic steps. It involves an initial screening step, which helps to identify and prioritize facilities for further analysis. This step is similar to the prioritization approach developed by the American Chemistry Council (ACC). Other steps help to determine the components of the risk equation and ultimately the risk. The VAM-CF process involves identifying the hazardous chemicals and processes at a chemical facility. It helps chemical facilities to focus their attention on the most critical areas. The VAM-CF is not a quantitative analysis but, rather, compares relative security risks. If the risks are deemed too high, recommendations are developed for measures to reduce the risk. This paper will briefly discuss the CFVA project and VAM-CF process.

28 CFR 115.341 - Obtaining information from residents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ACT NATIONAL STANDARDS Standards for Juvenile Facilities Screening for Risk of Sexual Victimization... use information about each resident's personal history and behavior to reduce the risk of sexual abuse... instrument. (c) At a minimum, the agency shall attempt to ascertain information about: (1) Prior sexual...

28 CFR 115.341 - Obtaining information from residents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ACT NATIONAL STANDARDS Standards for Juvenile Facilities Screening for Risk of Sexual Victimization... use information about each resident's personal history and behavior to reduce the risk of sexual abuse... instrument. (c) At a minimum, the agency shall attempt to ascertain information about: (1) Prior sexual...

28 CFR 115.341 - Obtaining information from residents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ACT NATIONAL STANDARDS Standards for Juvenile Facilities Screening for Risk of Sexual Victimization... use information about each resident's personal history and behavior to reduce the risk of sexual abuse... instrument. (c) At a minimum, the agency shall attempt to ascertain information about: (1) Prior sexual...

EPA’s permeable pavement research and the Edison Environmental Center

EPA Science Inventory

A deteriorated parking area on EPA’s Edison Environmental Center needed replacement. The replacement offered an opportunity for the facility managers to reduce the impervious footprint and the reduce stormwater runoff volume. This also provided researchers from the National Risk ...

Comparative research on NIMBY risk acceptability between Chinese and Japanese college students.

PubMed

Wu, Yunqing; Zhai, Guofang; Li, Shasha; Ren, Chongqiang; Tsuchida, Shoji

2014-10-01

Along with the progressive acceleration of urbanization, the need to identify potentially troublesome "Not In My Back Yard" (NIMBY) facilities in the city is inevitable. To resolve NIMBY conflict, it is important to know people's NIMBY risk acceptability for these facilities. A questionnaire survey was used among Chinese and Japanese college students to identify NIMBY risk acceptability. LISREL was used to construct a structural equation model to analyze the difference in NIMBY risk acceptability between the Chinese and Japanese college students. Factors that may affect NIMBY risk acceptability were analyzed: "perceiving utility," "perceiving risk," "trust in government," "reasonable compensation," and "procedural justice." The findings show that Japanese students' concerns were greater than Chinese students' concerns. Perceiving utility and perceiving risk were the most important factors that affect people's NIMBY risk acceptability, followed by procedural justice, trust in government, and reasonable compensation. There is a difference between the different cultural backgrounds in confronting the risk: Chinese students focus more on the reputation and value of real estate, while Japanese students pay more attention to environmental pollution and damage to health. Furthermore, cultural influences play a role in students' risk perception. To improve the risk acceptability for NIMBY facilities and provide a basis for resolving NIMBY conflicts, it is necessary to ensure the benefits of the NIMBY facility while reducing environmental pollution. The findings of this study may be of interest for policy makers and practitioners to devise future NIMBY strategies.

Reducing health risk assigned to organic emissions from a chemical weapons incinerator.

PubMed

Laman, David M; Weiler, B Douglas; Skeen, Rodney S

2013-03-01

Organic emissions from a chemical weapons incinerator have been characterized with an improved set of analytical methods to reduce the human health risk assigned to operations of the facility. A gas chromatography/mass selective detection method with substantially reduced detection limits has been used in conjunction with scanning electron microscopy/energy dispersive X-ray spectrometry and Fourier transform infrared microscopy to improve the speciation of semi-volatile and non-volatile organics emitted from the incinerator. The reduced detection limits have allowed a significant reduction in the assumed polycyclic aromatic hydrocarbon (PAH) and aminobiphenyl (ABP) emission rates used as inputs to the human health risk assessment for the incinerator. A mean factor of 17 decrease in assigned human health risk is realized for six common local exposure scenarios as a result of the reduced PAH and ABP detection limits.

Petroleum and hazardous material releases from industrial facilities associated with Hurricane Katrina.

PubMed

Santella, Nicholas; Steinberg, Laura J; Sengul, Hatice

2010-04-01

Hurricane Katrina struck an area dense with industry, causing numerous releases of petroleum and hazardous materials. This study integrates information from a number of sources to describe the frequency, causes, and effects of these releases in order to inform analysis of risk from future hurricanes. Over 200 onshore releases of hazardous chemicals, petroleum, or natural gas were reported. Storm surge was responsible for the majority of petroleum releases and failure of storage tanks was the most common mechanism of release. Of the smaller number of hazardous chemical releases reported, many were associated with flaring from plant startup, shutdown, or process upset. In areas impacted by storm surge, 10% of the facilities within the Risk Management Plan (RMP) and Toxic Release Inventory (TRI) databases and 28% of SIC 1311 facilities experienced accidental releases. In areas subject only to hurricane strength winds, a lower fraction (1% of RMP and TRI and 10% of SIC 1311 facilities) experienced a release while 1% of all facility types reported a release in areas that experienced tropical storm strength winds. Of industrial facilities surveyed, more experienced indirect disruptions such as displacement of workers, loss of electricity and communication systems, and difficulty acquiring supplies and contractors for operations or reconstruction (55%), than experienced releases. To reduce the risk of hazardous material releases and speed the return to normal operations under these difficult conditions, greater attention should be devoted to risk-based facility design and improved prevention and response planning.

The 'bankability' of the new waste technologies: an econometric method for risk sharing in private finance waste contracts.

PubMed

Black, I; Seaton, R; Chackiath, S; Wagland, S T; Pollard, S J T; Longhurst, P J

2011-12-01

The identification of risk and its appropriate allocation to partners in project consortia is essential for minimizing overall project risks, ensuring timely delivery and maximizing benefit for money invested. Risk management guidance available from government bodies, especially in the UK, does not specify methodologies for quantitative risk assessment, nor does it offer a procedure for allocating risk among project partners. Here, a methodology to quantify project risk and potential approaches to allocating risk and their implications are discussed. Construction and operation of a waste management facility through a public-private finance contract are discussed. Public-private partnership contracts are special purpose vehicle (SPV) financing methods promoted by the UK government to boost private sector investment in facilities for public service enhancement. Our findings question the appropriateness of using standard deviation as a measure for project risk and confirm the concept of portfolio theory, suggesting the pooling of risk can reduce total risk and its impact.

Evaluating and understanding fish health risks and their consequences in propagated and free-ranging fish populations

USGS Publications Warehouse

Moffitt, C.M.; Haukenes, A.H.; Williams, C.J.

2005-01-01

Fishery managers and resource conservationists are increasingly interested in understanding the fish health and disease risks of free-ranging fishes and whether propagated fishes or features and practices used at fish culture facilities pose a health risk to free-ranging populations. Disease agents are present in most both captive and all free-ranging fish populations, but the consequences and extent of infections in free-ranging populations are often difficult to measure, control, and understand. Sampling methods, protocols, and assay techniques developed to assess the health of captive populations are not as applicable for assessments of free-ranging fishes. The use of chemicals and therapeutics to control diseases and parasites in propagated fishes likely reduces the risk of introducing specific pathogens into the environment, but control measures may have localized effects on the environment surrounding fish culture facilities. To understand health risks of propagated and free ranging fishes, we must consider fish populations, culture facilities, fish releases, and their interactions within the greater geospatial features of the aquatic environment. ?? 2004 by the American Fisheries Society.

IRS issues guidance on tax-exempt bond requirements.

PubMed

Kalick, L

1998-07-01

Enforcing compliance with rules governing facilities financed with tax-exempt bonds recently has become an IRS priority. Integrated delivery systems (IDSs) that include such facilities, therefore, should take steps to ensure that the private business use of those facilities does not exceed the legal threshold amount, thereby jeopardizing the tax-exempt status of the bonds. Management contracts, research agreements, and leases are arrangements with the greatest potential to result in noncompliance. Instituting a compliance program to monitor the use of bond proceeds and minimize the amount of private business use of facilities over the bond term can reduce an organization's risk of penalty.

Developmental Assets: Profile of Youth in a Juvenile Justice Facility

ERIC Educational Resources Information Center

Chew, Weslee; Osseck, Jenna; Raygor, Desiree; Eldridge-Houser, Jennifer; Cox, Carol

2010-01-01

Background: Possessing high numbers of developmental assets greatly reduces the likelihood of a young person engaging in health-risk behaviors. Since youth in the juvenile justice system seem to exhibit many high-risk behaviors, the purpose of this study was to assess the presence of external, internal, and social context areas of developmental…

Residential proximity to industrial combustion facilities and risk of non-Hodgkin lymphoma: a case–control study

PubMed Central

2013-01-01

Background Residence near municipal solid waste incinerators, a major historical source of dioxin emissions, has been associated with increased risk of non-Hodgkin lymphoma (NHL) in European studies. The aim of our study was to evaluate residence near industrial combustion facilities and estimates of dioxin emissions in relation to NHL risk in the United States. Methods We conducted a population-based case–control study of NHL (1998–2000) in four National Cancer Institute-Surveillance Epidemiology and End Results centers (Detroit, Iowa, Los Angeles, Seattle). Residential histories 15 years before diagnosis (similar date for controls) were linked to an Environmental Protection Agency database of dioxin-emitting facilities for 969 cases and 749 controls. We evaluated proximity (3 and 5 km) to 10 facility types that accounted for >85% of U.S. emissions and a distance-weighted average emission index (AEI [ng toxic equivalency quotient (TEQ)/year]). Results Proximity to any dioxin-emitting facility was not associated with NHL risk (3 km OR = 1.0, 95% CI 0.8-1.3). Risk was elevated for residence near cement kilns (5 km OR = 1.7, 95% CI 0.8-3.3; 3 km OR = 3.8, 95% CI 1.1-14.0) and reduced for residence near municipal solid waste incinerators (5 km OR = 0.5, 95% CI 0.3-0.9; 3 km OR = 0.3, 95% CI 0.1-1.4). The AEI was not associated with risk of NHL overall. Risk for marginal zone lymphoma was increased for the highest versus lowest quartile (5 km OR = 2.6, 95% CI 1.0-6.8; 3 km OR = 3.0, 95% CI 1.1-8.3). Conclusions Overall, we found no association with residential exposure to dioxins and NHL risk. However, findings for high emissions and marginal zone lymphoma and for specific facility types and all NHL provide some evidence of an association and deserve future study. PMID:23433489

Preliminary volcanic hazards evaluation for Los Alamos National Laboratory Facilities and Operations : current state of knowledge and proposed path forward

DOE Office of Scientific and Technical Information (OSTI.GOV)

Keating, Gordon N.; Schultz-Fellenz, Emily S.; Miller, Elizabeth D.

2010-09-01

The integration of available information on the volcanic history of the region surrounding Los Alamos National Laboratory indicates that the Laboratory is at risk from volcanic hazards. Volcanism in the vicinity of the Laboratory is unlikely within the lifetime of the facility (ca. 50–100 years) but cannot be ruled out. This evaluation provides a preliminary estimate of recurrence rates for volcanic activity. If further assessment of the hazard is deemed beneficial to reduce risk uncertainty, the next step would be to convene a formal probabilistic volcanic hazards assessment.

Personal Hygiene Practices among Urban Homeless Persons in Boston, MA.

PubMed

Leibler, Jessica H; Nguyen, Daniel D; León, Casey; Gaeta, Jessie M; Perez, Debora

2017-08-18

Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA ( n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.

Personal Hygiene Practices among Urban Homeless Persons in Boston, MA

PubMed Central

Leibler, Jessica H.; León, Casey; Gaeta, Jessie M.; Perez, Debora

2017-01-01

Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities. PMID:28820454

Community outreach at biomedical research facilities.

PubMed

Goldman, M; Hedetniemi, J N; Herbert, E R; Sassaman, J S; Walker, B C

2000-12-01

For biomedical researchers to fulfill their responsibility for protecting the environment, they must do more than meet the scientific challenge of reducing the number and volume of hazardous materials used in their laboratories and the engineering challenge of reducing pollution and shifting to cleaner energy sources. They must also meet the public relations challenge of informing and involving their neighbors in these efforts. The experience of the Office of Community Liaison of the National Institutes of Health (NIH) in meeting the latter challenge offers a model and several valuable lessons for other biomedical research facilities to follow. This paper is based on presentations by an expert panel during the Leadership Conference on Biomedical Research and the Environment held 1--2 November 1999 at NIH, Bethesda, Maryland. The risks perceived by community members are often quite different from those identified by officials at the biomedical research facility. The best antidote for misconceptions is more and better information. If community organizations are to be informed participants in the decision-making process, they need a simple but robust mechanism for identifying and evaluating the environmental hazards in their community. Local government can and should be an active and fully informed partner in planning and emergency preparedness. In some cases this can reduce the regulatory burden on the biomedical research facility. In other cases it might simplify and expedite the permitting process or help the facility disseminate reliable information to the community. When a particular risk, real or perceived, is of special concern to the community, community members should be involved in the design, implementation, and evaluation of targeted risk assessment activities. Only by doing so will the community have confidence in the results of those activities. NIH has involved community members in joint efforts to deal with topics as varied as recycling and soil testing. These ad hoc efforts are more likely to succeed if community members and groups have also been included in larger and longer term advisory committees. These committees institutionalize the outreach process. This can provide the facility with vocal and influential allies who create an independent line of communication with the larger community.

The impact of primary health care on malaria morbidity - defining access by disease burden

PubMed Central

O’Meara, W.P.; Noor, A.; Gatakaa, H.; Tsofa, B.; McKenzie, F. E.; Marsh, K.

2009-01-01

Objectives The convergence of malaria endemicity and poor health care infrastructure has resulted in persistently high rates of malaria morbidity and mortality in many parts of sub-Saharan Africa. Primary care facilities are increasingly becoming the focal point for distribution of intervention strategies, but physical access to these facilities may limit the extent to which communities can be reached. Here we investigate the impact of travel time to primary care on the incidence of hospitalized malaria episodes in a rural district in Kenya. Methods The incidence of hospitalized malaria in a population under continuous demographic surveillance was recorded over three years. The time to travel to the nearest primary health care facility was calculated for every child between birth and five years of age and trends in incidence of hospitalized malaria as a function of travel time were evaluated. Results and conclusions We show that the incidence of hospitalized malaria more than doubled as travel time to the nearest primary care facility increased from ten minutes up to two hours. Good access to primary health facilities may reduce the burden of disease by as much as 66%. Our results highlight both the potential of the primary health care system in reaching those most at risk and reducing the disease burden, and that insufficient access is an important risk factor, one that may be inequitably distributed to the poorest households. PMID:19121148

Quantitative Estimation of Risks for Production Unit Based on OSHMS and Process Resilience

NASA Astrophysics Data System (ADS)

Nyambayar, D.; Koshijima, I.; Eguchi, H.

2017-06-01

Three principal elements in the production field of chemical/petrochemical industry are (i) Production Units, (ii) Production Plant Personnel and (iii) Production Support System (computer system introduced for improving productivity). Each principal element has production process resilience, i.e. a capability to restrain disruptive signals occurred in and out of the production field. In each principal element, risk assessment is indispensable for the production field. In a production facility, the occupational safety and health management system (Hereafter, referred to as OSHMS) has been introduced to reduce a risk of accidents and troubles that may occur during production. In OSHMS, a risk assessment is specified to reduce a potential risk in the production facility such as a factory, and PDCA activities are required for a continual improvement of safety production environments. However, there is no clear statement to adopt the OSHMS standard into the production field. This study introduces a metric to estimate the resilience of the production field by using the resilience generated by the production plant personnel and the result of the risk assessment in the production field. A method for evaluating how OSHMS functions are systematically installed in the production field is also discussed based on the resilience of the three principal elements.

Risk Factors for Low Bone Mineral Density in Individuals Residing in a Facility for the People with Intellectual Disability

ERIC Educational Resources Information Center

Jaffe, J. S.; Timell, A. M.; Elolia, R.; Thatcher, S. S.

2005-01-01

Background: Individuals with intellectual disability (ID) are known to have a high prevalence of both low bone mineral density (BMD) and fractures with significant attendant morbidity. Effective strategies aimed at reducing fractures will be facilitated by the identification of predisposing risk factors. Methods: Bone mineral density was measured…

Chemical Emergency Preparedness and Prevention Advisory: Hydrogen Fluoride

EPA Pesticide Factsheets

This advisory recommends ways Local Emergency Planning Committees (LEPCs) and chemical facilities can reduce risks posed by the presence of hydrogen fluoride (HF), a strong inorganic acid used to manufacture CFCs, in their communities.

Personalized technologist dose audit feedback for reducing patient radiation exposure from CT.

PubMed

Miglioretti, Diana L; Zhang, Yue; Johnson, Eric; Lee, Choonsik; Morin, Richard L; Vanneman, Nicholas; Smith-Bindman, Rebecca

2014-03-01

The aim of this study was to determine whether providing radiologic technologists with audit feedback on doses from CT examinations they conduct and education on dose-reduction strategies reduces patients' radiation exposure. This prospective, controlled pilot study was conducted within an integrated health care system from November 2010 to October 2011. Ten technologists at 2 facilities received personalized dose audit reports and education on dose-reduction strategies; 9 technologists at a control facility received no intervention. Radiation exposure was measured by the dose-length product (DLP) from CT scans performed before (n = 1,630) and after (n = 1,499) the intervention and compared using quantile regression. Technologists were surveyed before and after the intervention. For abdominal CT, DLPs decreased by 3% to 12% at intervention facilities but not at the control facility. For brain CT, DLPs significantly decreased by 7% to 12% at one intervention facility; did not change at the second intervention facility, which had the lowest preintervention DLPs; and increased at the control facility. Technologists were more likely to report always thinking about radiation exposure and associated cancer risk and optimizing settings to reduce exposure after the intervention. Personalized audit feedback and education can change technologists' attitudes about, and awareness of, radiation and can lower patient radiation exposure from CT imaging. Copyright © 2014 American College of Radiology. All rights reserved.

Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review.

PubMed

Bunn, Diane; Jimoh, Florence; Wilsher, Stephanie Howard; Hooper, Lee

2015-02-01

To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Systematic review of intervention and observational studies. Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies. The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Support to triage and public risk perception considering long-term response to a Cs-137 radiological dispersive device scenario.

PubMed

Andrade, Cristiane Ps; Souza, Cláudio J; Camerini, Eduardo Sn; Alves, Isabela S; Vital, Hélio C; Healy, Matthew Jf; Ramos De Andrade, Edson

2018-06-01

A radiological dispersive device (RDD) spreads radioactive material, complicates the treatment of physical injuries, raises cancer risk, and induces disproportionate fear. Simulating such an event enables more effective and efficient utilization of the triage and treatment resources of staff, facilities, and space. Fast simulation can give detail on events in progress or future events. The resources for triage and treatment of contaminated trauma victims can differ for pure exposure individuals, while discouraging the "worried well" from presenting in the crisis phase by media announcement would relieve pressure on hospital facilities. The proposed methodology integrates capabilities from different platforms in a convergent way composed of three phases: (a) scenario simulation, (b) data generation, and (c) risk assessment for triage focused on follow-up epidemiological assessment. Simulations typically indicate that most of the affected population does not require immediate medical assistance. Medical triage for the few severely injured and the radiological triage to diminish the contamination with radioactivity will always be the priority. For this study, however, higher priorities should be given to individuals from radiological "warm" and "hot" zones as required by risk criteria. The proposed methodology could thus help to (a) filter and reduce the number of individuals to be attended, (b) optimize the prioritization of medical care, (c) reduce or prepare for future costs, (d) effectively locate the operational triage site to avoid possible contamination on the main facility, and (e) provide the scientific data needed to develop an adequate approach to risk and its proper communication.

Risk factors for acute chemical releases with public health consequences: Hazardous Substances Emergency Events Surveillance in the U.S., 1996–2001

PubMed Central

Ruckart, Perri Z; Wattigney, Wendy A; Kaye, Wendy E

2004-01-01

Background Releases of hazardous materials can cause substantial morbidity and mortality. To reduce and prevent the public health consequences (victims or evacuations) from uncontrolled or illegally released hazardous substances, a more comprehensive analysis is needed to determine risk factors for hazardous materials incidents. Methods Hazardous Substances Emergency Events Surveillance (HSEES) data from 1996 through 2001 were analyzed using bivariate and multiple logistic regression. Fixed-facility and transportation-related events were analyzed separately. Results For fixed-facility events, 2,327 (8%) resulted in at least one victim and 2,844 (10%) involved ordered evacuations. For transportation-related events, 759 (8%) resulted in at least one victim, and 405 (4%) caused evacuation orders. Fire and/or explosion were the strongest risk factors for events involving either victims or evacuations. Stratified analysis of fixed-facility events involving victims showed a strong association for acid releases in the agriculture, forestry, and fisheries industry. Chlorine releases in fixed-facility events resulted in victims and evacuations in more industry categories than any other substance. Conclusions Outreach efforts should focus on preventing and preparing for fires and explosions, acid releases in the agricultural industry, and chlorine releases in fixed facilities. PMID:15496226

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial.

PubMed

Parsons, J; Mathieson, S; Jull, A; Parsons, M

2016-01-01

To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36). Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants. Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

PubMed

Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who delivered at home, the risk of perinatal mortality among women with intrapartum complications was 43.0% lower for women who delivered in a public health facility (OR = 0.57; 95% CI = 0.42-0.78) and 58.0% lower when delivered in a private health facility (OR = 0.42; 95% CI = 0.28-0.63). Maternal health programs need to promote timely recognition of intrapartum complications and delivery in health facilities to improve perinatal outcomes, particularly in populations where overall facility delivery rates are low. The differential risk between public and private health facilities may be due to differences in quality of care. Efforts should be made to improve the quality of care in all health facilities.

Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues.

PubMed

Penfold, Suzanne; Shamba, Donat; Hanson, Claudia; Jaribu, Jennie; Manzi, Fatuma; Marchant, Tanya; Tanner, Marcel; Ramsey, Kate; Schellenberg, David; Schellenberg, Joanna Armstrong

2013-02-14

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions.

Staff experiences of providing maternity services in rural southern Tanzania – a focus on equipment, drug and supply issues

PubMed Central

2013-01-01

Background The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Methods Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. Results The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result. Conclusions Inadequately stocked and equipped facilities compromise the health system’s ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions. PMID:23410228

Public farms: hygiene and zoonotic agents.

PubMed

Heuvelink, A E; Valkenburgh, S M; Tilburg, J J H C; Van Heerwaarden, C; Zwartkruis-Nahuis, J T M; De Boer, E

2007-10-01

In three successive years, we visited petting farms (n=132), care farms (n=91), and farmyard campsites (n=84), respectively, and completed a standard questionnaire with the objective of determining the hygienic status of these farms and describing hygiene measures implemented to reduce the risk of transmission of zoonotic agents from the animals to humans. For at least 85% of the farms, the overall impression of hygiene was recorded as good. However, more attention must be paid to: informing visitors on hygiene and handwashing, provision of handwashing facilities, and a footwear cleaning facility. Examination of samples of freshly voided faeces resulted in the detection of Shiga toxin-producing Escherichia coli O157 and/or Salmonella spp. and/or Campylobacter spp. at almost two-thirds (64.9%) of the petting farms, and around half of the care farms (56.0%) and farmyard campsites (45.2%). These data reinforce the need for control measures for both public and private farms to reduce human exposure to livestock faeces and thus the risk of transmission of zoonotic diseases. Public awareness of the risk associated with handling animals or faecal material should be increased.

Facility-level association of preoperative stress testing and postoperative adverse cardiac events.

PubMed

Valle, Javier A; Graham, Laura; Thiruvoipati, Thejasvi; Grunwald, Gary; Armstrong, Ehrin J; Maddox, Thomas M; Hawn, Mary T; Bradley, Steven M

2018-06-22

Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE). We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE. Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%-15.9%; range 6.0%-21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%-5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%-17.4%) and postoperative MACE was 3.8% (IQR 2.3%-5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation. In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities.

PubMed

Church, Jody L; Haas, Marion R; Goodall, Stephen

2015-12-01

To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.

Reducing stillbirths in Ethiopia: Results of an intervention programme.

PubMed

Lindtjørn, Bernt; Mitike, Demissew; Zidda, Zillo; Yaya, Yaliso

2018-01-01

Previous studies from South Ethiopia have shown that interventions that focus on intrapartum care substantially reduce maternal mortality and there is a need to operationalize health packages that could reduce stillbirths. The aim of this paper is to evaluate if a programme that aimed to improve maternal health, and mainly focusing on strengthening intrapartum care, also would reduce the number of stillbirths, and to estimate if there are other indicators that explains high stillbirth rates. Our study used a "continuum of care" approach and focussed on providing essential antenatal and obstetric services in communities through health extension workers, at antenatal and health facility services. In this follow up study, which includes the same 38.312 births registered by community health workers, shows that interventions focusing on improved intrapartum care can also reduce stillbirths (by 46%; from 14.5 to 7.8 per 1000 births). Other risk factors for stillbirths are mainly related to complications during delivery and illnesses during pregnancy. We show that focusing on Comprehensive Emergency Obstetric Care and antenatal services reduces stillbirths. However, the study also underlines that illnesses during pregnancy and complications during delivery still represent the main risk factors for stillbirths. This indicates that obstetric care need still to be strengthened, should include the continuum of care from home to the health facility, make care accessible to all, and reduce delays.

On-road bicycle facilities and bicycle crashes in Iowa, 2007-2010.

PubMed

Hamann, Cara; Peek-Asa, Corinne

2013-07-01

An average of 611 deaths and over 47,000 bicyclists are injured in traffic-related crashes in the United States each year. Efforts to increase bicycle safety are needed to reduce and prevent injuries and fatalities, especially as trends indicate that ridership is increasing rapidly. The objective of this study was to evaluate the effect of bicycle-specific roadway facilities (e.g., signage and bicycle lanes) in reducing bicycle crashes. We conducted a case site-control site study of 147 bicycle crash-sites identified from the Iowa Department of Transportation crash database from 2007 to 2010 and 147 matched non-crash sites. Control sites were randomly selected from intersections matched to case sites on neighborhood (census block group) and road classification (arterial, feeder, collector, etc.). We examined crash risk by any on-road bicycle facility present and by facility type (pavement markings--bicycle lanes and shared lane arrows, bicycle-specific signage, and the combination of markings and signage), controlling for bicycle volume, motor vehicle volume, street width, sidewalks, and traffic controls. A total of 11.6% of case sites and 15.0% of controls had an on-road bicycle facility. Case intersections had higher bicycle volume (3.52 vs. 3.34 per 30 min) and motor vehicle volume (248.77 vs. 205.76 per 30 min) than controls. Our results are suggestive that the presence of an on-road bicycle facility decreases crash risk by as much as 60% with a bicycle lane or shared lane arrow (OR=0.40, 95% CI=0.09-1.82) and 38% with bicycle-specific signage (OR=0.62, 95% CI=0.15-2.58). Investments in bicycle-specific pavement markings and signage have been shown to be beneficial to traffic flow, and our results suggest that they may also reduce the number of bicycle-motor vehicle crashes and subsequent injuries and fatalities. As a relatively low-cost traffic feature, community considerations for further implementation of these facilities are justified. Copyright © 2012 Elsevier Ltd. All rights reserved.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association

PubMed Central

Florez, Hermes; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

2016-01-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

LLRW disposal facility siting approaches: Connecticut`s innovative volunteer approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forcella, D.; Gingerich, R.E.; Holeman, G.R.

1994-12-31

The Connecticut Hazardous Waste Management Service (CHWMS) has embarked on a volunteer approach to siting a LLRW disposal facility in Connecticut. This effort comes after an unsuccessful effort to site a facility using a step-wise, criteria-based site screening process that was a classic example of the decide/announce/defend approach. While some of the specific features of the CHWMS` volunteer process reflect the unique challenge presented by the state`s physical characteristics, political structure and recent unsuccessful siting experience, the basic elements of the process are applicable to siting LLRW disposal facilities in many parts of the United States. The CHWMS` volunteer processmore » is structured to reduce the {open_quotes}outrage{close_quotes} dimension of two of the variables that affect the public`s perception of risk. The two variables are the degree to which the risk is taken on voluntarily (voluntary risks are accepted more readily than those that are imposed) and the amount of control one has over the risk (risks under individual control are accepted more readily than those under government control). In the volunteer process, the CHWMS will only consider sites that have been been voluntarily offered by the community in which they are located and the CHWMS will share control over the development and operation of the facility with the community. In addition to these elements which have broad applicability, the CHWMS has tailored the volunteer approach to take advantage of the unique opportunities made possible by the earlier statewide site screening process. Specifically, the approach presents a {open_quotes}win-win{close_quotes} situation for elected officials in many communities if they decide to participate in the process.« less

Proposal for a new categorization of aseptic processing facilities based on risk assessment scores.

PubMed

Katayama, Hirohito; Toda, Atsushi; Tokunaga, Yuji; Katoh, Shigeo

2008-01-01

Risk assessment of aseptic processing facilities was performed using two published risk assessment tools. Calculated risk scores were compared with experimental test results, including environmental monitoring and media fill run results, in three different types of facilities. The two risk assessment tools used gave a generally similar outcome. However, depending on the tool used, variations were observed in the relative scores between the facilities. For the facility yielding the lowest risk scores, the corresponding experimental test results showed no contamination, indicating that these ordinal testing methods are insufficient to evaluate this kind of facility. A conventional facility having acceptable aseptic processing lines gave relatively high risk scores. The facility showing a rather high risk score demonstrated the usefulness of conventional microbiological test methods. Considering the significant gaps observed in calculated risk scores and in the ordinal microbiological test results between advanced and conventional facilities, we propose a facility categorization based on risk assessment. The most important risk factor in aseptic processing is human intervention. When human intervention is eliminated from the process by advanced hardware design, the aseptic processing facility can be classified into a new risk category that is better suited for assuring sterility based on a new set of criteria rather than on currently used microbiological analysis. To fully benefit from advanced technologies, we propose three risk categories for these aseptic facilities.

Design of Work Facilities for Reducing Musculoskeletal Disorders Risk in Paper Pallet Assembly Station

NASA Astrophysics Data System (ADS)

Mardi Safitri, Dian; Arfi Nabila, Zahra; Azmi, Nora

2018-03-01

Musculoskeletal Disorders (MSD) is one of the ergonomic risks due to manual activity, non-neutral posture and repetitive motion. The purpose of this study is to measure risk and implement ergonomic interventions to reduce the risk of MSD on the paper pallet assembly work station. Measurements to work posture are done by Ovako Working Posture Analysis (OWAS) methods and Rapid Entire Body Assessment (REBA) method, while the measurement of work repetitiveness was using Strain Index (SI) method. Assembly processes operators are identified has the highest risk level. OWAS score, Strain Index, and REBA values are 4, 20.25, and 11. Ergonomic improvements are needed to reduce that level of risk. Proposed improvements will be developed using the Quality Function Deployment (QFD) method applied with Axiomatic House of Quality (AHOQ) and Morphological Chart. As the result, risk level based on OWAS score & REBA score turn out from 4 & 11 to be 1 & 2. Biomechanics analysis of the operator also shows the decreasing values for L4-L5 moment, compression, joint shear, and joint moment strength.

Environmental equity: Reducing risk for all communities. Volume 2. Supporting document

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1992-06-01

In targeting its protection efforts to reduce the most serious risks, the Agency has begun to examine how the patterns of environmental problems converge on different places, how the people who live in those places are affected, and how environmental programs should be refined to address identified differences. A community surrounded by Multiple sources of air pollution, ringed by waste treatment facilities and landfills, and whose residences contain lead-based paint clearly faces higher than average potential environmental risks. It is in this context that concerns have been raised about the relative risk burden borne by low-income and racial minority communities.more » Examination of these differences in risk burden and how government agencies respond is known as environmental equity. Although there are many types of equity, this report focuses on racial and socioeconomic equity.« less

Report: Atlanta Is Largely in Compliance with Its Combined Sewer Overflow Consent Decree, but Has Not Yet Met All Requirements

EPA Pesticide Factsheets

Report #18-P-0206, May 30, 2018. Decreases in sewage overflows from Atlanta's wastewater treatment facilities and sewage transmission pipes reduce the risk of city residents being exposed to pathogens.

Recirculating Air Filtration Significantly Reduces Exposure to Airborne Nanoparticles

PubMed Central

Pui, David Y.H.; Qi, Chaolong; Stanley, Nick; Oberdörster, Günter; Maynard, Andrew

2008-01-01

Background Airborne nanoparticles from vehicle emissions have been associated with adverse effects in people with pulmonary and cardiovascular disease, and toxicologic studies have shown that nanoparticles can be more hazardous than their larger-scale counterparts. Recirculating air filtration in automobiles and houses may provide a low-cost solution to reducing exposures in many cases, thus reducing possible health risks. Objectives We investigated the effectiveness of recirculating air filtration on reducing exposure to incidental and intentionally produced airborne nanoparticles under two scenarios while driving in traffic, and while generating nanomaterials using gas-phase synthesis. Methods We tested the recirculating air filtration in two commercial vehicles when driving in traffic, as well as in a nonventilation room with a nanoparticle generator, simulating a nanomaterial production facility. We also measured the time-resolved aerosol size distribution during the in-car recirculation to investigate how recirculating air filtration affects particles of different sizes. We developed a recirculation model to describe the aerosol concentration change during recirculation. Results The use of inexpensive, low-efficiency filters in recirculation systems is shown to reduce nanoparticle concentrations to below levels found in a typical office within 3 min while driving through heavy traffic, and within 20 min in a simulated nanomaterial production facility. Conclusions Development and application of this technology could lead to significant reductions in airborne nanoparticle exposure, reducing possible risks to health and providing solutions for generating nanomaterials safely. PMID:18629306

Changes in Patient Sorting to Nursing Homes under Public Reporting: Improved Patient Matching or Provider Gaming?

PubMed Central

Werner, Rachel M; Konetzka, R Tamara; Stuart, Elizabeth A; Polsky, Daniel

2011-01-01

Objective To test whether public reporting in the setting of postacute care in nursing homes results in changes in patient sorting. Data Sources/Study Setting All postacute care admissions from 2001 to 2003 in the nursing home Minimum Data Set. Study Design We test changes in patient sorting (or the changes in the illness severity of patients going to high- versus low-scoring facilities) when public reporting was initiated in nursing homes in 2002. We test for changes in sorting with respect to pain, delirium, and walking and then examine the potential roles of cream skimming and downcoding in changes in patient sorting. We use a difference-in-differences framework, taking advantage of the variation in the launch of public reporting in pilot and nonpilot states, to control for underlying trends in patient sorting. Principal Findings There was a significant change in patient sorting with respect to pain after public reporting was initiated, with high-risk patients being more likely to go to high-scoring facilities and low-risk patients more likely to go to low-scoring facilities. There was also an overall decrease in patient risk of pain with the launch of public reporting, which may be consistent with changes in documentation of pain levels (or downcoding). There was no significant change in sorting for delirium or walking. Conclusions Public reporting of nursing home quality improves matching of high-risk patients to high-quality facilities. However, efforts should be made to reduce the incentives for downcoding by nursing facilities. PMID:21105869

Are facilities following best practices of pediatric abdominal CT scans?

PubMed

Nosek, Amy E; Hartin, Charles W; Bass, Kathryn D; Glick, Philip L; Caty, Michael G; Dayton, Merril T; Ozgediz, Doruk E

2013-05-01

Established guidelines for pediatric abdominal CT scans include reduced radiation dosage to minimize cancer risk and the use of intravenous (IV) contrast to obtain the highest-quality diagnostic images. We wish to determine if these practices are being used at nonpediatric facilities that transfer children to a pediatric facility. Children transferred to a tertiary pediatric facility over a 16-mo period with abdominal CT scans performed for evaluation of possible appendicitis were retrospectively reviewed for demographics, diagnosis, radiation dosage, CT contrast use, and scan quality. If CT scans were repeated, the radiation dosage between facilities was compared using Student t-test. Ninety-one consecutive children transferred from 29 different facilities had retrievable CT scan images and clinical information. Half of CT scans from transferring institutions used IV contrast. Due to poor quality or inconclusive CT scans, 19 patients required a change in management. Children received significantly less radiation at our institution compared to the referring adult facility for the same body area scanned on the same child (9.7 mSv versus 19.9 mSv, P = 0.0079). Pediatric facilities may be using less radiation per CT scan due to a heightened awareness of radiation risks and specific pediatric CT scanning protocols. The benefits of IV contrast for the diagnostic yield of pediatric CT scans should be considered to obtain the best possible image and to prevent additional imaging. Every facility performing pediatric CT scans should minimize radiation exposure, and pediatric facilities should provide feedback and education to other facilities scanning children. Copyright © 2013 Elsevier Inc. All rights reserved.

Puerto Rican parrots and potential limitations of the metapopulation approach to species conservation

USGS Publications Warehouse

Wilson, Marcia H.; Kepler, Cameron B.; Snyder, Noel F.R.; Derrickson, Scott R.; Dein, F. Josh; Wiley, James W.; Wunderle, Joseph M.; Lugo, Ariel E.; Graham, David L.; Toone, William D.

1994-01-01

Population viability analyses for a number of endangered species have incorporated a metapopulation approach. The risk assessments of these viability analyses have indicated that some extant populations should be subdivided into numerous subgroups with exchange of individuals among them in order to reduce the chance of catastrophic loss of the species. However, routine application of a policy of extensive subdivision may have detrimental consequences for certain endangered species. We examine the Puerto Rican Parrot as a case history in which this policy is ill-advised. In 1989, a population viability analysis was conducted for the parrot. The document recommended subdivision of the existing small captive flock into three groups. One of these captive flocks would consist of individuals transferred to a multi-species facility in the continental United States. Subsequently, individuals from this facility would be exchanged with the insular captive population(s) and the relict wild flock. For two reasons, implementation of this recommendation might have led to serious repercussions. First, this parrot, like many endangered species, has gone through a genetic bottleneck and may have a heightened susceptibility to disease. Multi-species facilities are a high-risk environment favoring the transmission of pathogens, especially when the facilities are located outside the natural ranges of a particular species. Second, the parrot is a K-selected species for which mate selection is idiosyncratic. This type of species often proves difficult to breed in captivity in small groups. Part of the problem in mate selection may be reduced by a policy allowing frequent transfers of individuals among facilities, but such movements increase the chances of spreading disease in the metapopulation. Thus, population viability analyses need to acknowledge that proliferation of captive subgroups accompanied by exchanges of individuals can in themselves carry substantial risks that must be weighed against the presumed benefits of subdivision.

US Army Research Laboratory Lightweight and Specialty Metals Branch Research and Development (FY14)

DTIC Science & Technology

2015-04-01

LSMB’s vision is to be the leading metals research and development facility for the US Army, which is achieved by attracting and retaining world-class...servicemen and women. 1.2 LSMB Vision The LSMB vision is to be the leading metals research and development facility for the US Army. This vision is achieved...determining the effect from the combined processing of coating and cleaning was crucial to reducing the risk associated with replacing cadmium . In this

Pressure ulcer prevention in long-term-care facilities: a pilot study implementing standardized nurse aide documentation and feedback reports.

PubMed

Horn, Susan D; Sharkey, Siobhan S; Hudak, Sandra; Gassaway, Julie; James, Roberta; Spector, William

2010-03-01

To design and facilitate implementation of practice-based evidence changes associated with decreases in pressure ulcer (PrU) development in long-term-care (LTC) facilities and promote these practices as part of routine care. Pre/post observational study. Frail older adult residents in 11 US LTC facilities. Project facilitators assisted frontline multidisciplinary teams (certified nurse aides [CNAs], nurses, and dietitians/dietary aides) to develop streamlined standardized CNA documentation and weekly reports to identify high-risk residents and to integrate clinical reports into day-to-day practice and clinical decision making. The program was called "Real-Time Optimal Care Plans for Nursing Home QI" (Real-Time). Prevalence of PrUs using Centers for Medicare & Medicaid Services (CMS) quality measures (QMs), number of in-house-acquired PrUs, and number and completeness of CNA documentation forms. Seven study LTC facilities that reported data to CMS experienced a combined 33% (SD, 36.1%) reduction in the CMS high-risk PrU QM in 18 months and reduction in newly occurring PrUs (number of ulcers in the fourth quarter of 2003: range, 2-19; and in the third quarter of 2005: range, 1-6). Five of these LTC facilities that fully implemented Real-Time experienced a combined 48.1% (SD, 23.4%) reduction in the CMS high-risk PrU QM. Ten facilities reduced by an average of 2 to 5 their number of CNA documentation forms; CNA weekly documentation completeness reached a consistent level of 90% to 95%, and 8 facilities integrated the use of 2 to 4 weekly project reports in routine clinical decision making. Quality improvement efforts that provide access to focused and timely clinical information, facilitate change, and promote staff working together in multidisciplinary teams impacted clinical outcomes. Prevention of PrUs showed a trend of improvement in facilities that fully integrated tools to identify high-risk residents into day-to-day practice. CNA documentation facilitated better information for clinical decision making. More than 70 additional LTC facilities across the United States are implementing this QI program.

Systems Engineering for Contingency Basing

DTIC Science & Technology

2012-11-30

partner practices.  Reduced Environmental , Safety and Occupational Health (ESOH) Risks. The processes and tools need to enable the measurement...62 Figure 43: Fuel environmental considerations decision hierarchy .................................. 64 Figure 44: A Medical facility...66 Figure 46: Screen Shot of CB-Decider, a web-based collaborative modeling environment

Risk-based targeting: A new approach in environmental protection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fox, C.A.

1995-12-31

Risk-based targeting has recently emerged as an effective tool to help prioritize efforts to identify and manage geographic areas, chemicals, facilities, and agricultural activities that cause the most environmental degradation. This paper focuses on how the Environmental Protection Agency (EPA) has recently used risk-based targeting to identify and screen Federal, industrial, commercial and municipal facilities which contribute to probable human health (fish consumption advisories and contaminated fish tissue) and aquatic life (contaminated sediments) impacts. Preliminary results identified several hundred potential contributors of problem chemicals to probable impacts within the same river reach in 1991--93. Analysis by industry sector showed thatmore » the majority of the facilities identified were publicly owned treatment works (POTWs), in addition to industry organic and inorganic chemical manufacturers, petroleum refineries, and electric services, coatings, engravings, and allied services, among others. Both compliant and non-compliant potentially contributing facilities were identified to some extent in all EPA regions. Additional results identifying possible linkages of other pollutant sources to probable impacts, as well as estimation of potential exposure of these contaminants to minority and/or poverty populations are also presented. Out of these analyses, a number of short and long-term strategies are being developed that EPA may use to reduce loadings of problem contaminants to impacted waterbodies.« less

Factors associated with problem drinking among women employed in food and recreational facilities in northern Tanzania.

PubMed

Mongi, Aika S; Baisley, Kathy; Ao, Trong Thanh-Hoang; Chilongani, Joseph; Aguirre-Andreasen, Aura; Francis, Suzanna C; Shao, John; Hayes, Richard; Kapiga, Saidi

2013-01-01

There is growing evidence that alcohol consumption is associated with increased risk of HIV infection. To determine factors associated with problem drinking, we analyzed data collected in two prospective cohorts of at-risk female food and recreational facility workers in northern Tanzania. We enrolled HIV seronegative women aged 18-44 years and employed in the towns of Geita, Kahama, Moshi, and Shinyanga. At enrolment, women were interviewed to obtain information about alcohol use, using CAGE and AUDIT screening scales, and risk factors for HIV infection. Blood and genital samples were collected for detection of HIV and sexually transmitted infections (STIs). We characterized alcohol use, concordance, and agreement of the scales, and examined the associations between characteristics of participants and problem drinking as defined by both scales using logistic regression. Lastly, we assessed problem drinking as a risk factor for recent sexual behavior and prevalent STIs. Among enrollees, 68% women reported ever drinking alcohol; of these 76% reported drinking alcohol in the past 12 months. The prevalence of problem drinking was 20% using CAGE and 13% using AUDIT. Overall concordance between the scales was 75.0% with a Kappa statistic of 0.58. After adjusting for age, independent factors associated with problem drinking, on both scales, were marital status, occupation, facility type, increasing number of lifetime sexual partners, and transactional sex in the past 12 months. In addition, women who were problem drinkers on either scale were more likely to report having ≥ 1 sexual partner (CAGE: aOR = 1.56, 95% confidence interval, CI: 1.10-2.23; aOR = 2.00, 95% CI: 1.34-3.00) and transactional sex (CAGE: aOR = 1.79, 95% CI: 1.26-2.56; aOR = 1.51, 95% CI: 1.04-2.18), in the past 3 months. These findings suggest that interventions to reduce problem drinking in this population may reduce high-risk sexual behaviors and contribute in lowering the risk of HIV infection.

Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.

PubMed

Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison

2018-01-01

In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.

Work plan for the Isotopes Facilities Deactivation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-08-01

The purpose of the Isotopes Facilities Deactivation Project (IFDP) is to place former isotopes production facilities at the Oak Ridge National Laboratory in a safe, stable, and environmentally sound condition; suitable for an extended period of minimum surveillance and maintenance (S and M) and as quickly and economical as possible. Implementation and completion of the deactivation project will further reduce the risks to the environment and to public safety and health. Furthermore, completion of the project will result in significant S and M cost savings in future years. The IFDP work plan defines the project schedule, the cost estimate, andmore » the technical approach for the project. A companion document, the EFDP management plan, has been prepared to document the project objectives, define organizational relationships and responsibilities, and outline the management control systems to be employed in the management of the project. The project has adopted the strategy of deactivating the simple facilities first, to reduce the scope of the project and to gain experience before addressing more difficult facilities. A decision support system is being developed to identify the activities that best promote the project mission and result in the largest cost savings. This work plan will be reviewed and revised annually. Deactivation of EFDP Facilities was initiated in FY 1994 and will be completed in FY 2000. The schedule for deactivation of facilities is shown. The total cost of the project is estimated to be $51M. The costs are summarized. Upon completion of deactivation, annual S and M costs of these facilities will be reduced from the current level of $5M per year to less than $1M per year.« less

Characterization of exposure to silver nanoparticles in a manufacturing facility

NASA Astrophysics Data System (ADS)

Park, Junsu; Kwak, Byoung Kyu; Bae, Eunjoo; Lee, Jeongjin; Kim, Younghun; Choi, Kyunghee; Yi, Jongheop

2009-10-01

An assessment of the extent of exposure to nanomaterials in the workplace will be helpful in improving the occupational safety of workers. It is essential that the exposure data in the workplace are concerned with risk management to evaluate and reduce worker exposure. In a manufacturing facility dealing with nanomaterials, some exposure data for gas-phase reactions are available, but much less information is available regarding liquid-phase reactions. Although the potential for inhaling nanomaterials in a liquid-phase process is less than that for gas-phase, the risks of exposure during wet-chemistry processes are not negligible. In this study, we monitored and analyzed the exposure characteristics of silver nanoparticles during a liquid-phase process in a commercial production facility. Based on the measured exposure data, the source of Ag nanoparticles emitted during the production processes was indentified and a mechanism for the growth of Ag nanoparticle released is proposed. The data reported in this study could be used to establish occupational safety guidelines in the nanotechnology workplace, especially in a liquid-phase production facility.

A prioritization and analysis strategy for environmental surveillance results.

PubMed

Shyr, L J; Herrera, H; Haaker, R

1997-11-01

DOE facilities are required to conduct environmental surveillance to verify that facility operations are operated within the approved risk envelope and have not caused undue risk to the public and the environment. Given a reduced budget, a strategy for analyzing environmental surveillance data was developed to set priorities for sampling needs. The radiological and metal data collected at Sandia National Laboratories, New Mexico, were used to demonstrate the analysis strategy. Sampling locations were prioritized for further investigation and the needs for routine sampling. The process of data management, analysis, prioritization, and presentation has been automated through a custom-designed computer tool. Data collected over years can be analyzed and summarized in a short table format for prioritization and decision making.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kumar, Satish; Fisk, William J.

Research into indoor environmental quality (IEQ) and its effects on health, comfort and performance of occupants is becoming increasingly essential. Facility managers are interested in IEQ's close relationship to energy use. Employers hope to enhance employee comfort and productivity, reduce absenteeism and health-care costs, and reduce risk of litigation. The rising interest in this field has placed additional pressure on the research community for practical guidelines on creating a safe, healthy and comfortable indoor environment.

Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

PubMed Central

Knight, Patrick H; Maheshwari, Neelabh; Hussain, Jafar; Scholl, Michael; Hughes, Michael; Papadimos, Thomas J; Guo, Weidun Alan; Cipolla, James; Stawicki, Stanislaw P; Latchana, Nicholas

2015-01-01

Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies. PMID:26807395

Understanding and mitigating the challenge of bioaerosol emissions from urban community composting

NASA Astrophysics Data System (ADS)

Pankhurst, L. J.; Akeel, U.; Hewson, C.; Maduka, I.; Pham, P.; Saragossi, J.; Taylor, J.; Lai, K. M.

2011-01-01

Within the UK, local and regional government drives to reduce the quantity of waste being sent to landfill have led to an increase in small-scale composting schemes, instigated by local councils and not-for-profit organisations. The composting process relies upon the proliferation of microorganisms, leading to their emission into the ambient environment. In this investigative study, total bacteria and Aspergillus fumigatus emitted from a small-scale composting facility in central London were measured in different spatial and temporal dimensions. Bioaerosols did not disperse in concentrations significantly higher than those measured at 'background' locations, where maximum geometric mean was 55 × 10 2 Colony Forming Units (CFU) per m -3. Concentrations on-site and at the nearest potential receptor were comparable to those found at commercial facilities, reaching 25 × 10 4 and 29 × 10 3 CFU m -3 for total bacteria and A. fumigatus respectively. The room housing the facility was contaminated by moulds; likely to result from high relative humidity of the air (consistently above 80% during this study), building material, and the generation of organic dust. The complex diurnal meteorological variations of urban environments are likely to influence bioaerosol dispersal, and consequent exposure risk for sensitive receptors. Site planning tools including Geographical Information Systems (GIS) mapping with buffer zones around schools and hospitals, and use of computerised models for the design of rooms housing urban composting facilities are proposed as methods for reducing the risk of occupational and off-site receptor exposure.

Environmentally Preferred Coatings for Steel

NASA Technical Reports Server (NTRS)

Kessel, Kurt R.

2016-01-01

NASA is responsible for a number of facilities and structures with metallic structural and nonstructural components in a highly corrosive environment. Metals require periodic maintenance activity to guard against the insidious effects of corrosion and thus ensure that structures meet or exceed design or performance life. The deleterious effects of corrosion result in steep costs, asset downtime affecting mission readiness, and safety risks to personnel. It is vital to reduce corrosion costs and risks in a sustainable manner.

Environmental cleaning and disinfection of patient areas.

PubMed

Doll, Michelle; Stevens, Michael; Bearman, Gonzalo

2018-02-01

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Nutritional strategies to boost immunity and prevent infection in elderly individuals.

PubMed

High, K P

2001-12-01

Older adults are at risk for malnutrition, which may contribute to their increased risk of infection. Nutritional supplementation strategies can reduce this risk and reverse some of the immune dysfunction associated with advanced age. This review discusses nutritional interventions that have been examined in clinical trials of older adults. The data support use of a daily multivitamin or trace-mineral supplement that includes zinc (elemental zinc, >20 mg/day) and selenium (100 microg/day), with additional vitamin E, to achieve a daily dosage of 200 mg/day. Specific syndromes may also be addressed by nutritional interventions (for example, cranberry juice consumption to reduce urinary tract infections) and may reduce antibiotic use in older adults, particularly those living in long-term care facilities. Drug-nutrient interactions are common in elderly individuals, and care providers should be aware of these interactions. Future research should evaluate important clinical end points rather than merely surrogate markers of immunity.

Laboratory-associated infections and biosafety.

PubMed Central

Sewell, D L

1995-01-01

An estimated 500,000 laboratory workers in the United States are at risk of exposure to infectious agents that cause disease ranging from inapparent to life-threatening infections, but the precise risk to a given worker unknown. The emergence of human immunodeficiency virus and hantavirus, the continuing problem of hepatitis B virus, and the reemergence of Mycobacterium tuberculosis have renewed interest in biosafety for the employees of laboratories and health care facilities. This review examines the history, the causes, and the methods for prevention of laboratory-associated infections. The initial step in a biosafety program is the assessment of risk to the employee. Risk assessment guidelines include the pathogenicity of the infectious agent, the method of transmission, worker-related risk factors, the source and route of infection, and the design of the laboratory facility. Strategies for the prevention and management of laboratory-associated infections are based on the containment of the infectious agent by physical separation from the laboratory worker and the environment, employee education about the occupational risks, and availability of an employee health program. Adherence to the biosafety guidelines mandated or proposed by various governmental and accrediting agencies reduces the risk of an occupational exposure to infectious agents handled in the workplace. PMID:7553572

Inequality in diabetes-related hospital admissions in England by socioeconomic deprivation and ethnicity: facility-based cross-sectional analysis.

PubMed

Nishino, Yoshitaka; Gilmour, Stuart; Shibuya, Kenji

2015-01-01

To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Facility-based cross-sectional analysis. National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010-2011 (355 facilities). Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0-1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02-2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51-2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80-0.94). More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better interventions in poorer areas, are needed to reduce these inequalities.

Reducing Proliferation Rick Through Multinational Fuel Cycle Facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Amanda Rynes

2010-11-01

With the prospect of rapid expansion of the nuclear energy industry and the ongoing concern over weapons proliferation, there is a growing need for a viable alternative to traditional nation-based fuel production facilities. While some in the international community remain apprehensive, the advantages of multinational fuel cycle facilities are becoming increasingly apparent, with states on both sides of the supply chain able to garner the security and financial benefits of such facilities. Proliferation risk is minimized by eliminating the need of states to establish indigenous fuel production capabilities and the concept's structure provides an additional internationally monitored barrier against themore » misuse or diversion of nuclear materials. This article gives a brief description of the arguments for and against the implementation of a complete multinational fuel cycle.« less

Women and Alcohol Problems: Tools for Prevention.

ERIC Educational Resources Information Center

National Inst. on Alcohol Abuse and Alcoholism (DHHS), Rockville, MD.

This report presents a practical guide to the prevention of women's alcohol problems. It is intended for use by individuals interested in incorporating prevention measures into the workplace, schools, treatment facilities, and other settings, and for women interested in reducing the risks of alcohol problems or preventing existing problems from…

Characterization of Airborne Particles in an Electronic Waste Recycling Facility and Their Toxicity Assessment

EPA Science Inventory

Improper disposal of electronic waste (e-waste) can lead to release of toxic chemicals into the environment and also may pose health risks. Thus, recycling e-waste, instead of landfilling, is considered to be an effective way to reduce pollutant release and exposure. However, lit...

Prevalence and Risk Factors for Depressive Disorders in Adults with Intellectual Disability.

ERIC Educational Resources Information Center

Meins, Wolfgang

1993-01-01

Evaluation of 798 adults with intellectual disability in German residential facilities and group homes revealed that subjects did not seem especially vulnerable to depressive disorders. Almost 5% were identified with depressive disorder. Those with depressive disorders experienced reduced social support. Age, epilepsy, and etiology did not show…

Assessment of the Incentives Created by Public Disclosure of Off-Site Consequence Analysis Information for Reduction in the Risk of Accidental Releases

EPA Pesticide Factsheets

The off-site consequence analysis (OCA) evaluates the potential for worst-case and alternative accidental release scenarios to harm the public and environment around the facility. Public disclosure would likely reduce the number/severity of incidents.

[Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

PubMed

Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

2012-01-01

DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

Autonomous rendezvous and capture development infrastructure

NASA Technical Reports Server (NTRS)

Bryan, Thomas C.; Roe, Fred; Coker, Cindy; Nelson, Pam; Johnson, B.

1991-01-01

In the development of the technology for autonomous rendezvous and docking, key infrastructure capabilities must be used for effective and economical development. This involves facility capabilities, both equipment and personnel, to devise, develop, qualify, and integrate ARD elements and subsystems into flight programs. One effective way of reducing technical risks in developing ARD technology is the use of the ultimate test facility, using a Shuttle-based reusable free-flying testbed to perform a Technology Demonstration Test Flight which can be structured to include a variety of additional sensors, control schemes, and operational approaches. This conceptual testbed and flight demonstration will be used to illustrate how technologies and facilities at MSFC can be used to develop and prove an ARD system.

Enumerating actinomycetes in compost bioaerosols at source—Use of soil compost agar to address plate 'masking'

NASA Astrophysics Data System (ADS)

Taha, M. P. M.; Drew, G. H.; Tamer Vestlund, A.; Aldred, D.; Longhurst, P. J.; Pollard, S. J. T.

Actinomycetes are the dominant bacteria isolated from bioaerosols sampled at composting facilities. Here, a novel method for the isolation of actinomycetes is reported, overcoming masking of conventional agar plates, as well as reducing analysis time and costs. Repeatable and reliable actinomycetes growth was best achieved using a soil compost media at an incubation temperature of 44 °C and 7 days' incubation. The results are of particular value to waste management operators and their advisors undertaking regulatory risk assessments that support environmental approvals for compost facilities.

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007-2011: Case-Control Study.

PubMed

Baker, Kelly K; O'Reilly, Ciara E; Levine, Myron M; Kotloff, Karen L; Nataro, James P; Ayers, Tracy L; Farag, Tamer H; Nasrin, Dilruba; Blackwelder, William C; Wu, Yukun; Alonso, Pedro L; Breiman, Robert F; Omore, Richard; Faruque, Abu S G; Das, Sumon Kumar; Ahmed, Shahnawaz; Saha, Debasish; Sow, Samba O; Sur, Dipika; Zaidi, Anita K M; Quadri, Fahreen; Mintz, Eric D

2016-05-01

Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age. The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1-2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India. This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

PubMed

Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

2016-02-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Electrostatic hazards of charging of bedclothes and ignition in medical facilities.

PubMed

Endo, Yuta; Ohsawa, Atsushi; Yamaguma, Mizuki

2018-02-26

We investigated the charge generated on bedclothes (cotton and polyester) during bedding exchange with different humidities and the ignitability of an alcohol-based hand sanitizer (72.3 mass% ethanol) due to static spark with different temperatures to identify the hazards of electrostatic shocks and ignitions occurring previously in medical facilities. The results indicated that charging of the polyester bedclothes may induce a human body potential of over about 10 kV, resulting in shocks even at a relative humidity of 50%, and a human body potential of higher than about 8 kV can cause a risk for the ignition of the hand sanitizer. The grounding of human bodies via footwear and flooring, therefore, is essential to avoid such hazards (or to reduce such risks).

Cost-Effectiveness Analysis of Interventions to Reduce Risk of Aspiration in Elderly Cancer Survivors Residing in Skilled Nursing Facilities.

PubMed

Mantravadi, S

2017-04-01

Aspiration can occur in patients of any age group, but it can be prevented. The primary population at risk is made up of survivors of cancer because of their increased risk of mucositis, mucosal atrophy, and dysphagia associated with chemotherapy, radiotherapy, and the disease process itself. The rate of incidence of aspiration cannot be quantified, because minor cases of aspiration often go unreported. Sequelae ensuing from aspirations can include pneumonia, end-stage kidney disease, dialysis, and death. Analyses of cost, decision-tree modeling, and cost effectiveness were performed to compare a hypothetical, interventional model based on best practices with usual (standard) care. A societal perspective was used as the economic view point. Direct costs, caregiver time, and market values for wages were estimated for the 2 interventions. Effectiveness values for the cost-effectiveness and decision-tree analyses were obtained from the literature. The incremental-cost-effectiveness ratio was calculated and used to compare the intervention with usual care. The interventional method was more costly but more effective than usual care. A sensitivity analysis considered the uncertainty of event probability (aspiration vs no aspiration). The interventional protocol for aspiration reduction continued to be more cost effective than usual care. Aspiration takes a financial toll on all facets of health care, including on nurses, skilled nursing facilities, patients, their families, and insurers, among others. Implementing guidelines that describe best practices for aspiration appears to be a cost-effective strategy for reducing aspirations among cancer survivors - especially elderly patients - who live in skilled nursing facilities.

Summary of findings from the evaluation of a pilot medically supervised safer injecting facility

PubMed Central

Wood, Evan; Tyndall, Mark W.; Montaner, Julio S.; Kerr, Thomas

2006-01-01

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use. PMID:17116909

Preventing disease transmission by deceased tissue donors by testing blood for viral nucleic acid.

PubMed

Strong, D Michael; Nelson, Karen; Pierce, Marge; Stramer, Susan L

2005-01-01

Nucleic acid testing (NAT) has reduced the risk of transmitting infectious disease through blood transfusion. Currently NAT for HIV-1 and HCV are FDA licensed and performed by nearly all blood collection facilities, but HBV NAT is performed under an investigational study protocol. Residual risk estimates indicate that NAT could potentially reduce disease transmission through transplanted tissue. However, tissue donor samples obtained post-mortem have the potential to produce an invalid NAT result due to inhibition of amplification reactions by hemolysis and other factors. The studies reported here summarize the development of protocols to allow NAT of deceased donor samples with reduced rates of invalid results. Using these protocols, inventories from two tissue centers were tested with greater than 99% of samples producing a valid test result.

Information, Avoidance Behavior, and Health: The Effect of Ozone on Asthma Hospitalizations

ERIC Educational Resources Information Center

Neidell, Matthew

2009-01-01

This paper assesses whether responses to information about risk impact estimates of the relationship between ozone and asthma in Southern California. Using a regression discontinuity design, I find smog alerts significantly reduce daily attendance at two major outdoor facilities. Using daily time-series regression models that include year-month…

Protect Against Personal Injury to Limit Your Liability.

ERIC Educational Resources Information Center

Greene, Brenda Z.

1985-01-01

Accidents and injuries involving students, employees, or others using school facilities or equipment can result in lengthy and costly litigation. A proven way to reduce potential accidents and injuries is to work to eliminate the circumstances in which accidents occur. It is important to identify risks; the areas with the highest accident…

Risk factors for visual impairment and blindness amongst black adult diabetics receiving treatment at Government healthcare facilities in Mopani District, Limpopo province, South Africa.

PubMed

Mabaso, Raymond G; Oduntan, Olalekan A

2014-11-21

Diabetes mellitus (DM) is a common systemic disease amongst Black South Africans. It may lead to diabetic retinopathy (DR), a common cause of visual impairment (VI) and blindness. DR may signifiantly increase the prevalence of VI and blindness. To assess risk factors for VI and blindness amongst a black diabetic South African population aged ≥ 40 years. The study was conducted in seven Government healthcare facilities (two hospitals, four clinics and one health centre) in Mopani District, Limpopo province, South Africa. This was a cross-sectional health facility-based quantitative study. Structured interviews were used to obtain information, which included sociodemographic profie, knowledge about DM and its ocular complications, presence of hypertension and accessibility to health facilities. Subsequently participants were examined for VI and blindness using an autorefractor, pinhole disc, ophthalmoscope and logMAR visual acuity chart. Anthropometric measurements (height, weight and waist) were also taken. Associations between 31 risk factors and VI as well as blindness were statistically examined. Participants (N = 225) included 161 women and 64 men aged 40-90 years (mean 61.5 ± 10.49 years); 41.3% of them had VI and 3.6% were blind. Cataracts (76.8%) and DR (7.1%) were the common causes of compensated VI and blindness. Risk factors that were associated with VI and blindness were age, monthly income, compliance with losing weight and physical activity. Findings suggest that lifestyle intervention and appropriate eyecare programmes may reduce VI and blindness in this population.

Risk factors for visual impairment and blindness amongst black adult diabetics receiving treatment at Government healthcare facilities in Mopani District, Limpopo province, South Africa

PubMed Central

Oduntan, Olalekan A.

2014-01-01

Abstract Background Diabetes mellitus (DM) is a common systemic disease amongst Black South Africans. It may lead to diabetic retinopathy (DR), a common cause of visual impairment (VI) and blindness. DR may significantly increase the prevalence of VI and blindness. Aim To assess risk factors for VI and blindness amongst a black diabetic South African population aged ≥ 40 years. Setting The study was conducted in seven Government healthcare facilities (two hospitals, four clinics and one health centre) in Mopani District, Limpopo province, South Africa. Methods This was a cross-sectional health facility-based quantitative study. Structured interviews were used to obtain information, which included sociodemographic profile, knowledge about DM and its ocular complications, presence of hypertension and accessibility to health facilities. Subsequently participants were examined for VI and blindness using an autorefractor, pinhole disc, ophthalmoscope and logMAR visual acuity chart. Anthropometric measurements (height, weight and waist) were also taken. Associations between 31 risk factors and VI as well as blindness were statistically examined. Results Participants (N = 225) included 161 women and 64 men aged 40–90 years (mean 61.5 ± 10.49 years); 41.3% of them had VI and 3.6% were blind. Cataracts (76.8%) and DR (7.1%) were the common causes of compensated VI and blindness. Risk factors that were associated with VI and blindness were age, monthly income, compliance with losing weight and physical activity. Conclusion Findings suggest that lifestyle intervention and appropriate eyecare programmes may reduce VI and blindness in this population. PMID:26245418

Mission Risk Reduction Regulatory Change Management

NASA Technical Reports Server (NTRS)

Scroggins, Sharon

2007-01-01

NASA Headquarters Environmental Management Division supports NASA's mission to pioneer the future in space exploration, scientific discovery, and aeronautics research by integrating environmental considerations into programs and projects early-on, thereby proactively reducing NASA's exposure to institutional, programmatic and operational risk. As part of this effort, NASA established the Principal Center for Regulatory Risk Analysis and Communication (RRAC PC) as a resource for detecting, analyzing, and communicating environmental regulatory risks to the NASA stakeholder community. The RRAC PC focuses on detecting emerging environmental regulations and other operational change drivers that may pose risks to NASA programs and facilities, and effectively communicating the potential risks. For example, regulatory change may restrict how and where certain activities or operations may be conducted. Regulatory change can also directly affect the ability to use certain materials by mandating a production phase-out or restricting usage applications of certain materials. Regulatory change can result in significant adverse impacts to NASA programs and facilities due to NASA's stringent performance requirements for materials and components related to human-rated space vehicles. Even if a regulation does not directly affect NASA operations, U.S. and international regulations can pose program risks indirectly through requirements levied on manufacturers and vendors of components and materials. For example, manufacturers can change their formulations to comply with new regulatory requirements. Such changes can require time-consuming and costly requalification certification for use in human spaceflight programs. The RRAC PC has implemented a system for proactively managing regulatory change to minimize potential adverse impacts to NASA programs and facilities. This presentation highlights the process utilized by the RRACPC to communicate regulatory change and the associated potential risks within NASA, as well as the process for communicating and cooperating with other government agencies and industry partners, both domestic and international, to ensure mission success.

Dietitians employed by health care facilities preferred a HACCP system over irradiation or chemical rinses for reducing risk of foodborne disease.

PubMed

Giamalva, J N; Redfern, M; Bailey, W C

1998-08-01

To survey dietitians in health care facilities about the acceptability of alternative meat and poultry processing methods designed to reduce the risk of foodborne disease and their willingness to pay for these processes. A geographically representative sample of 600 members of The American Dietetic Association who work in health care facilities. The response rate was 250 completed questionnaires from 592 eligible subjects (42%). A mail survey was used to gather information on the acceptability of a Hazard Analysis and Critical Control Point (HACCP) system, chemical rinses, and irradiation for increasing the safety of food. Discrete choice contingent valuation was used to determine the acceptability at current prices and at 5, 10, and 25 cents per pound above current prices. Logistic regression was used to estimate mean willingness to pay (the maximum amount respondents are willing to pay) for each process. A simultaneous equations regression model was used to estimate the effects of other variables on acceptability. Respondents expressed a high level of concern for food safety in health care facilities. The estimated mean willingness to pay was highest for a HACCP system and lowest for chemical rinses. The successful adoption of alternative methods to increase food safety depends on their acceptance by foodservice professionals. The professionals sampled were most accepting of a HACCP system, somewhat less accepting of irradiation, and least accepting of new chemical rinses. Poultry and beef processors and government agencies concerned with food safety may want to take into account the attitudes of foodservice professionals.

An Innovative Approach for Decreasing Fall Trauma Admissions from Geriatric Living Facilities: Preliminary Investigation.

PubMed

Evans, Tracy; Gross, Brian; Rittenhouse, Katelyn; Harnish, Carissa; Vellucci, Ashley; Bupp, Katherine; Horst, Michael; Miller, Jo Ann; Baier, Ron; Chandler, Roxanne; Rogers, Frederick B

2015-12-01

Geriatric living facilities have been associated with a high rate of falls. We sought to develop an innovative intervention approach targeting geriatric living facilities that would reduce geriatric fall admissions to our Level II trauma center. In 2011, a Trauma Prevention Taskforce visited 5 of 28 local geriatric living facilities to present a fall prevention protocol composed of three sections: fall education, risk factor identification, and fall prevention strategies. To determine the impact of the intervention, the trauma registry was queried for all geriatric fall admissions attributed to patients living at local geriatric living facilities. The fall admission rate (total fall admissions/total beds) of the pre-intervention period (2010-2011) was compared with that of the postintervention period (2012-2013) at the 5 intervention and 23 control facilities. A P value < 0.05 was considered statistically significant. From 2010 to 2013, there were 487 fall admissions attributed to local geriatric living facilities (intervention: 179 fall admissions; control: 308 fall admissions). The unadjusted fall rate decreased at intervention facilities from 8.9 fall admissions/bed pre-intervention to 8.1 fall admissions/bed postintervention, whereas fall admission rates increased at control sites from 5.9 to 7.7 fall admissions/bed during the same period [control/intervention odds ratio (OR), 95% confidence interval (CI) = 1.32, 1.05-1.67; period OR, 95%CI = 1.55, 1.18-2.04, P = 0.002; interaction of control/intervention group and period OR 95% CI = 0.68, 0.46-1.00, P = 0.047]. An aggressive intervention program targeting high-risk geriatric living facilities resulted in a statistically significant decrease in geriatric fall admissions to our Level II trauma center.

Reducing software security risk through an integrated approach research initiative model based verification of the Secure Socket Layer (SSL) Protocol

NASA Technical Reports Server (NTRS)

Powell, John D.

2003-01-01

This document discusses the verification of the Secure Socket Layer (SSL) communication protocol as a demonstration of the Model Based Verification (MBV) portion of the verification instrument set being developed under the Reducing Software Security Risk (RSSR) Trough an Integrated Approach research initiative. Code Q of the National Aeronautics and Space Administration (NASA) funds this project. The NASA Goddard Independent Verification and Validation (IV&V) facility manages this research program at the NASA agency level and the Assurance Technology Program Office (ATPO) manages the research locally at the Jet Propulsion Laboratory (California institute of Technology) where the research is being carried out.

137Cs Radiological risk estimation of NSD facility at Karawang site by using RESRAD onsite application: effect of cover thickness

NASA Astrophysics Data System (ADS)

Setiawan, B.; Prihastuti, S.; Moersidik, S. S.

2018-02-01

The operational of near surface disposal facility during waste packages loading activity into the facility, or in a monitoring activity around disposal facility at Karawang area is predicted to give a radiological risk to radiation workers. The thickness of disposal facility cover system affected the number of radiological risk of workers. Due to this reason, a radiological risk estimation needs to be considered. RESRAD onsite code is applied for this purpose by analyse the individual accepted dose and radiological risk data of radiation workers. The obtained results and then are compared with radiation protection reference in accordance with national regulation. In this case, the data from the experimental result of Karawang clay as host of disposal facility such as Kd value of 137Cs was used. Results showed that the thickness of the cover layer of disposal facility affected to the radiological risk which accepted by workers in a near surface disposal facility.

Autonomous rendezvous and capture development infrastructure

NASA Technical Reports Server (NTRS)

Bryan, Thomas C.

1991-01-01

In the development of the technology for autonomous rendezvous and docking, key infrastructure capabilities must be used for effective and economical development. This need involves facility capabilities, both equipment and personnel, to devise, develop, qualify, and integrate ARD elements and subsystems into flight programs. One effective way of reducing technical risks in developing ARD technology is the use of the Low Earth Orbit test facility. Using a reusable free-flying testbed carried in the Shuttle, as a technology demonstration test flight, can be structured to include a variety of sensors, control schemes, and operational approaches. This testbed and flight demonstration concept will be used to illustrate how technologies and facilities at MSFC can be used to develop and prove an ARD system.

Factors Associated with Problem Drinking among Women Employed in Food and Recreational Facilities in Northern Tanzania

PubMed Central

Mongi, Aika S.; Baisley, Kathy; Ao, Trong Thanh-Hoang; Chilongani, Joseph; Aguirre-Andreasen, Aura; Francis, Suzanna C.; Shao, John; Hayes, Richard; Kapiga, Saidi

2013-01-01

Background There is growing evidence that alcohol consumption is associated with increased risk of HIV infection. To determine factors associated with problem drinking, we analyzed data collected in two prospective cohorts of at-risk female food and recreational facility workers in northern Tanzania. Methods We enrolled HIV seronegative women aged 18–44 years and employed in the towns of Geita, Kahama, Moshi, and Shinyanga. At enrolment, women were interviewed to obtain information about alcohol use, using CAGE and AUDIT screening scales, and risk factors for HIV infection. Blood and genital samples were collected for detection of HIV and sexually transmitted infections (STIs). We characterized alcohol use, concordance, and agreement of the scales, and examined the associations between characteristics of participants and problem drinking as defined by both scales using logistic regression. Lastly, we assessed problem drinking as a risk factor for recent sexual behavior and prevalent STIs. Results Among enrollees, 68% women reported ever drinking alcohol; of these 76% reported drinking alcohol in the past 12 months. The prevalence of problem drinking was 20% using CAGE and 13% using AUDIT. Overall concordance between the scales was 75.0% with a Kappa statistic of 0.58. After adjusting for age, independent factors associated with problem drinking, on both scales, were marital status, occupation, facility type, increasing number of lifetime sexual partners, and transactional sex in the past 12 months. In addition, women who were problem drinkers on either scale were more likely to report having ≥1 sexual partner (CAGE: aOR = 1.56, 95% confidence interval, CI: 1.10–2.23; AUDIT: aOR = 2.00, 95% CI: 1.34–3.00) and transactional sex (CAGE: aOR = 1.79, 95% CI: 1.26–2.56; AUDIT: aOR = 1.51, 95% CI: 1.04–2.18), in the past 3 months. Conclusion These findings suggest that interventions to reduce problem drinking in this population may reduce high-risk sexual behaviors and contribute in lowering the risk of HIV infection. PMID:24391956

Hemodialysis patients receiving a greater Kt dose than recommended have reduced mortality and hospitalization risk.

PubMed

Maduell, Francisco; Ramos, Rosa; Varas, Javier; Martin-Malo, Alejandro; Molina, Manuel; Pérez-Garcia, Rafael; Marcelli, Daniele; Moreso, Francesc; Aljama, Pedro; Merello, Jose Ignacio

2016-12-01

Achieving an adequate dialysis dose is one of the key goals for dialysis treatments. Here we assessed whether patients receiving the current cleared plasma volume (Kt), individualized for body surface area per recommendations, had improved survival and reduced hospitalizations at 2 years of follow-up. Additionally, we assessed whether patients receiving a greater dose gained more benefit. This prospective, observational, multicenter study included 6129 patients in 65 Fresenius Medical Care Spanish facilities. Patients were classified monthly into 1 of 10 risk groups based on the difference between achieved and target Kt. Patient groups with a more negative relationship were significantly older with a higher percentage of diabetes mellitus and catheter access. Treatment dialysis time, effective blood flow, and percentage of on-line hemodiafiltration were significantly higher in groups with a higher dose. The mortality risk profile showed a progressive increase when achieved minus target Kt became more negative but was significantly lower in the group with 1 to 3 L clearance above target Kt and in groups with greater increases above target Kt. Additionally, hospitalization risk appeared significantly reduced in groups receiving 9 L or more above the minimum target. Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk. As such, future prospective studies are required to confirm these dose effect findings. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Reducing the Risk of Human Space Missions with INTEGRITY

NASA Technical Reports Server (NTRS)

Jones, Harry W.; Dillon-Merill, Robin L.; Tri, Terry O.; Henninger, Donald L.

2003-01-01

The INTEGRITY Program will design and operate a test bed facility to help prepare for future beyond-LEO missions. The purpose of INTEGRITY is to enable future missions by developing, testing, and demonstrating advanced human space systems. INTEGRITY will also implement and validate advanced management techniques including risk analysis and mitigation. One important way INTEGRITY will help enable future missions is by reducing their risk. A risk analysis of human space missions is important in defining the steps that INTEGRITY should take to mitigate risk. This paper describes how a Probabilistic Risk Assessment (PRA) of human space missions will help support the planning and development of INTEGRITY to maximize its benefits to future missions. PRA is a systematic methodology to decompose the system into subsystems and components, to quantify the failure risk as a function of the design elements and their corresponding probability of failure. PRA provides a quantitative estimate of the probability of failure of the system, including an assessment and display of the degree of uncertainty surrounding the probability. PRA provides a basis for understanding the impacts of decisions that affect safety, reliability, performance, and cost. Risks with both high probability and high impact are identified as top priority. The PRA of human missions beyond Earth orbit will help indicate how the risk of future human space missions can be reduced by integrating and testing systems in INTEGRITY.

Predictors and economic burden of serious workplace falls in health care.

PubMed

Alamgir, H; Ngan, K; Drebit, S; Guiyun Li, H; Keen, D

2011-06-01

To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers. Fall injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls. Nine hundred and thirty-eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls. Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs.

Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.

PubMed

Ganchimeg, T; Ota, E; Morisaki, N; Laopaiboon, M; Lumbiganon, P; Zhang, J; Yamdamsuren, B; Temmerman, M; Say, L; Tunçalp, Ö; Vogel, J P; Souza, J P; Mori, R

2014-03-01

To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Twenty-nine countries in Africa, Latin America, Asia and the Middle East. Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Risk of adverse pregnancy outcomes among adolescent mothers. A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Summary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Powell, Danny H; Elwood Jr, Robert H

2011-01-01

An effective risk assessment system is needed to address the threat posed by an active or passive insider who, acting alone or in collusion, could attempt diversion or theft of nuclear material. The material control and accountability (MC&A) system effectiveness tool (MSET) is a self-assessment or inspection tool utilizing probabilistic risk assessment (PRA) methodology to calculate the system effectiveness of a nuclear facility's material protection, control, and accountability (MPC&A) system. The MSET process is divided into four distinct and separate parts: (1) Completion of the questionnaire that assembles information about the operations of every aspect of the MPC&A system; (2)more » Conversion of questionnaire data into numeric values associated with risk; (3) Analysis of the numeric data utilizing the MPC&A fault tree and the SAPHIRE computer software; and (4) Self-assessment using the MSET reports to perform the effectiveness evaluation of the facility's MPC&A system. The process should lead to confirmation that mitigating features of the system effectively minimize the threat, or it could lead to the conclusion that system improvements or upgrades are necessary to achieve acceptable protection against the threat. If the need for system improvements or upgrades is indicated when the system is analyzed, MSET provides the capability to evaluate potential or actual system improvements or upgrades. A facility's MC&A system can be evaluated at a point in time. The system can be reevaluated after upgrades are implemented or after other system changes occur. The total system or specific subareas within the system can be evaluated. Areas of potential system improvement can be assessed to determine where the most beneficial and cost-effective improvements should be made. Analyses of risk importance factors show that sustainability is essential for optimal performance and reveals where performance degradation has the greatest impact on total system risk. The risk importance factors show the amount of risk reduction achievable with potential upgrades and the amount of risk reduction achieved after upgrades are completed. Applying the risk assessment tool gives support to budget prioritization by showing where budget support levels must be sustained for MC&A functions most important to risk. Results of the risk assessment are also useful in supporting funding justifications for system improvements that significantly reduce system risk. The functional model, the system risk assessment tool, and the facility evaluation questionnaire are valuable educational tools for MPC&A personnel. These educational tools provide a framework for ongoing dialogue between organizations regarding the design, development, implementation, operation, assessment, and sustainability of MPC&A systems. An organization considering the use of MSET as an analytical tool for evaluating the effectiveness of its MPC&A system will benefit from conducting a complete MSET exercise at an existing nuclear facility.« less

76 FR 60781 - Toxics Release Inventory (TRI) Reporting for Facilities Located in Indian Country and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... potential problems, set priorities, and take appropriate steps to reduce any potential risks to human health... not be disclosed except in accordance with procedures set forth in 40 CFR part 2. II. Introduction... Tribes, which is published periodically in the Federal Register. As also set forth at 40 CFR 372.3...

Societal-Equity-Enhancing Criteria and Facility-Host Incentives Supporting Five Key Elements in the January 2012 Blue Ribbon Commission Report - 13015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eriksson, Leif G.; Dials, George E.; George, Critz H.

2013-07-01

In February 2009, the Obama Administration announced it would abandon USA's only candidate SNF/HLW-disposal facility since 1987. In 2010, all related activities were stopped and the Blue Ribbon Commission on America's Nuclear Future was established 'to recommend a new strategy for managing the back end of the nuclear fuel cycle', which it did in January 2012, emphasizing eight key elements. However, Key Element 1, 'A new, consent-based approach to siting future nuclear facilities', is qualitative/indeterminate rather than quantitative/measurable. It is thus highly-susceptible to semantic permutations that could extend rather than, as intended, expedite the siting of future nuclear facilities unlessmore » it also defines: a) Whose consent is needed?; and b) What constitutes consent? The following 'generic', radiation-risk- and societal-equity-based criteria address these questions: 1. Identify areas affected by projected radiation and other health risks from: a. The proposed nuclear facility (facility stakeholders); and b. The related nuclear-materials-transportation routes (transportation stakeholders); then 2. Surround each stakeholder area with a buffer zone and use this enlarged foot print to identify: a. Stakeholder hosts; and b. Areas not hosting any stakeholder category (interested parties). 3. Define 'consent-based' as being at least 60 percent of the 'population' in the respective stakeholder category and apply this yardstick to both 'in favor' and 'against' votes. Although criteria 1 and 2 also need facility-based definitions to make Key Element 1 measurable, the described siting approach, augmented by related facility-host incentives, would expedite the schedule and reduce the cost for achieving Key Elements 4-6 and 8, politics permitting. (authors)« less

Risk management study for the retired Hanford Site facilities: Qualitative risk evaluation for the retired Hanford Site facilities. Volume 3

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coles, G.A.; Shultz, M.V.; Taylor, W.E.

1993-09-01

This document provides a risk evaluation of the 100 and 200 Area retired, surplus facilities on the Hanford Site. Also included are the related data that were compiled by the risk evaluation team during investigations performed on the facilities. Results are the product of a major effort performed in fiscal year 1993 to produce qualitative information that characterizes certain risks associated with these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1,450-km{sup 2} (570-mi{sup 2}) Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State.more » The nearest population center is Richland, Washington, (population 32,000) 30-km (20 mi) southeast of the 200 Area. During walkdown investigations of these facilities, data on real and potential hazards that threatened human health or safety or created potential environmental release issues were identified by the risk evaluation team. Using these findings, the team categorized the identified hazards by facility and evaluated the risk associated with each hazard. The factors contributing to each risk, and the consequence and likelihood of harm associated with each hazard also are included in this evaluation.« less

Advanced Disease at Enrollment in HIV Care in Four Sub-Saharan African Countries: Change from 2006-2011 and Multi-Level Predictors in 2011

PubMed Central

Hoffman, Susie; Wu, Yingfeng; Lahuerta, Maria; Kulkarni, Sarah Gorrell; Nuwagaba-Biribonwoha, Harriet; Sadr, Wafaa El; Remien, Robert H.; Mugisha, Veronicah; Hawken, Mark; Chuva, Ema; Nash, Denis; Elul, Batya

2015-01-01

Objectives To examine changes between 2006 and 2011 in the proportion of HIV-positive patients newly-enrolled in HIV care with advanced disease and the median CD4+ cell count at enrollment; and identify patient-, facility-, and contextual-level factors associated with late enrollment in care in 2011. Design Cross sectional over time. Methods For time trends analyses, routinely-collected patient-level data (307,110 adults newly-enrolled in 138 HIV clinical care facilities) in Kenya, Mozambique, Rwanda and Tanzania; and for analyses of correlates, patient-level data (46,201 in 195 facilities), and facility- and population-level survey data were used. Late enrollment was defined as CD4+ count ≤350 cells/μl and/or WHO clinical stage 3/4. Results Late enrollment declined from 69.9% to 57.2%, (p<0.0001); median CD4+ count increased from 242 to 292 cells/μL (ptrend<0.0001). In 2011, risk of late enrollment was significantly higher for men and non-pregnant women vs. pregnant women; patients aged >25 vs. 15-25 years; non-married vs. married; and those entering from sites other than prevention of mother to child transmission (PMTCT). More extensive HIV testing coverage in the region of a facility was significantly associated with lower risk of late enrollment. Conclusions Despite improvement, in 2011, 57% of patients entered HIV care already ART-eligible. The lower risk of late enrollment among those referred from PMTCT and in regions where HIV testing coverage was higher suggests that innovative approaches to rapidly increase testing uptake among people living with HIV prior to the development of symptoms have the potential to reduce late enrollment in care. PMID:25136842

Environmental Risk Profiling of the Volta Delta, Ghana

NASA Astrophysics Data System (ADS)

Nyarko, B. K.; Appeaning-Addo, K.; Amisigo, B.

2017-12-01

Volta Delta communities find it difficult to absorb or bear risk at different levels, because of the physical and economic impacts of environmental hazards. In this regards various agencies and organizations have in recent years launched initiatives to measure and identify risk areas with a set of indicators and indices. The theory underpinning this study is concepts of Modern Portfolio Theory (MPT). The Cox proportional hazards regression model will be used as the model for the risk profile. Finding the optimal level of environmental risk for activities in the Volta Delta considering the risk required, risk capacity and risk tolerance. Using data from different sources, an environmental risk profile was developed for the Volta Delta. The result indicates that risks are distributed across the Delta. However, areas that have government interventions, such as sea defense system and irrigation facilities have less threat. In addition wealthy areas do effectively reduce the threat of any form of disaster.

Site-wide seismic risk model for Savannah River Site nuclear facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eide, S.A.; Shay, R.S.; Durant, W.S.

1993-09-01

The 200,000 acre Savannah River Site (SRS) has nearly 30 nuclear facilities spread throughout the site. The safety of each facility has been established in facility-specific safety analysis reports (SARs). Each SAR contains an analysis of risk from seismic events to both on-site workers and the off-site population. Both radiological and chemical releases are considered, and air and water pathways are modeled. Risks to the general public are generally characterized by evaluating exposure to the maximally exposed individual located at the SRS boundary and to the off-site population located within 50 miles. Although the SARs are appropriate methods for studyingmore » individual facility risks, there is a class of accident initiators that can simultaneously affect several of all of the facilities, Examples include seismic events, strong winds or tornados, floods, and loss of off-site electrical power. Overall risk to the off-site population from such initiators is not covered by the individual SARs. In such cases multiple facility radionuclide or chemical releases could occur, and off-site exposure would be greater than that indicated in a single facility SAR. As a step towards an overall site-wide risk model that adequately addresses multiple facility releases, a site-wide seismic model for determining off-site risk has been developed for nuclear facilities at the SRS. Risk from seismic events up to the design basis earthquake (DBE) of 0.2 g (frequency of 2.0E-4/yr) is covered by the model. Present plans include expanding the scope of the model to include other types of initiators that can simultaneously affect multiple facilities.« less

Impact of SMS/GPRS Printers in Reducing Time to Early Infant Diagnosis Compared With Routine Result Reporting: A Systematic Review and Meta-Analysis

PubMed Central

Markby, Jessica; Boeke, Caroline; Penazzato, Martina; Urick, Brittany; Ghadrshenas, Anisa; Harris, Lindsay; Ford, Nathan; Peter, Trevor

2017-01-01

Background: Despite significant gains made toward improving access, early infant diagnosis (EID) testing programs suffer from long test turnaround times that result in substantial loss to follow-up and mortality associated with delays in antiretroviral therapy initiation. These delays in treatment initiation are particularly impactful because of significant HIV-related infant mortality observed by 2–3 months of age. Short message service (SMS) and general packet radio service (GPRS) printers allow test results to be transmitted immediately to health care facilities on completion of testing in the laboratory. Methods: We conducted a systematic review and meta-analysis to assess the benefit of using SMS/GPRS printers to increase the efficiency of EID test result delivery compared with traditional courier paper–based results delivery methods. Results: We identified 11 studies contributing data for over 16,000 patients from East and Southern Africa. The test turnaround time from specimen collection to result received at the health care facility with courier paper–based methods was 68.0 days (n = 6835), whereas the test turnaround time with SMS/GPRS printers was 51.1 days (n = 6711), resulting in a 2.5-week (25%) reduction in the turnaround time. Conclusions: Courier paper–based EID test result delivery methods are estimated to add 2.5 weeks to EID test turnaround times in low resource settings and increase the risk that infants receive test results during or after the early peak of infant mortality. SMS/GPRS result delivery to health care facility printers significantly reduced test turnaround time and may reduce this risk. SMS/GPRS printers should be considered for expedited delivery of EID and other centralized laboratory test results. PMID:28825941

R2 TRI facilities with 1999-2011 risk related estimates throughout the census blockgroup

EPA Pesticide Factsheets

This dataset delineates the distribution of estimate risk from the TRI facilities for 1999 - 2011 throughout the census blockgroup of the region using Office of Pollution, Prevention & Toxics (OPPT)'s Risk-Screening Environmental Indicators model (RSEI). The model uses the reported quantities of TRI releases of chemicals to estimate the impacts associated with each type of air release or transfer by every TRI facility.The RSEI was run to generate the estimate risk for each TRI facility in the region. The result from the model is joined to the TRI spatial data. Estimate risk values for each census block group were calculated based on the inverse distance of all the facilities which are within a 50 km radius of the census block group centroid. The estimate risk value for each census block group thus is an aggregated value that takes into account the estimate potential risk of all the facilities within the searching radius (50km).

Tuberculosis Infection Control in Health-Care Facilities: Environmental Control and Personal Protection.

PubMed

Lee, Ji Yeon

2016-10-01

Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection.

Addressing Early Retention in Antenatal Care Among HIV-Positive Women Through a Simple Intervention in Kinshasa, DRC: The Elombe "Champion" Standard Operating Procedure.

PubMed

Gill, Michelle M; Ditekemena, John; Loando, Aimé; Mbonze, Nana; Bakualufu, Jo; Machekano, Rhoderick; Nyombe, Cady; Temmerman, Marleen; Fwamba, Franck

2018-03-01

This cluster-randomized study aimed to assess the Elombe ("Champion") standard operating procedure (SOP), implemented by providers and Mentor Mothers, on HIV-positive pregnant women's retention between first and second antenatal visits. Sixteen facilities in Kinshasa were randomly assigned to intervention (SOP) or comparison (no SOP). Effect of the SOP was estimated using relative risk. Women in comparison facilities were more likely to miss second visits (RR 2.5, 95% CI 1.05-5.98) than women in intervention facilities (30.0%, n = 27 vs. 12.0%, n = 9, p < 0.002). Findings demonstrate that a simple intervention can reduce critical early loss to care in PMTCT programs providing universal, lifelong treatment.

Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

PubMed Central

2014-01-01

Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews. Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications. At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs. PMID:25208539

Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership.

PubMed

Elwy, A Rani; Bokhour, Barbara G; Maguire, Elizabeth M; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Schiffner, Susan; Jesse, Robert L

2014-12-01

The Department of Veterans Affairs (VA) mandates disclosure of large-scale adverse events to patients, even if risk of harm is not clearly present. Concerns about past disclosures warranted further examination of the impact of this policy. Through a collaborative partnership between VA leaders, policymakers, researchers and stakeholders, the objective was to empirically identify critical aspects of disclosure processes as a first step towards improving future disclosures. Semi-structured interviews were conducted with participants at nine VA facilities where recent disclosures took place. Ninety-seven stakeholders participated in the interviews: 38 employees, 28 leaders (from facilities, regions and national offices), 27 Veteran patients and family members, and four congressional staff members. Facility and regional leaders were interviewed by telephone, followed by a two-day site visit where employees, patients and family members were interviewed face-to-face. National leaders and congressional staff also completed telephone interviews. Interviews were analyzed using rapid qualitative assessment processes. Themes were mapped to the stages of the Crisis and Emergency Risk Communication model: pre-crisis, initial event, maintenance, resolution and evaluation. Many areas for improvement during disclosure were identified, such as preparing facilities better (pre-crisis), creating rapid communications, modifying disclosure language, addressing perceptions of harm, reducing complexity, and seeking assistance from others (initial event), managing communication with other stakeholders (maintenance), minimizing effects on staff and improving trust (resolution), and addressing facilities' needs (evaluation). Through the partnership, five recommendations to improve disclosures during each stage of communication have been widely disseminated throughout the VA using non-academic strategies. Some improvements have been made; other recommendations will be addressed through implementation of a large-scale adverse event disclosure toolkit. These toolkit strategies will enable leaders to provide timely and transparent information to patients and families, while reducing the burden on employees and the healthcare system during these events.

Working conditions and public health risks in slaughterhouses in western Kenya.

PubMed

Cook, Elizabeth Anne Jessie; de Glanville, William Anson; Thomas, Lian Francesca; Kariuki, Samuel; Bronsvoort, Barend Mark de Clare; Fèvre, Eric Maurice

2017-01-05

Inadequate facilities and hygiene at slaughterhouses can result in contamination of meat and occupational hazards to workers. The objectives of this study were to assess current conditions in slaughterhouses in western Kenya and the knowledge, and practices of the slaughterhouse workers toward hygiene and sanitation. Between February and October 2012 all consenting slaughterhouses in the study area were recruited. A standardised questionnaire relating to facilities and practices in the slaughterhouse was administered to the foreperson at each site. A second questionnaire was used to capture individual slaughterhouse workers' knowledge, practices and recent health events. A total of 738 slaughterhouse workers from 142 slaughterhouses completed questionnaires. Many slaughterhouses had poor infrastructure, 65% (95% CI 63-67%) had a roof, cement floor and walls, 60% (95% CI 57-62%) had a toilet and 20% (95% CI 18-22%) had hand-washing facilities. The meat inspector visited 90% (95% CI 92-95%) of slaughterhouses but antemortem inspection was practiced at only 7% (95% CI 6-8%). Nine percent (95% CI 7-10%) of slaughterhouses slaughtered sick animals. Only half of workers wore personal protective clothing - 53% (95% CI 51-55%) wore protective coats and 49% (95% CI 46-51%) wore rubber boots. Knowledge of zoonotic disease was low with only 31% (95% CI 29-33%) of workers aware that disease could be transmitted from animals. The current working conditions in slaughterhouses in western Kenya are not in line with the recommendations of the Meat Control Act of Kenya. Current facilities and practices may increase occupational exposure to disease or injury and contaminated meat may enter the consumer market. The findings of this study could enable the development of appropriate interventions to minimise public health risks. Initially, improvements need to be made to facilities and practices to improve worker safety and reduce the risk of food contamination. Simultaneously, training programmes should target workers and inspectors to improve awareness of the risks. In addition, education of health care workers should highlight the increased risks of injury and disease in slaughterhouse workers. Finally, enhanced surveillance, targeting slaughterhouse workers could be used to detect disease outbreaks. This "One Health" approach to disease surveillance is likely to benefit workers, producers and consumers.

Death Associated with Inadequate Reassessment of Venous Thromboembolism Prophylaxis at and after Hospital Discharge.

PubMed

2015-01-01

Venous thromboembolism (VTE) prophylaxis, also known as thromboprophylaxis, reduces the risk of deep vein thrombosis, pulmonary embolism, and associated complications, including death, in high-risk patients. VTE prophylaxis is recommended for acutely ill, hospitalized medical patients at risk of thrombosis. Anticoagulants, the pharmacologic agents of choice to prevent VTE, are considered high-alert medications. By definition, therefore, anticoagulants bear a hightened risk of causing significant patient harm when they are used in error. As part of ongoing collaboration with a provincial death investigation service, ISMP Canada received a report of a fatal incident that involved continuation of VTE prophylaxis with enoxaparin for a patient discharge to a long-term care (LTC) facility from an acute care setting. The findings and recommendations from this case are charged to highlight the need to build routine reassessment of VTE prophylaxis into the process for discharging patients from the acute care setting and upon transfer to another facility or to primary care. The incident described in this bulletin highlights the importance of continually reassessing the need for VTE prophylaxis, especially at transitions of care, such as discharge from an acute care setting. Evidence and guidelines confirm the benefits of VTE prophylaxis in certain patients during a hospital stay for an acute illness, but the balance of benefits and risks may become unfavourable once the patient is discharged. Clear documentation from the acute care facility can assist the receiving facility and health-care providers, as well as family caregivers, when determining whether thromboprophylaxis is still warranted. Until clear guidance to continue thromboprophylaxis after acute care is available, health-care organizations and practitioners across the spectrum of care are urged to share and consider the strategies presented in this bulletin to ensure the safe use of VTE prophylaxis and improved communication among health-care providers. ISMP Canada will be integrating the learning from this case in an update of the Hospital-Self-Assessment for Anticoagulant Safety. This assessment is available on a complimentary basis to all facilities across Canada after sign up at HTTPS://mssa.ismp-canada.org/hsasas/.

Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies.

PubMed

Chinkhumba, Jobiba; De Allegri, Manuela; Muula, Adamson S; Robberstad, Bjarne

2014-09-28

Facility-based delivery has gained traction as a key strategy for reducing maternal and perinatal mortality in developing countries. However, robust evidence of impact of place of delivery on maternal and perinatal mortality is lacking. We aimed to estimate the risk of maternal and perinatal mortality by place of delivery in sub-Saharan Africa. We conducted a systematic review of population-based cohort studies reporting on risk of maternal or perinatal mortality at the individual level by place of delivery in sub-Saharan Africa. Newcastle-Ottawa Scale was used to assess study quality. Outcomes were summarized in pooled analyses using fixed and random effects models. We calculated attributable risk percentage reduction in mortality to estimate exposure effect. We report mortality ratios, crude odds ratios and associated 95% confidence intervals. We found 9 population-based cohort studies: 6 reporting on perinatal and 3 on maternal mortality. The mean study quality score was 10 out of 15 points. Control for confounders varied between the studies. A total of 36,772 pregnancy episodes were included in the analyses. Overall, perinatal mortality is 21% higher for home compared to facility-based deliveries, but the difference is only significant when produced with a fixed effects model (OR 1.21, 95% CI: 1.02-1.46) and not when produced by a random effects model (OR 1.21, 95% CI: 0.79-1.84). Under best settings, up to 14 perinatal deaths might be averted per 1000 births if the women delivered at facilities instead of homes. We found significantly increased risk of maternal mortality for facility-based compared to home deliveries (OR 2.29, 95% CI: 1.58-3.31), precluding estimates of attributable risk fraction. Evaluating the impact of facility-based delivery strategy on maternal and perinatal mortality using population-based studies is complicated by selection bias and poor control of confounders. Studies that pool data at an individual level may overcome some of these problems and provide better estimates of relative effectiveness of place of delivery in the region.

Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.

PubMed

Cakar, E; Dincer, U; Kiralp, M Z; Cakar, D B; Durmus, O; Kilac, H; Soydan, F C; Sevinc, S; Alper, C

2010-03-01

The objective of this study was to determine whether regular combined exercise program, which consists strength, stretching and aerobic exercises and additional jumping training, improve balance, fall risk, quality of life and depression status of older people living in a residential care. A total of 168 residents who live in a long term care facility were screened. The trial began with 78 eligible participants and they were randomly grouped as combined exercises program (COM) group that includes stretching, strength and aerobic exercises, and COM plus jumping (COMpJ) group. 66 of the participants finished the trial. The groups were convened three times a week for six weeks. Each group had a warm-up, effective training and a cooling down periods. The total exercising time was no longer than 45 minutes in each group. Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk, short form 36 (SF 36) for the health related quality of life and Geriatric Depression Scale (GDS) for evaluation of the depression status were used. The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial; however, the improvements were statistically better in jumping combined group. Also health related quality of life improved in both groups. Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement, fall risk reduction and quality of life. The addition of jumping to strength, stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction.

Organizational- and individual-level correlates of posttreatment substance use: a multilevel analysis.

PubMed

Ghose, Toorjo

2008-03-01

In addressing the need to study the effects of organizational factors on individual-level treatment outcomes, this study used hierarchical models to examine the organizational- and individual-level correlates of posttreatment substance use. Risk for posttreatment use varied significantly across organizations. Factors in the external institutional environment of facilities significantly influenced risk for use: managed care regulation increased the risk, whereas Joint Commission on the Accreditation of Healthcare Organizations accreditation decreased it (p < .01 for both). On the individual level, longer treatment episodes and treatment completion reduced the risk (p < .01 for both) after controlling for client characteristics. The benefits of length of stay in treatment were modified by elements of the external institutional environment and organizational treatment technology. The ameliorative effects of prolonged treatment were reduced by higher levels of managed care regulation, organizational monitoring, caseload size (p < .01 for all), and proportion of degreed staff (p < .05). The results highlight the influence of organizational factors on posttreatment use.

Minimum separation distances for natural gas pipeline and boilers in the 300 area, Hanford Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daling, P.M.; Graham, T.M.

1997-08-01

The U.S. Department of Energy (DOE) is proposing actions to reduce energy expenditures and improve energy system reliability at the 300 Area of the Hanford Site. These actions include replacing the centralized heating system with heating units for individual buildings or groups of buildings, constructing a new natural gas distribution system to provide a fuel source for many of these units, and constructing a central control building to operate and maintain the system. The individual heating units will include steam boilers that are to be housed in individual annex buildings located at some distance away from nearby 300 Area nuclearmore » facilities. This analysis develops the basis for siting the package boilers and natural gas distribution systems to be used to supply steam to 300 Area nuclear facilities. The effects of four potential fire and explosion scenarios involving the boiler and natural gas pipeline were quantified to determine minimum separation distances that would reduce the risks to nearby nuclear facilities. The resulting minimum separation distances are shown in Table ES.1.« less

Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility.

PubMed

Miller, Renee; Simmons, Sarah; Dale, Charles; Stachowiak, Julie; Stibich, Mark

2015-12-01

Health care-associated transmission of Clostridium difficile has been well documented in long-term acute care facilities. This article reports on 2 interventions aimed at reducing the transmission risk: multidisciplinary care teams and no-touch pulsed-xenon disinfection. C difficile transmission rates were tracked over a 39-month period while these 2 interventions were implemented. After a baseline period of 1 year, multidisciplinary teams were implemented for an additional 1-year period with a focus on reducing C difficile infection. During this time, transmission rates dropped 17% (P = .91). In the following 15-month period, the multidisciplinary teams continued, and pulsed-xenon disinfection was added as an adjunct to manual cleaning of patient rooms and common areas. During this time, transmission rates dropped 57% (P = .02). These results indicate that the combined use of multidisciplinary teams and pulsed-xenon disinfection can have a significant impact on C difficile transmission rates in long-term care facilities. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Who delivers where? The effect of obstetric risk on facility delivery in East Africa.

PubMed

Virgo, Sandra; Gon, Giorgia; Cavallaro, Francesca L; Graham, Wendy; Woodd, Susannah

2017-09-01

Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk. Demographic and Health Survey data for Kenya 2014, Rwanda 2014-15, Tanzania 2015-16 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three-level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery. We analysed data from 13 119 women across the four countries of whom 42-45% were considered at medium risk and 12-17% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59-66%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery. In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care. © 2017 John Wiley & Sons Ltd.

Facility-Level Characteristics Associated with Serious Suicide Attempts and Deaths from Suicide in Juvenile Justice Residential Facilities

ERIC Educational Resources Information Center

Gallagher, Catherine A.; Dobrin, Adam

2006-01-01

Little is known about how facility-level characteristics affect the risk of suicide and suicide attempts in juvenile justice residential facilities. This leaves facility administrators and mental health providers without evidence-based guidance on how the facility itself affects risks. The current study uses data from two recently developed…

Exposure to airborne fungi during sorting of recyclable plastics in waste treatment facilities.

PubMed

Černá, Kristýna; Wittlingerová, Zdeňka; Zimová, Magdaléna; Janovský, Zdeněk

2017-02-28

In working environment of waste treatment facilities, employees are exposed to high concentrations of airborne microorganisms. Fungi constitute an essential part of them. This study aims at evaluating the diurnal variation in concentrations and species composition of the fungal contamination in 2 plastic waste sorting facilities in different seasons. Air samples from the 2 sorting facilities were collected through the membrane filters method on 4 different types of cultivation media. Isolated fungi were classified to genera or species by using a light microscopy. Overall, the highest concentrations of airborne fungi were recorded in summer (9.1×10³-9.0×10⁵ colony-forming units (CFU)/m₃), while the lowest ones in winter (2.7×10³-2.9×10⁵ CFU/m³). The concentration increased from the beginning of the work shift and reached a plateau after 6-7 h of the sorting. The most frequently isolated airborne fungi were those of the genera Penicillium and Aspergillus. The turnover of fungal species between seasons was relatively high as well as changes in the number of detected species, but potentially toxigenic and allergenic fungi were detected in both facilities during all seasons. Generally, high concentrations of airborne fungi were detected in the working environment of plastic waste sorting facilities, which raises the question of health risk taken by the employees. Based on our results, the use of protective equipment by employees is recommended and preventive measures should be introduced into the working environment of waste sorting facilities to reduce health risk for employees. Med Pr 2017;68(1):1-9. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Dairy food supplementation may reduce malnutrition risk in institutionalised elderly.

PubMed

Iuliano, Sandra; Poon, Shirley; Wang, Xiaofang; Bui, Minh; Seeman, Ego

2017-01-01

Malnutrition in institutionalised elderly increases morbidity and care costs. Meat and dairy foods are high-quality protein sources so adequate intakes may reduce malnutrition risk. We aimed to determine whether inadequate intakes of meat and dairy foods contribute to malnutrition in institutionalised elderly. This cross-sectional study involved 215 elderly residents (70·2 % females, mean age 85·8 years) from twenty-one aged-care facilities in Melbourne, Australia. Dietary intake was assessed using observed plate waste. Food groups and serving sizes were based on the Australian Guide to Healthy Eating. Nutrient content was analysed using a computerised nutrient analysis software (Xyris). Malnutrition risk was assessed using the Mini Nutrition Assessment (MNA) tool; a score between 24 and 30 indicates normal nutritional status. Data were analysed using robust regression. Mean MNA score was 21·6 (sd 2·7). In total, 68 % of residents were malnourished or at risk of malnutrition (MNA score≤23·5). Protein intake was 87 (sd 28) % of the Australian recommended dietary intake (RDI). Consumption averaged 1 serving each of dairy foods and meat daily. Number of dairy and meat servings related to proportion of protein RDI (both P24 points). Provision of meat and dairy foods did not meet recommended levels. On the basis of current dietary intakes in aged-care residents, increasing consumption of dairy foods to the recommended four servings daily ensures protein adequacy and may reduce malnutrition risk in institutionalised elderly, and so reduce risk of comorbidities and costs associated with malnutrition.

Industrial Processes to Reduce Generation of Hazardous Waste at DoD Facilities. Phase III Report. Appendix B. Workshop Manual Innovative Hard Chrome Plating, Pensacola Naval Air Rework Facility, Pensacola, Florida.

DTIC Science & Technology

1985-12-01

The first cases of occupational health effects from hexa- 1. Chromium metals and alloys valent chromium were reported in 1827(2) by Cumin , who .. This...however, has reported an increase in lung Costa et ap4) in 1916 described chrome ulcers in tanners and other cancers in chrome platers in England. and... cancer risk. With the data 2.8 mg/m 3 (as Cr6). Levels of Cr6 in the form of chromi- available, however, this TLV provides an ade- urn trioxide, were

Non-therapeutic infant male circumcision

PubMed Central

Alkhenizan, Abdullah; Elabd, Kossay

2016-01-01

Objectives: To review the evidence of the benefits and harms of infant male circumcision, and the legal and ethical perspectives of infant male circumcision. Methods: We conducted a systematic search of the literature using PubMed, EMBASE, and the Cochrane library up to June 2015. We searched the medical law literature using the Westlaw and Lexis Library law literature resources up to June 2015. Results: Male circumcision significantly reduced the risk of urinary tract infections by 87%. It also significantly reduced transmission of human immunodeficiency virus among circumcised men by 70%. Childhood and adolescent circumcision is associated with a 66% reduction in the risk of penile cancer. Circumcision was associated with 43% reduction of human papilloma virus infection, and 58% reduction in the risk of cervical cancer among women with circumcised partners compared with women with uncircumcised partners. Male infant circumcision reduced the risk of foreskin inflammation by 68%. Conclusion: Infant male circumcision should continue to be allowed all over the world, as long as it is approved by both parents, and performed in facilities that can provide appropriate sterilization, wound care, and anesthesia. Under these conditions, the benefits of infant male circumcision outweigh the rare and generally minor potential harms of the procedure. PMID:27570848

Health risk assessment: WTE (waste-to-energy) vs. peanut butter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michaels, R.A.

1988-10-01

The degree to which society will come to accept potential health risks associated with municipal waste-to-energy plants depends on three factors: the reliability with which exposure and adverse health effects associated with facility emissions can be described, quantified, and gradually reduced; the relative magnitude of the risks compared with those of other waste management options, especially landfilling and recycling; and the relative magnitude of the risks compared with those of more familiar activities, such as driving, flying, smoking, and eating peanut butter sandwiches. Progress in risk assessment has already improved quantification of human exposure to emissions through the food chain,more » as well as through other pathways within the general categories of inhalation, ingestion, and dermal contact. Where does this progress leave municipal refuse incineration relative to other risks This article explores that issue.« less

Environmentally-Preferable Launch Coatings

NASA Technical Reports Server (NTRS)

Kessel, Kurt R.

2015-01-01

The Ground Systems Development and Operations (GSDO) Program at NASA Kennedy Space Center (KSC), Florida, has the primary objective of modernizing and transforming the launch and range complex at KSC to benefit current and future NASA programs along with other emerging users. Described as the launch support and infrastructure modernization program in the NASA Authorization Act of 2010, the GSDO Program will develop and implement shared infrastructure and process improvements to provide more flexible, affordable, and responsive capabilities to a multi-user community. In support of NASA and the GSDO Program, the objective of this project is to determine the feasibility of environmentally friendly corrosion protecting coatings for launch facilities and ground support equipment (GSE). The focus of the project is corrosion resistance and survivability with the goal to reduce the amount of maintenance required to preserve the performance of launch facilities while reducing mission risk. The project compares coating performance of the selected alternatives to existing coating systems or standards.

Overall Control on Solid Rocket Motor Hazard Zone: Example of VEGA an Innovative Solution at System Level

NASA Astrophysics Data System (ADS)

Vertueux, M.

2013-09-01

The arrival of additional Space launch vehicles Soyouz and Vega in Guiana Space Center facilities faced a new ground range safety major question: The technical hazards assessment and management related to the preparation of these three launchers simultaneously with the same high level of safety. The objective of this publication is to highlight the new safety solutions that are applied in CSG to reduce the risk of self-propulsion of the stages of VEGA launcher. During all the preparation campaign of VEGA launch vehicle, the explosive risk due to the use of solid propellant is permanent. Uncontrolled propulsion of a solid rocket motor is capable of destruction of other important installations with catastrophic effects. This event could cause loss of human lives and great damages to the CSG launch site structures. Early in the space program development phases of VEGA, the risk of self- propulsion of solid rocket motors and the solutions to avoid the "domino effects" on neighboring facilities have been issued as one of the major concern in term of safety.

Multi-objective reverse logistics model for integrated computer waste management.

PubMed

Ahluwalia, Poonam Khanijo; Nema, Arvind K

2006-12-01

This study aimed to address the issues involved in the planning and design of a computer waste management system in an integrated manner. A decision-support tool is presented for selecting an optimum configuration of computer waste management facilities (segregation, storage, treatment/processing, reuse/recycle and disposal) and allocation of waste to these facilities. The model is based on an integer linear programming method with the objectives of minimizing environmental risk as well as cost. The issue of uncertainty in the estimated waste quantities from multiple sources is addressed using the Monte Carlo simulation technique. An illustrated example of computer waste management in Delhi, India is presented to demonstrate the usefulness of the proposed model and to study tradeoffs between cost and risk. The results of the example problem show that it is possible to reduce the environmental risk significantly by a marginal increase in the available cost. The proposed model can serve as a powerful tool to address the environmental problems associated with exponentially growing quantities of computer waste which are presently being managed using rudimentary methods of reuse, recovery and disposal by various small-scale vendors.

RCRA Facility Investigation/Remedial Investigation Report with Baseline Risk Assessment for the Fire Department Hose Training Facility (904-113G)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palmer, E.

1997-04-01

This report documents the Resource Conservation and Recovery Act (RCRA) Facility Investigation/Remedial Investigation/Baseline Risk Assessment (RFI/RI/BRA) for the Fire Department Hose Training Facility (FDTF) (904-113G).

What Are Nursing Facilities Doing to Reduce Potentially Avoidable Hospitalizations?

PubMed

Daras, Laura Coots; Wang, Joyce M; Ingber, Melvin J; Ormond, Catherine; Breg, Nathaniel W; Khatutsky, Galina; Feng, Zhanlian

2017-05-01

Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. Cross-sectional survey. 236 nursing facilities from 7 states. Nursing facility administrators. Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Small Projects Rapid Integration and Test Environment (SPRITE): Application for Increasing Robustness

NASA Technical Reports Server (NTRS)

Rakoczy, John; Heater, Daniel; Lee, Ashley

2013-01-01

Marshall Space Flight Center's (MSFC) Small Projects Rapid Integration and Test Environment (SPRITE) is a Hardware-In-The-Loop (HWIL) facility that provides rapid development, integration, and testing capabilities for small projects (CubeSats, payloads, spacecraft, and launch vehicles). This facility environment focuses on efficient processes and modular design to support rapid prototyping, integration, testing and verification of small projects at an affordable cost, especially compared to larger type HWIL facilities. SPRITE (Figure 1) consists of a "core" capability or "plant" simulation platform utilizing a graphical programming environment capable of being rapidly re-configured for any potential test article's space environments, as well as a standard set of interfaces (i.e. Mil-Std 1553, Serial, Analog, Digital, etc.). SPRITE also allows this level of interface testing of components and subsystems very early in a program, thereby reducing program risk.

Single-Event Gate Rupture in Power MOSFETs: A New Radiation Hardness Assurance Approach

NASA Technical Reports Server (NTRS)

Lauenstein, Jean-Marie

2011-01-01

Almost every space mission uses vertical power metal-semiconductor-oxide field-effect transistors (MOSFETs) in its power-supply circuitry. These devices can fail catastrophically due to single-event gate rupture (SEGR) when exposed to energetic heavy ions. To reduce SEGR failure risk, the off-state operating voltages of the devices are derated based upon radiation tests at heavy-ion accelerator facilities. Testing is very expensive. Even so, data from these tests provide only a limited guide to on-orbit performance. In this work, a device simulation-based method is developed to measure the response to strikes from heavy ions unavailable at accelerator facilities but posing potential risk on orbit. This work is the first to show that the present derating factor, which was established from non-radiation reliability concerns, is appropriate to reduce on-orbit SEGR failure risk when applied to data acquired from ions with appropriate penetration range. A second important outcome of this study is the demonstration of the capability and usefulness of this simulation technique for augmenting SEGR data from accelerator beam facilities. The mechanisms of SEGR are two-fold: the gate oxide is weakened by the passage of the ion through it, and the charge ionized along the ion track in the silicon transiently increases the oxide electric field. Most hardness assurance methodologies consider the latter mechanism only. This work demonstrates through experiment and simulation that the gate oxide response should not be neglected. In addition, the premise that the temporary weakening of the oxide due to the ion interaction with it, as opposed to due to the transient oxide field generated from within the silicon, is validated. Based upon these findings, a new approach to radiation hardness assurance for SEGR in power MOSFETs is defined to reduce SEGR risk in space flight projects. Finally, the potential impact of accumulated dose over the course of a space mission on SEGR susceptibility is explored. SEGR evaluation of gamma-irradiated power MOSFETs suggests a non-significant SEGR susceptibility enhancement due to accumulated dose from gamma rays. During SEGR testing, an unexpected enhanced dose effect from heavy-ion irradiation was detected. We demonstrate that this effect could be due to direct ionization by two or more ions at the same channel location. The probability on-orbit for such an occurrence is near-zero given the low heavy-ion fluence over a typical mission lifetime, and did not affect SEGR susceptibility. The results of this work can be used to bound the risk of SEGR in power MOSFETs considered for insertion into spacecraft and instruments.

IPM Standards for Schools: A Program for Reducing Pest and Pesticide Risks in Schools and Other Sensitive Environments. Version 2.0.

ERIC Educational Resources Information Center

Green, Thomas A., Ed.

This guide presents Integrated Pest Management (IPM) practice standards for educational facilities to help schools become certified in providing effective and safe pest control. The guide is divided into two parts with three modules each for both buildings and grounds. The first module addresses building the IPM foundation to meet all legal…

Great Expectations: How to Ensure that Specified Door, Frame, Hardware and Access-Control Software Components Will Perform as Planned

ERIC Educational Resources Information Center

Vigue, Beverly

2006-01-01

The goal of an effective security program is to prevent vandalism, reduce the risk of personal violence, prevent direct or collateral damage to assets and facilities, preserve a safe and secure environment while limiting liability, and lower repair and maintenance costs. With the proper equipment it is possible to achieve all these things. A door…

Risk factors for cervical dysplasia in Kerala, India.

PubMed Central

Varghese, C.; Amma, N. S.; Chitrathara, K.; Dhakad, N.; Rani, P.; Malathy, L.; Nair, M. K.

1999-01-01

A study in Kerala, India, confirmed the importance of genital hygiene in the fight against infections that have a role in the development of cervical dysplasia and cancer. Many women cannot afford sanitary pads, while adequate facilities for washing after coitus are often unavailable. Health education, satisfactory living standards, and the empowerment of women are prerequisites for reducing the incidence of cervical dysplasia. PMID:10212523

Taking Risk Assessment and Management to the Next Level: Program-Level Risk Analysis to Enable Solid Decision-Making on Priorities and Funding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, J. G.; Morton, R. L.; Castillo, C.

2011-02-01

A multi-level (facility and programmatic) risk assessment was conducted for the facilities in the Nevada National Security Site (NNSS) Readiness in Technical Base and Facilities (RTBF) Program and results were included in a new Risk Management Plan (RMP), which was incorporated into the fiscal year (FY) 2010 Integrated Plans. Risks, risk events, probability, consequence(s), and mitigation strategies were identified and captured, for most scope areas (i.e., risk categories) during the facilitated risk workshops. Risk mitigations (i.e., efforts in addition to existing controls) were identified during the facilitated risk workshops when the risk event was identified. Risk mitigation strategies fell intomore » two broad categories: threats or opportunities. Improvement projects were identified and linked to specific risks they mitigate, making the connection of risk reduction through investments for the annual Site Execution Plan. Due to the amount of that was collected, analysis to be performed, and reports to be generated, a Risk Assessment/ Management Tool (RAMtool) database was developed to analyze the risks in real-time, at multiple levels, which reinforced the site-level risk management process and procedures. The RAMtool database was developed and designed to assist in the capturing and analysis of the key elements of risk: probability, consequence, and impact. The RAMtool calculates the facility-level and programmatic-level risk factors to enable a side-by-side comparison to see where the facility manager and program manager should focus their risk reduction efforts and funding. This enables them to make solid decisions on priorities and funding to maximize the risk reduction. A more active risk management process was developed where risks and opportunities are actively managed, monitored, and controlled by each facility more aggressively and frequently. risk owners have the responsibility and accountability to manage their assigned risk in real-time, using the RAMtool database.« less

The Healthy Teen Girls project: comparison of health education and STD risk reduction intervention for incarcerated adolescent females.

PubMed

Robertson, Angela A; Robertson, Angela R; St Lawrence, Janet; Morse, David T; Baird-Thomas, Connie; Liew, Hui; Gresham, Kathleen

2011-06-01

Adolescent girls incarcerated in a state reformatory (N = 246) were recruited and assigned to an 18-session health education program or a time-equivalent HIV prevention program. Cohorts were assigned to conditions using a randomized block design separated by a washout period to reduce contamination. Post intervention, girls in the HIV risk reduction program demonstrated the acquisition of risk-reduction behavioral skills and improved condom application skill. At a follow-up assessment approximately 9 months after release from the correctional facility, girls in both conditions reported fewer unprotected sexual intercourse occasions and less sex while under the influence of alcohol or other drugs.

Successful heel pressure ulcer prevention program in a long-term care setting.

PubMed

Lyman, Vicky

2009-01-01

Heel pressure ulcers (PUs) are common in long-term healthcare settings. Early identification of risk and the use of preventive measures are central to reducing the morbidity, mortality, and high medical costs associated with heel PUs. A Quality Improvement Process was initated based on a tailored protocol, in-service education program, and a heel protective device was approved by the US Food and Drug Administration. The Braden Scale was used to evaluate PU risk in 550 patients in a long-term healthcare facility. Patients with a Braden Scale score of 18 or less and with 1 of 7 high-risk comorbidities were considered at high risk for PUs, and this prompted a more aggressive prevention program that included a protocol for reducing the risk of heel ulceration. The number of hospital-acquired heel PUs during the 6-month preintervention period was 39. Following the intervention, there were 2 occurrences, representing a 95% reduction in heel ulcers between the 2 periods. After the cost of 2 heel protectors for 550 at-risk patients was subtracted from the estimated cost of treating the 37 heel ulcers prevented, the estimated cost savings was calculated to be between $12,400 and $1,048,400.

ART Attrition across Health Facilities Implementing Option B+ in Haiti.

PubMed

Myrtil, Martine Pamphile; Puttkammer, Nancy; Gloyd, Stephen; Robinson, Julia; Yuhas, Krista; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner

2018-01-01

Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti. We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients. There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition. Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.

R&D for a Soft X-Ray Free Electron Laser Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Corlett, John; Attwood, David; Byrd, John

2009-06-08

Several recent reports have identified the scientific requirements for a future soft x-ray light source, and a high-repetition-rate free-electron laser (FEL) facility that is responsive to these requirements is now on the horizon. R&D in some critical areas is needed, however, to demonstrate technical performance, thus reducing technical risks and construction costs. Such a facility most likely will be based on a CW superconducting linear accelerator with beam supplied by a high-brightness, high-repetition-rate photocathode electron gun operating in CW mode, and on an array of FELs to which the accelerated beam is distributed, each operating at high repetition rate andmore » with even pulse spacing. Dependent on experimental requirements, the individual FELs can be configured for either self-amplified spontaneous emission (SASE), seeded, or oscillator mode of operation, including the use of high-gain harmonic generation (HGHG), echo-enhanced harmonic generation (EEHG), harmonic cascade, or other configurations. In this White Paper we identify the overall accelerator R&D needs, and highlight the most important pre-construction R&D tasks required to value-engineer the design configuration and deliverables for such a facility. In Section 1.4 we identify the comprehensive R&D ultimately needed. We identify below the highest-priority requirements for understanding machine performance and reduce risk and costs at this pre-conceptual design stage. Details of implementing the required tasks will be the subject of future evaluation. Our highest-priority R&D program is the injector, which must be capable of delivering a beam with bunches up to a nanocoulomb at MHz repetition rate and with normalized emittance {le} 1 mm {center_dot} mrad. This will require integrated accelerating structure, cathode, and laser systems development. Cathode materials will impact the choice of laser technology in wavelength and energy per pulse, as well as vacuum requirements in the accelerating structure. Demonstration experiments in advanced seeding techniques, such as EEHG, and other optical manipulations to enhance the FEL process are required to reduce technical risk in producing temporally coherent and ultrashort x-ray output using optical seed lasers. Success of EEHG in particular would result in reduced development and cost of laser systems and accelerator hardware for seeded FELs. With a 1.5-2.5 GeV linac, FELs could operate in the VUV-soft x-ray range, where the actual beam energy will be determined by undulator technology; for example, to use the lower energy would require the use of advanced designs for which undulator R&D is needed. Significant reductions in both unit costs and accelerator costs resulting from the lower electron beam energy required to achieve lasing at a particular wavelength could be obtained with undulator development. Characterization of the wakefields of the vacuum chambers in narrow-gap undulators will be needed to minimize risk in ability to deliver close to transform limited pulses. CW superconducting RF technology for an FEL facility with short bunches at MHz rate and up to mA average current will require selection of design choices in cavity frequency and geometry, higher order mode suppression and power dissipation, RF power supply and distribution, accelerating gradient, and cryogenics systems. R&D is needed to define a cost and performance optimum. Developments in laser technology are proceeding at rapid pace, and progress in high-power lasers, harmonic generation, and tunable sources will need to be tracked.« less

Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities

PubMed Central

Aliabadi, Amir A.; Rogak, Steven N.; Bartlett, Karen H.; Green, Sheldon I.

2011-01-01

Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk. PMID:22162813

Preventing airborne disease transmission: review of methods for ventilation design in health care facilities.

PubMed

Aliabadi, Amir A; Rogak, Steven N; Bartlett, Karen H; Green, Sheldon I

2011-01-01

Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk.

Capacity planning for electronic waste management facilities under uncertainty: multi-objective multi-time-step model development.

PubMed

Poonam Khanijo Ahluwalia; Nema, Arvind K

2011-07-01

Selection of optimum locations for locating new facilities and decision regarding capacities at the proposed facilities is a major concern for municipal authorities/managers. The decision as to whether a single facility is preferred over multiple facilities of smaller capacities would vary with varying priorities to cost and associated risks such as environmental or health risk or risk perceived by the society. Currently management of waste streams such as that of computer waste is being done using rudimentary practices and is flourishing as an unorganized sector, mainly as backyard workshops in many cities of developing nations such as India. Uncertainty in the quantification of computer waste generation is another major concern due to the informal setup of present computer waste management scenario. Hence, there is a need to simultaneously address uncertainty in waste generation quantities while analyzing the tradeoffs between cost and associated risks. The present study aimed to address the above-mentioned issues in a multi-time-step, multi-objective decision-support model, which can address multiple objectives of cost, environmental risk, socially perceived risk and health risk, while selecting the optimum configuration of existing and proposed facilities (location and capacities).

Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.

PubMed

Nayak, Lina; Miyake, Kanae K; Leung, Jessica W T; Price, Elissa R; Liu, Yueyi I; Joe, Bonnie N; Sickles, Edward A; Thomas, William R; Lipson, Jafi A; Daniel, Bruce L; Hargreaves, Jonathan; Brenner, R James; Bassett, Lawrence W; Ojeda-Fournier, Haydee; Lindfors, Karen K; Feig, Stephen A; Ikeda, Debra M

2016-09-01

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management. © 2016 Wiley Periodicals, Inc.

Screening for Atrial Fibrillation in Patients ≥65 Years Using an Automatic Blood Pressure Monitor in a Skilled Nursing Facility.

PubMed

Wiesel, Joseph; Salomone, Thomas J

2017-10-15

Early detection of asymptomatic atrial fibrillation (AF) provides an opportunity to treat patients to reduce their risk of stroke. Long-term residents of skilled nursing facilities frequently have multiple risk factors for strokes due to AF and may benefit from screening for AF. Patients in a skilled nursing facility 65 years and older, without a history of AF and without a pacemaker or defibrillator, were evaluated using a Microlife WatchBP Home A automatic blood pressure monitor that can detect AF when set to a triple reading mode. Those with readings positive for AF were evaluated with a standard 12-lead electrocardiogram (ECG) or a 30-second single-channel ECG to confirm the presence of AF. A total of 101 patients were screened with an average age of 78 years, and 48 (48%) were female. Nine automatic blood pressure monitor readings were positive for possible AF. Of those, 7 (6.9%, 95% confidence intervals 3.0% to 14.2%) had AF confirmed with ECG. Only 2 (2%, 95% confidence interval 0.3% to 7.7%) were false-positive readings. One-time screening for AF using an automatic blood pressure monitor in a skilled nursing facility resulted in a high number of patients with newly diagnosed AF. Copyright © 2017 Elsevier Inc. All rights reserved.

6 CFR 27.200 - Information regarding security risk for a chemical facility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Information regarding security risk for a chemical facility. 27.200 Section 27.200 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.200 Information...

Analyses in support of risk-informed natural gas vehicle maintenance facility codes and standards :

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ekoto, Isaac W.; Blaylock, Myra L.; LaFleur, Angela Christine

2014-03-01

Safety standards development for maintenance facilities of liquid and compressed gas fueled large-scale vehicles is required to ensure proper facility design and operation envelopes. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase I work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest. Finally, scenario analyses were performed using detailed simulations and modeling to estimate the overpressure hazardsmore » from HAZOP defined scenarios. The results from Phase I will be used to identify significant risk contributors at NGV maintenance facilities, and are expected to form the basis for follow-on quantitative risk analysis work to address specific code requirements and identify effective accident prevention and mitigation strategies.« less

Risk assessment of CST-7 proposed waste treatment and storage facilities Volume I: Limited-scope probabilistic risk assessment (PRA) of proposed CST-7 waste treatment & storage facilities. Volume II: Preliminary hazards analysis of proposed CST-7 waste storage & treatment facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sasser, K.

1994-06-01

In FY 1993, the Los Alamos National Laboratory Waste Management Group [CST-7 (formerly EM-7)] requested the Probabilistic Risk and Hazards Analysis Group [TSA-11 (formerly N-6)] to conduct a study of the hazards associated with several CST-7 facilities. Among these facilities are the Hazardous Waste Treatment Facility (HWTF), the HWTF Drum Storage Building (DSB), and the Mixed Waste Receiving and Storage Facility (MWRSF), which are proposed for construction beginning in 1996. These facilities are needed to upgrade the Laboratory`s storage capability for hazardous and mixed wastes and to provide treatment capabilities for wastes in cases where offsite treatment is not availablemore » or desirable. These facilities will assist Los Alamos in complying with federal and state requlations.« less

Quantitative assessment of risk reduction from hand washing with antibacterial soaps.

PubMed

Gibson, L L; Rose, J B; Haas, C N; Gerba, C P; Rusin, P A

2002-01-01

The Centers for Disease Control and Prevention have estimated that there are 3,713,000 cases of infectious disease associated with day care facilities each year. The objective of this study was to examine the risk reduction achieved from using different soap formulations after diaper changing using a microbial quantitative risk assessment approach. To achieve this, a probability of infection model and an exposure assessment based on micro-organism transfer were used to evaluate the efficacy of different soap formulations in reducing the probability of disease following hand contact with an enteric pathogen. Based on this model, it was determined that the probability of infection ranged from 24/100 to 91/100 for those changing diapers of babies with symptomatic shigellosis who used a control product (soap without an antibacterial ingredient), 22/100 to 91/100 for those who used an antibacterial soap (chlorohexadine 4%), and 15/100 to 90/100 for those who used a triclosan (1.5%) antibacterial soap. Those with asymptomatic shigellosis who used a non-antibacterial control soap had a risk between 49/100,000 and 53/100, those who used the 4% chlorohexadine-containing soap had a risk between 43/100,000 and 51/100, and for those who used a 1.5% triclosan soap had a risk between 21/100,000 and 43/100. The adequate washing of hands after diapering reduces risk and can be further reduced by a factor of 20% by the use of an antibacterial soap. Quantitative risk assessment is a valuable tool in the evaluation of household sanitizing agents and low risk outcomes.

Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

PubMed Central

Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.

2012-01-01

Background Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 35% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. PMID:19815201

Nuclear Rocket Facility Decommissioning Project: Controlled Explosive Demolition of Neutron Activated Shield Wall

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michael R. Kruzic

2007-09-16

Located in Area 25 of the Nevada Test Site (NTS), the Test Cell A (TCA) Facility was used in the early to mid-1960s for the testing of nuclear rocket engines, as part of the Nuclear Rocket Development Program, to further space travel. Nuclear rocket testing resulted in the activation of materials around the reactors and the release of fission products and fuel particles in the immediate area. Identified as Corrective Action Unit 115, the TCA facility was decontaminated and decommissioned (D&D) from December 2004 to July 2005 using the Streamlined Approach for Environmental Restoration (SAFER) process, under the ''Federal Facilitymore » Agreement and Consent Order''. The SAFER process allows environmental remediation and facility closure activities (i.e., decommissioning) to occur simultaneously provided technical decisions are made by an experienced decision maker within the site conceptual site model, identified in the Data Quality Objective process. Facility closure involved a seven-step decommissioning strategy. Key lessons learned from the project included: (1) Targeted preliminary investigation activities provided a more solid technical approach, reduced surprises and scope creep, and made the working environment safer for the D&D worker. (2) Early identification of risks and uncertainties provided opportunities for risk management and mitigation planning to address challenges and unanticipated conditions. (3) Team reviews provided an excellent mechanism to consider all aspects of the task, integrated safety into activity performance, increase team unity and ''buy-in'' and promoted innovative and time saving ideas. (4) Development of CED protocols ensured safety and control. (5) The same proven D&D strategy is now being employed on the larger ''sister'' facility, Test Cell C.« less

Influence of 5 Different Caging Types and the Use of Cage-Changing Stations on Mouse Allergen Exposure

PubMed Central

Feistenauer, Susan; Sander, Ingrid; Schmidt, Jörg; Zahradnik, Eva; Raulf, Monika; Brielmeier, Markus

2014-01-01

Animal allergens constitute a serious health risk in laboratory animal facilities. To assess possibilities for allergen reduction by technical and organizational measures, we studied personnel exposure to mouse urinary aeroallergens in an animal facility with a holding capacity of 30,000 cages. Short-term (2 h) and intermediate-term (12 h) stationary samples (n = 107) and short-term (2 h) personnel samples (n = 119) were collected on polytetrafluorethylene filters by using air pumps. Long-term (14 d) stationary dust samples containing airborne allergens (n = 165) were collected with electrostatic dust fall collectors (EDC). Mouse allergens were quantified by ELISA. Personnel samples were collected during bedding disposal and refilling of clean cages as well as during cage changing with and without use of cage-changing station. Animal rooms were equipped with either open cages, cages with a soft filter top, cages with a rigid filter top (static microisolation caging), or with individually ventilated cages (IVC) with either a sealed or nonsealed lid, each in positive- or negative-pressure mode. Highest personnel allergen exposure was detected during cage change and emptying of soiled cages. Allergen concentrations were lowest in rooms with sealed IVC under positive or negative pressure, with unsealed IVC under negative pressure, and with static microisolation caging. The use of cage-changing stations and a vacuum bedding-disposal system reduced median personnel exposures 14- to 25-fold, respectively. Using sealed IVC and changing stations minimized allergen exposure, indicating that state-of-the-art equipment reduces exposure to mouse allergens and decreases health risks among animal facility personnel. PMID:25199090

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

PubMed

Kang, Yu; Meng, Hongdao; Miller, Nancy A

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Improved E-ELT subsystem and component specifications, thanks to M1 test facility

NASA Astrophysics Data System (ADS)

Dimmler, M.; Marrero, J.; Leveque, S.; Barriga, Pablo; Sedghi, B.; Kornweibel, N.

2014-07-01

During the last 2 years ESO has operated the "M1 Test Facility", a test stand consisting of a representative section of the E-ELT primary mirror equipped with 4 complete prototype segment subunits including sensors, actuators and control system. The purpose of the test facility is twofold: it serves to study and get familiar with component and system aspects like calibration, alignment and handling procedures and suitable control strategies on real hardware long before the primary mirror (hereafter M1) components are commissioned. Secondly, and of major benefit to the project, it offered the possibility to evaluate component and subsystem performance and interface issues in a system context in such detail, that issues could be identified early enough to feed back into the subsystem and component specifications. This considerably reduces risk and cost of the production units and allows refocusing the project team on important issues for the follow-up of the production contracts. Experiences are presented in which areas the results of the M1 Test Facility particularly helped to improve subsystem specifications and areas, where additional tests were adopted independent of the main test facility. Presented are the key experiences of the M1 Test Facility which lead to improved specifications or identified the need for additional testing outside of the M1 Test Facility.

Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS.

PubMed

Doran, Kelly; Resnick, Barbara; Kim, Natalie; Lynn, Donna; McCormick, Tyrell

2017-02-01

Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). The intervention is ongoing, but measures are described. As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.

Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities.

PubMed

O'Riley, Alisa; Nadorff, Michael R; Conwell, Yeates; Edelstein, Barry

2013-06-01

Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents' responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Greene, William D.

2017-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. During the ABEDRR effort, the Dynetics Team has modified flight-proven Apollo-Saturn F-1 engine components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the objectives of this work are to demonstrate combustion stability and measure performance of a 500,000 lbf class Oxidizer-Rich Staged Combustion (ORSC) cycle main injector. A trade study was completed to investigate the feasibility, cost effectiveness, and technical maturity of a domestically-produced engine that could potentially both replace the RD-180 on Atlas V and satisfy NASA SLS payload-to-orbit requirements via an advanced booster application. Engine physical dimensions and performance parameters resulting from this study provide the system level requirements for the ORSC risk reduction test article. The test article is scheduled to complete fabrication and assembly soon and continue testing through late 2019. Dynetics has also designed, developed, and built innovative tank and structure assemblies using friction stir welding to leverage recent NASA investments in manufacturing tools, facilities, and processes, significantly reducing development and recurring costs. The full-scale cryotank assembly was used to verify the structural design and prove affordable processes. Dynetics performed hydrostatic and cryothermal proof tests on the assembly to verify the assembly meets performance requirements..

Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.

PubMed

Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent

2018-06-05

To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.

Environmentally Preferable Coatings for Structural Steel Project

NASA Technical Reports Server (NTRS)

Lewis, Pattie L. (Editor)

2014-01-01

The Ground Systems Development and Operations (GSDO) Program at NASA John F. Kennedy Space Center (KSC) has the primary objective of modernizing and transforming the launch and range complex at KSC to benefit current and future NASA programs along with other emerging users. Described a the "launch support and infrastructure modernization program" in the NASA Authorization Act of 2010, the GSDO Program will develop and implement shared infrastructure and process improvements to provide more flexible, affordable, and responsive capabilities to a multi-user community. In support of the GSDO Program, the objective of this project is to determine the feasibility of environmentally friendly corrosion resistant coatings for launch facilities and ground support equipment. The focus of the project is corrosion resistance and survivability with the goal to reduce the amount of maintenance required to preserve the performance of launch facilities while reducing mission risk. Number of facilities/structures with metallic structural and non-structural components in a highly corrosive environment. Metals require periodic maintenance activity to guard against the insidious effects of corrosion and thus ensure that structures meet or exceed design or performance life. The standard practice for protecting metallic substrates in atmospheric environments is the application of corrosion protective coating system.

Identifying and Reducing Remaining Stocks of Rinderpest Virus

PubMed Central

Visser, Dawid; Evans, Brian; Vallat, Bernard

2015-01-01

In 2011, the world was declared free from rinderpest, one of the most feared and devastating infectious diseases of animals. Rinderpest is the second infectious disease, after smallpox, to have been eradicated. However, potentially infectious rinderpest virus material remains widely disseminated among research and diagnostic facilities across the world and poses a risk for disease recurrence should it be released. Member Countries of the World Organisation for Animal Health and the Food and Agricultural Organization of the United Nations are committed to destroying remaining stocks of infectious material or ensuring that it is stored under international supervision in a limited number of approved facilities. To facilitate this commitment and maintain global freedom from rinderpest, World Organisation for Animal Health Member Countries must report annually on rinderpest material held in their countries. The first official surveys, conducted during 2013–2015, revealed that rinderpest material was stored in an unacceptably high number of facilities and countries. PMID:26584400

Employing clinical decision support to attain our strategic goal: the safe care of the surgical patient.

PubMed

Magid, Steven K; Pancoast, Paul E; Fields, Theodore; Bradley, Diane G; Williams, Robert B

2007-01-01

Clinical decision support can be employed to increase patient safety and improve workflow efficiencies for physicians and other healthcare providers. Physician input into the design and deployment of clinical decision support systems can increase the utility of the alerts and reduce the likelihood of "alert fatigue." The Hospital for Special Surgery is a 146-bed orthopedic facility that performs approximately 18,000 surgeries a year Efficient work processes are a necessity. The facility began implementing a new electronic health record system in June 2005 and plan to go live in summer 2007. This article reports on some of the clinical decision support rules and alerts being incorporated into the facility's system in the following categories--high-risk, high-frequency scenarios, rules that provide efficiencies and value from the presciber perspective, and rules that relate to patient safety.

Evaluation of five years of nursing home inspection forms: structural and hygiene-related violation trends.

PubMed

Avery, Chris; Humphrey, Charles; Balany, Jo Anne

2014-11-01

Health inspections are performed at nursing homes to identify and reduce risk and to help maintain a safe environment for nursing home residents. The study described in this article aimed to identify the most frequent violations, types of violations (hygiene or structural), and repeat violations in nursing home facilities during health inspections; and to determine if the age of the facility influenced inspection scores. Nursing home health inspection forms (N = 131) completed between 2005 and 2011 in Pitt County, North Carolina, were analyzed. Results indicated that 60% of all violations were hygiene-related and could possibly be corrected without significant financial investments by management. Significant correlations occurred between the total number of violations and the facility age (p = .003) and between the number of repeat violations and total violations (p < .001). The average inspection score for nursing homes could be increased by more than three points if sanitation practices were improved.

Cost-effectiveness of essential newborn care training in urban first-level facilities.

PubMed

Manasyan, Albert; Chomba, Elwyn; McClure, Elizabeth M; Wright, Linda L; Krzywanski, Sara; Carlo, Waldemar A

2011-05-01

To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia. Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated. A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006. All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted. ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.

The design of a long range megatransport aircraft

NASA Technical Reports Server (NTRS)

Weisshaar, T. A.; Layton, J. B.; Allen, C. L.

1993-01-01

Megatransport objectives and constraints are briefly reviewed, and certain solutions developed by student design teams at Perdue University are summarized. Particular attention is given to the market needs and the economic risks involved in such a project; and the different approaches taken to solve the problem and difficulties faced by the design teams. A long range megatransport aircraft is aimed at carrying more than 600 passengers at reduced cost, and at the same time, reducing airport and airway congestion. The design effort must take into account airport terminal facilities; passenger loading and unloading; and defeating the 'square-cube' law to design large structures.

Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso.

PubMed

Tiono, Alfred B; Kaboré, Youssouf; Traoré, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B

2008-10-03

Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated. A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level. The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season. A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%-22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%-71.5%), respectively in the intervention and control arms (p < 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the health facility level. These findings suggest that implementation of HMM, by reducing the workload in health facilities, might contributes to an overall increase of the performance of the peripheral health facilities.

Nosocomial infections in geriatric long-term-care and rehabilitation facilities: exploration in the development of a risk index for epidemiological surveillance.

PubMed

Golliot, F; Astagneau, P; Cassou, B; Okra, N; Rothan-Tondeur, M; Brücker, G

2001-12-01

To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities. Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly. 248 geriatric units in 77 hospitals located in northern France. All hospital inpatients on the day of the survey were included. Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity. The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.

Motivation to Reduce Risk Behaviors While in Prison: Qualitative Analysis of Interviews with Current and Formerly Incarcerated Women

PubMed Central

Abad, Neetu; Carry, Monique; Herbst, Jeffrey H.; Fogel, Catherine I.

2015-01-01

Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women’s motivation to reduce risky behaviors during incarceration. In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. Analyses revealed key motivators of behavior change: Viewing prison as a place to recover from past trauma, removing oneself from negative social networks, gaining access to needed mental and physical health services, and engaging in self-care and self-reflection. Barriers to behavior change include fear of recidivism, stigma of being in prison, and return to undesirable social networks post-release. Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners. Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one’s commitment.—Nelson Mandela, 1995 PMID:26693183

Motivation to Reduce Risk Behaviors While in Prison: Qualitative Analysis of Interviews with Current and Formerly Incarcerated Women.

PubMed

Abad, Neetu; Carry, Monique; Herbst, Jeffrey H; Fogel, Catherine I

2013-10-01

Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women's motivation to reduce risky behaviors during incarceration. In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. Analyses revealed key motivators of behavior change: Viewing prison as a place to recover from past trauma, removing oneself from negative social networks, gaining access to needed mental and physical health services, and engaging in self-care and self-reflection. Barriers to behavior change include fear of recidivism, stigma of being in prison, and return to undesirable social networks post-release. Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners. Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one's commitment.-Nelson Mandela, 1995.

Preparation for Testing, Safe Packing and Shipping of Spent Nuclear Fuel from IFIN-HH, Bucharest-Magurele to Russian Federation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dragolici, C.A.; Zorliu, A.; Popa, V.

2007-07-01

The Russian Research Reactor Fuel Return (RRRFR) program is promoted by IAEA and DOE in order to repatriate of irradiated research reactor fuel originally supplied by Russia to facilities outside the country. Developed under the framework of the Global Threat Reduction Initiative (GTRI) the take-back program [1] common goal is to reduce both proliferation and security risks by eliminating or consolidating inventories of high-risk material. The main objective of this program is to support the return to Russian Federation of fresh or irradiated HEU and LEU fuel. Being part of this project, Romania is fulfilling its tasks by examining transportmore » and transfer cask options, assessment of transport routes, and providing cost estimates for required equipment and facility modifications. Spent Nuclear Fuel (SNF) testing, handling, packing and shipping are the most common interests on which the National Institute of Research and Development for Physics and Nuclear Engineering 'Horia Hulubei' (IFIN-HH) is focusing at the moment. (authors)« less

Methods of quantitative risk assessment: The case of the propellant supply system

NASA Astrophysics Data System (ADS)

Merz, H. A.; Bienz, A.

1984-08-01

As a consequence of the disastrous accident in Lapua (Finland) in 1976, where an explosion in a cartridge loading facility killed 40 and injured more than 70 persons, efforts were undertaken to examine and improve the safety of such installations. An ammunition factory in Switzerland considered the replacement of the manual supply of propellant hoppers by a new pneumatic supply system. This would reduce the maximum quantity of propellant in the hoppers to a level, where an accidental ignition would no longer lead to a detonation, and this would drastically limit the effects on persons. A quantitative risk assessment of the present and the planned supply system demonstrated that, in this particular case, the pneumatic supply system would not reduce the risk enough to justify the related costs. In addition, it could be shown that the safety of the existing system can be improved more effectively by other safety measures at considerably lower costs. Based on this practical example, the advantages of a strictly quantitative risk assessment for the safety planning in explosives factories are demonstrated. The methodological background of a risk assessment and the steps involved in the analysis are summarized. In addition, problems of quantification are discussed.

6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Determination that a chemical facility âpresents a high level of security risk.â 27.205 Section 27.205 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security...

Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial.

PubMed

Wiggers, John; McElwaine, Kathleen; Freund, Megan; Campbell, Libby; Bowman, Jenny; Wye, Paula; Wolfenden, Luke; Tremain, Danika; Barker, Daniel; Slattery, Carolyn; Gillham, Karen; Bartlem, Kate

2017-08-22

Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision. Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.

Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE).

PubMed

Nanda, Sudip; Dey, Tanujit; Gulstrand, Rudolph E; Cudnik, Daniel; Haller, Harold S

2011-02-01

The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric inpatients and develop a screening tool to accurately predict falls. The study sample consisted of 225 geriatric-psychiatric inpatients at a Midwestern referral facility. The sample included 136 inpatients who fell and a random stratified sample of 89 inpatients who did not fall. Data collected included age, gender, activities of daily living, and nursing parameters such as bathing assistance, bed height, use of bed rails, one-on-one observation, fall warning system, Conley Scale fall risk assessment, medical diagnosis, and medications. History of falls, impaired judgment, impaired gait, dizziness, delusions, delirium, chronic use of sedative or antipsychotic agents, and anticholinergic urinary bladder medications significantly increased fall risk. Alzheimer's disease, acute use of sedative or anti-psychotic agents, and depression reduced fall risk. A falls risk tool, Fall Risk Assessment in Geriatric-psychiatric Inpatients to Lower Events (FRAGILE), was developed for assessment and risk stratification with new diagnoses or medications. Copyright 2011, SLACK Incorporated.

Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

PubMed

Lee, Seon Heui; Kim, Hee Sun

2017-02-01

Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings. © 2016 Sigma Theta Tau International.

Safety skills of mental health workers: empirical evidence of a risk management strategy.

PubMed

Flannery, Raymond B; Walker, Andrew P

2003-01-01

To reduce violence in the workplace, health care facilities invest time and resources in risk management strategies such as photo identification and controlled access and surveillance. Studies of assaultive psychiatric patients continue to document that mental health workers (MHWs) are the most frequent targets of the patient violence. Unexamined in these findings is the role skilled MHWs contribute in restoring safety and order in the aftermath of these assaults. This six-year, empirical retrospective study examined the safety skills of MHWs in containing violence. Although they were 28% of the workforce, MHWs restored order in the majority of single assault incidents and restraint procedures. Their skills appear to be a risk management strategy in their own right. The implications are discussed.

Killing of Campylobacter on contaminated plastic and wooden cutting boards by glycerol monocaprate (monocaprin).

PubMed

Thormar, H; Hilmarsson, H

2010-09-01

Contamination in the kitchen with foodborne bacteria is a risk factor in human exposure to these pathogens, an important route being transfer of bacteria from contaminated cutting boards and other surfaces to humans. The aim of this study was to test microbicidal emulsions of glycerol monocaprate (monocaprin) against Campylobacter on contaminated cutting boards. Plastic and wooden cutting boards, soiled with meat juice heavily contaminated with Campylobacter, were treated for 2 min with emulsions of monocaprin (MC) made in water or in buffer at low pH. Viable Campylobacter counts were reduced below the detectable level on plastic board surfaces after treatment with MC emulsions with or without 1.25% washing-up liquids (WUL). The counts were also greatly reduced on wooden boards (P < 0.05). Monocaprin emulsions and mixtures of MC emulsions and WUL may be useful as sanitizers/disinfectants in kitchens and in other food preparing and processing facilities. Cleaning with MC emulsions with or without WUL may reduce the risk of human exposure to Campylobacter.

Life cycle cost-based risk model for energy performance contracting retrofits

NASA Astrophysics Data System (ADS)

Berghorn, George H.

Buildings account for 41% of the primary energy consumption in the United States, nearly half of which is accounted for by commercial buildings. Among the greatest energy users are those in the municipalities, universities, schools, and hospitals (MUSH) market. Correctional facilities are in the upper half of all commercial building types for energy intensity. Public agencies have experienced reduced capital budgets to fund retrofits; this has led to the increased use of energy performance contracts (EPC), which are implemented by energy services companies (ESCOs). These companies guarantee a minimum amount of energy savings resulting from the retrofit activities, which in essence transfers performance risk from the owner to the contractor. Building retrofits in the MUSH market, especially correctional facilities, are well-suited to EPC, yet despite this potential and their high energy intensities, efficiency improvements lag behind that of other public building types. Complexities in project execution, lack of support for data requests and sub-metering, and conflicting project objectives have been cited as reasons for this lag effect. As a result, project-level risks must be understood in order to support wider adoption of retrofits in the public market, in particular the correctional facility sub-market. The goal of this research is to understand risks related to the execution of energy efficiency retrofits delivered via EPC in the MUSH market. To achieve this goal, in-depth analysis and improved understanding was sought with regard to ESCO risks that are unique to EPC in this market. The proposed work contributes to this understanding by developing a life cycle cost-based risk model to improve project decision making with regard to risk control and reduction. The specific objectives of the research are: (1) to perform an exploratory analysis of the EPC retrofit process and identify key areas of performance risk requiring in-depth analysis; (2) to construct a framework describing the sources of and mitigation strategies employed for assessing key risks in EPC retrofits; (3) to develop a strategy for analyzing and evaluating risks for EPC retrofits focused on managing expected costs throughout the project life cycle, and use data collected through this strategy to develop and parameterize a risk model; and (4) to demonstrate the applicability of the proposed life cost-based risk model through a pilot application to a case study site. Five major contributions to the body of knowledge resulting from the research include: (1) a consensus-based assessment of ESCO risk management; (2) characterization of EPC retrofit risks borne by ESCOs; (3) an empirical evaluation of scenario failure mode and effects analysis and its application to this domain; (4) development and pilot application of a life cycle cost-based risk model; and (5) future expansion of the research approach to other domains. The researcher envisions that full implementation of the research will further encourage the growth of the energy services industry, and support focused retrofits in complex building types that typically can benefit the most from such work. Ultimately, this will reduce the energy consumption of public sector buildings to levels that are more fitting with the global principles of sustainability and responsible management of constrained resources.

Risk factors associated with traffic violations and accident severity in China.

PubMed

Zhang, Guangnan; Yau, Kelvin K W; Chen, Guanghan

2013-10-01

With the recent economic boom in China, vehicle volume and the number of traffic accident fatalities have become the highest in the world. Meanwhile, traffic accidents have become the leading cause of death in China. Systematically analyzing road safety data from different perspectives and applying empirical methods/implementing proper measures to reduce the fatality rate will be an urgent and challenging task for China in the coming years. In this study, we analyze the traffic accident data for the period 2006-2010 in Guangdong Province, China. These data, extracted from the Traffic Management Sector-Specific Incident Case Data Report, are the only officially available and reliable source of traffic accident data (with a sample size>7000 per year). In particular, we focus on two outcome measures: traffic violations and accident severity. Human, vehicle, road and environmental risk factors are considered. First, the results establish the role of traffic violations as one of the major risks threatening road safety. An immediate implication is: if the traffic violation rate could be reduced or controlled successfully, then the rate of serious injuries and fatalities would be reduced accordingly. Second, specific risk factors associated with traffic violations and accident severity are determined. Accordingly, to reduce traffic accident incidence and fatality rates, measures such as traffic regulations and legislation-targeting different vehicle types/driver groups with respect to the various human, vehicle and environment risk factors-are needed. Such measures could include road safety programs for targeted driver groups, focused enforcement of traffic regulations and road/transport facility improvements. Data analysis results arising from this study will shed lights on the development of similar (adjusted) measures to reduce traffic violations and/or accident fatalities and injuries, and to promote road safety in other regions. Copyright © 2013 Elsevier Ltd. All rights reserved.

The potential of volunteers to implement non-pharmacological interventions to reduce agitation associated with dementia in nursing home residents.

PubMed

van der Ploeg, Eva S; Mbakile, Tapiwa; Genovesi, Sandra; O'Connor, Daniel W

2012-11-01

Advanced dementia may be accompanied by behavioral and psychological symptoms of dementia (BPSD). BPSD stemming from pain, depression, or psychosis benefit from treatment with drugs, but in other cases, medications have limited efficacy and may elicit adverse effects. Therefore, more attention has been paid to non-pharmacological interventions, which have fewer risks and can be successful in reducing agitation and negative mood. However, these interventions are frequently not implemented in nursing homes due to staffing constraints. This study explores the potential of volunteers to further assist staff. We interviewed 18 staff members and 39 volunteers in 17 aged care facilities in southeast Melbourne, Australia. Three-quarters of the facilities in this region worked with at least one regular volunteer. Both self-interest and altruistic reasons were identified as motives for volunteering. Volunteers were perceived by facility representatives as helpful to residents through provision of stimulation and company. However, they were discouraged from engaging with individuals with prominent BPSD. A majority of facility representatives and volunteers had experienced some difficulties in negotiating working relationships but most were easily resolved. A large majority of volunteers expressed an interest in learning new methods of interacting with residents. Despite their beneficial effects for agitated residents, non-pharmacological interventions are often not implemented in aged care facilities. Staff members often lack time but current volunteers in the sector are available, experienced, and interested in learning new methods of interacting. Volunteers therefore potentially are a valuable resource to assist with the application of new treatments.

Escherichia coli O157:H7 in beef cattle: on farm contamination and pre-slaughter control methods.

PubMed

Soon, J M; Chadd, S A; Baines, R N

2011-12-01

This paper addresses food safety in beef cattle production, with particular emphasis on factors that affect the prevalence of Escherichia coli O157:H7 in beef cattle and on control methods that have been investigated. Product recalls and foodborne diseases due to this organism continue to occur even though control measures have been under investigation for over 20 years. Most meatborne outbreaks are due to improper food handling practices and consumption of undercooked meat. However, the majority of pathogenic bacteria that can spread at slaughter by cross-contamination can be traced back to the farm rather than originating from the slaughter plant. This would ideally require the adoption of rigorous on-farm intervention strategies to mitigate risks at the farm level. On-farm strategies to control and reduce E. coli O157:H7 at the farm level will reduce the risk of carcass contamination at slaughter and processing facilities although they will not eliminate E. coli O157:H7. The most successful strategy for reducing the risk of contamination of beef and beef products will involve the implementation of both pre- and post-harvest measures.

An exercise trial targeting African-American women with metabolic syndrome and at high risk for breast cancer: Rationale, design, and methods.

PubMed

Dash, Chiranjeev; Makambi, Kepher; Wallington, Sherrie F; Sheppard, Vanessa; Taylor, Teletia R; Hicks, Jennifer S; Adams-Campbell, Lucile L

2015-07-01

Metabolic syndrome and obesity are known risk factors for breast cancers. Exercise interventions can potentially modify circulating biomarkers of breast cancer risk but evidence in African-Americans and women with metabolic syndrome is lacking. The Focused Intervention on Exercise to Reduce CancEr (FIERCE) trial is a prospective, 6-month, 3-arm, randomized controlled trial to examine the effect of exercise on obesity, metabolic syndrome components, and breast cancer biomarkers among African-American women at high risk of breast cancer. Two hundred-forty inactive women with metabolic syndrome and absolute risk of breast cancer ≥ 1.40 will be randomized to one of the three trial arms: 1) a supervised, facility-based exercise arm; 2) a home-based exercise arm; and 3) a control group that maintains physical activity levels through the course of the trial. Assessments will be conducted at baseline, 3 months, and 6 months. The primary outcome variables are anthropometric indicators of obesity, metabolic syndrome components, and inflammatory, insulin-pathway, and hormonal biomarkers of breast cancer risk. The FIERCE trial will provide evidence on whether a short-term exercise intervention might be effective in reducing breast cancer risk among African-American women with comorbidities and high breast cancer risk--a group traditionally under-represented in non-therapeutic breast cancer trials. NCT02103140. Copyright © 2015. Published by Elsevier Inc.

Water pollution risk associated with natural gas extraction from the Marcellus Shale.

PubMed

Rozell, Daniel J; Reaven, Sheldon J

2012-08-01

In recent years, shale gas formations have become economically viable through the use of horizontal drilling and hydraulic fracturing. These techniques carry potential environmental risk due to their high water use and substantial risk for water pollution. Using probability bounds analysis, we assessed the likelihood of water contamination from natural gas extraction in the Marcellus Shale. Probability bounds analysis is well suited when data are sparse and parameters highly uncertain. The study model identified five pathways of water contamination: transportation spills, well casing leaks, leaks through fractured rock, drilling site discharge, and wastewater disposal. Probability boxes were generated for each pathway. The potential contamination risk and epistemic uncertainty associated with hydraulic fracturing wastewater disposal was several orders of magnitude larger than the other pathways. Even in a best-case scenario, it was very likely that an individual well would release at least 200 m³ of contaminated fluids. Because the total number of wells in the Marcellus Shale region could range into the tens of thousands, this substantial potential risk suggested that additional steps be taken to reduce the potential for contaminated fluid leaks. To reduce the considerable epistemic uncertainty, more data should be collected on the ability of industrial and municipal wastewater treatment facilities to remove contaminants from used hydraulic fracturing fluid. © 2012 Society for Risk Analysis.

Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting.

PubMed

Thomas, Dan; Pavic, Andrea; Bisaccia, Erin; Grotts, Jonathan

2016-09-01

To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Retrospective validation study. The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3 days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling. © 2015 Association of Rehabilitation Nurses.

Medicare Advantage Members' Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services.

PubMed

Keohane, Laura M; Grebla, Regina C; Mor, Vincent; Trivedi, Amal N

2015-06-01

Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans' expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare Advantage Members’ Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services

PubMed Central

Keohane, Laura M.; Grebla, Regina C.; Mor, Vincent; Trivedi, Amal N.

2015-01-01

Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans’ expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing. PMID:26056208

Analysis of local acceptance of a radioactive waste disposal facility.

PubMed

Chung, Ji Bum; Kim, Hong-Kew; Rho, Sam Kew

2008-08-01

Like many other countries in the world, Korea has struggled to site a facility for radioactive waste for almost 30 years because of the strong opposition from local residents. Finally, in 2005, Gyeongju was established as the first Korean site for a radioactive waste facility. The objectives of this research are to verify Gyeongju citizens' average level of risk perception of a radioactive waste disposal facility as compared to other risks, and to explore the best model for predicting respondents' acceptance level using variables related to cost-benefit, risk perception, and political process. For this purpose, a survey is conducted among Gyeongju residents, the results of which are as follows. First, the local residents' risk perception of an accident in a radioactive waste disposal facility is ranked seventh among a total of 13 risks, which implies that nuclear-related risk is not perceived very highly by Gyeongju residents; however, its characteristics are still somewhat negative. Second, the comparative regression analyses show that the cost-benefit and political process models are more suitable for explaining the respondents' level of acceptance than the risk perception model. This may be the result of the current economic depression in Gyeongju, residents' familiarity with the nuclear industry, or cultural characteristics of risk tolerance.

Assessing cow-calf welfare. Part 2: Risk factors for beef cow health and behavior and stockperson handling.

PubMed

Simon, G E; Hoar, B R; Tucker, C B

2016-08-01

Epidemiological studies can be used to identify risk factors for livestock welfare concerns but have not been conducted in the cow-calf sector for this purpose. The objectives of this study were to investigate the relationships of 1) herd-level management, facilities, and producer perspectives with cattle health and behavior and stockperson handling and 2) stockperson handling on cattle behavior at the individual cow level. Cow ( = 3,065) health and behavior and stockperson handling during a routine procedure (e.g., pregnancy checks) were observed on 30 California ranches. Management and producer perspectives were evaluated using an interview, and handling facility features were recorded at the chute. After predictors were screened for univariable associations, multivariable models were built for cattle health (i.e., thin body condition, lameness, abrasions, hairless patches, swelling, blind eyes, and dirtiness) and behavior (i.e., balking, vocalizing, stumbling and falling in the chute and while exiting the restraint, and running out of the restraint) and stockperson handling (i.e., electric prod use, moving aid use, tail twisting, and mis-catching cattle). When producers empathized more toward an animal's pain experience, there was a lower risk of swelling (odds ratio [OR] = 0.7) but a higher risk of lameness (OR = 1.3), which may indicate a lack of awareness of the latter. Training stockpersons using the Beef Quality Assurance program had a protective effect on cow cleanliness and mis-catching in the restraint (OR = 0.2 and OR = 0.5, respectively). Hydraulic chutes increased the risk of vocalizations (OR = 2.7), possibly because these systems can apply greater pressure to the sides of the animal than manual restraints. When a moving aid was used to move an individual cow, it increased the risk of her balking, but when hands, in particular, were used, the risk of balking decreased across the herd (OR = 34.1 and OR = 0.3, respectively). Likewise, individual cows were at a greater risk of balking, vocalizing, stumbling and falling in the chute, and stumbling and running at exit when they were touched with an electric prod (OR = 11.0, OR = 3.3, OR = 1.9, OR = 2.3, OR = 1.8, and OR = 1.7, respectively). Although the implications of using moving aids are unclear, reducing the use of electric prods could improve cattle handling. In conclusion, cattle handling was influenced by a number of facility and stockperson factors: personnel training, facility design, and electric prod use are key areas for future improvements.

Achieving Effective Risk Management Reduction Throughout Decommissioning at the Columbus Closure Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson, K.D.

2006-07-01

Nuclear facility decontamination, dismantlement, and demolition activities provide a myriad of challenges along the path to reaching a safe, effective, and compliant decommissioning. Among the challenges faced during decommissioning, is the constant management and technical effort to eliminate, mitigate, or minimize the potential of risks of radiation exposures and other hazards to the worker, the surrounding community, and the environment. Management strategies to eliminate, mitigate, or minimize risks include incorporating strong safety and As Low As Reasonably Achievable (ALARA) principles into an integrated work planning process. Technical and operational strategies may include utilizing predictive risk analysis tools to establish contaminationmore » limits for demolition and using remote handling equipment to reduce occupational and radiation exposures to workers. ECC and E2 Closure Services, LLC (Closure Services) have effectively utilized these management and technical tools to eliminate, mitigate, and reduce radiation exposures under contract to the U.S. Department of Energy (DOE) for the decontamination and decommissioning Columbus Closure Project (CCP). In particular, Closure Services achieved significant dose reduction during the dismantling, decontamination, and demolition activities for Building JN-1. Management strategies during the interior dismantlement, decontamination, and demolition of the facility demanded an integrated work planning processes that involved project disciplines. Integrated planning processes identified multiple opportunities to incorporate the use of remote handling equipment during the interior dismantling and demolition activities within areas of high radiation. Technical strategies employed predictive risk analysis tools to set upper bounding contamination limits, allowed for the radiological demolition of the building without exceeding administrative dose limits to the worker, general public, and the environment. Adhering to management and technical strategies during the dismantlement, decontamination, and demolition of Building JN-1 enabled Closure Services to achieve strong ALARA performance, maintain absolute compliance under the regulatory requirements and meeting licensing conditions for decommissioning. (authors)« less

Cancer risks near nuclear facilities: the importance of research design and explicit study hypotheses.

PubMed

Wing, Steve; Richardson, David B; Hoffmann, Wolfgang

2011-04-01

In April 2010, the U.S. Nuclear Regulatory Commission asked the National Academy of Sciences to update a 1990 study of cancer risks near nuclear facilities. Prior research on this topic has suffered from problems in hypothesis formulation and research design. We review epidemiologic principles used in studies of generic exposure-response associations and in studies of specific sources of exposure. We then describe logical problems with assumptions, formation of testable hypotheses, and interpretation of evidence in previous research on cancer risks near nuclear facilities. Advancement of knowledge about cancer risks near nuclear facilities depends on testing specific hypotheses grounded in physical and biological mechanisms of exposure and susceptibility while considering sample size and ability to adequately quantify exposure, ascertain cancer cases, and evaluate plausible confounders. Next steps in advancing knowledge about cancer risks near nuclear facilities require studies of childhood cancer incidence, focus on in utero and early childhood exposures, use of specific geographic information, and consideration of pathways for transport and uptake of radionuclides. Studies of cancer mortality among adults, cancers with long latencies, large geographic zones, and populations that reside at large distances from nuclear facilities are better suited for public relations than for scientific purposes.

Risky Sex in High-Risk Adolescents: Associations with Alcohol Use, Marijuana Use, and Co-Occurring Use.

PubMed

Gillman, Arielle S; Yeater, Elizabeth A; Feldstein Ewing, Sarah W; Kong, Alberta S; Bryan, Angela D

2018-04-01

Risky sexual behavior and substance use appear to be interconnected behaviors among adolescents, but data are scarce regarding the extent to which sexual risk behavior is associated with high levels of marijuana and alcohol use, both separately and in combination. 301 adolescents were recruited from a short-term detention facility, and substance use and risky sexual behavior were assessed. We found that adolescents who frequently used marijuana, but not alcohol, reported significantly less risky sex as well as greater intentions to use condoms than either adolescents who frequently used alcohol, but not marijuana, or adolescents who frequently used both substances. Substance use status as a predictor of future risky sexual behavior followed a similar pattern. When designing interventions to reduce substance use in the context of risky sex, it might be especially effective to target efforts toward reducing harm associated with alcohol use, either alone or in combination with marijuana use.

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

PubMed

D'Alton, Mary E; Friedman, Alexander M; Smiley, Richard M; Montgomery, Douglas M; Paidas, Michael J; D'Oria, Robyn; Frost, Jennifer L; Hameed, Afshan B; Karsnitz, Deborah; Levy, Barbara S; Clark, Steven L

2016-10-01

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.

Vulnerability assessment of chemical industry facilities in South Korea based on the chemical accident history

NASA Astrophysics Data System (ADS)

Heo, S.; Lee, W. K.; Jong-Ryeul, S.; Kim, M. I.

2016-12-01

The use of chemical compounds are keep increasing because of their use in manufacturing industry. Chemical accident is growing as the consequence of the chemical use increment. Devastating damages from chemical accidents are far enough to aware people's cautious about the risk of the chemical accident. In South Korea, Gumi Hydrofluoric acid leaking accident triggered the importance of risk management and emphasized the preventing the accident over the damage reducing process after the accident occurs. Gumi accident encouraged the government data base construction relate to the chemical accident. As the result of this effort Chemical Safety-Clearing-house (CSC) have started to record the chemical accident information and damages according to the Harmful Chemical Substance Control Act (HCSC). CSC provide details information about the chemical accidents from 2002 to present. The detail informations are including title of company, address, business type, accident dates, accident types, accident chemical compounds, human damages inside of the chemical industry facilities, human damage outside of the chemical industry facilities, financial damages inside of the chemical industry facilities, and financial damages outside of the chemical industry facilities, environmental damages and response to the chemical accident. Collected the chemical accident history of South Korea from 2002 to 2015 and provide the spatial information to the each accident records based on their address. With the spatial information, compute the data on ArcGIS for the spatial-temporal analysis. The spatial-temporal information of chemical accident is organized by the chemical accident types, damages, and damages on environment and conduct the spatial proximity with local community and environmental receptors. Find the chemical accident vulnerable area of South Korea from 2002 to 2015 and add the vulnerable area of total period to examine the historically vulnerable area from the chemical accident in South Korea.

Threshold Values for Identification of Contamination Predicted by Reduced-Order Models

DOE PAGES

Last, George V.; Murray, Christopher J.; Bott, Yi-Ju; ...

2014-12-31

The U.S. Department of Energy’s (DOE’s) National Risk Assessment Partnership (NRAP) Project is developing reduced-order models to evaluate potential impacts on underground sources of drinking water (USDWs) if CO2 or brine leaks from deep CO2 storage reservoirs. Threshold values, below which there would be no predicted impacts, were determined for portions of two aquifer systems. These threshold values were calculated using an interwell approach for determining background groundwater concentrations that is an adaptation of methods described in the U.S. Environmental Protection Agency’s Unified Guidance for Statistical Analysis of Groundwater Monitoring Data at RCRA Facilities.

Amnioinfusion for meconium-stained liquor in labour.

PubMed

Hofmeyr, G J

2000-01-01

Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. It is also thought to dilute meconium when present in the amniotic fluid and so reduce the risk of meconium aspiration. However it may be that the mechanism of effect is that it corrects oligohydramnios (reduced amniotic fluid), for which thick meconium staining is a marker. The objective of this review was to assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid. Eligibility and trial quality were assessed by one reviewer. Ten studies, most involving small numbers of participants, were included. Under standard perinatal surveillance, amnioinfusion was associated with a reduction in the following: heavy meconium staining of the liquor (relative risk 0.03, 95% confidence interval 0.01 to 0.15); variable fetal heart rate deceleration (relative risk 0.47, 95% confidence interval 0.24 to 0. 90); and a trend to reduced caesarean section overall (relative risk 0.83, 95% confidence interval 0.69 to 1.00). No perinatal deaths were reported. Under limited perinatal surveillance, amnioinfusion was associated with a reduction in the following: meconium aspiration syndrome (relative risk 0.24, 95% confidence interval 0. 12 to 0.48); neonatal hypoxic ischaemic encephalopathy (relative risk 0.07, 95% confidence interval 0.01 to 0.56) and neonatal ventilation or intensive care unit admission (relative risk 0.56, 95% confidence interval 0.39 to 0.79); there was a trend towards reduced perinatal mortality (relative risk 0.34, 95% confidence interval 0.11 to 1.06). Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for perinatal surveillance are limited. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Amnioinfusion for meconium-stained liquor in labour.

PubMed

Hofmeyr, G J

2002-01-01

Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. It is also thought to dilute meconium when present in the amniotic fluid and so reduce the risk of meconium aspiration. However, it may be that the mechanism of effect is that it corrects oligohydramnios (reduced amniotic fluid), for which thick meconium staining is a marker. The objective of this review was to assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. The Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) were searched. Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid. Eligibility and trial quality were assessed by one reviewer. Twelve studies, most involving small numbers of participants, were included. Under standard perinatal surveillance, amnioinfusion was associated with a reduction in the following: heavy meconium staining of the liquor (relative risk 0.03, 95% confidence interval 0.01 to 0.15); variable fetal heart rate deceleration (relative risk 0.65, 95% confidence interval 0.49 to 0.88); and reduced caesarean section overall (relative risk 0.82, 95% confidence interval 0.69 to 1.97). No perinatal deaths were reported. Under limited perinatal surveillance, amnioinfusion was associated with a reduction in the following: meconium aspiration syndrome (relative risk 0.24, 95% confidence interval 0.12 to 0.48); neonatal hypoxic ischaemic encephalopathy (relative risk 0.07, 95% confidence interval 0.01 to 0.56) and neonatal ventilation or intensive care unit admission (relative risk 0.56, 95% confidence interval 0.39 to 0.79); there was a trend towards reduced perinatal mortality (relative risk 0.34, 95% confidence interval 0.11 to 1.06). Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for perinatal surveillance are limited. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi.

PubMed

Tweya, Hannock; Oboho, Ikwo Kitefre; Gugsa, Salem T; Phiri, Sam; Rambiki, Ethel; Banda, Rebecca; Mwafilaso, Johnbosco; Munthali, Chimango; Gupta, Sundeep; Bateganya, Moses; Maida, Alice

2018-01-01

Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients' demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi. We conducted a retrospective cohort study of HIV-infected individuals aged 15 years or older at the time of registration for HIV care in 12 ART facilities, between April 2012 and March 2013. HIV-positive individuals who had not started ART (pre-ART patients) were clinically assessed to determine ART eligibility at registration and during clinic follow-up visits. ART-eligible patients were initiated on triple antiretroviral combination. Study data were abstracted from patients' cards, facility ART registers or electronic medical record system from the date of registration for HIV care to a maximum follow-up period of 24 months. Descriptive statistics were undertaken to summarize characteristics of the study patients. Separate univariable and multivariable poisson regression models were used to explore factors associated with LTFU in pre-ART and ART care. A total of 10,812 HIV-infected individuals registered for HIV care. Of these patients, 1,907 (18%) and 8,905 (82%) enrolled in pre-ART and ART care, respectively. Of the 1,907 pre-ART patients, 490 (26%) subsequently initiated ART and were included in both the pre-ART and ART analyses. The LTFU rates among patients in pre-ART and ART care were 48 and 26 per 100 person-years, respectively. Of the 9,105 ART patients with reasons for starting ART, 2,451 (27%) were initiated on ART because of pregnancy or breastfeeding (Option B+) status. Multivariable analysis showed that being ≥35 years and female were associated with decreased risk of LTFU in the pre-ART and ART phases of HIV care. However, being in WHO clinical stage 3 (adjusted risk ratio (aRR) 1.35, 95% confidence interval (CI): 1.20-1.51) and stage 4 (aRR 1.87, 95% CI: 1.62-2.18), body mass index ≤ 18.4 (aRR 1.24, 95% CI: 1.11-1.39) at ART initiation, poor adherence to clinic appointments (aRR 4.55, 95% CI: 4.16-4.97) and receiving HIV care in rural facilities (aRR 2.32, 95% CI: 1.94-2.87) were associated with increased risk of LTFU among ART patients. Being re-initiated on ART once (aRR 0.20, 95% CI: 0.17-0.22), more than once (aRR 0.06, 95% CI: 0.05-0.07), and being enrolled at a low-volume facility (aRR 0.25, 95% CI: 0.20-0.30) were associated with decreased risk of LTFU from ART care. A sizeable proportion of ART LTFU occurred among women enrolled during pregnancy or breast-feeding. Non- compliance to clinic and receiving ART in a rural facility or high-volume facility were associated with increased risk of LTFU from ART care. Developing effective interventions that target high-risk subgroups and contexts may help reduce LTFU from HIV care.

Site specific risk assessment of an energy-from-waste thermal treatment facility in Durham Region, Ontario, Canada. Part A: Human health risk assessment.

PubMed

Ollson, Christopher A; Knopper, Loren D; Whitfield Aslund, Melissa L; Jayasinghe, Ruwan

2014-01-01

The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. This paper presents the results of a comprehensive human health risk assessment for this facility. This assessment was based on extensive sampling of baseline environmental conditions (e.g., collection and analysis of air, soil, water, and biota samples) as well as detailed site specific modeling to predict facility-related emissions of 87 identified contaminants of potential concern. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and for the maximum design capacity (400,000 tonnes per year). For the 140,000 tonnes per year scenario, this assessment indicated that facility-related emissions are unlikely to cause adverse health risks to local residents, farmers, or other receptors (e.g., recreational users). For the 400,000 tonnes per year scenarios, slightly elevated risks were noted with respect to inhalation (hydrogen chloride) and infant consumption of breast milk (dioxins and furans), but only during predicted 'upset conditions' (i.e. facility start-up, shutdown, and loss of air pollution control) that represent unusual and/or transient occurrences. However, current provincial regulations require that additional environmental screening would be mandatory prior to expansion of the facility beyond the initial approved capacity (140,000 tonnes per year). Therefore, the potential risks due to upset conditions for the 400,000 tonnes per year scenario should be more closely investigated if future expansion is pursued. © 2013.

Site specific risk assessment of an energy-from-waste/thermal treatment facility in Durham Region, Ontario, Canada. Part B: Ecological risk assessment.

PubMed

Ollson, Christopher A; Whitfield Aslund, Melissa L; Knopper, Loren D; Dan, Tereza

2014-01-01

The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste (EFW) thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. In this paper we present the results of a comprehensive ecological risk assessment (ERA) for this planned facility, based on baseline sampling and site specific modeling to predict facility-related emissions, which was subsequently accepted by regulatory authorities. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and the maximum design capacity (400,000 tonnes per year). In general, calculated ecological hazard quotients (EHQs) and screening ratios (SRs) for receptors did not exceed the benchmark value (1.0). The only exceedances noted were generally due to existing baseline media concentrations, which did not differ from those expected for similar unimpacted sites in Ontario. This suggests that these exceedances reflect conservative assumptions applied in the risk assessment rather than actual potential risk. However, under predicted upset conditions at 400,000 tonnes per year (i.e., facility start-up, shutdown, and loss of air pollution control), a potential unacceptable risk was estimated for freshwater receptors with respect to benzo(g,h,i)perylene (SR=1.1), which could not be attributed to baseline conditions. Although this slight exceedance reflects a conservative worst-case scenario (upset conditions coinciding with worst-case meteorological conditions), further investigation of potential ecological risk should be performed if this facility is expanded to the maximum operating capacity in the future. © 2013.

Anaemia prevention for reduction of mortality in mothers and children.

PubMed

Brabin, Bernard; Prinsen-Geerligs, Paul; Verhoeff, Francine; Kazembe, Peter

2003-01-01

The relationship of anaemia as a risk factor for child and maternal mortality is described. Maternal case fatality rates, mainly from hospital studies vary from < 1% to > 50%. These large differences in risk were related primarily to differences in available obstetric care for women living in areas with inadequate antenatal and delivery care facilities. The relative risk of mortality associated with moderate anaemia (haemoglobin [Hb] 40-80 g/L) was 1.35 (95% confidence interval [95% CI] 0.92-2.00) and for severe anaemia (Hb < 47 g/L) was 3.51 (95% CI 2.05-6.00). Nutritional-related anaemia mortality is likely to be greater than malarial anaemia-related mortality. With good antenatal and obstetric care most anaemia-related deaths are preventable, and policies to reduce anaemia prevalence should not be divorced from efforts to provide adequate antenatal and delivery facilities for women in developing countries. In children, although mortality was increased with anaemia (< 50 g/L), the evidence for increased risk with less severe anaemia was inconclusive. A survival analysis of Malawian infants indicated that if Hb decreased by 10 g/L after 6 months of age, the risk of dying before 12 months of age increased 1.72 times. Evidence from a number of studies suggests that mortality due to severe malarial anaemia in children is greater than that due to iron-deficiency anaemia. Primary prevention of nutritional and malarial anaemia in young children could lead to reductions in child mortality.

[Effectiveness of interventions for the control and prevention of tuberculosis in health care facilities: a review of ATS,CDC, OSHA recommendations].

PubMed

Franchi, A; Banfi, M B; Franco, G

2003-01-01

Health care workers (HCWs) are occupationally exposed to a multitude of biological hazards, and among these to the risk of tuberculosis (TB) infection, especially involving individuals working in specific workplace (TB and Chest divisions, Infectious Diseases wards, Microbiology laboratories) and performing thoracic endoscopy and "cough-inducing" procedures. According to national legislation (title VIII D.lgs. 626/94, 1998 Health Minister guide lines document) concerning the control and prevention of TB transmission among HCWs, health care facilities are required to (i) perform an accurate risk assessment and (ii) implement an exposure control plan and worker health surveillance program, thus involving the occupational health professionals. The aim of this paper is to provide a general view of the epidemiological and scientific evidence related to the effectiveness of health interventions in the prevention of occupational TB infection. Comparative evaluation and critical review of U.S. CDC (1994) guidelines, OSHA (1997) rules, and the most recent ATS and CDC (2000) "statement" documents. In low risk groups TCT shows decreased positive predictive value, high variability, and can be confounded by other factors (age, BCG, MNT), thus reducing its diagnostic value for latent TB infection. Recent recommendations on the control of TB infection in health care settings underline the need of implementing accurate risk evaluation in all hospital units, compared to the epidemiological profile in the community, and "targeted tuberculin testing" programs among high risk HCWs.

The "Nursing Home Compare" measure of urinary/fecal incontinence: cross-sectional variation, stability over time, and the impact of case mix.

PubMed

Li, Yue; Schnelle, John; Spector, William D; Glance, Laurent G; Mukamel, Dana B

2010-02-01

To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R(2) were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R(2)<0.10), even for facilities with more extreme or more unstable outcome. Current "Nursing Home Compare" incontinence QM reflects considerable case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.

[Violence by and against people with mental illnesses].

PubMed

Steinert, Tilman; Traub, Hans-Joachim

2016-01-01

There is robust evidence for an increased risk of violence through people with psychotic disorders. Until recently this was frequently denied to prevent stigmatization. Alcohol and drug abuse equally increases the risk, while appropriate treatment reduces it drastically. Staff in psychiatric hospitals is exposed to an elevated risk of aggressive assaults. A limited number of severely ill and socially disintegrated patients accounts for these incidents, which are often recurrent. Besides patient characteristics, factors such as ward climate, staffing levels, education and attitudes of staff, and physical environment play a major role in aggressive escalations. On the other hand, mentally ill people, particularly women, are themselves at a higher risk of becoming victims of violent and non-violent crime. This also applies after correction for variables such as social status and living environment. Additionally mentally ill people are confronted with violence in the form of coercive interventions legitimised by the state (involuntary admission, involuntary treatment, freedom-restrictive measures such as seclusion or manual/physical restraint). In contrast to other countries in Central and Western Europe, involuntary outpatient treatment has never been legalized in Germany. Efforts to reduce violence and coercion in psychiatric facilities by evidence-based interventions are widespread nowadays, treatment guidelines are available.

Efficacy of umbilical cord cleansing with a single application of 4% chlorhexidine for the prevention of newborn infections in Uganda: study protocol for a randomized controlled trial.

PubMed

Nankabirwa, Victoria; Tylleskär, Thorkild; Tumuhamye, Josephine; Tumwine, James K; Ndeezi, Grace; Martines, José C; Sommerfelt, Halvor

2017-07-12

Yearly, nearly all the estimated worldwide 2.7 million neonatal deaths occur in low- and middle-income countries. Infections, including those affecting the umbilical cord (omphalitis), are a significant factor in approximately a third of these deaths. In fact, the odds of all-cause mortality are 46% higher among neonates with omphalitis than in those without. Five large randomized controlled trials in Asia and Sub-Saharan Africa (SSA) have examined the effect of multiple cord stump applications with 4% chlorhexidine (CHX) for at least 7 days on the risk of omphalitis and neonatal death. These studies, all community-based, show that multiple CHX applications reduced the risk of omphalitis. Of these trials, only one study from South Asia (the Bangladeshi study) and none from Africa examined the effect of a single application of CHX as soon as possible after birth. In this Bangladeshi trial, CHX led to a reduction in the risk of mild-moderate omphalitis and neonatal death. It is important, in an African setting, to explore the effect of a single application among health-facility births. A single application is programmatically much simpler to implement than daily applications for 7 days. Therefore, our study compares umbilical cord cleansing with a single application of 4% CHX at birth with dry cord care among Ugandan babies born in health facilities, on the risk of omphalitis and severe neonatal illness. The CHX study is a facility-based, individually randomized controlled trial that will be conducted among 4760 newborns in Uganda. The primary outcomes are severe illness and omphalitis during the neonatal period. Analysis will be by intention-to-treat. This study will provide novel evidence, from a Sub-Saharan African setting, of the effect of umbilical cord cleansing with a single application of 4% CHX at birth and identify modifiable risk factors for omphalitis. ClinicalTrials.gov, identifier: NCT02606565 . Registered on 12 November 2015.

Turning for Ulcer Reduction (TURN) Study: An Economic Analysis.

PubMed

Paulden, Mike; Bergstrom, Nancy; Horn, Susan D; Rapp, Mary; Stern, Anita; Barrett, Ryan; Watkiss, Michael; Krahn, Murray

2014-01-01

The Turning for Ulcer Reduction (TURN) study was a multisite, randomized controlled trial that aimed to determine the optimal frequency of turning nursing facility residents with mobility limitations who are at moderate and high risk for pressure ulcer (PrU) development. Here we present data from the economic analysis. This economic analysis aims to estimate the economic consequences for Ontario of switching from a repositioning schedule of 2-hour intervals to a schedule of 3-hour or 4-hour intervals. Costs considered in the analysis included those associated with nursing staff time spent repositioning residents and with incontinent care supplies, which included briefs, barrier cream, and washcloths. The total economic benefit of switching to 3-hour or 4-hour repositioning is estimated to be $11.05 or $16.74 per day, respectively, for every resident at moderate or high risk of developing PrUs. For a typical facility with 123 residents, 41 (33%) of whom are at moderate or high risk of developing PrUs, the total economic benefit is estimated to be $453 daily for 3-hour or $686 daily for 4-hour repositioning. For Ontario as a whole, assuming that there are 77,933 residents at 634 LTC facilities, 25,927 (33%) of whom are at moderate or high risk of developing PrUs, the total economic benefits of switching to 3-hour or 4-hour repositioning are estimated to be $286,420 or $433,913 daily, respectively, equivalent to $104.5 million or $158.4 million per year. We did not consider the savings the Ontario Ministry of Health and Long-Term Care might incur should less frequent repositioning reduce the incidence of work-related injury among nursing staff, so our findings are potentially conservative. A switch to 3-hour or 4-hour repositioning appears likely to yield substantial economic benefits to Ontario without placing residents at greater risk of developing PrUs.

Turning for Ulcer Reduction (TURN) Study: An Economic Analysis

PubMed Central

Paulden, Mike; Bergstrom, Nancy; Horn, Susan D.; Rapp, Mary; Stern, Anita; Barrett, Ryan; Watkiss, Michael; Krahn, Murray

2014-01-01

Background The Turning for Ulcer Reduction (TURN) study was a multisite, randomized controlled trial that aimed to determine the optimal frequency of turning nursing facility residents with mobility limitations who are at moderate and high risk for pressure ulcer (PrU) development. Here we present data from the economic analysis. Objectives This economic analysis aims to estimate the economic consequences for Ontario of switching from a repositioning schedule of 2-hour intervals to a schedule of 3-hour or 4-hour intervals. Data Sources Costs considered in the analysis included those associated with nursing staff time spent repositioning residents and with incontinent care supplies, which included briefs, barrier cream, and washcloths. Results The total economic benefit of switching to 3-hour or 4-hour repositioning is estimated to be $11.05 or $16.74 per day, respectively, for every resident at moderate or high risk of developing PrUs. For a typical facility with 123 residents, 41 (33%) of whom are at moderate or high risk of developing PrUs, the total economic benefit is estimated to be $453 daily for 3-hour or $686 daily for 4-hour repositioning. For Ontario as a whole, assuming that there are 77,933 residents at 634 LTC facilities, 25,927 (33%) of whom are at moderate or high risk of developing PrUs, the total economic benefits of switching to 3-hour or 4-hour repositioning are estimated to be $286,420 or $433,913 daily, respectively, equivalent to $104.5 million or $158.4 million per year. Limitations We did not consider the savings the Ontario Ministry of Health and Long-Term Care might incur should less frequent repositioning reduce the incidence of work-related injury among nursing staff, so our findings are potentially conservative. Conclusions A switch to 3-hour or 4-hour repositioning appears likely to yield substantial economic benefits to Ontario without placing residents at greater risk of developing PrUs. PMID:26330894

EMFs: cutting through the controversy.

PubMed Central

Wartenberg, D

1996-01-01

SOME SCIENTISTS ALLEGE that exposure to electric and magnetic fields generated by electric power delivery systems is responsible for certain cancers (particularly among children), reproductive dysfunction, birth defects, neurological disorders, and Alzheimer's disease. Some activist groups believe the hazard to be so great that they are calling for closure of schools and other public facilities near power lines and restructuring of the entire electric power delivery system. Some utilities, with equally strong beliefs, claim that there is no proof of risk. They argue that the science is sufficient to confirm the alleged associations and that no action is warranted. This article provides a broad overview of the current scientific data on the association between magnetic fields and disease, providing summary risk estimates and highlighting the uncertainties in the data. Building on this information, three complementary policy perspectives are presented. From a fiscally conservative perspective, the cost of mitigation already instituted far exceeds the health protection offered and mitigation of other environmental risks is more important. From a cost-benefit view, only limited, low-cost mitigation should be considered. These measures, however, would substantially reduce many exposures. From an aggressive exposure reduction perspective, much can be done to reduce exposure by personal and societal actions. If the suggested association is validated, substantially reducing magnetic field exposure could lower health risks. Images p205-a p207-a PMID:8643811

The care of Filipino juvenile offenders in residential facilities evaluated using the risk-need-responsivity model.

PubMed

Spruit, Anouk; Wissink, Inge B; Stams, Geert Jan J M

2016-01-01

According to the risk-need-responsivity model of offender, assessment and rehabilitation treatment should target specific factors that are related to re-offending. This study evaluates the residential care of Filipino juvenile offenders using the risk-need-responsivity model. Risk analyses and criminogenic needs assessments (parenting style, aggression, relationships with peers, empathy, and moral reasoning) have been conducted using data of 55 juvenile offenders in four residential facilities. The psychological care has been assessed using a checklist. Statistical analyses showed that juvenile offenders had a high risk of re-offending, high aggression, difficulties in making pro-social friends, and a delayed socio-moral development. The psychological programs in the residential facilities were evaluated to be poor. The availability of the psychological care in the facilities fitted poorly with the characteristics of the juvenile offenders and did not comply with the risk-need-responsivity model. Implications for research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Potential vulnerability to flooding at public health facilities in four northern regions of Peru].

PubMed

Hernández-Vásquez, Akram; Arroyo-Hernández, Hugo; Bendezú-Quispe, Guido; Díaz-Seijas, Deysi; Vilcarromero, Stalin; Rubilar-González, Juan; Gutierrez-Lagos, Edith

2016-03-01

In order to determine the potential vulnerability of public health facilities in four northern regions of Peru to the possible effects of El Niño-Southern Oscillation (ENSO) phenomenon. An exploratory spatial analysis was performed using the geo-referenced points for at-risk areas based on the activation of gullies that were reported by the National Water Authority, and the location of the four regional public health facilities of the Ministry of Health. Concentric areas of influence were simulate from the points of risk towards the public health facilities using radii of 200, 1000 and 1500 meters. The Tumbes region would be the most affected with 37.2% of its health facilities being affected by floods and landslides. The I-2 and I-3 categories of health facilities appeared to be the most affected with 28.9% and 31.6% respectively. Therefore, public health facilities near the risk zones may be affected by the ENSO.

Groundwater contamination from waste management sites: The interaction between risk-based engineering design and regulatory policy: 1. Methodology

NASA Astrophysics Data System (ADS)

Massmann, Joel; Freeze, R. Allan

1987-02-01

This paper puts in place a risk-cost-benefit analysis for waste management facilities that explicitly recognizes the adversarial relationship that exists in a regulated market economy between the owner/operator of a waste management facility and the government regulatory agency under whose terms the facility must be licensed. The risk-cost-benefit analysis is set up from the perspective of the owner/operator. It can be used directly by the owner/operator to assess alternative design strategies. It can also be used by the regulatory agency to assess alternative regulatory policy, but only in an indirect manner, by examining the response of an owner/operator to the stimuli of various policies. The objective function is couched in terms of a discounted stream of benefits, costs, and risks over an engineering time horizon. Benefits are in the form of revenues for services provided; costs are those of construction and operation of the facility. Risk is defined as the cost associated with the probability of failure, with failure defined as the occurrence of a groundwater contamination event that violates the licensing requirements established for the facility. Failure requires a breach of the containment structure and contaminant migration through the hydrogeological environment to a compliance surface. The probability of failure can be estimated on the basis of reliability theory for the breach of containment and with a Monte-Carlo finite-element simulation for the advective contaminant transport. In the hydrogeological environment the hydraulic conductivity values are defined stochastically. The probability of failure is reduced by the presence of a monitoring network operated by the owner/operator and located between the source and the regulatory compliance surface. The level of reduction in the probability of failure depends on the probability of detection of the monitoring network, which can be calculated from the stochastic contaminant transport simulations. While the framework is quite general, the development in this paper is specifically suited for a landfill in which the primary design feature is one or more synthetic liners in parallel. Contamination is brought about by the release of a single, inorganic nonradioactive species into a saturated, high-permeability, advective, steady state horizontal flow system which can be analyzed with a two-dimensional analysis. It is possible to carry out sensitivity analyses for a wide variety of influences on this system, including landfill size, liner design, hydrogeological parameters, amount of exploration, extent of monitoring network, nature of remedial schemes, economic factors, and regulatory policy.

Reducing hospital readmission rates: current strategies and future directions.

PubMed

Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

2014-01-01

New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

Exposure to hazardous substances in Cathode Ray Tube (CRT) recycling sites in France

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lecler, Marie-Thérèse, E-mail: marie-therese.lecler@inrs.fr; Zimmermann, François; Silvente, Eric

Highlights: • Chemical risks were assessed in the nine cathode ray tube screens recycling facilities. • The main hazardous agents are dust containing lead, cadmium, barium and yttrium. • Exposure and pollutant levels are described for different operations and processes. • All the operations and processes are concerned by significant levels of pollutants. • We suggest recommendations to reduce chemical risk. - Abstract: The Waste Electrical and Electronic Equipment (WEEE) or e-waste recycling sector has grown considerably in the last fifteen years due to the ever shorter life cycles of consumables and an increasingly restrictive policy context. Cathode Ray Tubesmore » (CRTs) from used television and computer screens represent one of the main sources of e-waste. CRTs contain toxic materials such as lead, cadmium, barium, and fluorescent powders which can be released if recycling of CRTs is not appropriate. Exposure to these harmful substances was assessed in nine workshops where CRT screens are treated. Particulate exposure levels were measured using a gravimetric method and metals were analysed by plasma emission spectrometry. The maximum levels of worker exposure were 8.8 mg/m{sup 3}, 1504.3 μg/m{sup 3}, 434.9 μg/m{sup 3}, 576.3 μg/m{sup 3} and 2894.3 μg/m{sup 3} respectively for inhalable dust, barium, cadmium, lead and yttrium. The maximum levels of airborne pollutants in static samples were 39.0 mg/m{sup 3}, 848.2 μg/m{sup 3}, 698.4 μg/m{sup 3}, 549.3 μg/m{sup 3} and 3437.9 μg/m{sup 3} for inhalable dust, barium, cadmium, lead and yttrium. The most harmful operations were identified, and preventive measures for reducing the chemical risk associated with screen recycling were proposed. Workplace measurements were used to define recommendations for reducing the chemical risks in CRT screens recycling facilities and for promoting the design and development of “clean and safe” processes in emerging recycling channels.« less

Soil Sample Report in Support of the Site 300 EWTF Ecological Risk Assessment and Permit Renewal-September 2012

DOE Office of Scientific and Technical Information (OSTI.GOV)

Terusaki, Stanley; Gallegos, Gretchen; MacQueen, Donald

2012-10-02

LLNL Site 300 has applied to renew the permits for its Explosives Waste Treatment Facility (EWTF), Explosives Waste Storage Facility (EWSF) and Building 883 Storage Facility. As a part of the permit renewal process, the Department of Toxic Substances Control (DTSC) requested LLNL to obtain soil samples in order to conduct a scoping-level ecological risk assessment pursuant to the Department of Toxic Substances Control, Guidance for Ecological Risk Assessment at Hazardous Waste Sites and Permitted Facilities, Part A: Overview, July 4, 1996. As stated in the guidance document, the scoping-level ecological risk assessment provides a framework to determine the potentialmore » interaction ecological receptors and chemicals of concern from hazardous waste treatment operations in the area of EWTF.« less

Biopsychosocial Causes of Suicide and Suicide Prevention Outcome Studies in Juvenile Detention Facilities: A Review.

PubMed

Joshi, Kshamta; Billick, Stephen Bates

2017-03-01

To identify various biopsychosocial risk factors associated with suicidality in juvenile detention facilities and the effectiveness of suicide prevention protocols currently in use. Medical literature searches were conducted using databases like Pub Med, Ovid, and Google Scholar to identify studies conducted in and outside of United States. The prevalence of suicide among youth imprisoned at detention facilities has risen. Psychiatric disorders are common among such population, making them vulnerable to suicidal tendencies. Suicide risk screening within first 24 h of admission to the detention facility has shown to lower the risk of suicide. Identification of high risk individuals and their further psychiatric assessment is advocated. Much of work with regards to screening tools and instruments is underway and further study is required to get a better understanding.

Job Hazard Analyses for Musculoskeletal Disorder Risk Factors in Pressing Operations of Dry-cleaning Establishments.

PubMed

Park, Jung-Keun

2016-12-01

Job hazard analyses were conducted to assess exposure to musculoskeletal disorder (MSD) risk factors in seven workers of three dry-cleaning establishments. In accordance with the Washington State Ergonomics Rule, the analyses were performed in two separate steps: (1) observation and checklist approaches were made to identify a "caution zone job" in the seven workers' pressing operations across the three shops; and (2) detailed posture and motion analyses were undertaken to determine a "MSD hazard" in one worker's operation using a video technique. One "caution zone job" was identified and it was the pressing operation job in which five physical risk factors were found in the pressing operations. The detailed analyses confirmed that one "MSD hazard", i.e., awkward posture in shoulders, was prevalent in the pressing operations of the three dry-cleaning facilities. It would be desirable to reduce MSD risk factors including awkward shoulder posture in the dry-cleaning industry.

Risk factors for severe injury following indoor and outdoor falls in geriatric patients.

PubMed

Kim, Sun Hyu

2016-01-01

This study was performed to examine the characteristics of indoor and outdoor falls in older patients and the factors related to severe injury in the emergency department (ED). In total, 26,515 patients fell indoors and 19,581 outdoors. The general and clinical characteristics were compared between the two groups and factors associated with severe injury following the falls were evaluated. Younger males fell more frequently outdoors than indoors. The common activities during outdoor falls were sports and leisure activities. Environmental hazards lead to more outdoor falls than indoor falls. Factors associated with severe injury after indoor falls were transport to the ED by public ambulance or from another medical facility rather than individual transportation, fall from stairs rather than fell over, and a head and neck injury rather than a lower extremity injury. Factors related to severe injury after outdoor falls were male sex, transport to the ED by public ambulance or from another medical facility or by another method rather than individual transportation, state employed, fall from stairs rather than fell over, head and neck or thorax or abdomen injury rather than a lower extremity injury. Transport to the ED by public ambulance or from another medical facility, and head and neck injury were risks for severe injury following indoor and outdoor falls in elderly subjects. Efforts to identify the risk factors for severe injury and for falling itself are important to prevent and reduce fall injuries in elderly subjects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Corporate compliance: framework and implementation.

PubMed

Fowler, N

1999-01-01

The federal government has created numerous programs to combat fraud and abuse. The government now encourages healthcare facilities to have a corporate compliance program (CCP), a plan that reduces the chances that the facility will violate laws or regulations. A CCP is an organization-wide program comprised of a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms and other features, all designed to prevent and detect violations of governmental laws, regulations and policies. It is a system or method ensuring that employees understand and will comply with laws that apply to what they do every day. Seven factors, based on federal sentencing guidelines, provide the framework for developing a CCP. First, a facility must establish rules that are reasonably capable of reducing criminal conduct. Second, high-level personnel must oversee the compliance effort. Third, a facility must use due care in delegating authority in the compliance initiative. Fourth, standards must be communicated effectively to employees, and fifth, a facility must take reasonable steps to achieve compliance. Sixth, standards must be enforced consistently across the organization and last, standards must be modified or changed for reported concerns, to ensure they are not repeated. PROMINA Health System, Inc. in Atlanta, Ga., designed a program to meet federal guidelines. It started with a self-assessment to define its areas or risk. Next, it created the internal structure and assigned organizational responsibility for running the CCP. PROMINA then developed standards of business and professional conduct, established vehicles of communication and trained employees on the standards. Finally, it continues to develop evidence of the program's effectiveness by monitoring and documenting its compliance activities.

Cancer Risks near Nuclear Facilities: The Importance of Research Design and Explicit Study Hypotheses

PubMed Central

Wing, Steve; Richardson, David B.; Hoffmann, Wolfgang

2011-01-01

Background In April 2010, the U.S. Nuclear Regulatory Commission asked the National Academy of Sciences to update a 1990 study of cancer risks near nuclear facilities. Prior research on this topic has suffered from problems in hypothesis formulation and research design. Objectives We review epidemiologic principles used in studies of generic exposure–response associations and in studies of specific sources of exposure. We then describe logical problems with assumptions, formation of testable hypotheses, and interpretation of evidence in previous research on cancer risks near nuclear facilities. Discussion Advancement of knowledge about cancer risks near nuclear facilities depends on testing specific hypotheses grounded in physical and biological mechanisms of exposure and susceptibility while considering sample size and ability to adequately quantify exposure, ascertain cancer cases, and evaluate plausible confounders. Conclusions Next steps in advancing knowledge about cancer risks near nuclear facilities require studies of childhood cancer incidence, focus on in utero and early childhood exposures, use of specific geographic information, and consideration of pathways for transport and uptake of radionuclides. Studies of cancer mortality among adults, cancers with long latencies, large geographic zones, and populations that reside at large distances from nuclear facilities are better suited for public relations than for scientific purposes. PMID:21147606

Aquifer disposal of carbon dioxide for greenhouse effect mitigation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gupta, N.; Naymik, T.G.; Bergman, P.

1998-07-01

Deep aquifer sequestration of carbon dioxide (CO{sup 2}), generated from power plant and other industrial emissions, is being evaluated as one of the potential options for the reduction of atmospheric greenhouse gas emissions. The major advantages of using deep aquifers are that the disposal facilities may be located close to the sources, thus reducing the CO{sub 2} transport costs. The potential capacity is much larger than the projected CO{sub 2} emissions over the next century, and it is a long-term/permanent sequestration option, because a large portion of the injected CO{sub 2} may be fixed into the aquifer by dissolution ormore » mineralization. The major limitations include the potentially high cost, the risk of upward migration, and the public perception of risk. Most of the cost is due to the need to separate CO{sub 2} from other flue gases, rather than the actual cost of disposal. Hazardous liquid waste and acid gas disposal in deep sedimentary formations is a well-established practice. There are also numerous facilities for storage of natural gases in depleted oil and gas reservoirs. The only current facility for aquifer disposal of CO{sub 2} is the offshore injection well at Sleipner Vest in the North Sea in Norway operated by Statoil. Exxon and Pertamina are planning an offshore aquifer disposal facility at Natuna gas field in Indonesia. A major evaluation of the feasibility of CO{sub 2} disposal in the European Union and Norway has been conducted under project Joule II. The data and experience obtained from the existing deep-waste disposal facilities and from the Sleipner Vest site form a strong foundation for further research and development on CO{sub 2} sequestration. Federal Energy Technology Center (FETC) is currently leading a project that uses data from an existing hazardous waste disposal facility injecting in the Mt. Simon Sandstone aquifer in Ohio to evaluate hydrogeologic, geochemical, and social issues related to CO{sub 2} disposal.« less

Aquifer disposal of carbon dioxide for greenhouse effect mitigation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gupta, N.; Naymik, T.G.; Bergman, P.

1998-04-01

Deep aquifer sequestration of carbon dioxide (CO{sub 2}) generated from power plant and other industrial emissions, is being evaluated as one of the potential options for the reduction of atmospheric greenhouse gas emissions. The major advantages of using deep aquifers are that the disposal facilities may be located close to the sources, thus reducing the CO{sub 2} transport costs. The potential capacity is much larger than the projected CO{sub 2} emissions over the next century, and it is a long-term/permanent sequestration option, because a large portion of the injected CO{sub 2} may be fixed into the aquifer by dissolution ormore » mineralization. The major limitations include the potentially high cost, the risk of upward migration, and the public perception of risk. Most of the cost is due to the need to separate CO{sub 2} from other flue gases, rather than the actual cost of disposal. Hazardous liquid waste and acid gas disposal in deep sedimentary formations is a well-established practice. There are also numerous facilities for storage of natural gases in depleted oil and gas reservoirs. The only current facility for aquifer disposal of CO{sub 2} is the offshore injection well at Sleipner Vest in the North Sea in Norway operated by Statoil. Exxon and Pertamina are planning an offshore aquifer disposal facility at Natuna gas field in Indonesia. A major evaluation of the feasibility of CO{sub 2} disposal in the European Union and Norway has been conducted under project Joule II. The data and experience obtained from the existing deep-waste disposal facilities and from the Sleipner Vest site form a strong foundation for further research and development on CO{sub 2} sequestration. Federal Energy Technology Center (FETC) is currently leading a project that uses data from an existing hazardous waste disposal facility injecting in the Mt. Simon Sandstone aquifer in Ohio to evaluate hydrogeologic, geochemical, and social issues related to CO{sub 2} disposal.« less

Design and Fabrication of the ISTAR Direct-Connect Combustor Experiment at the NASA Hypersonic Tunnel Facility

NASA Technical Reports Server (NTRS)

Lee, Jin-Ho; Krivanek, Thomas M.

2005-01-01

The Integrated Systems Test of an Airbreathing Rocket (ISTAR) project was a flight demonstration project initiated to advance the state of the art in Rocket Based Combined Cycle (RBCC) propulsion development. The primary objective of the ISTAR project was to develop a reusable air breathing vehicle and enabling technologies. This concept incorporated a RBCC propulsion system to enable the vehicle to be air dropped at Mach 0.7 and accelerated up to Mach 7 flight culminating in a demonstration of hydrocarbon scramjet operation. A series of component experiments was planned to reduce the level of risk and to advance the technology base. This paper summarizes the status of a full scale direct connect combustor experiment with heated endothermic hydrocarbon fuels. This is the first use of the NASA GRC Hypersonic Tunnel facility to support a direct-connect test. The technical and mechanical challenges involved with adapting this facility, previously used only in the free-jet configuration, for use in direct connect mode will be also described.

Non-proliferation, safeguards, and security for the fissile materials disposition program immobilization alternatives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duggan, R.A.; Jaeger, C.D.; Tolk, K.M.

1996-05-01

The Department of Energy is analyzing long-term storage and disposition alternatives for surplus weapons-usable fissile materials. A number of different disposition alternatives are being considered. These include facilities for storage, conversion and stabilization of fissile materials, immobilization in glass or ceramic material, fabrication of fissile material into mixed oxide (MOX) fuel for reactors, use of reactor based technologies to convert material into spent fuel, and disposal of fissile material using geologic alternatives. This paper will focus on how the objectives of reducing security and proliferation risks are being considered, and the possible facility impacts. Some of the areas discussed inmore » this paper include: (1) domestic and international safeguards requirements, (2) non-proliferation criteria and measures, (3) the threats, and (4) potential proliferation, safeguards, and security issues and impacts on the facilities. Issues applicable to all of the possible disposition alternatives will be discussed in this paper. However, particular attention is given to the plutonium immobilization alternatives.« less

Aerothermodynamic testing requirements for future space transportation systems

NASA Technical Reports Server (NTRS)

Paulson, John W., Jr.; Miller, Charles G., III

1995-01-01

Aerothermodynamics, encompassing aerodynamics, aeroheating, and fluid dynamic and physical processes, is the genesis for the design and development of advanced space transportation vehicles. It provides crucial information to other disciplines involved in the development process such as structures, materials, propulsion, and avionics. Sources of aerothermodynamic information include ground-based facilities, computational fluid dynamic (CFD) and engineering computer codes, and flight experiments. Utilization of this triad is required to provide the optimum requirements while reducing undue design conservatism, risk, and cost. This paper discusses the role of ground-based facilities in the design of future space transportation system concepts. Testing methodology is addressed, including the iterative approach often required for the assessment and optimization of configurations from an aerothermodynamic perspective. The influence of vehicle shape and the transition from parametric studies for optimization to benchmark studies for final design and establishment of the flight data book is discussed. Future aerothermodynamic testing requirements including the need for new facilities are also presented.

Prioritization methodology for the decommissioning of nuclear facilities: a study case on the Iraq former nuclear complex.

PubMed

Jarjies, Adnan; Abbas, Mohammed; Monken Fernandes, Horst; Wong, Melanie; Coates, Roger

2013-05-01

There are a number of sites in Iraq which have been used for nuclear activities and which contain potentially significant amounts of radioactive waste. The principal nuclear site being Al-Tuwaitha. Many of these sites suffered substantial physical damage during the Gulf Wars and have been subjected to subsequent looting. All require decommissioning in order to ensure both radiological and non-radiological safety. However, it is not possible to undertake the decommissioning of all sites and facilities at the same time. Therefore, a prioritization methodology has been developed in order to aid the decision-making process. The methodology comprises three principal stages of assessment: i) a quantitative surrogate risk assessment ii) a range of sensitivity analyses and iii) the inclusion of qualitative modifying factors. A group of Tuwaitha facilities presented the highest risk among the evaluated ones, followed by a middle ranking grouping of Tuwaitha facilities and some other sites, and a relatively large group of lower risk facilities and sites. The initial order of priority is changed when modifying factors are taken into account. It has to be considered the Iraq's isolation from the international nuclear community over the last two decades and the lack of experienced personnel. Therefore it is appropriate to initiate decommissioning operations on selected low risk facilities at Tuwaitha in order to build capacity and prepare for work to be carried out in more complex and potentially high hazard facilities. In addition it is appropriate to initiate some prudent precautionary actions relating to some of the higher risk facilities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Importation of beef from countries infected with foot and mouth disease: a review of risk mitigation measures.

PubMed

Sutmoller, P

2001-12-01

Risk mitigation measures to reduce the risks associated with importing beef from countries affected by foot and mouth disease (FMD) consist of controls at the farm of origin, inspection of slaughterhouses and maturation and deboning of carcasses. This assessment evaluates the effect of these measures on the mitigation of the risks presented by meat from cattle with FMD, for each of the different stages of the disease. The four disease stages considered are the incubation period, the period of clinical signs, convalescence and the carrier stage. Efficient animal health systems, disease surveillance, and ante-mortem and post-mortem inspection of all cattle effectively reduce the risk of FMD transmission from cattle slaughtered during the period of clinical signs or convalescence. These measures fail if the cattle are slaughtered during the incubation period, because of the absence of clinical signs. Cattle in this stage of the infection are likely to be viraemic, with FMD virus present in the skeletal muscles. Maturation of the carcasses of viraemic cattle reduces the risk of virus presence in the beef. In addition, deboning and removal of the principal lymph nodes and large blood vessels eliminate a source of FMD contamination of the beef. However, the slaughter of viraemic cattle creates an additional hazard of gross environmental viral contamination of the slaughterhouse facilities. Therefore, the maturation process may create a false sense of security, and the emphasis should instead be placed on disease surveillance within the infected zone and on the farms of origin, to prevent the slaughter of herds that are incubating FMD. Cattle slaughtered during the carrier stage do not pose a risk for the international beef trade.

A population-based case-control study of marijuana use and head and neck squamous cell carcinoma.

PubMed

Liang, Caihua; McClean, Michael D; Marsit, Carmen; Christensen, Brock; Peters, Edward; Nelson, Heather H; Kelsey, Karl T

2009-08-01

Cannabinoids, constituents of marijuana smoke, have been recognized to have potential antitumor properties. However, the epidemiologic evidence addressing the relationship between marijuana use and the induction of head and neck squamous cell carcinoma (HNSCC) is inconsistent and conflicting. Cases (n = 434) were patients with incident HNSCC disease from nine medical facilities in the Greater Boston, MA area between December 1999 and December 2003. Controls (n = 547) were frequency matched to cases on age (+/-3 years), gender, and town of residence, randomly selected from Massachusetts town books. A questionnaire was adopted to collect information on lifetime marijuana use (decade-specific exposures) and associations evaluated using unconditional logistic regression. After adjusting for potential confounders (including smoking and alcohol drinking), 10 to 20 years of marijuana use was associated with a significantly reduced risk of HNSCC [odds ratio (OR)(10-<20 years versus never users), 0.38; 95% confidence interval (CI), 0.22-0.67]. Among marijuana users moderate weekly use was associated with reduced risk (OR(0.5-<1.5 times versus <0.5 time), 0.52; 95% CI, 0.32-0.85). The magnitude of reduced risk was more pronounced for those who started use at an older age (OR(15-<20 years versus never users), 0.53; 95% CI, 0.30-0.95; OR(> or =20 years versus never users), 0.39; 95% CI, 0.17-0.90; P(trend) < 0.001). These inverse associations did not depend on human papillomavirus 16 antibody status. However, for the subjects who have the same level of smoking or alcohol drinking, we observed attenuated risk of HNSCC among those who use marijuana compared with those who do not. Our study suggests that moderate marijuana use is associated with reduced risk of HNSCC.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andy; Graham, Bart

2016-01-01

Dynetics has designed innovative structure assemblies; manufactured them using Friction Stir Welding (FSW) to leverage NASA investments in tools, facilities, and processes; conducted proof and burst testing, demonstrating viability of design/build processes Dynetics/AR has applied state-of-the-art manufacturing and processing techniques to the heritage F-1, reducing risk for engine development Dynetics/AR has also made progress on technology demonstrations for ORSC cycle engine, which offers affordability and performance for both NASA and other launch vehicles Full-scale integrated oxidizer-rich test article. Testing will evaluate performance and combustion stability characteristics. Contributes to technology maturation for ox-rich staged combustion engines.

Typical whole body vibration exposure magnitudes encountered in the open pit mining industry.

PubMed

Howard, Bryan; Sesek, Richard; Bloswick, Don

2009-01-01

According to recent research, a causal link has been established between occupational exposure to whole body vibration and an increased occurrence of low back pain. To aid in the further development of an in-house health and safety program for a large open pit mining facility interested in reducing back pain among its operators, whole body vibration magnitudes were characterized for a range of jobs. Specifically, thirty-five individual jobs from five different areas across the facility were evaluated for tri-axial acceleration levels during normal operating conditions. Tri-axial acceleration magnitudes were categorized into thirteen job groups. Job groups were ranked according to exposure and compared to the ISO 2631-1 standard for health risk assessment. Three of the thirteen job groups produced tri-axial acceleration magnitudes below the ISO 2631-1 low/moderate health caution limit for a twelve hour exposure. Six of the thirteen job groups produced exposures within the moderate health risk range. Four job groups were found to subject operators to WBV acceleration magnitudes above the moderate/high health caution limit.

6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

Code of Federal Regulations, 2011 CFR

2011-01-01

... a high level of security risk.â 27.205 Section 27.205 Domestic Security DEPARTMENT OF HOMELAND... Program § 27.205 Determination that a chemical facility “presents a high level of security risk.” (a... a high level of security risk based on any information available (including any information...

Browns Ferry Nuclear Plant low-level radwaste storage facility ground-water pathway analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boggs, J.M.

1982-10-01

The proposed low-level radwaste storage facility (LLRWSF) at Browns Ferry Nuclear Plant is underlain by soils having low hydraulic conductivity and high sorptive capacity which greatly reduce the risks associated with a potential contaminant excursion. A conservative ground-water pathway accident analysis using flow and solute transport modeling techniques indicates that without interdiction the concentrations of the five radionuclides of concern (Sr-90, Cs-137, Cs-134, Co-60, and Mn-54) would be well below 10 CFR Part 20 criteria at downgradient receptors. These receptors include a possible future private water well located near the eastern site boundary and Wheeler Reservoir. Routine ground-water monitoring ismore » not recommended at the LLRWSF except in the unlikely event of an accident.« less

DEVELOPMENT OF THE METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST)

EPA Science Inventory

Recently the US EPA completed the development of the first version of the Metal Finishing Facility Risk Screening Tool (MFFRST) and has made this product available to the general public. MFFRST calculates the air emissions from a metal plating line and determines the risk to bot...

Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits.

PubMed

Ranasinghe, Isuru; Parzynski, Craig S; Searfoss, Rana; Montague, Julia; Lin, Zhenqiu; Allen, John; Vender, Ronald; Bhat, Kanchana; Ross, Joseph S; Bernheim, Susannah; Krumholz, Harlan M; Drye, Elizabeth E

2016-01-01

Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. We calculated a risk-adjusted measure of outpatient colonoscopy quality, which shows important variation in quality among outpatient facilities. This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa.

PubMed

Fatti, G; Shaikh, N; Eley, B; Jackson, D; Grimwood, A

2014-12-01

South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy. To explore risks associated with pregnancy in young HIV-infected women, we compared mother-to-child transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories. A cohort of HIV-positive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as 24 years old and adolescents as 19 years. The effect of younger maternal age categories on MTCT and maternal and child health outcomes was assessed using log-binomial and Cox regression controlling for confounding, using women aged > 24 years as the comparison group. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (CI) 1.21 - 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 - 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 - 0.94), and increased MTCT (aRR 3.07; 95% CI 1.18 - 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 - 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 - 426) and stillbirth (aRR 3.33; 95% CI 1.53 - 7.25). An increasing proportion of pregnant HIV-positive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal and infant outcomes if SA is to attain its Millennium Development Goals.

Validation of a model for ranking aquaculture facilities for risk-based disease surveillance.

PubMed

Diserens, Nicolas; Falzon, Laura Cristina; von Siebenthal, Beat; Schüpbach-Regula, Gertraud; Wahli, Thomas

2017-09-15

A semi-quantitative model for risk ranking of aquaculture facilities in Switzerland with regard to the introduction and spread of Viral Haemorrhagic Septicaemia (VHS) and Infectious Haematopoietic Necrosis (IHN) was developed in a previous study (Diserens et al., 2013). The objective of the present study was to validate this model using data collected during field visits on aquaculture sites in four Swiss cantons compared to data collected through a questionnaire in the previous study. A discrepancy between the values obtained with the two different methods was found in 32.8% of the parameters, resulting in a significant difference (p<0.001) in the risk classification of the facilities. As data gathered exclusively by means of a questionnaire are not of sufficient quality to perform a risk-based surveillance of aquaculture facilities a combination of questionnaires and farm inspections is proposed. A web-based reporting system could be advantageous for the factors which were identified as being more likely to vary over time, in particular for factors considering fish movements, which showed a marginally significant difference in their risk scores (p≥0.1) within a six- month period. Nevertheless, the model proved to be stable over the considered period of time as no substantial fluctuations in the risk categorisation were observed (Kappa agreement of 0.77).Finally, the model proved to be suitable to deliver a reliable risk ranking of Swiss aquaculture facilities according to their risk of getting infected with or spreading of VHS and IHN, as the five facilities that tested positive for these diseases in the last ten years were ranked as medium or high risk. Moreover, because the seven fish farms that were infected with Infectious Pancreatic Necrosis (IPN) during the same period also belonged to the risk categories medium and high, the classification appeared to correlate with the occurrence of this third viral fish disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Examining Racial and Ethnic Differences in Nursing Home Quality.

PubMed

Hefele, Jennifer Gaudet; Ritter, Grant A; Bishop, Christine E; Acevedo, Andrea; Ramos, Candi; Nsiah-Jefferson, Laurie A; Katz, Gabrielle

2017-11-01

Identifying racial/ethnic differences in quality is central to identifying, monitoring, and reducing disparities. Although disparities across all individual nursing home residents and disparities associated with between-nursing home differences have been established, little is known about the degree to which quality of care varies by race//ethnicity within nursing homes. A study was conducted to measure within-facility differences for a range of publicly reported nursing home quality measures. Resident assessment data on approximately 15,000 nursing homes and approximately 3 million residents (2009) were used to assess eight commonly used and publicly reported long-stay quality measures: the proportion of residents with weight loss, with high-risk and low-risk pressure ulcers, with incontinence, with depressive symptoms, in restraints daily, and who experienced a urinary tract infection or functional decline. Each measure was stratified by resident race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), and within-facility differences were examined. Small but significant differences in care on average were found, often in an unexpected direction; in many cases, white residents were experiencing poorer outcomes than black and Hispanic residents in the same facility. However, a broad range of differences in care by race/ethnicity within nursing homes was also found. The results suggest that care is delivered equally across all racial/ethnic groups in the same nursing home, on average. The results support the call for publicly reporting stratified nursing home quality measures and suggest that nursing home providers should attempt to identify racial/ethnic within-facility differences in care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Develop and Manufacture an airlock sliding tray

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lawton, Cindy M.

2014-02-26

The goal of this project is to continue to develop an airlock sliding tray and then partner with an industrial manufacturing company for production. The sliding tray will be easily installed into and removed from most glovebox airlocks in a few minutes. Technical Approach: A prototype of a sliding tray has been developed and tested in the LANL cold lab and 35 trays are presently being built for the plutonium facility (PF-4). The current, recently approved design works for a 14-inch diameter round airlock and has a tray length of approximately 20 inches. The grant will take the already testedmore » and approved round technology and design for the square airlock. These two designs will be suitable for the majority of the existing airlocks in the multitude of DOE facilities. Partnering with an external manufacturer will allow for production of the airlock trays at a much lower cost and increase the availability of the product for all DOE sites. Project duration is estimated to be 12-13 months. Benefits: The purpose of the airlock sliding trays is fourfold: 1) Mitigate risk of rotator cuff injuries, 2) Improve ALARA, 3) Reduce risk of glovebox glove breaches and glove punctures, and 4) Improve worker comfort. I have had the opportunity to visit many other DOE facilities including Savannah, Y-12, ORNL, Sandia, and Livermore for assistance with ergonomic problems and/or injuries. All of these sites would benefit from the airlock sliding tray and I can assume all other DOE facilities with gloveboxes built prior to 1985 could also use the sliding trays.« less

Application of Robotics in Decommissioning and Decontamination - 12536

DOE Office of Scientific and Technical Information (OSTI.GOV)

Banford, Anthony; Kuo, Jeffrey A.; Bowen, R.A.

Decommissioning and dismantling of nuclear facilities is a significant challenge worldwide and one which is growing in size as more plants reach the end of their operational lives. The strategy chosen for individual projects varies from the hands-on approach with significant manual intervention using traditional demolition equipment at one extreme to bespoke highly engineered robotic solutions at the other. The degree of manual intervention is limited by the hazards and risks involved, and in some plants are unacceptable. Robotic remote engineering is often viewed as more expensive and less reliable than manual approaches, with significant lead times and capital expenditure.more » However, advances in robotics and automation in other industries offer potential benefits for future decommissioning activities, with the high probability of reducing worker exposure and other safety risks as well as reducing the schedule and costs required to complete these activities. Some nuclear decommissioning tasks and facility environments are so hazardous that they can only be accomplished by exclusive use of robotic and remote intervention. Less hazardous tasks can be accomplished by manual intervention and the use of PPE. However, PPE greatly decreases worker productivity and still exposes the worker to both risk and dose making remote operation preferable to achieve ALARP. Before remote operations can be widely accepted and deployed, there are some economic and technological challenges that must be addressed. These challenges will require long term investment commitments in order for technology to be: - Specifically developed for nuclear applications; - At a sufficient TRL for practical deployment; - Readily available as a COTS. Tremendous opportunities exist to reduce cost and schedule and improve safety in D and D activities through the use of robotic and/or tele-operated systems. - Increasing the level of remote intervention reduces the risk and dose to an operator. Better environmental information identifies hazards, which can be assessed, managed and mitigated. - Tele-autonomous control in a congested unstructured environment is more reliable compared to a human operator. Advances in Human Machine Interfaces contribute to reliability and task optimization. Use of standardized dexterous manipulators and COTS, including standardized communication protocols reduces project time scales. - The technologies identified, if developed to a sufficient TRL would all contribute to cost reductions. Additionally, optimizing a project's position on a Remote Intervention Scale, a Bespoke Equipment Scale and a Tele-autonomy Scale would provide cost reductions from the start of a project. Of the technologies identified, tele-autonomy is arguably the most significant, because this would provide a fundamental positive change for robotic control in the nuclear industry. The challenge for technology developers is to develop versatile robotic technology that can be economically deployed to a wide range of future D and D projects and industrial sectors. The challenge for facility owners and project managers is to partner with the developers to provide accurate systems requirements and an open and receptive environment for testing and deployment. To facilitate this development and deployment effort, the NNL and DOE have initiated discussions to explore a collaborative R and D program that would accelerate development and support the optimum utilization of resources. (authors)« less

Drug-nutrient interactions in three long-term-care facilities.

PubMed

Lewis, C W; Frongillo, E A; Roe, D A

1995-03-01

To assess the risk of drug-nutrient interactions (DNIs) in three long-term-care facilities. Retrospective audit of charts. Three long-term-care facilities in central New York State. Fifty-three patients selected randomly from each facility. Data were collected from the medical record of each patient for a period of 6 months. A computerized algorithm was used to assess the risk for DNIs. Mean drug use, most frequently consumed drugs, incidence of potential DNIs, and the most commonly observed potential DNIs are reported. In facilities A, B, and C, respectively, patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month. The most commonly observed potential DNIs were gastrointestinal interactions affecting drug bioavailability and interactions affecting electrolyte status. Patients in long-term-care facilities, who are primarily elderly and chronically ill and who consume multiple medications, are at notable risk for certain DNIs. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities. Dietitians can play an important role in training other health professionals and in designing policies to prevent DNIs.

Fact Sheet for Friction Materials Manufacturing Facilities Residual Risk and Technology Review

EPA Pesticide Factsheets

proposed amendments to the National Emission Standards for Hazardous Air Pollutants (NESHAP) for Friction Materials Manufacturing Facilities to address the results of the residual risk and technology review

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

A Strategy to Safely Live and Work in the Space Radiation Environment

NASA Technical Reports Server (NTRS)

Corbin, Barbara J.; Sulzman, Frank M.; Krenek, Sam

2006-01-01

The goal of the National Aeronautics and Space Agency and the Space Radiation Project is to ensure that astronauts can safely live and work in the space radiation environment. The space radiation environment poses both acute and chronic risks to crew health and safety, but unlike some other aspects of space travel, space radiation exposure has clinically relevant implications for the lifetime of the crew. The term safely means that risks are sufficiently understood such that acceptable limits on mission, post-mission and multi-mission consequences (for example, excess lifetime fatal cancer risk) can be defined. The Space Radiation Project strategy has several elements. The first element is to use a peer-reviewed research program to increase our mechanistic knowledge and genetic capabilities to develop tools for individual risk projection, thereby reducing our dependency on epidemiological data and population-based risk assessment. The second element is to use the NASA Space Radiation Laboratory to provide a ground-based facility to study the understanding of health effects/mechanisms of damage from space radiation exposure and the development and validation of biological models of risk, as well as methods for extrapolation to human risk. The third element is a risk modeling effort that integrates the results from research efforts into models of human risk to reduce uncertainties in predicting risk of carcinogenesis, central nervous system damage, degenerative tissue disease, and acute radiation effects. To understand the biological basis for risk, we must also understand the physical aspects of the crew environment. Thus the fourth element develops computer codes to predict radiation transport properties, evaluate integrated shielding technologies and provide design optimization recommendations for the design of human space systems. Understanding the risks and determining methods to mitigate the risks are keys to a successful radiation protection strategy.

Constructing vulnerabilty and protective measures indices for the enhanced critical infrastructure protection program.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisher, R. E.; Buehring, W. A.; Whitfield, R. G.

2009-10-14

The US Department of Homeland Security (DHS) has directed its Protective Security Advisors (PSAs) to form partnerships with the owners and operators of assets most essential to the Nation's well being - a subclass of critical infrastructure and key resources (CIKR) - and to conduct site visits for these and other high-risk assets as part of the Enhanced Critical Infrastructure Protection (ECIP) Program. During each such visit, the PSA documents information about the facility's current CIKR protection posture and overall security awareness. The primary goals for ECIP site visits (DHS 2009) are to: (1) inform facility owners and operators ofmore » the importance of their facilities as an identified high-priority CIKR and the need to be vigilant in light of the ever-present threat of terrorism; (2) identify protective measures currently in place at these facilities, provide comparisons of CIKR protection postures across like assets, and track the implementation of new protective measures; and (3) enhance existing relationships among facility owners and operators; DHS; and various Federal, State, local tribal, and territorial partners. PSAs conduct ECIP visits to assess overall site security; educate facility owners and operators about security; help owners and operators identify gaps and potential improvements; and promote communication and information sharing among facility owners and operators, DHS, State governments, and other security partners. Information collected during ECIP visits is used to develop metrics; conduct sector-by-sector and cross-sector vulnerability comparisons; identify security gaps and trends across CIKR sectors and subsectors; establish sector baseline security survey results; and track progress toward improving CIKR security through activities, programs, outreach, and training (Snyder 2009). The data being collected are used in a framework consistent with the National Infrastructure Protection Plan (NIPP) risk criteria (DHS 2009). The NIPP framework incorporates consequence, threat, and vulnerability components and addresses all hazards. The analysis of the vulnerability data needs to be reproducible, support risk analysis, and go beyond protection. It also needs to address important security/vulnerability topics, such as physical security, cyber security, systems analysis, and dependencies and interdependencies. This report provides an overview of the approach being developed to estimate vulnerability and provide vulnerability comparisons for sectors and subsectors. the information will be used to assist DHS in analyzing existing protective measures and vulnerability at facilities, to identify potential ways to reduce vulnerabilities, and to assist in preparing sector risk estimates. The owner/operator receives an analysis of the data collected for a specific asset, showing a comparison between the facility's protection posture/vulnerability index and those of DHS sector/subsector sites visited. This comparison gives the owner/operator an indication of the asset's security strengths and weaknesses that may be contributing factors to its vulnerability and protection posture. The information provided to the owner/operator shows how the asset compares to other similar assets within the asset's sector or subsector. A 'dashboard' display is used to illustrate the results in a convenient format. The dashboard allows the owner/operator to analyze the implementation of additional protective measures and to illustrate how such actions would impact the asset's Protective Measures Index (PMI) or Vulnerability Index (VI).« less

Sex workers in Vietnam: how many, how risky?

PubMed

Minh, Truong Tan; Nhan, Do Thi; West, Gary R; Durant, Tonji M; Jenkins, Richard A; Huong, Pham Thi; Valdiserri, Ronald O

2004-10-01

Because of concerns for HIV risks and need to plan effective programs, we assessed the number and risks of sex workers in Nha Trang City, Vietnam. Sex workers were contacted in streets, beaches, bars, and restaurants, and a capture-recapture method was used to estimate their number. An estimated 444 women worked on the streets and beach ("direct" sex workers) and 486 worked in bars and restaurants or other facilities ("indirect" sex workers). Direct and indirect sex workers engaged in sex work primarily to support their families. Direct sex workers were older and were more at risk for HIV risk than were indirect sex workers. Direct sex workers had more clients, were less likely to report always using condoms (67% vs. 81%), more likely to report a prior sexually transmitted infection (19% vs. 16%), and more likely to have clients who inject drugs (16% vs. 13%). This assessment has implications for planning programs to reduce sex work and its risks in Vietnam and potentially other countries.

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

PubMed Central

Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

2013-01-01

Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

Fear of rape from behind prison walls.

PubMed

Shermer, Lauren O'Neill; Sudo, Heather

2017-06-12

Purpose The Prison Rape Elimination Act has brought significant attention to the issue of sexual victimization within correctional institutions. While the actual risk of sexual victimization remains low, the perception of rape among inmates is high. Given how one's fear can translate into behavior, understanding how institutions impact the culture surrounding prison rape highlights areas for reducing violence within prisons. The paper aims to discuss these issues. Design/methodology/approach This study includes secondary analysis of a quantitative database created from semi-structured interviews with 564 high security, general population inmates. Using fear of rape as the outcome of interest, bivariate and logistic regression analyses are used to comment on the impact of individual and facility level characteristics on this outcome. Findings In general, the results from this study suggest that the greatest risk factors for fearing rape while in prison are being male, having a mental health issue, and hearing about rape within the institution. From these specific findings a few general lessons can be learned with the hope that practitioners can translate these lessons into policy initiatives in order to combat fear of rape among our inmate population. Originality/value This paper aims to fill a gap in the research on how the facility contributes to the fear of rape within prison. The end goal is to inform policy makers so that suggestions can be made to combat this problem and prevent further misconduct within these facilities.

Are environmental risk estimations linked to the actual environmental impact? Application to an oil handling facility (NE Spain).

PubMed

Valdor, Paloma F; Puente, Araceli; Gómez, Aina G; Ondiviela, Bárbara; Juanes, José A

2017-01-30

The environmental risk analysis of aquatic systems includes the evaluation of the likelihood that adverse ecological effects may occur as a result of exposure to one or more stressors. In harbor areas, pollution is provided by a complex mixture of substances with different levels of toxicity, persistence and bioaccumulation, which complicates the hazards characterization and their multiple effects. A study of the relationship between the environmental impact and the environmental risk assessment at a specific isolated oil handling facility was undertaken. The environmental risk of the oil handling facility, considering the consequences of specific pollutants, was estimated and the associated environmental impact was quantified based on a 'weights of evidence' approach. The contamination quantified at the potentially affected area around the monobuoy of Tarragona has proved to be related with environmental risk estimations but the lines of evidence obtained do not allow us to assert that the activity developed at this facility has an associated environmental impact. Copyright © 2016 Elsevier Ltd. All rights reserved.

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

PubMed Central

Weiser, Prisca; Becker, Thomas; Losert, Carolin; Alptekin, Köksal; Berti, Loretta; Burti, Lorenzo; Burton, Alexandra; Dernovsek, Mojca; Dragomirecka, Eva; Freidl, Marion; Friedrich, Fabian; Genova, Aneta; Germanavicius, Arunas; Halis, Ulaş; Henderson, John; Hjorth, Peter; Lai, Taavi; Larsen, Jens Ivar; Lech, Katarzyna; Lucas, Ramona; Marginean, Roxana; McDaid, David; Mladenova, Maya; Munk-Jørgensen, Povl; Paziuc, Alexandru; Paziuc, Petronela; Priebe, Stefan; Prot-Klinger, Katarzyna; Wancata, Johannes; Kilian, Reinhold

2009-01-01

Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities. PMID:19715560

DOE Office of Scientific and Technical Information (OSTI.GOV)

Myers, C.W.; Giraud, K.M.

Newcomer countries expected to develop new nuclear power programs by 2030 are being encouraged by the International Atomic Energy Agency to explore the use of shared facilities for spent fuel storage and geologic disposal. Multinational underground nuclear parks (M-UNPs) are an option for sharing such facilities. Newcomer countries with suitable bedrock conditions could volunteer to host M-UNPs. M-UNPs would include back-end fuel cycle facilities, in open or closed fuel cycle configurations, with sufficient capacity to enable M-UNP host countries to provide for-fee waste management services to partner countries, and to manage waste from the M-UNP power reactors. M-UNP potential advantagesmore » include: the option for decades of spent fuel storage; fuel-cycle policy flexibility; increased proliferation resistance; high margin of physical security against attack; and high margin of containment capability in the event of beyond-design-basis accidents, thereby reducing the risk of Fukushima-like radiological contamination of surface lands. A hypothetical M-UNP in crystalline rock with facilities for small modular reactors, spent fuel storage, reprocessing, and geologic disposal is described using a room-and-pillar reference-design cavern. Underground construction cost is judged tractable through use of modern excavation technology and careful site selection. (authors)« less

Novel Laser Ablation Technology for Surface Decontamination

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, Chung H.

2004-06-01

Laser ablation for surface cleaning has been pursued for the removal of paint on airplanes. It has also been pursued for the cleaning of semiconductor surfaces. However, all these approaches have been pursued by laser ablation in air. For highly contaminated surface, laser ablation in air can easily cause secondary contamination. Thus it is not suitable to apply to achieve surface decontamination for DOE facilities since many of these facilities have radioactive contaminants on the surface. Any secondary contamination will be a grave concern. The objective of this project is to develop a novel technology for laser ablation in liquidmore » for surface decontamination. It aims to achieve more efficient surface decontamination without secondary contamination and to evaluate the economic feasibility for large scale surface decontamination with laser ablation in liquid. When laser ablation is pursued in the solution, all the desorbed contaminants will be confined in liquid. The contaminants can be precipitated and subsequently contained in a small volume for disposal. It can reduce the risk of the decontamination workers. It can also reduce the volume of contaminants dramatically.« less

NASA Microgravity Combustion Science Research Plans for the ISS

NASA Technical Reports Server (NTRS)

Sutliff, Thomas J.

2003-01-01

A peer-reviewed research program in Microgravity Combustion Science has been chartered by the Physical Sciences Research Division of the NASA Office of Biological and Physical Research. The scope of these investigations address both fundamental combustion phenomena and applied combustion research topics of interest to NASA. From this pool of research, flight investigations are selected which benefit from access to a microgravity environment. Fundamental research provides insights to develop accurate simulations of complex combustion processes and allows developers to improve the efficiency of combustion devices, to reduce the production of harmful emissions, and to reduce the incidence of accidental uncontrolled combustion (fires, explosions). Through its spacecraft fire safety program, applied research is conducted to decrease risks to humans living and working in space. The Microgravity Combustion Science program implements a structured flight research process utilizing the International Space Station (ISS) and two of its premier facilities- the Combustion Integrated Rack of the Fluids and Combustion Facility and the Microgravity Science Glovebox - to conduct space-based research investigations. This paper reviews the current plans for Microgravity Combustion Science research on the International Space Station from 2003 through 2012.

Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi

PubMed Central

Tweya, Hannock; Oboho, Ikwo Kitefre; Gugsa, Salem T.; Phiri, Sam; Rambiki, Ethel; Banda, Rebecca; Mwafilaso, Johnbosco; Munthali, Chimango; Gupta, Sundeep; Bateganya, Moses; Maida, Alice

2018-01-01

Introduction Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients’ demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi. Methods We conducted a retrospective cohort study of HIV-infected individuals aged 15 years or older at the time of registration for HIV care in 12 ART facilities, between April 2012 and March 2013. HIV-positive individuals who had not started ART (pre-ART patients) were clinically assessed to determine ART eligibility at registration and during clinic follow-up visits. ART-eligible patients were initiated on triple antiretroviral combination. Study data were abstracted from patients’ cards, facility ART registers or electronic medical record system from the date of registration for HIV care to a maximum follow-up period of 24 months. Descriptive statistics were undertaken to summarize characteristics of the study patients. Separate univariable and multivariable poisson regression models were used to explore factors associated with LTFU in pre-ART and ART care. Results A total of 10,812 HIV-infected individuals registered for HIV care. Of these patients, 1,907 (18%) and 8,905 (82%) enrolled in pre-ART and ART care, respectively. Of the 1,907 pre-ART patients, 490 (26%) subsequently initiated ART and were included in both the pre-ART and ART analyses. The LTFU rates among patients in pre-ART and ART care were 48 and 26 per 100 person-years, respectively. Of the 9,105 ART patients with reasons for starting ART, 2,451 (27%) were initiated on ART because of pregnancy or breastfeeding (Option B+) status. Multivariable analysis showed that being ≥35 years and female were associated with decreased risk of LTFU in the pre-ART and ART phases of HIV care. However, being in WHO clinical stage 3 (adjusted risk ratio (aRR) 1.35, 95% confidence interval (CI): 1.20–1.51) and stage 4 (aRR 1.87, 95% CI: 1.62–2.18), body mass index ≤ 18.4 (aRR 1.24, 95% CI: 1.11–1.39) at ART initiation, poor adherence to clinic appointments (aRR 4.55, 95% CI: 4.16–4.97) and receiving HIV care in rural facilities (aRR 2.32, 95% CI: 1.94–2.87) were associated with increased risk of LTFU among ART patients. Being re-initiated on ART once (aRR 0.20, 95% CI: 0.17–0.22), more than once (aRR 0.06, 95% CI: 0.05–0.07), and being enrolled at a low-volume facility (aRR 0.25, 95% CI: 0.20–0.30) were associated with decreased risk of LTFU from ART care. Conclusion A sizeable proportion of ART LTFU occurred among women enrolled during pregnancy or breast-feeding. Non- compliance to clinic and receiving ART in a rural facility or high-volume facility were associated with increased risk of LTFU from ART care. Developing effective interventions that target high-risk subgroups and contexts may help reduce LTFU from HIV care. PMID:29373574

Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

PubMed Central

Rahman, Md. Mizanur; Gilmour, Stuart; Saito, Eiko; Sultana, Papia; Shibuya, Kenji

2013-01-01

Background Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection. PMID:23451102

Association between access to accelerated partial breast irradiation and use of adjuvant radiotherapy.

PubMed

Wang, Elyn H; Park, Henry S; Rutter, Charles E; Gross, Cary P; Soulos, Pamela R; Yu, James B; Evans, Suzanne B

2017-02-01

The current study was performed to determine whether access to facilities performing accelerated partial breast irradiation (APBI) is associated with differences in the use of adjuvant radiotherapy (RT). Using the National Cancer Data Base, the authors performed a retrospective study of women aged ≥50 years who were diagnosed with early-stage breast cancer between 2004 and 2013 and treated with breast-conserving surgery (BCS). Facilities performing APBI in ≥10% of their eligible patients within a given year were defined as APBI facilities whereas those not performing APBI were defined as non-APBI facilities. All other facilities were excluded. The authors identified independent factors associated with RT use using multivariable logistic regression with clustering in the overall sample as well as in subsets of patients with standard-risk invasive cancer, low-risk invasive cancer, and ductal carcinoma in situ. Among 222,544 patients, 76.6% underwent BCS plus RT and 23.4% underwent BCS alone. The likelihood of RT receipt in the overall sample did not appear to differ significantly between APBI and non-APBI facilities (adjusted odds ratio [AOR], 1.02; P = .61). Subgroup multivariable analysis demonstrated that among patients with standard-risk invasive cancer, there was no association between evaluation at an APBI facility and receipt of RT (AOR, 0.98; P = .69). However, patients with low-risk invasive cancer were found to be significantly more likely to receive RT (54.4% vs 59.5%; AOR, 1.22 [P<.001]), whereas patients with ductal carcinoma in situ were less likely to receive RT (56.9% vs 55.3%; AOR, 0.89 [P = .04]) at APBI facilities. Patients who were eligible for observation were more likely to receive RT in APBI facilities but no difference was observed among patients with standard-risk invasive cancer who would most benefit from RT. Cancer 2017;123:502-511. © 2016 American Cancer Society. © 2016 American Cancer Society.

Translational models of infection prevention and control: lessons from studying high risk aging populations.

PubMed

Mody, Lona

2018-06-13

The present review describes our research experiences and efforts in advancing the field of infection prevention and control in nursing facilities including postacute and long-term care settings. There are over two million infections in postacute and long-term care settings each year in the United States and $4 billion in associated costs. To define a target group most amenable to infection prevention and control interventions, we sought to quantify the relation between indwelling device use and microbial colonization in nursing facility patients. Using various methodologies including survey methods, observational epidemiology, randomized controlled studies, and collaboratives, we showed that indwelling device type is related to the site of multidrug-resistant organism (MDRO) colonization; multianatomic site colonization with MDROs is common; community-associated methicillin-resistant Staphylococcus aureus (MRSA) appeared in the nursing facility setting almost immediately following its emergence in acute care; (4) MDRO prevalence and catheter-associated infection rates can be reduced through a multimodal targeted infection prevention intervention; and (5) using a collaborative approach, such an intervention can be successfully scaled up. Our work advances the infection prevention field through translational research utilizing various methodologies, including quantitative and qualitative surveys, patient-oriented randomized controlled trials, and clinical microbiologic and molecular methods. The resulting interventions employ patient-oriented methods to reduce infections and antimicrobial resistance, and with partnerships from major national entities, can be implemented nationally.

Seismic risk management solution for nuclear power plants

DOE PAGES

Coleman, Justin; Sabharwall, Piyush

2014-12-01

Nuclear power plants should safely operate during normal operations and maintain core-cooling capabilities during off-normal events, including external hazards (such as flooding and earthquakes). Management of external hazards to expectable levels of risk is critical to maintaining nuclear facility and nuclear power plant safety. Seismic risk is determined by convolving the seismic hazard with seismic fragilities (capacity of systems, structures, and components). Seismic isolation (SI) is one protective measure showing promise to minimize seismic risk. Current SI designs (used in commercial industry) reduce horizontal earthquake loads and protect critical infrastructure from the potentially destructive effects of large earthquakes. The benefitmore » of SI application in the nuclear industry is being recognized and SI systems have been proposed in American Society of Civil Engineer Standard 4, ASCE-4, to be released in the winter of 2014, for light water reactors facilities using commercially available technology. The intent of ASCE-4 is to provide criteria for seismic analysis of safety related nuclear structures such that the responses to design basis seismic events, computed in accordance with this standard, will have a small likelihood of being exceeded. The U.S. nuclear industry has not implemented SI to date; a seismic isolation gap analysis meeting was convened on August 19, 2014, to determine progress on implementing SI in the U.S. nuclear industry. The meeting focused on the systems and components that could benefit from SI. As a result, this article highlights the gaps identified at this meeting.« less

A randomized controlled exercise training trial on insulin sensitivity in African American men: The ARTIIS study: Major category: study design, statistical design, study protocols.

PubMed

Newton, Robert L; Johnson, William D; Hendrick, Chelsea; Harris, Melissa; Andrews, Emanuel; Johannsen, Neil; Rodarte, Ruben Q; Hsia, Daniel S; Church, Timothy S

2015-07-01

Lack of regular physical activity at prescribed intensity levels is a modifiable risk factor for insulin resistance and the development of diabetes. African American men are at increased risk for developing diabetes and most African American men are not meeting the current recommended levels of physical activity. The primary objective of the Aerobic Plus Resistance Training and Insulin Resistance in African American Men (ARTIIS) study is to determine the effectiveness of an exercise training intervention aimed at reducing diabetes risk factors in African American men at risk for developing diabetes. Insufficiently active 35-70 year old African American men with a family history of diabetes were eligible for the study. The 5-month randomized controlled trial assigns 116 men to an exercise training or healthy living control arm. The exercise training arm combines aerobic and resistance training according to the current national physical activity recommendations and is conducted in community (YMCA) facilities. The healthy living arm receives information promoting healthy lifestyle changes. Insulin response to an oral glucose load is the primary outcome measure, and changes in physiological parameters, cardiorespiratory fitness, strength, body composition, and psychological well-being comprise the secondary outcomes. The ARTIIS study is one of the first adequately powered, rigorously designed studies to investigate the effects of an aerobic plus resistance exercise training program and to assess adherence to exercise training in community facilities, in African American men. Copyright © 2015 Elsevier Inc. All rights reserved.

Preliminary Evaluation of Convective Heat Transfer in a Water Shield for a Surface Power Reactor

NASA Technical Reports Server (NTRS)

Pearson J. Boise; Reid, Robert S.

2007-01-01

As part of the Vision for Space Exploration, the end of the next decade will bring man back to the surface of the moon. A crucial issue for the establishment of human presence on the moon will be the availability of compact power sources. This presence could require greater than 10's of kWt's in follow on years. Nuclear reactors are well suited to meet the needs for power generation on the lunar or Martian surface. Radiation shielding is a key component of any surface power reactor system. Several competing concepts exist for lightweight, safe, robust shielding systems such as a water shield, lithium hydride (LiH), and boron carbide. Water offers several potential advantages, including reduced cost, reduced technical risk, and reduced mass. Water has not typically been considered for space reactor applications because of the need for gravity to fix the location of any vapor that could form radiation streaming paths. The water shield concept relies on the predictions of passive circulation of the shield water by natural convection to adequately cool the shield. This prediction needs to be experimentally evaluated, especially for shields with complex geometries. NASA Marshall Space Flight Center has developed the experience and facilities necessary to do this evaluation in its Early Flight Fission - Test Facility (EFF-TF).

Development and introduction of inactivated poliovirus vaccines derived from Sabin strains in Japan.

PubMed

Shimizu, Hiroyuki

2016-04-07

During the endgame of global polio eradication, the universal introduction of inactivated poliovirus vaccines is urgently required to reduce the risk of vaccine-associated paralytic poliomyelitis and polio outbreaks due to wild and vaccine-derived polioviruses. In particular, the development of inactivated poliovirus vaccines (IPVs) derived from the attenuated Sabin strains is considered to be a highly favorable option for the production of novel IPV that reduce the risk of facility-acquired transmission of poliovirus to the communities. In Japan, Sabin-derived IPVs (sIPVs) have been developed and introduced for routine immunization in November 2012. They are the first licensed sIPVs in the world. Consequently, trivalent oral poliovirus vaccine was used for polio control in Japan for more than half a century but has now been removed from the list of vaccines licensed for routine immunization. This paper reviews the development, introduction, characterization, and global status of IPV derived from attenuated Sabin strains. Copyright © 2014 Elsevier Ltd. All rights reserved.

Population-based contracting (population health): part II.

PubMed

Jacofsky, D J

2017-11-01

Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4. ©2017 The British Editorial Society of Bone & Joint Surgery.

European Consensus on Primary Prevention of Coronary Heart Disease.

PubMed

Assmann, G

1988-07-01

The European Consensus on Primary Prevention of Coronary Heart Disease has recommended that providing care for individuals at particular risk for coronary artery disease (CAD) requires case finding through medical examinations in primary care, hospital and employment health examination settings. Decisions concerning management of elevated lipid levels should be based on overall cardiovascular risk. The goal of reducing cholesterol levels through risk reduction can ultimately be accomplished only with the implementation of health education efforts directed toward all age groups and actions by government and supranational agencies, including adequate food labelling to identify fat content, selective taxation to encourage healthful habits and wider availability of exercise facilities. Only measures directed at the overall population can eventually reach the large proportion of individuals at mildly to moderately increased risk for CAD. The European Policy Statement on the Prevention of Coronary Heart Disease recognizes that the question of lipid elevation as a risk factor for CAD involves assessment, not only of cholesterol level alone, but also of triglycerides and the HDL cholesterol lipid fraction. Five specific categories of dyslipidemia have been identified, with individualized screening and treatment strategies advised for each. It is the consensus of the study group panel members that these procedures are both practical and feasible. They begin the necessary long term process to reduce the unacceptably high levels of morbidity and mortality due to CAD throughout the European community.

Report of the New England Task Force on Reducing Heart Disease and Stroke Risk.

PubMed Central

Havas, S; Wozenski, S; Deprez, R; Miller, L; Charman, R; Hamrell, M; Green, L; Benn, S

1989-01-01

Five years ago, a task force on reducing risk for heart disease and stroke was established by the six New England States. The task force included representatives from State public health departments, academia, the corporate sector, and voluntary organizations. This article is the final report of the task force. Heart disease and cerebrovascular disease are major causes of mortality in the New England region. Heart disease causes nearly 40 percent of all deaths in each of the six States and cerebrovascular disease, 7 percent of the deaths. Major risk factors for ischemic heart disease that have been identified--elevated serum cholesterol, high blood pressure, and cigarette smoking--are caused largely by lifestyle behaviors. Similarly, cerebrovascular disease results largely from uncontrolled high blood pressure, much of which is attributable to unhealthy lifestyle behaviors. In a series of studies evidence has accumulated that the reduction or elimination of these risk factors results in a decline in mortality rates. Many intervention programs have been mounted in the region, but there has been no population-wide effort to attack these risk factors. The task force proposed a broad range of activities for New Englanders at sites in the community and in health facilities. These activities would promote not smoking, exercising regularly, and maintaining desirable levels of serum cholesterol and blood pressure. PMID:2495547

EMU Shoulder Injury Tiger Team Report

NASA Technical Reports Server (NTRS)

Williams, David R.; Johnson, Brian J.

2003-01-01

The number and complexity of extravehicular activities required for the completion and maintenance of the International Space Station is unprecedented. It is not surprising that training to perform these space walks presents a risk of overuse musculoskeletal injuries. The goal of this tiger team, created in December 2002, was to identify the different factors contributing to the risk of EVA training-related shoulder injury in the Neutral Buoyancy Lab at the Sonny Carter Training Facility and to make recommendations that would either significantly reduce or eliminate those risks. Since 1999, concerns have been expressed about the risk of shoulder injury associated with EVA training at the NBL, particularly in inverted body positions (McMonigal, 1999). A survey was developed and administered to 42 astronauts and astronaut candidates; the results suggest a causal relationship between EVA training at the NBL and the observed injuries. Also, during the tiger team review, it became evident that training in the extravehicular mobility unit may also result in other types of injuries, including fingernail delamination, elbow pain, knee pain, foot pain, and nerve compression leading to transient loss of sensation in certain areas of the upper or lower extremity. A multi-directorate team to detect, evaluate and respond to the medical issues associated with EVA training should be implemented immediately and given the appropriate resources and authority to reduce the risk of injury to crew during training to a level as low as reasonably achievable.

A Prospective, Multicenter Study to Compare a Disposable, High-fluid Capacity Underpad to Nonpermeable, Disposable, Reusable Containment Products on Incontinence-associated Dermatitis Rates Among Skilled Nursing Facility Residents.

PubMed

Motta, Glenda; Milne, Catherine T

2017-12-01

Due to the high prevalence of incontinence among skilled nursing facility (SNF) residents, incontinence-associated derma- titis (IAD) is a common occurrence. In addition, facility staff may mistakenly identify IAD as a pressure injury. A prospective, descriptive, multicenter study was conducted in 3 Connecticut facilities to evaluate the effect of substituting a disposable, high- uid capacity underpad for nonpermeable disposable and reusable containment products on the rate of IADs. Residents with and without IAD but with high IAD risk scores who were bed- or chairbound or ambulatory and used disposable nonpermeable briefs and underpads or reusable, laundered containment products when in bed longer than 2 hours were randomly enrolled and observed for a 4-week period. Facility staff were trained on the importance of differentiating between IAD and pressure injury; they substituted the study product (a disposable, high- uid capacity underpad) for all previously used containment products. Patient risk for IAD and skin condition were assessed using the Perineal Assessment Tool (PAT) and the Skin Condition Assessment Tool (SAT), respectively, at 5 time points: baseline, week 1, week 2, week 3, and week 4. The PAT is a 4-item instrument based conceptually on the 4 determinants in perineal skin breakdown; subscales are rated from 1 (least risk) to 3 (most risk), with a total score range of 4 to 12. The SAT is used to evaluate IAD speci cally, generating a cumulative severity score ranging from 0 to 3 on area of skin affected, degree of redness, and depth of ero- sion. Final data analysis was conducted on 40 residents: 25 had IAD present at enrollment and 15 were deemed high risk for developing IAD. Mean SAT scores in the 25 participants with IAD decreased with signi cance at week 1 (P = .0016), week 2 (P = .0023), week 3 (P = .0005), and week 4 (P <.0001). Baseline IAD severity scores averaged 3.3 ± 1.7. Overall IAD average severity scores in this group decreased from baseline mean of 3.3 ± 1.7 to 0.7 ± 1.4 at week 4 (P <.001). The 15 participants with intact, nondamaged skin at enrollment did not develop IAD from baseline to week 4, and PAT score risk levels decreased from high (7 or greater) to low (6 or less) as a result of a speci c reduction in the duration of irritant exposure category for 11 (73%) of this group of participants by week 4. PAT risk level scores for both IAD and non-IAD participants at baseline averaged 8.1 ± 1.4; after 4 weeks, they averaged 7.0 ± 1.5). Although change was not significant, results suggest the use of a disposable, high- uid capacity underpad improved SAT scores over time. IAD rates increased in each facility, but pressure injury incidence rates decreased for the study duration. Replacing a nonpermeable, reusable containment product with a disposable, high- uid capacity underpad when SNF residents are in bed longer than 2 hours may impact the severity of IAD and reduce its incidence. The inverse impact reported on IAD and pressure injury incidence rates 1 month after training suggest study educational efforts had a short-lasting effect. Future research is indicated to determine the most effective method to improve nurses' ability to identify and distinguish IAD from pressure injury in the SNF setting.

Effect of water treatment additives on lime softening residual trace chemical composition--implications for disposal and reuse.

PubMed

Cheng, Weizhi; Roessler, Justin; Blaisi, Nawaf I; Townsend, Timothy G

2014-12-01

Drinking water treatment residues (WTR) offer potential benefits when recycled through land application. The current guidance in Florida, US allows for unrestricted land application of lime softening WTR; alum and ferric WTR require additional evaluation of total and leachable concentrations of select trace metals prior to land application. In some cases a mixed WTR is produced when lime softening is accompanied by the addition of a coagulant or other treatment chemical; applicability of the current guidance is unclear. The objective of this research was to characterize the total and leachable chemical content of WTR from Florida facilities that utilize multiple treatment chemicals. Lime and mixed lime WTR samples were collected from 18 water treatment facilities in Florida. Total and leachable concentrations of the WTR were measured. To assess the potential for disposal of mixed WTR as clean fill below the water table, leaching tests were conducted at multiple liquid to solid ratios and under reducing conditions. The results were compared to risk-based soil and groundwater contamination thresholds. Total metal concentrations of WTR were found to be below Florida soil contaminant thresholds with Fe found in the highest abundance at a concentration of 3600 mg/kg-dry. Aluminum was the only element that exceeded the Florida groundwater contaminant thresholds using SPLP (95% UCL = 0.23 mg/L; risk threshold = 0.2 mg/L). Tests under reducing conditions showed elevated concentrations of Fe and Mn, ranging from 1 to 3 orders of magnitude higher than SPLP leachates. Mixed lime WTR concentrations (total and leachable) were lower than the ferric and alum WTR concentrations, supporting that mixed WTR are appropriately represented as lime WTR. Testing of WTR under reducing conditions demonstrated the potential for release of certain trace metals (Fe, Al, Mn) above applicable regulatory thresholds; additional evaluation is needed to assess management options where reducing conditions may develop. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

PubMed

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.

An Evaluation of the Additional Acoustic Power Needed to Overcome the Effects of a Test-Articles Absorption During Reverberant Chamber Acoustic Testing of Spaceflight Hardware

NASA Technical Reports Server (NTRS)

Hozman, Aron D.; Hughes, William O.

2014-01-01

It is important to realize that some test-articles may have significant sound absorption that may challenge the acoustic power capabilities of a test facility. Therefore, to mitigate this risk of not being able to meet the customers target spectrum, it is prudent to demonstrate early-on an increased acoustic power capability which compensates for this test-article absorption. This paper describes a concise method to reduce this risk when testing aerospace test-articles which have significant absorption. This method was successfully applied during the SpaceX Falcon 9 Payload Fairing acoustic test program at the NASA Glenn Research Center Plum Brook Stations RATF.

Development of risk-based decision methodology for facility design.

DOT National Transportation Integrated Search

2014-06-01

This report develops a methodology for CDOT to use in the risk analysis of various types of facilities and provides : illustrative examples for the use of the proposed framework. An overview of the current practices and applications to : illustrate t...

Earthquakes and building design: a primer for the laboratory animal professional.

PubMed

Vogelweid, Catherine M; Hill, James B; Shea, Robert A; Johnson, Daniel B

2005-01-01

Earthquakes can occur in most regions of the United States, so it might be necessary to reinforce vulnerable animal facilities to better protect research animals during these unpredictable events. A risk analysis should include an evaluation of the seismic hazard risk at the proposed building site balanced against the estimated consequences of losses. Risk analysis can help in better justifying and recommending to building owners the costs of incorporating additional seismic reinforcements. The planning team needs to specify the level of post-earthquake building function that is desired in the facility, and then design the facility to it.

Integration of Biosafety into Core Facility Management

PubMed Central

Fontes, Benjamin

2013-01-01

This presentation will discuss the implementation of biosafety policies for small, medium and large core laboratories with primary shared objectives of ensuring the control of biohazards to protect core facility operators and assure conformity with applicable state and federal policies, standards and guidelines. Of paramount importance is the educational process to inform core laboratories of biosafety principles and policies and to illustrate the technology and process pathways of the core laboratory for biosafety professionals. Elevating awareness of biohazards and the biosafety regulatory landscape among core facility operators is essential for the establishment of a framework for both project and material risk assessment. The goal of the biohazard risk assessment process is to identify the biohazard risk management parameters to conduct the procedure safely and in compliance with applicable regulations. An evaluation of the containment, protective equipment and work practices for the procedure for the level of risk identified is facilitated by the establishment of a core facility registration form for work with biohazards and other biological materials with potential risk. The final step in the biocontainment process is the assumption of Principal Investigator role with full responsibility for the structure of the site-specific biosafety program plan by core facility leadership. The presentation will provide example biohazard protocol reviews and accompanying containment measures for core laboratories at Yale University.

WITHDRAWN: Amnioinfusion for meconium-stained liquor in labour.

PubMed

Hofmeyr, G Justus

2009-01-21

Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. It is also thought to dilute meconium when present in the amniotic fluid and so reduce the risk of meconium aspiration. However, it may be that the mechanism of effect is that it corrects oligohydramnios (reduced amniotic fluid), for which thick meconium staining is a marker. The objective of this review was to assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. The Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) were searched. Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid. Eligibility and trial quality were assessed by one reviewer. Twelve studies, most involving small numbers of participants, were included. Under standard perinatal surveillance, amnioinfusion was associated with a reduction in the following: heavy meconium staining of the liquor (relative risk 0.03, 95% confidence interval 0.01 to 0.15); variable fetal heart rate deceleration (relative risk 0.65, 95% confidence interval 0.49 to 0.88); and reduced caesarean section overall (relative risk 0.82, 95% confidence interval 0.69 to 1.97). No perinatal deaths were reported. Under limited perinatal surveillance, amnioinfusion was associated with a reduction in the following: meconium aspiration syndrome (relative risk 0.24, 95% confidence interval 0.12 to 0.48); neonatal hypoxic ischaemic encephalopathy (relative risk 0.07, 95% confidence interval 0.01 to 0.56) and neonatal ventilation or intensive care unit admission (relative risk 0.56, 95% confidence interval 0.39 to 0.79); there was a trend towards reduced perinatal mortality (relative risk 0.34, 95% confidence interval 0.11 to 1.06). Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for perinatal surveillance are limited. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

The Effect of Dialysis Chains on Mortality among Patients Receiving Hemodialysis

PubMed Central

Zhang, Yi; Cotter, Dennis J; Thamer, Mae

2011-01-01

Objective To examine the association between dialysis facility chain affiliation and patient mortality. Study Setting Medicare dialysis population. Study Design Data from the United States Renal Data System (USRDS) were used to identify 3,601 free-standing dialysis facilities and 34,914 Medicare patients' incidence to end-stage renal disease (ESRD) in 2004. Mixed-effect regression models were used to estimate patient mortality by dialysis facility chain and profit status during the 2-year follow-up. Data Collection USRDS data were matched with facility, cost, and census data. Principle Findings Of the five largest dialysis chains, the lowest mortality risk was observed among patients dialyzed at nonprofit (NP) Chain 5 facilities. Compared with Chain 5, hazard ratios were 19 percent higher (95 percent CI 1.06–1.34) and 24 percent higher (95 percent CI 1.10–1.40) for patients dialyzed at for-profit (FP) Chain 1 and Chain 2 facilities, respectively. In addition, patients at FP facilities had a 13 percent higher risk of mortality than those in NP facilities (95 percent CI 1.06–1.22). Conclusions Large chain affiliation is an independent risk factor for ESRD mortality in the United States. Given the movement toward further consolidation of large FP chains, reasons behind the increase in mortality require scrutiny. PMID:21143480

[Airborne particles in a multi-wall carbon nanotube production plant: observation of particle emission and personal exposure 1: Measurement in the packing process].

PubMed

Takaya, Mitsutoshi; Serita, Fumio; Ono-Ogasawara, Mariko; Shinohara, Yasushi; Saito, Hiroyuki; Koda, Shigeki

2010-01-01

In order to assess the exposure risks of multiwall carbon nanotubes (MWCNT) for packing workers, we carried out real-time monitoring in the two types of packing facilities of MWCNT, and exposure measurements for the packing workers. In the real-time monitoring, a scanning mobility particle sizer (SMPS) and an optical particle counter (OPC) were used to measure nanoscale particles and sub-micron/micron scale particles, respectively. A personal sampler with PM 4.0 was used to measure the personal exposures in the packing facilities. One of the packing facilities is manually operated and the other is automated. The concentrations of airborne dust in both facilities were almost the same as each other at 0.24 mg/m(3) (total dust). However, the results of personal exposure measurements were quite different between the two facilities. The exposure concentrations of workers in the manually and automated operations were 2.39/0.39 (total/respirable) mg/m(3) and 0.29/0.08 (total/respirable) mg/m(3), respectively. From the time series study, submicron scale particles were released into the workplace air when the CNT products were put into temporary container bags from a hopper and manually packed into shipping bags. However, the task-related nanoscale particle release was not observed. The manual packing operation is one of the "hot spots" in MWCNT production facilities, and automation brings much improvement to reduce MWCNT exposure.

A Biosecurity Survey in Kenya, November 2014 to February 2015.

PubMed

Ndhine, Edwardina Otieno; Slotved, Hans-Christian; Osoro, Eric Mogaka; Olsen, Katja N; Rugutt, Moses; Wanjohi, Cathryn W; Mwanda, Walter; Kinyagia, Benson Mburu; Steenhard, Nina R; Hansen, John-Erik Stig

2016-01-01

A biosecurity survey was performed to gather information on the biosecurity level and laboratory capacity in Kenya for the purpose of providing information outlining relevant components for biosecurity legislation, biosecurity implementation, and enforcement of biosecurity measures in Kenya. This survey is, to the authors' knowledge, the first to be published from an African country. A total of 86 facilities with laboratories covering relevant categories, such as training laboratories, human diagnostic laboratories, veterinary diagnostic laboratories, and research laboratories, were selected to participate in the survey. Each facility was visited by a survey team and staff were asked to answer 29 groups of questions from a questionnaire. The survey showed that Kenyan laboratory facilities contain biological agents of biosecurity concern. The restrictions for these agents were found to be limited for several of the facilities, in that many laboratory facilities and storage units were open for access by either students or staff who had no need of access to the laboratory. The survey showed a great deal of confusion in the terms biosecurity and biosafety and a generally limited biosecurity awareness among laboratory personnel. The survey showed that the security of biological agents of biosecurity concern in many facilities does not meet the international requirements. The authors recommend developing a legal framework in Kenya for effective controls, including national biosecurity regulations, guidelines, and procedures, thereby reducing the risk that a Kenyan laboratory would be the source of a future biological attack.

Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study.

PubMed

van Buul, Laura W; van der Steen, Jenny T; Doncker, Sarah M M M; Achterberg, Wilco P; Schellevis, François G; Veenhuizen, Ruth B; Hertogh, Cees M P M

2014-12-16

Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors. Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff. The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics). Our interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently intervene at the level of those factors to promote appropriate antibiotic prescribing.

Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

PubMed

Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo

2018-04-01

To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Potential advantages associated with implementing a risk-based inspection program by a nuclear facility

NASA Astrophysics Data System (ADS)

McNeill, Alexander, III; Balkey, Kenneth R.

1995-05-01

The current inservice inspection activities at a U.S. nuclear facility are based upon the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code, Section XI. The Code selects examination locations based upon a sampling criteria which includes component geometry, stress, and usage among other criteria. This can result in a significant number of required examinations. As a result of regulatory action each nuclear facility has conducted probabilistic risk assessments (PRA) or individual plant examinations (IPE), producing plant specific risk-based information. Several initiatives have been introduced to apply this new plant risk information. Among these initiatives is risk-based inservice inspection. A code case has been introduced for piping inspections based upon this new risk- based technology. This effort brought forward to the ASME Section XI Code committee, has been initiated and championed by the ASME Research Task Force on Risk-Based Inspection Guidelines -- LWR Nuclear Power Plant Application. Preliminary assessments associated with the code case have revealed that potential advantages exist in a risk-based inservice inspection program with regard to a number of exams, risk, personnel exposure, and cost.

Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations.

PubMed

Marshall, Mark R; Polkinghorne, Kevan R; Kerr, Peter G; Hawley, Carmel M; Agar, John W M; McDonald, Stephen P

2016-04-01

Intensive hemodialysis (HD) is characterized by increased frequency and/or session length compared to conventional HD. Previous analyses from Australia and New Zealand did not suggest benefit with intensive HD, although recent research suggests that relationships have changed. We present updated analyses. Observational cohort study using marginal structural modeling to adjust for changes in renal replacement modality and time-varying medical comorbid conditions. Adults initiating renal replacement therapy since March 31, 1996, followed up through December 31, 2012; this analysis included 40,842 patients over 2,187,689 patient-months. Time-varying renal replacement modality: conventional facility HD (≤3 times per week, ≤6 hours per session), quasi-intensive facility HD (between conventional and intensive), intensive facility HD (≥5 times per week, any hours per session), conventional home HD, quasi-intensive home HD, intensive home HD, peritoneal dialysis, deceased donor kidney transplantation, and living donor kidney transplantation. Patient mortality, with a 3-month lag in primary analyses and 6- and 12-month lags in sensitivity analyses. Conventional facility HD was the reference group. Conventional home HD had a similar mortality risk. For quasi-intensive home HD, mortality risk was lower (HR, 0.56; 95% CI, 0.44-0.73). For intensive home HD, mortality risk was nonsignificantly lower in primary analyses and significantly lower using a 6-month lag (HR, 0.41; 95% CI, 0.20-0.85), but not using a 12-month lag. For quasi-intensive facility HD, mortality risk was nonsignificantly lower in primary analyses, although significantly lower using 6- (HR, 0.41; 95% CI, 0.20-0.85) and 12-month lags (HR, 0.59; 95% CI, 0.44-0.80). Mortality risk was similar between intensive and conventional facility HD. For peritoneal dialysis, mortality risk was greater than for conventional facility HD (HR, 1.07; 95% CI, 1.03-1.12). Kidney transplantation had the lowest mortality risk. Potential residual confounding from limited collection of comorbid condition, socioeconomic, and medication data. There is an emerging HD dose-effect in Australia and New Zealand, with lower mortality risks associated with some of the more intensive HD regimens in these countries. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Societal acceptance of controversial facilities: The role of two public participation strategies---negotiation and risk communication

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wolfe, A.K.

Public participation in decision making about the siting of controversial facilities is viewed in contradictory ways by different groups of people. Some see public participation as an impediment, while others think it is an important mechanism in gaining societal acceptance for eventual siting. This paper discusses two strategies for obtaining societal acceptance--- negotiation and risk communication---in light of the extent to which they (1) involve members of the public; (2) focus on risk-related issues; and (3) contribute to decisions to site controversial facilities. The paper presents an integrated conceptual model for public participation in siting decisions that incorporates risk asmore » well as social, political, and historical contexts. 20 refs., 1 fig.« less

A macro environmental risk assessment methodology for establishing priorities among risks to human health and the environment in the Philippines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gernhofer, S.; Oliver, T.J.; Vasquez, R.

1994-12-31

A macro environmental risk assessment (ERA) methodology was developed for the Philippine Department of Environment and Natural Resources (DENR) as part of the US Agency for International Development Industrial Environmental Management Project. The DENR allocates its limited resources to mitigate those environmental problems that pose the greatest threat to human health and the environment. The National Regional Industry Prioritization Strategy (NRIPS) methodology was developed as a risk assessment tool to establish a national ranking of industrial facilities. The ranking establishes regional and national priorities, based on risk factors, that DENR can use to determine the most effective allocation of itsmore » limited resources. NRIPS is a systematic framework that examines the potential risk to human health and the environment from hazardous substances released from a facility, and, in doing so, generates a relative numerical score that represents that risk. More than 3,300 facilities throughout the Philippines were evaluated successfully with the NRIPS.« less

Survey of laboratory-acquired infections around the world in biosafety level 3 and 4 laboratories.

PubMed

Wurtz, N; Papa, A; Hukic, M; Di Caro, A; Leparc-Goffart, I; Leroy, E; Landini, M P; Sekeyova, Z; Dumler, J S; Bădescu, D; Busquets, N; Calistri, A; Parolin, C; Palù, G; Christova, I; Maurin, M; La Scola, B; Raoult, D

2016-08-01

Laboratory-acquired infections due to a variety of bacteria, viruses, parasites, and fungi have been described over the last century, and laboratory workers are at risk of exposure to these infectious agents. However, reporting laboratory-associated infections has been largely voluntary, and there is no way to determine the real number of people involved or to know the precise risks for workers. In this study, an international survey based on volunteering was conducted in biosafety level 3 and 4 laboratories to determine the number of laboratory-acquired infections and the possible underlying causes of these contaminations. The analysis of the survey reveals that laboratory-acquired infections have been infrequent and even rare in recent years, and human errors represent a very high percentage of the cases. Today, most risks from biological hazards can be reduced through the use of appropriate procedures and techniques, containment devices and facilities, and the training of personnel.

Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda – Moving towards elimination

PubMed Central

Bessell, Paul Richard; Ndung’u, Joseph Mathu

2017-01-01

Introduction The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk. Methodology / Principal findings In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015. Conclusions This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility. PMID:29023573

Basis for Interim Operation for Fuel Supply Shutdown Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

BENECKE, M.W.

2003-02-03

This document establishes the Basis for Interim Operation (BIO) for the Fuel Supply Shutdown Facility (FSS) as managed by the 300 Area Deactivation Project (300 ADP) organization in accordance with the requirements of the Project Hanford Management Contract procedure (PHMC) HNF-PRO-700, ''Safety Analysis and Technical Safety Requirements''. A hazard classification (Benecke 2003a) has been prepared for the facility in accordance with DOE-STD-1027-92 resulting in the assignment of Hazard Category 3 for FSS Facility buildings that store N Reactor fuel materials (303-B, 3712, and 3716). All others are designated Industrial buildings. It is concluded that the risks associated with the currentmore » and planned operational mode of the FSS Facility (uranium storage, uranium repackaging and shipment, cleanup, and transition activities, etc.) are acceptable. The potential radiological dose and toxicological consequences for a range of credible uranium storage building have been analyzed using Hanford accepted methods. Risk Class designations are summarized for representative events in Table 1.6-1. Mitigation was not considered for any event except the random fire event that exceeds predicted consequences based on existing source and combustible loading because of an inadvertent increase in combustible loading. For that event, a housekeeping program to manage transient combustibles is credited to reduce the probability. An additional administrative control is established to protect assumptions regarding source term by limiting inventories of fuel and combustible materials. Another is established to maintain the criticality safety program. Additional defense-in-depth controls are established to perform fire protection system testing, inspection, and maintenance to ensure predicted availability of those systems, and to maintain the radiological control program. It is also concluded that because an accidental nuclear criticality is not credible based on the low uranium enrichment, the form of the uranium, and the required controls, a Criticality Alarm System (CAS) is not required as allowed by DOE Order 420.1 (DOE 2000).« less

77 FR 48970 - Sunshine Act Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... DEFENSE NUCLEAR FACILITIES SAFETY BOARD Sunshine Act Notice AGENCY: Defense Nuclear Facilities... given of the Defense Nuclear Facilities Safety Board's (Board) public meeting and hearing described... (NNSA) efforts to mitigate risks to public and worker safety posed by aging defense nuclear facilities...

Identifying public water facilities with low spatial variability of disinfection by-products for epidemiological investigations

PubMed Central

Hinckley, A; Bachand, A; Nuckols, J; Reif, J

2005-01-01

Background and Aims: Epidemiological studies of disinfection by-products (DBPs) and reproductive outcomes have been hampered by misclassification of exposure. In most epidemiological studies conducted to date, all persons living within the boundaries of a water distribution system have been assigned a common exposure value based on facility-wide averages of trihalomethane (THM) concentrations. Since THMs do not develop uniformly throughout a distribution system, assignment of facility-wide averages may be inappropriate. One approach to mitigate this potential for misclassification is to select communities for epidemiological investigations that are served by distribution systems with consistently low spatial variability of THMs. Methods and Results: A feasibility study was conducted to develop methods for community selection using the Information Collection Rule (ICR) database, assembled by the US Environmental Protection Agency. The ICR database contains quarterly DBP concentrations collected between 1997 and 1998 from the distribution systems of 198 public water facilities with minimum service populations of 100 000 persons. Facilities with low spatial variation of THMs were identified using two methods; 33 facilities were found with low spatial variability based on one or both methods. Because brominated THMs may be important predictors of risk for adverse reproductive outcomes, sites were categorised into three exposure profiles according to proportion of brominated THM species and average TTHM concentration. The correlation between THMs and haloacetic acids (HAAs) in these facilities was evaluated to see whether selection by total trihalomethanes (TTHMs) corresponds to low spatial variability for HAAs. TTHMs were only moderately correlated with HAAs (r = 0.623). Conclusions: Results provide a simple method for a priori selection of sites with low spatial variability from state or national public water facility datasets as a means to reduce exposure misclassification in epidemiological studies of DBPs. PMID:15961627

Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys.

PubMed

Fink, Günther; Ross, Rebecca; Hill, Kenneth

2015-12-01

Child and maternal mortality remain high in many developing countries. A principal strategy used in low- and middle-income countries is increasing the proportion of pregnancies delivered at facilities. Although this strategy is reasonable with high quality facilities, evidence for the protective effects of facility deliveries is mixed. We pooled 1.47 million birth records collected by the Demographic and Health Surveys to estimate the association between institutional deliveries and early neonatal mortality. Subsample analysis and instrumental variable estimation were used to assess and correct the extent to which mortality differentials are biased by an increased likelihood of facility attendance for high-risk deliveries. No associations between institutional deliveries and early neonatal mortality were found in the pooled sample [adjusted odds ratio (aOR) 0.995, 95% confidence interval (CI) 0.966-1.025)]. When stratified by facility type, protective effects were found for private facilities (aOR 0.876, 95% CI 0.840-0.914), but not for public hospitals or health centres. Significant protective effects were found when past behaviour was used to eliminate selection bias generated by short-term responses to medical need (aOR 0.884, 95% CI 0.814-0.961). At the community and country levels, strong positive associations were found between early neonatal mortality among facility deliveries and the prevalence of institutional deliveries. Facility deliveries have the potential to reduce early neonatal mortality in developing countries. The results presented suggest that the quality, utilization and protective effects of institutional deliveries vary widely across countries; major improvements in both utilization and quality of care will be needed to achieve further improvements in maternal and child health. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Development of cloud-operating platform for detention facility design

NASA Astrophysics Data System (ADS)

Tun Lee, Kwan; Hung, Meng-Chiu; Tseng, Wei-Fan; Chan, Yi-Ping

2017-04-01

In the past 20 years, the population of Taiwan has accumulated in urban areas. The land development has changed the hydrological environment and resulted in the increase of surface runoff and shortened the time to peak discharge. The change of runoff characteristics increases the flood risk and reduces resilient ability of the city during flood. Considering that engineering measures may not be easy to implement in populated cities, detention facilities set on building basements have been proposed to compromise the increase of surface runoff resulting from development activities. In this study, a web-based operational platform has been developed to integrate the GIS technologies, hydrological analyses, as well as relevant regulations for the design of detention facilities. The design procedure embedded in the system includes a prior selection of type and size of the detention facility, integrated hydrological analysis for the developing site, and inspection of relevant regulations. After login the platform, designers can access the system database to retrieve road maps, land use coverages, and storm sewer information. Once the type, size, inlet, and outlet of the detention facility are assigned, the system can acquire the rainfall intensity-duration-frequency information from adjacent rain gauges to perform hydrological analyses for the developing site. The increase of the runoff volume due to the development and the reduction of the outflow peak through the construction of the detention facility can be estimated. The outflow peak at the target site is then checked with relevant regulations to confirm the suitability of the detention facility design. The proposed web-based platform can provide a concise layout of the detention facility and the drainageway of the developing site on a graphical interface. The design information can also be delivered directly through a web link to authorities for inspecting to simplify the complex administrative procedures.

Effect of steam generator configuration in a loss of the RHR during mid-loop operation at PKL facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Villanueva, J. F.; Carlos, S.; Martorell, S.

The loss of the residual heat removal system in mid-loop conditions may occur with a non-negligible contribution to the plant risk, so the analysis of the accidental sequences and the actions to mitigate the accident are of great interest in shutdown conditions. In order to plan the appropriate measures to mitigate the accident is necessary to understand the thermal-hydraulic processes following the loss of the residual heat removal system during shutdown. Thus, transients of this kind have been simulated using best-estimate codes in different integral test facilities and compared with experimental data obtained in different facilities. In PKL (Primaerkreislauf-Versuchsanlage, primarymore » coolant loop test facility) test facility different series of experiments have been undertaken to analyze the plant response in shutdown. In this context, the E3 and F2 series consist of analyzing the loss of the residual heat removal system with a reduced inventory in the primary system. In particular, the experiments were developed to investigate the influence of the steam generators secondary side configuration on the plant response, what involves the consideration of different number of steam generators filled with water and ready for activation, on the heat transfer mechanisms inside the steam generators U-tubes. This work presents the results of such experiments calculated using, RELAP5/Mod 3.3. (authors)« less

Assessment of Volatile Organic Compounds (VOCs) in indooor parking facilities at Houston, Texas

NASA Astrophysics Data System (ADS)

Kristanto, Gabriel Andari

This dissertation identified the types, magnitudes, sources, and assessed risk exposure of VOCs in different types of indoor parking facilities. VOCs are ones of major pollutants emitted from automobiles. The indoor parking facilities included were attached garages, grounds, and underground parking. Modification of method TO15 by EPA had been applied for identifying types and magnitudes of VOCs. Results of these identifications are presented. Eight most abundant VOCs could be identified in every sampling location with toluene as the most abundant compound followed by m,p-xylene, ethylbenzene and benzene. Compare to ground and underground parking, attached garages have the highest concentration of TVOCs. For sources identification, BTEX, m,p-xylene and benzene, and toluene and benzene ratios are calculated. BTEX ratios for ground and underground parking are similar compare to attached garage due to the similar pattern of driving speed and the content of gasoline fuel. On the other hand the ratios of m,p-xylene and benzene and toluene and benzene in attached garage are higher compare to the same ratios for ground and underground parking due to other significant contributor of VOCs such as solvent, household cleanings stored. Cancer and noncancer risk assessment were also calculated. Results showed that cancer and noncancer risk due human exposures to VOC in indoor parking facilities were relatively low. However the risk of the human exposure to VOCs from indoor parking facilities has to be considered as a part of total risks of VOC exposures on human during their daily activities. When people in Houston have already exposed to high VOC concentrations from outdoor environment activities such as traffic and refineries and petrochemical facilities, additional activities causing VOC exposures will add the risk significantly.

Multi-Hazard Advanced Seismic Probabilistic Risk Assessment Tools and Applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coleman, Justin L.; Bolisetti, Chandu; Veeraraghavan, Swetha

Design of nuclear power plant (NPP) facilities to resist natural hazards has been a part of the regulatory process from the beginning of the NPP industry in the United States (US), but has evolved substantially over time. The original set of approaches and methods was entirely deterministic in nature and focused on a traditional engineering margins-based approach. However, over time probabilistic and risk-informed approaches were also developed and implemented in US Nuclear Regulatory Commission (NRC) guidance and regulation. A defense-in-depth framework has also been incorporated into US regulatory guidance over time. As a result, today, the US regulatory framework incorporatesmore » deterministic and probabilistic approaches for a range of different applications and for a range of natural hazard considerations. This framework will continue to evolve as a result of improved knowledge and newly identified regulatory needs and objectives, most notably in response to the NRC activities developed in response to the 2011 Fukushima accident in Japan. Although the US regulatory framework has continued to evolve over time, the tools, methods and data available to the US nuclear industry to meet the changing requirements have not kept pace. Notably, there is significant room for improvement in the tools and methods available for external event probabilistic risk assessment (PRA), which is the principal assessment approach used in risk-informed regulations and risk-informed decision-making applied to natural hazard assessment and design. This is particularly true if PRA is applied to natural hazards other than seismic loading. Development of a new set of tools and methods that incorporate current knowledge, modern best practice, and state-of-the-art computational resources would lead to more reliable assessment of facility risk and risk insights (e.g., the SSCs and accident sequences that are most risk-significant), with less uncertainty and reduced conservatisms.« less

Amnioinfusion for meconium-stained liquor in labour.

PubMed

Hofmeyr, G Justus; Xu, Hairong; Eke, Ahizechukwu C

2014-01-23

Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid. Three review authors independently assessed eligibility and trial quality, and extracted data. Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced. Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Money for Research, Not for Energy Bills: Finding Energy and Cost Savings in High Performance Computer Facility Designs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drewmark Communications; Sartor, Dale; Wilson, Mark

2010-07-01

High-performance computing facilities in the United States consume an enormous amount of electricity, cutting into research budgets and challenging public- and private-sector efforts to reduce energy consumption and meet environmental goals. However, these facilities can greatly reduce their energy demand through energy-efficient design of the facility itself. Using a case study of a facility under design, this article discusses strategies and technologies that can be used to help achieve energy reductions.

Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?

PubMed

Hranjec, Tjasa; Turrentine, Florence E; Stukenborg, George; Young, Jeffrey S; Sawyer, Robert G; Calland, James F

2012-05-01

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

Individual privacy versus public good: protecting confidentiality in health research.

PubMed

O'Keefe, Christine M; Rubin, Donald B

2015-10-15

Health and medical data are increasingly being generated, collected, and stored in electronic form in healthcare facilities and administrative agencies. Such data hold a wealth of information vital to effective health policy development and evaluation, as well as to enhanced clinical care through evidence-based practice and safety and quality monitoring. These initiatives are aimed at improving individuals' health and well-being. Nevertheless, analyses of health data archives must be conducted in such a way that individuals' privacy is not compromised. One important aspect of protecting individuals' privacy is protecting the confidentiality of their data. It is the purpose of this paper to provide a review of a number of approaches to reducing disclosure risk when making data available for research, and to present a taxonomy for such approaches. Some of these methods are widely used, whereas others are still in development. It is important to have a range of methods available because there is also a range of data-use scenarios, and it is important to be able to choose between methods suited to differing scenarios. In practice, it is necessary to find a balance between allowing the use of health and medical data for research and protecting confidentiality. This balance is often presented as a trade-off between disclosure risk and data utility, because methods that reduce disclosure risk, in general, also reduce data utility. Copyright © 2015 John Wiley & Sons, Ltd.

Risk Management Technique for design and operation of facilities and equipment

NASA Technical Reports Server (NTRS)

Fedor, O. H.; Parsons, W. N.; Coutinho, J. De S.

1975-01-01

The Risk Management System collects information from engineering, operating, and management personnel to identify potentially hazardous conditions. This information is used in risk analysis, problem resolution, and contingency planning. The resulting hazard accountability system enables management to monitor all identified hazards. Data from this system are examined in project reviews so that management can decide to eliminate or accept these risks. This technique is particularly effective in improving the management of risks in large, complex, high-energy facilities. These improvements are needed for increased cooperation among industry, regulatory agencies, and the public.

The European Political Environment and NATO Maritime Strategy: The Future Role of Naval Forces in the Forward Defense of Western Europe. Volume 2.

DTIC Science & Technology

1985-07-10

defence of Malaysia 1964-66 is an example. The actions of Alliance members may be altruistic, but certainly can help to reduce the risks of local...have favoured the Silent Service tradition and had resisted the efforts of the chief censor to provide facilities for newspaper correspondents to visit... Malaysia , New Zealand, Singapore and the United Kingdom is such a one. There are good reasons why as many members as possible should maintain the

Ergonomics and simulation-based approach in improving facility layout

NASA Astrophysics Data System (ADS)

Abad, Jocelyn D.

2018-02-01

The use of the simulation-based technique in facility layout has been a choice in the industry due to its convenience and efficient generation of results. Nevertheless, the solutions generated are not capable of addressing delays due to worker's health and safety which significantly impact overall operational efficiency. It is, therefore, critical to incorporate ergonomics in facility design. In this study, workstation analysis was incorporated into Promodel simulation to improve the facility layout of a garment manufacturing. To test the effectiveness of the method, existing and improved facility designs were measured using comprehensive risk level, efficiency, and productivity. Results indicated that the improved facility layout generated a decrease in comprehensive risk level and rapid upper limb assessment score; an increase of 78% in efficiency and 194% increase in productivity compared to existing design and thus proved that the approach is effective in attaining overall facility design improvement.

Strategy and technology to prevent hospital-acquired infections: Lessons from SARS, Ebola, and MERS in Asia and West Africa.

PubMed

Rajakaruna, Sanjeewa Jayachandra; Liu, Wen-Bin; Ding, Yi-Bo; Cao, Guang-Wen

2017-10-27

Hospital-acquired infections (HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.

Hip fracture risk and safety with alendronate treatment in the oldest-old.

PubMed

Axelsson, K F; Wallander, M; Johansson, H; Lundh, D; Lorentzon, M

2017-12-01

There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (≥80 years old), the population with the highest fracture risk, has not been studied. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients. © 2017 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

Multidimensional approach to invasive species prevention.

PubMed

Briski, Elizabeta; Allinger, Lisa E; Balcer, Mary; Cangelosi, Allegra; Fanberg, Lana; Markee, Tom P; Mays, Nicole; Polkinghorne, Christine N; Prihoda, Kelsey R; Reavie, Euan D; Regan, Deanna H; Reid, Donald M; Saillard, Heidi J; Schwerdt, Tyler; Schaefer, Heidi; TenEyck, Matthew; Wiley, Chris J; Bailey, Sarah A

2013-02-05

Nonindigenous species (NIS) cause global biotic homogenization and extinctions, with commercial shipping being a leading vector for spread of aquatic NIS. To reduce transport of NIS by ships, regulations requiring ballast water exchange (BWE) have been implemented by numerous countries. BWE appears to effectively reduce risk for freshwater ports, but provides only moderate protection of marine ports. In the near future, ships may be required to undertake ballast water treatment (BWT) to meet numeric performance standards, and BWE may be phased out of use. However, there are concerns that BWT systems may not operate reliably in fresh or turbid water, or both. Consequently, it has been proposed that BWE could be used in combination with BWT to maximize the positive benefits of both management strategies for protection of freshwater ports. We compared the biological efficacy of "BWE plus BWT" against "BWT alone" at a ballast water treatment experimental test facility. Our comparative evaluation showed that even though BWT alone significantly reduced abundances of all tested organism groups except total heterotrophic bacteria, the BWE plus BWT strategy significantly reduced abundances for all groups and furthermore resulted in significantly lower abundances of most groups when compared to BWT alone. Our study clearly demonstrates potential benefits of combining BWE with BWT to reduce invasion risk of freshwater organisms transported in ships' ballast water, and it should be of interest to policy makers and environmental managers.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

PubMed

Jain, Anrudh K; Sathar, Zeba; Salim, Momina; Shah, Zakir Hussain

2013-09-01

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

Academic status does not affect outcome following complex hepato-pancreato-biliary procedures.

PubMed

Altieri, Maria S; Yang, Jie; Groves, Donald; Yin, Donglei; Cagino, Kristen; Talamini, Mark; Pryor, Aurora

2018-05-01

There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery. The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models. There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility. No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.

Improvement of the safety of the red pepper spice with FMEA and post processing EWMA quality control charts.

PubMed

Ozilgen, Sibel; Bucak, Seyda; Ozilgen, Mustafa

2013-06-01

Although there are numerous decades-old studies drawing attention to the presence of aflatoxins in spices, and particularly in red pepper spice, the problem has not been eradicated. In the present study, information presented in the literature, about production method of red pepper spice, its contamination with aflatoxin, and the uncertainty about the data are assessed to find out the points where improvement may be achieved. Failure Mode and Effect Analysis (FMEA) are performed to assess the risk. The highest total risk attributable to chemical plus physical plus biological causes is associated with the washing stage (RPN=363), which is followed by the receiving (RPN=342) and the storage (RPN=342) stages. The highest risk attributable to biological causes (RPN=180) is associated with microbial growth and aflatoxin production due to insufficient control of drying conditions. The highest chemical risk (RPN=144) is found for the presence of unintentional food additives, such as pesticides, herbicides, hormones, and heavy metals in fresh red pepper fruits. EWMA (exponentially weighted average) charts are employed to monitor aflatoxin production during storage. They successfully distinguished between the batches, which turned to be unsafe. Risk associated with unintentional additives may be reduced by using certified additives only. Better drying control will definitely reduce the risk associated with the drying process. Codex Alimentarius plan has worldwide acceptance for assessing safety of the nuts. Risk of accepting the batches contaminated with aflatoxin may be eliminated by applying the Codex Alimentarius sampling plan before putting the dry pulverized red pepper into the storage facility.

Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.

PubMed

Sprague, Daniel A; Jeffery, Caroline; Crossland, Nadine; House, Thomas; Roberts, Gareth O; Vargas, William; Ouma, Joseph; Lwanga, Stephen K; Valadez, Joseph J

2016-01-01

It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups. We show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. Our results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year.

Dose and Dose Risk Caused by Natural Phenomena - Proposed Powder Metallurgy Core Manufacturing Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holmes, W.G.

2001-08-16

The offsite radiological effects from high velocity straight winds, tornadoes, and earthquakes have been estimated for a proposed facility for manufacturing enriched uranium fuel cores by powder metallurgy. Projected doses range up to 30 mrem/event to the maximum offsite individual for high winds and up to 85 mrem/event for very severe earthquakes. Even under conservative assumptions on meteorological conditions, the maximum offsite dose would be about 20 per cent of the DOE limit for accidents involving enriched uranium storage facilities. The total dose risk is low and is dominated by the risk from earthquakes. This report discusses this test.

Hurricane risk mitigation - High Pressure Gas Facility

NASA Image and Video Library

2008-07-29

A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

Medical Waste Management Implications for Small Medical Facilities.

ERIC Educational Resources Information Center

Byrns, George; Burke, Thomas

1992-01-01

Discusses the implications of the Medical Waste Management Act of 1988 for small medical facilities, public health, and the environment. Reviews health and environmental risks associated with medical waste, current regulatory approaches, and classifications. Concludes that the health risk of medical wastes has been overestimated; makes…

Hurricane risk mitigation - High Pressure Gas Facility

NASA Technical Reports Server (NTRS)

2008-01-01

A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

THE USEPA'S METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST)

EPA Science Inventory

The US Environmetal ProtectionAgenccy's Metal Finishing
Facility Risk Screening Tool (MFFRST)

William M. Barrett Jr, Ph.D. , P.E. ; Paul Harten, Ph.D.1, and Matthew Lorber

The US Environmental Protection Agency completed the development of the first version of...

Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi.

PubMed

Kabaghe, Alinune N; Phiri, Mphatso D; Phiri, Kamija S; van Vugt, Michèle

2017-10-18

Prompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children. A cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted. Health workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63-84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96-100%) RDT negative children, respectively. However, 24% (95% CI 13-37%) of children receiving artemisinin-lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51-69%) of children presented within 24 h of onset of child's symptoms. The survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.

Optimal location of emergency stations in underground mine networks using a multiobjective mathematical model.

PubMed

Lotfian, Reza; Najafi, Mehdi

2018-02-26

Background Every year, many mining accidents occur in underground mines all over the world resulting in the death and maiming of many miners and heavy financial losses to mining companies. Underground mining accounts for an increasing share of these events due to their special circumstances and the risks of working therein. Thus, the optimal location of emergency stations within the network of an underground mine in order to provide medical first aid and transport injured people at the right time, plays an essential role in reducing deaths and disabilities caused by accidents Objective The main objective of this study is to determine the location of emergency stations (ES) within the network of an underground coal mine in order to minimize the outreach time for the injured. Methods A three-objective mathematical model is presented for placement of ES facility location selection and allocation of facilities to the injured in various stopes. Results Taking into account the radius of influence for each ES, the proposed model is capable to reduce the maximum time for provision of emergency services in the event of accident for each stope. In addition, the coverage or lack of coverage of each stope by any of the emergency facility is determined by means of Floyd-Warshall algorithm and graph. To solve the problem, a global criterion method using GAMS software is used to evaluate the accuracy and efficiency of the model. Conclusions 7 locations were selected from among 46 candidates for the establishment of emergency facilities in Tabas underground coal mine. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

78 FR 48029 - Improving Chemical Facility Safety and Security

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

... responding to risks in chemical facilities (including during pre-inspection, inspection execution, post.... Sec. 2. Establishment of the Chemical Facility Safety and Security Working Group. (a) There is established a Chemical Facility Safety and Security Working Group (Working Group) co-chaired by the Secretary...

Independent organ donor facilities: The future of organ donation?

PubMed

Bruzzone, Paolo

2014-01-01

Since 2001 independent Organ Donor Facilities(OFOs) have been proposed within Organ Procurement Organizations (OPOs) with the aim of reducing organ procurement costs 1, cold ischemia time of donor organs and the flight-related risk 2 for donor surgeons, perfusionists and coordinators. An independent OFO has been established in 2001 in St. Louis 3, half away between the 2 Transplant Centers (TCs) (Washington University School of Medicine and St. Louis University) and now includes a two-bed intensive care facility, a complete laboratory, a cardiac catheterization facility, a Computed Tomography (CT) scanner and an operating room. All brain-dead (BD) patients within OPO (Mid-America Transplant Services), after family's informed consent, are transferred, if necessary by an OPO owned and operated airplane, to this facility, where undergo multiorgan harvesting. By doing so the organ acquisition charges (OACs) apparently decreased, as well as delay in recovery, which can affect organ viability and move families to withdraw consent; also risks and tiring of transplant surgeons were reduced. This independent OFO successfully procured in 2001 not only livers, but also pancreas, kidneys, hearts and lungs 4-6. Cold ischemia time was reduced and there was no Primary Non Function (PNF) of harvested organs, but only kidney delayed graft function (DGF). In the past, heart donors were moved to the recipient's hospital. With the development of multiorgan harvesting, usually donor surgeons are sent by the TCs in order to evaluate liver, pancreas, heart and lungs, while the only local surgeons is the "nephrectomist", that in local hospital is not a transplant surgeon. To move a donor, although hemodinamically stable, is always a risk. Finally, the decrease of OAC must balance the extra expenses to create and operate independent OFOs. In all the papers published by the members of this OFO, the control group of the retrospective analysis consisted of less selected BD donors, requiring more vasosuppressor support, which can be a study bias. It has been proposed that OPOs should organize "recovery teams" for multiple TCs but most transplant surgeons, in case of marginal donors, would like to inspect the organ prior to starting recipient surgery or would send their own team to harvest organs. According to literature, there are no other independent OFOs in US, probably because there is no need for them, and increasing their numbers would not increase organ donation rate. Considering Europe, we do not have information about the existence of independent OFOs: this may be a consequence of logistical organization and minor distances, as well as the higher concentration of TCs. However, the acceptance of such a procedure from donors' families may be less enthusiastic in Europe than in USA, particularly from minorities. In Italy would not be acceptable that the maintenance of BD donors and more generally the operation of independent OFO would rely on non-physicians, to save costs. Finally it is not clear from the reviewed papers who pay for transportation of the donor's body from the independent OFO back to home, but donor's family should not be charged for these expenses. At least 5 donors were lost during transportation, confirming that moving of BD donors remains a risky procedure. The potential economical and organizative benefits of independent OFOs could be counterweighted by the perceived (by relatives and public opinion) commodification/ reification of BD patients. Anyway, the authors of these papers should be congratulated for their innovative proposal. However, a prospective randomized trial would be needed to draw more definitive conclusions on the real benefits of independent OFOs.

Hospitalization and associated factors in people with Alzheimer's disease residing in a long-term care facility in southern Taiwan.

PubMed

Lin, Chu-Sheng; Lin, Shih-Yi; Chou, Ming-Yueh; Chen, Liang-Yu; Wang, Kuei-Yu; Chen, Liang-Kung; Lin, Yu-Te; Loh, Ching-Hui

2017-04-01

It has been reported that many people with dementia require hospitalizations. The objective of the present study was to determine predictive factors for hospitalizations in people with dementia. A total of 70 individuals with dementia living in a veterans' home in southern Taiwan were consecutively enrolled. During prospective follow up, all hospitalization events were recorded. The mean age of residents with dementia was 86.1 ± 4.0 years, and the mean follow-up time for this population was 2.2 ± 1.1 years. Among individuals, 62.9% suffered from malnutrition or were at risk of malnutrition (minimal nutritional assessment-short form score ≤11), and 8.6% of individuals had a body mass index of <18.5 Kg/m 2 . There were 52 (74.3%) individuals who had previously fallen. Overall, 51 of 70 residents were hospitalized during the follow-up period. In those individuals with previous falls, there was a significantly increased risk of hospitalization (odds ratio 5.61, 95% CI 1.18-26.7). Furthermore, three factors were significantly associated with the risk of fall, including handgrip strength, malnutrition and Mini-Mental State Examination score. The results of the present study showed that hospitalization was a frequent event in residents with dementia living in a long-term care facility. The major predictor for hospital admission was history of a previous fall. Screening those with dementia for history of injurious falls and associated risk factors for falling could help identify those at risk of hospitalization, thus necessitating a comprehensive intervention to reduce hospitalization. Geriatr Gerontol Int 2017; 17 (Suppl. 1): 50-56. © 2017 Japan Geriatrics Society.

Determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania: analysis of data from the 2010 Tanzania Demographic and Health Survey.

PubMed

Wilunda, Calistus; Massawe, Siriel; Jackson, Caroline

2013-12-01

To identify determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania. We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio-demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio-demographic, contextual, reproductive and lifestyle factors, and moderate-to-severe anaemia and investigated interactions between certain risk factors. Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43-2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43-0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00-1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis. Pregnant women in Tanzania are particularly at risk of moderate-to-severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups. © 2013 John Wiley & Sons Ltd.

Empirical estimation of the conditional probability of natech events within the United States.

PubMed

Santella, Nicholas; Steinberg, Laura J; Aguirra, Gloria Andrea

2011-06-01

Natural disasters are the cause of a sizeable number of hazmat releases, referred to as "natechs." An enhanced understanding of natech probability, allowing for predictions of natech occurrence, is an important step in determining how industry and government should mitigate natech risk. This study quantifies the conditional probabilities of natechs at TRI/RMP and SICS 1311 facilities given the occurrence of hurricanes, earthquakes, tornadoes, and floods. During hurricanes, a higher probability of releases was observed due to storm surge (7.3 releases per 100 TRI/RMP facilities exposed vs. 6.2 for SIC 1311) compared to category 1-2 hurricane winds (5.6 TRI, 2.6 SIC 1311). Logistic regression confirms the statistical significance of the greater propensity for releases at RMP/TRI facilities, and during some hurricanes, when controlling for hazard zone. The probability of natechs at TRI/RMP facilities during earthquakes increased from 0.1 releases per 100 facilities at MMI V to 21.4 at MMI IX. The probability of a natech at TRI/RMP facilities within 25 miles of a tornado was small (∼0.025 per 100 facilities), reflecting the limited area directly affected by tornadoes. Areas inundated during flood events had a probability of 1.1 releases per 100 facilities but demonstrated widely varying natech occurrence during individual events, indicating that factors not quantified in this study such as flood depth and speed are important for predicting flood natechs. These results can inform natech risk analysis, aid government agencies responsible for planning response and remediation after natural disasters, and should be useful in raising awareness of natech risk within industry. © 2011 Society for Risk Analysis.

Barriers to formal emergency obstetric care services' utilization.

PubMed

Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

2011-06-01

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.

Bird Mortality in Oil Field Wastewater Disposal Facilities

NASA Astrophysics Data System (ADS)

Ramirez, Pedro

2010-11-01

Commercial and centralized oilfield wastewater disposal facilities (COWDFs) are used in the Western United States for the disposal of formation water produced from oil and natural gas wells. In Colorado, New Mexico, Utah, and Wyoming, COWDFs use large evaporation ponds to dispose of the wastewater. Birds are attracted to these large evaporation ponds which, if not managed properly, can cause wildlife mortality. The U.S. Fish and Wildlife Service (USFWS) and the U.S. Environmental Protection Agency (EPA) conducted 154 field inspections of 28 COWDFs in Wyoming from March 1998 through September 2008 and documented mortality of birds and other wildlife in 9 COWDFs. Of 269 bird carcasses recovered from COWDFs, grebes (Family Podicipedidae) and waterfowl (Anatidae) were the most frequent casualties. Most mortalities were attributed to oil on evaporation ponds, but sodium toxicity and surfactants were the suspected causes of mortality at three COWDFs. Although the oil industry and state and federal regulators have made much progress in reducing bird mortality in oil and gas production facilities, significant mortality incidents continue in COWDFs, particularly older facilities permitted in the early 1980’s. Inadequate operation and management of these COWDFs generally results in the discharge of oil into the large evaporation ponds which poses a risk for birds and other wildlife.

Bird mortality in oil field wastewater disposal facilities.

PubMed

Ramirez, Pedro

2010-11-01

Commercial and centralized oilfield wastewater disposal facilities (COWDFs) are used in the Western United States for the disposal of formation water produced from oil and natural gas wells. In Colorado, New Mexico, Utah, and Wyoming, COWDFs use large evaporation ponds to dispose of the wastewater. Birds are attracted to these large evaporation ponds which, if not managed properly, can cause wildlife mortality. The U.S. Fish and Wildlife Service (USFWS) and the U.S. Environmental Protection Agency (EPA) conducted 154 field inspections of 28 COWDFs in Wyoming from March 1998 through September 2008 and documented mortality of birds and other wildlife in 9 COWDFs. Of 269 bird carcasses recovered from COWDFs, grebes (Family Podicipedidae) and waterfowl (Anatidae) were the most frequent casualties. Most mortalities were attributed to oil on evaporation ponds, but sodium toxicity and surfactants were the suspected causes of mortality at three COWDFs. Although the oil industry and state and federal regulators have made much progress in reducing bird mortality in oil and gas production facilities, significant mortality incidents continue in COWDFs, particularly older facilities permitted in the early 1980's. Inadequate operation and management of these COWDFs generally results in the discharge of oil into the large evaporation ponds which poses a risk for birds and other wildlife.

The differential associations of preexisting conditions with trauma-related outcomes in the presence of competing risks.

PubMed

Calvo, Richard Yee; Lindsay, Suzanne P; Edland, Steven D; Macera, Caroline A; Wingard, Deborah L; Ohno-Machado, Lucila; Sise, Michael J

2016-03-01

Pre-existing chronic conditions (PECs) pose a unique problem for the care of aging trauma populations. However, the relationships between specific conditions and outcomes after injury are relatively unknown. Evaluation of trauma patients is further complicated by their discharge to care facilities, where mortality risk remains high. Traditional approaches for evaluating in-hospital mortality do not account for the discharge of at-risk patients, which constitutes a competing risk event to death. The objective of this study was to evaluate associations between 40 PECs and two clinical outcomes in the context of competing risks among older trauma patients. This retrospective study evaluated blunt-injured patients aged 55 years and older admitted to a level I trauma centre in 2006-2012. Outcomes were hospital length of stay (HLOS) and in-hospital mortality. Survivors were classified as discharges home or discharges to care facilities. Competing risks regression was used to evaluate each PEC with in-hospital mortality, accounting for discharges to care facilities as competing events. Competing risk estimates were compared to Cox model estimates, for which all survivors to discharge were non-events. Analyses were stratified using injury-based mortality risk at a 50% cutpoint (high versus low). Among 4653 patients, 176 died in-hospital, 3059 were discharged home, and 1418 were discharged to a care facility. Most patients (98%) were classified with a low mortality risk. Only haemophilia and coagulopathy were consistently associated with longer HLOS. In the low-risk subgroup, in-hospital mortality was most strongly associated with liver diseases, haemophilia, and coagulopathy. In the high-risk group, Parkinson's disease, depression, and cancers showed the strongest associations. Accounting for the competing event altered estimates for 12 of 19 significant conditions. Excess mortality among patients expected to survive their injuries may be attributable to complications resulting from PECs. Discharges to care facilities constitute a bias in the evaluation of in-hospital mortality and should be considered for the accurate calculation of risk. In conjunction with injury measures, consideration of PECs provides physicians with a foundation to plan clinical decisions in older trauma patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

New food safety law: effectiveness on the ground.

PubMed

Drew, Christa A; Clydesdale, Fergus M

2015-01-01

The demand for safety in the US food supply from production to consumption necessitates a scientific, risk-based strategy for the management of microbiological, chemical, and physical hazards in food. The key to successful management is an increase in systematic collaboration and communication and in enforceable procedures with all domestic and international stakeholders. The enactment of the Food Safety Modernization Act (FSMA) aims to prevent or reduce large-scale food-borne illness outbreaks through stricter facility registration and records standards, mandatory prevention-based controls, increased facility inspections in the United States and internationally, mandatory recall authority, import controls, and increased consumer communication. The bill provisions are expected to cost $1.4 billion over the next four years. Effective implementation of the FSMA's 50 rules, reports, studies, and guidance documents in addition to an increased inspection burden requires further funding appropriations. Additional full-time inspectors and unprecedented foreign compliance is necessary for the full and effective implementation of the FSMA.

Understanding Jordanian Psychiatric Nurses' Smoking Behaviors: A Grounded Theory Study

PubMed Central

Aldiabat, Khaldoun M.; Clinton, Michael

2013-01-01

Purpose. Smoking is prevalent in psychiatric facilities among staff and patients. However, there have been few studies of how contextual factors in specific cultures influence rates of smoking and the health promotion role of psychiatric nurses. This paper reports the findings of a classical grounded theory study conducted to understand how contextual factors in the workplace influences the smoking behaviors of Jordanian psychiatric nurses (JPNs). Method. Semi-structured individual interviews were conducted with a sample of eight male JPNs smokers at a psychiatric facility in Amman, Jordan. Findings. Constant comparative analysis identified becoming a heavy smoker as a psychosocial process characterized by four sub-categories: normalization of smoking; living in ambiguity; experiencing workplace conflict; and, facing up to workplace stressors. Conclusion. Specific contextual workplace factors require targeted smoking cessation interventions if JPNs are to receive the help they need to reduce health risks associated with heavy smoking. PMID:23844286

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities: Results from a Multi-Site Survey

PubMed Central

Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O’Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

2013-01-01

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of among CJ-DATS correctional agency partners revealed that HIV policies and practices in prevention, detection and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections. PMID:24078624

Indoor air quality investigation and health risk assessment at correctional institutions.

PubMed

Ofungwu, Joseph

2005-04-01

A comprehensive indoor air-quality (IAQ) investigation was conducted at a state correctional facility in New Jersey, USA with a lengthy history of IAQ problems. The IAQ investigation comprised preliminary indoor air screening using direct readout instrumentation, indoor air/surface wipe sampling and laboratory analysis, as well as a heating, ventilation, and air-conditioning system evaluation, and a building envelope survey. In addition to air sampling, a human health risk assessment was performed to evaluate the potential for exposure to site-related air contaminants with respect to the inmate and worker populations. The risk assessment results for the prison facility indicated the potential for significant health risks for the inmate population, possibly reflecting the effects of their confinement and extended exposure to indoor air contaminants, as compared to the prison guard and worker population. Based on the results of the risk assessment, several mitigation measures are recommended to minimize prison population health risks and improve indoor air quality at prison facilities.

Risk assessment associated to possible concrete degradation of a near surface disposal facility

NASA Astrophysics Data System (ADS)

Capra, B.; Billard, Y.; Wacquier, W.; Gens, R.

2013-07-01

This article outlines a risk analysis of possible concrete degradation performed in the framework of the preparation of the Safety Report of ONDRAF/NIRAS, the Belgian Agency for Radioactive Waste and Enriched Fissile Materials, for the construction and operation of a near surface disposal facility of category A waste - short-lived low and intermediate level waste - in Dessel. The main degradation mechanism considered is the carbonation of different concrete components over different periods (from the building phase up to 2000 years), which induces corrosion of the rebars. A dedicated methodology mixing risk analysis and numerical modeling of concrete carbonation has been developed to assess the critical risks of the disposal facility at different periods. According to the results obtained, risk mapping was used to assess the impact of carbonation of concrete on the different components at the different stages. The most important risk is related to an extreme situation with complete removal of the earth cover and side embankment.

Human health risk characterization of petroleum coke calcining facility emissions.

PubMed

Singh, Davinderjit; Johnson, Giffe T; Harbison, Raymond D

2015-12-01

Calcining processes including handling and storage of raw petroleum coke may result in Particulate Matter (PM) and gaseous emissions. Concerns have been raised over the potential association between particulate and aerosol pollution and adverse respiratory health effects including decrements in lung function. This risk characterization evaluated the exposure concentrations of ambient air pollutants including PM10 and gaseous pollutants from a petroleum coke calciner facility. The ambient air pollutant levels were collected through monitors installed at multiple locations in the vicinity of the facility. The measured and modeled particulate levels in ambient air from the calciner facility were compared to standards protective of public health. The results indicated that exposure levels were, on occasions at sites farther from the facility, higher than the public health limit of 150 μg/m(3) 24-h average for PM10. However, the carbon fraction demonstrated that the contribution from the calciner facility was de minimis. Exposure levels of the modeled SO2, CO, NOx and PM10 concentrations were also below public health air quality standards. These results demonstrate that emissions from calcining processes involving petroleum coke, at facilities that are well controlled, are below regulatory standards and are not expected to produce a public health risk. Copyright © 2015 Elsevier Inc. All rights reserved.

49 CFR 1155.27 - Board determinations under 49 U.S.C. 10909.

Code of Federal Regulations, 2010 CFR

2010-10-01

... determines that the facility at the existing or proposed location would not pose an unreasonable risk to... risk to public health, safety, or the environment, the Board shall weigh the particular facility's... comply with an environmental, public health, or public safety standard that falls under the traditional...

Guidelines for Automatic Data Processing Physical Security and Risk Management. Federal Information Processing Standards Publication 31.

ERIC Educational Resources Information Center

National Bureau of Standards (DOC), Washington, DC.

These guidelines provide a handbook for use by federal organizations in structuring physical security and risk management programs for their automatic data processing facilities. This publication discusses security analysis, natural disasters, supporting utilities, system reliability, procedural measures and controls, off-site facilities,…

Webinar Presentation: Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time

EPA Pesticide Factsheets

This presentation, Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome.

Mistreatment in Assisted Living Facilities: Complaints, Substantiations, and Risk Factors

ERIC Educational Resources Information Center

Phillips, Linda R.; Guo, Guifang

2011-01-01

Purpose of the Study: Use archived public data from Arizona to explore relationships among selected institutional and resident risk and situation-specific factors and complaints and substantiated allegations of various types of mistreatment in assisted living facilities (ALFs). Design and Methods: An exploratory/descriptive 2-group design was…

THE USEPA'S METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST) AND POLLUTION PREVENTION TOOL (MFFP2T)

EPA Science Inventory

This presentation will provide an overview of the USEPA's Metal Finishing Facility Risk Screening Tool, including a discussion of the models used and outputs. The tool is currently being expanded to include pollution prevention considerations as part of the model. The current st...

Safety analysis, risk assessment, and risk acceptance criteria

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jamali, K.; Stack, D.W.; Sullivan, L.H.

1997-08-01

This paper discusses a number of topics that relate safety analysis as documented in the Department of Energy (DOE) safety analysis reports (SARs), probabilistic risk assessments (PRA) as characterized primarily in the context of the techniques that have assumed some level of formality in commercial nuclear power plant applications, and risk acceptance criteria as an outgrowth of PRA applications. DOE SARs of interest are those that are prepared for DOE facilities under DOE Order 5480.23 and the implementing guidance in DOE STD-3009-94. It must be noted that the primary area of application for DOE STD-3009 is existing DOE facilities andmore » that certain modifications of the STD-3009 approach are necessary in SARs for new facilities. Moreover, it is the hazard analysis (HA) and accident analysis (AA) portions of these SARs that are relevant to the present discussions. Although PRAs can be qualitative in nature, PRA as used in this paper refers more generally to all quantitative risk assessments and their underlying methods. HA as used in this paper refers more generally to all qualitative risk assessments and their underlying methods that have been in use in hazardous facilities other than nuclear power plants. This discussion includes both quantitative and qualitative risk assessment methods. PRA has been used, improved, developed, and refined since the Reactor Safety Study (WASH-1400) was published in 1975 by the Nuclear Regulatory Commission (NRC). Much debate has ensued since WASH-1400 on exactly what the role of PRA should be in plant design, reactor licensing, `ensuring` plant and process safety, and a large number of other decisions that must be made for potentially hazardous activities. Of particular interest in this area is whether the risks quantified using PRA should be compared with numerical risk acceptance criteria (RACs) to determine whether a facility is `safe.` Use of RACs requires quantitative estimates of consequence frequency and magnitude.« less

Application of the API/NPRA SVA methodology to transportation security issues.

PubMed

Moore, David A

2006-03-17

Security vulnerability analysis (SVA) is becoming more prevalent as the issue of chemical process security is of greater concern. The American Petroleum Institute (API) and the National Petrochemical and Refiner's Association (NPRA) have developed a guideline for conducting SVAs of petroleum and petrochemical facilities in May 2003. In 2004, the same organizations enhanced the guidelines by adding the ability to evaluate transportation security risks (pipeline, truck, and rail). The importance of including transportation and value chain security in addition to fixed facility security in a SVA is that these issues may be critically important to understanding the total risk of the operation. Most of the SVAs done using the API/NPRA SVA and other SVA methods were centered on the fixed facility and the operations within the plant fence. Transportation interfaces alone are normally studied as a part of the facility SVA, and the entire transportation route impacts and value chain disruption are not commonly considered. Particularly from a national, regional, or local infrastructure analysis standpoint, understanding the interdependencies is critical to the risk assessment. Transportation risks may include weaponization of the asset by direct attack en route, sabotage, or a Trojan Horse style attack into a facility. The risks differ in the level of access control and the degree of public exposures, as well as the dynamic nature of the assets. The public exposures along the transportation route need to be carefully considered. Risks may be mitigated by one of many strategies including internment, staging, prioritization, conscription, or prohibition, as well as by administrative security measures and technology for monitoring and isolating the assets. This paper illustrates how these risks can be analyzed by the API/NPRA SVA methodology. Examples are given of a pipeline operation, and other examples are found in the guidelines.

Risk assessment for physical and cyber attacks on critical infrastructures.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Bryan J.; Sholander, Peter E.; Phelan, James M.

2005-08-01

Assessing the risk of malevolent attacks against large-scale critical infrastructures requires modifications to existing methodologies. Existing risk assessment methodologies consider physical security and cyber security separately. As such, they do not accurately model attacks that involve defeating both physical protection and cyber protection elements (e.g., hackers turning off alarm systems prior to forced entry). This paper presents a risk assessment methodology that accounts for both physical and cyber security. It also preserves the traditional security paradigm of detect, delay and respond, while accounting for the possibility that a facility may be able to recover from or mitigate the results ofmore » a successful attack before serious consequences occur. The methodology provides a means for ranking those assets most at risk from malevolent attacks. Because the methodology is automated the analyst can also play 'what if with mitigation measures to gain a better understanding of how to best expend resources towards securing the facilities. It is simple enough to be applied to large infrastructure facilities without developing highly complicated models. Finally, it is applicable to facilities with extensive security as well as those that are less well-protected.« less

[Harm related to medical device use - legal and organisational risks].

PubMed

Hölscher, U M

2014-12-01

The effectiveness of the risk management systems established by medical device manufacturers and health-care facilities is clearly mitigated by European and national legal provisions. Laws, regulations and authorities prevent the systematic exchange of much safety-relevant information. The obligation to report adverse events is suspended for many relevant risks associated with medical device use. Reporting into the vigilance system is of little avail for users. Reporting even may endanger the information provider. The federal fragmentation of the German vigilance system poses a risk for patients. Risk management in health-care facilities without risk policy is dangerously incomplete. © Georg Thieme Verlag KG Stuttgart · New York.

The Committed Intimate Partnerships of Incarcerated African-American Men: Implications for Sexual HIV Transmission Risk and Prevention Opportunities.

PubMed

Khan, Maria R; El-Bassel, Nabila; Golin, Carol E; Scheidell, Joy D; Adimora, Adaora A; Coatsworth, Ashley M; Hu, Hui; Judon-Monk, Selena; Medina, Katie P; Wohl, David A

2017-10-01

Incarceration is thought to influence HIV transmission by disrupting partnerships that provide support and protect against sex risk-taking. Current correctional facility-based family-strengthening programs focus on marital partnerships, a minority of inmates' partnerships. Research on the sex partnerships of incarcerated African-American men and the types of partnerships most likely to protect against HIV-related sex risk is limited. Improved understanding can inform expansion of correctional facility-based family-strengthening programs to a greater proportion of protective partnerships and HIV risk reduction programs to partnerships vulnerable to sex risk. Project DISRUPT is a cohort study of African-American men being released from prison in North Carolina who were in committed heterosexual partnerships at prison entry. Using baseline survey data (N = 189), we conducted latent class analysis (LCA) to identify subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the six months before incarceration. LCA indicated a two-class solution, with relationships distinguished by satisfaction/stability (satisfied/stable class: 58.0%; dissatisfied/unstable class: 42.0%); each class had comparable relationship length and levels of marriage and cohabitation. Dissatisfied/unstable relationships were associated with multiple partnerships among participants (AOR 2.93, 95% CI 1.50, 5.72) and partners (AOR 4.95, 95% CI 1.68, 14.58). Satisfaction indicators-versus length, marriage, or cohabitation-were the strongest independent correlates of inmates' and partners' multiple partnerships. Pre-incarceration economic deprivation, mental disorder symptoms, substance use, and violence in relationships were associated with dissatisfaction/instability. Prison-based programs designed to maintain healthy partnerships, strengthen relationship skills, and reduce HIV risk-taking and violence in relationships are warranted and should be targeted to both marital and nonmarital partnerships. Programming also should address the poverty, mental illness, and substance use factors that threaten relationship satisfaction/stability and increase HIV risk.

In-Situ Resource Utilization (ISRU) Development Program

NASA Technical Reports Server (NTRS)

Sanders, Jerry

1998-01-01

The question "Why In-Situ Resource Utilization (ISRU)?" is addressed in this presentation. The reasons given concentrate on Cost reduction, Mass reduction, Risk reduction, the expansion of human exploration and presence and the enabling of industrial exploitation. A review of the Martian and Lunar resources available for ISRU is presented. Other ISRU concepts (i.e., In-Situ Consumable production (ISCP) and In-Situ Propellant Production (ISPP)) are introduced and further explained. The objectives of a Mars ISRU System Technology (MIST) include (1) the characterization of technology and subsystem performance for mission modeling and technology funding planning, (2) reduce risk and concerns arising from sample return and human missions utilizing ISRU, and (3) demonstrate the environmental suitability of ISRU components/processes and systems. A proof of concept demonstration schedule and a facility overview for MIST is presented.

Biological Risks and Laboratory-Acquired Infections: A Reality That Cannot be Ignored in Health Biotechnology

PubMed Central

Coelho, Ana Cláudia; García Díez, Juan

2015-01-01

Advances and research in biotechnology have applications over a wide range of areas, such as microbiology, medicine, the food industry, agriculture, genetically modified organisms, and nanotechnology, among others. However, research with pathogenic agents, such as virus, parasites, fungi, rickettsia, bacterial microorganisms, or genetic modified organisms, has generated concern because of their potential biological risk – not only for people, but also for the environment due to their unpredictable behavior. In addition, concern for biosafety is associated with the emergence of new diseases or re-emergence of diseases that were already under control. Biotechnology laboratories require biosafety measures designed to protect their staff, the population, and the environment, which may be exposed to hazardous organisms and materials. Laboratory staff training and education is essential, not only to acquire a good understanding about the direct handling of hazardous biological agents but also knowledge of the epidemiology, pathogenicity, and human susceptibility to the biological materials used in research. Biological risk can be reduced and controlled by the correct application of internationally recognized procedures such as proper microbiological techniques, proper containment apparatus, adequate facilities, protective barriers, and special training and education of laboratory workers. To avoid occupational infections, knowledge about standardized microbiological procedures and techniques and the use of containment devices, facilities, and protective barriers is necessary. Training and education about the epidemiology, pathogenicity, and biohazards of the microorganisms involved may prevent or decrease the risk. In this way, the scientific community may benefit from the lessons learned in the past to anticipate future problems. PMID:25973418

NASA Strategy to Safely Live and Work in the Space Radiation Environment

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.; Wu, Honglu; Corbin, Barbara J.; Sulzman, Frank M.; Krenek, Sam

2007-01-01

In space, astronauts are constantly bombarded with energetic particles. The goal of the National Aeronautics and Space Agency and the NASA Space Radiation Project is to ensure that astronauts can safely live and work in the space radiation environment. The space radiation environment poses both acute and chronic risks to crew health and safety, but unlike some other aspects of space travel, space radiation exposure has clinically relevant implications for the lifetime of the crew. Among the identified radiation risks are cancer, acute and late CNS damage, chronic and degenerative tissue decease, and acute radiation syndrome. The term "safely" means that risks are sufficiently understood such that acceptable limits on mission, post-mission and multi-mission consequences can be defined. The NASA Space Radiation Project strategy has several elements. The first element is to use a peer-reviewed research program to increase our mechanistic knowledge and genetic capabilities to develop tools for individual risk projection, thereby reducing our dependency on epidemiological data and population-based risk assessment. The second element is to use the NASA Space Radiation Laboratory to provide a ground-based facility to study the health effects/mechanisms of damage from space radiation exposure and the development and validation of biological models of risk, as well as methods for extrapolation to human risk. The third element is a risk modeling effort that integrates the results from research efforts into models of human risk to reduce uncertainties in predicting the identified radiation risks. To understand the biological basis for risk, we must also understand the physical aspects of the crew environment. Thus, the fourth element develops computer algorithms to predict radiation transport properties, evaluate integrated shielding technologies and provide design optimization recommendations for the design of human space systems. Understanding the risks and determining methods to mitigate the risks are keys to a successful radiation protection strategy.

INCINERATION RESEARCH FACILITY

EPA Science Inventory

The Cincinnati-based Risk Reduction Engineering Laboratory, ORD, U.S. EPA operates the Incineration Research Facility *IRF) in Jefferson, Arkansas. This facility's pilot-scale experimental incineration systems include a Rotary Kiln System and a Liquid Injection System. Each syste...

Optimizing liquid effluent monitoring at a large nuclear complex.

PubMed

Chou, Charissa J; Barnett, D Brent; Johnson, Vernon G; Olson, Phil M

2003-12-01

Effluent monitoring typically requires a large number of analytes and samples during the initial or startup phase of a facility. Once a baseline is established, the analyte list and sampling frequency may be reduced. Although there is a large body of literature relevant to the initial design, few, if any, published papers exist on updating established effluent monitoring programs. This paper statistically evaluates four years of baseline data to optimize the liquid effluent monitoring efficiency of a centralized waste treatment and disposal facility at a large defense nuclear complex. Specific objectives were to: (1) assess temporal variability in analyte concentrations, (2) determine operational factors contributing to waste stream variability, (3) assess the probability of exceeding permit limits, and (4) streamline the sampling and analysis regime. Results indicated that the probability of exceeding permit limits was one in a million under normal facility operating conditions, sampling frequency could be reduced, and several analytes could be eliminated. Furthermore, indicators such as gross alpha and gross beta measurements could be used in lieu of more expensive specific isotopic analyses (radium, cesium-137, and strontium-90) for routine monitoring. Study results were used by the state regulatory agency to modify monitoring requirements for a new discharge permit, resulting in an annual cost savings of US dollars 223,000. This case study demonstrates that statistical evaluation of effluent contaminant variability coupled with process knowledge can help plant managers and regulators streamline analyte lists and sampling frequencies based on detection history and environmental risk.

Evaluation of biodiesel’s impact on real-world occupational and environmental particulate matter exposures at a municipal facility in Keene, NH

PubMed Central

Thelen, Brett Amy; Ingalls, Jaime Kathryn; Treadwell, Melinda Dawn

2016-01-01

Many organizations are interested in biodiesel as a renewable, domestic energy source for use in transportation and heavy-duty equipment. Although numerous biodiesel emission studies exist, biodiesel exposure studies are nearly absent from the literature. This study compared the impact of petroleum diesel fuel and a B20 blend (20% soy-based biodiesel/80% petroleum diesel) on occupational and environmental exposures at a rural municipal facility in Keene, NH. For each fuel type, we measured concentrations of fine particulate matter (PM2.5), elemental carbon (EC), and organic carbon (OC) at multiple locations (in-cabin, work area, and near-field) at a materials recovery facility utilizing non-road equipment. B20 fuel use resulted in significant reductions in PM2.5 mass (56–76%), reductions in EC (5–29%), and increases in OC (294–467%). Concentrations of PM2.5 measured during petroleum diesel use were up to four times higher than PM2.5 concentrations during B20 use. Further analysis of the EC and OC fractions of total carbon also indicated substantial differences between fuels. Our results demonstrate that biodiesel blends significantly reduced PM2.5 exposure compared to petroleum diesel fuel in a workplace utilizing non-road construction-type equipment. While this suggests that biodiesel may reduce health risks associated with exposure to fine particulate matter mass, more exposure research is needed to better understand biodiesel-related changes in particulate matter composition and other exposure metrics.

Tax Reform Act of 1986: implications and trends.

PubMed

Harris, R F

1988-10-01

The Tax Reform Act of 1986 contains several changes that substantially reduce economic flexibility for not-for-profit hospitals and healthcare systems. These changes, involving limited partnerships, investment tax credit, depreciation, and income deferral plans, among other items, carry several implications. Tax-motivated joint ventures will no longer be attractive to physician investors, donations to hospitals are expected to decline by up to 15 percent, and flexibility in attracting and retaining high-caliber employees is reduced. Efforts to reduce the federal budget deficit and renewed scrutiny of unrelated business income further jeopardize economic flexibility. Another threat is intensified Internal Revenue Service scrutiny of Form 990, which is filed by all not-for-profit organizations with $25,000 or more in annual gross receipts, and Form 990T, which is used to report unrelated business income. Measures to protect facilities' economic flexibility include careful return preparation, alternative recruitment tactics, objective opinions, refusal of high-risk deals, and outside appraisals.

Estimating earthquake-induced failure probability and downtime of critical facilities.

PubMed

Porter, Keith; Ramer, Kyle

2012-01-01

Fault trees have long been used to estimate failure risk in earthquakes, especially for nuclear power plants (NPPs). One interesting application is that one can assess and manage the probability that two facilities - a primary and backup - would be simultaneously rendered inoperative in a single earthquake. Another is that one can calculate the probabilistic time required to restore a facility to functionality, and the probability that, during any given planning period, the facility would be rendered inoperative for any specified duration. A large new peer-reviewed library of component damageability and repair-time data for the first time enables fault trees to be used to calculate the seismic risk of operational failure and downtime for a wide variety of buildings other than NPPs. With the new library, seismic risk of both the failure probability and probabilistic downtime can be assessed and managed, considering the facility's unique combination of structural and non-structural components, their seismic installation conditions, and the other systems on which the facility relies. An example is offered of real computer data centres operated by a California utility. The fault trees were created and tested in collaboration with utility operators, and the failure probability and downtime results validated in several ways.

Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.

PubMed

Oo, Htun Nyunt; Hone, San; Fujita, Masami; Maw-Naing, Amaya; Boonto, Krittayawan; Jacobs, Marjolein; Phyu, Sabe; Bollen, Phavady; Cheung, Jacquie; Aung, Htin; Aung Sang, May Thu; Myat Soe, Aye; Pendse, Razia; Murphy, Eamonn

2016-11-28

Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load;•Prioritising integration of HIV and related services in high-burden areas;•Increasing the proportion of PLHIV receiving testing and treatment at public facilities by improving human resources and increasing public facilities providing these services to ensure sustainability;•Obtaining intelligence and tailoring services in hard-to-reach/under-served areas;•Strengthening planning, monitoring, and coordination capacity especially at regional levels.

A 2D simulation model for urban flood management

NASA Astrophysics Data System (ADS)

Price, Roland; van der Wielen, Jonathan; Velickov, Slavco; Galvao, Diogo

2014-05-01

The European Floods Directive, which came into force on 26 November 2007, requires member states to assess all their water courses and coast lines for risk of flooding, to map flood extents and assets and humans at risk, and to take adequate and coordinated measures to reduce the flood risk in consultation with the public. Flood Risk Management Plans are to be in place by 2015. There are a number of reasons for the promotion of this Directive, not least because there has been much urban and other infrastructural development in flood plains, which puts many at risk of flooding along with vital societal assets. In addition there is growing awareness that the changing climate appears to be inducing more frequent extremes of rainfall with a consequent increases in the frequency of flooding. Thirdly, the growing urban populations in Europe, and especially in the developing countries, means that more people are being put at risk from a greater frequency of urban flooding in particular. There are urgent needs therefore to assess flood risk accurately and consistently, to reduce this risk where it is important to do so or where the benefit is greater than the damage cost, to improve flood forecasting and warning, to provide where necessary (and possible) flood insurance cover, and to involve all stakeholders in decision making affecting flood protection and flood risk management plans. Key data for assessing risk are water levels achieved or forecasted during a flood. Such levels should of course be monitored, but they also need to be predicted, whether for design or simulation. A 2D simulation model (PriceXD) solving the shallow water wave equations is presented specifically for determining flood risk, assessing flood defense schemes and generating flood forecasts and warnings. The simulation model is required to have a number of important properties: -Solve the full shallow water wave equations using a range of possible solutions; -Automatically adjust the time step and keep it as large as possible while maintaining the stability of the flow calculations; -Operate on a square grid at any resolution while retaining at least some details of the ground topography of the basic grid, the storage, and the form roughness and conveyance of the ground surface; -Account for the overall average ground slope for particular coarse cells; -Have the facility to refine the grid locally; -Have the facility to treat ponds or lakes as single, irregular cells; -Permit prescribed inflows and arbitrary outflows across the boundaries of the model domain or internally, and sources and sinks at any interior cell; -Simulate runoff for spatial rainfall while permitting infiltration; -Use ground surface cover and soil type indices to determine surface roughness, interception and infiltration parameters; -Present results at the basic cell level; -Have the facility to begin a model run with monitored soil moisture data; -Have the facility to hot-start a simulation using dumped data from a previous simulation; -Operate with a graphics cards for parallel processing; -Have the facility to link directly to the urban drainage simulation software such as SWMM through an Open Modelling Interface; -Be linked to the Netherlands national rainfall database for continuous simulation of rainfall-runoff for particular polders and urban areas; -Make the engine available as Open Source together with benchmark datasets; PriceXD forms a key modelling component of an integrated urban water management system consisting of an on-line database and a number of complementary modelling systems for urban hydrology, groundwater, potable water distribution, wastewater and stormwater drainage (separate and combined sewerage), wastewater treatment, and surface channel networks. This will be a 'plug and play' system. By linking the models together, confidence in the accuracy of the above-ground damage and construction costs is comparable to the below-ground costs. What is more, PriceXD can be used to examine additional physical phenomenon such as the interaction between flood flows and flows to and from inlets distributed along the pipes of the underground network, and to optimize the removal of blockages and improve asset management. Finally, PriceXD is already an integral component on a number of operational projects and platforms, including the MyWater distributed platform and the HydroNET web portal, where it is already applied to realistic case studies on the Netherlands (namely the Rijnland area), facilitating the access to both the model execution and results, by abstracting most of the complexity out of the model setup and configuration.

Amnioinfusion for meconium-stained liquor in labour.

PubMed

Hofmeyr, G Justus; Xu, Hairong

2010-01-20

Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009). Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid. Two review authors assessed eligibility and trial quality, and extracted data, independently. Thirteen studies of variable quality (4143 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: two studies (855 women) were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (RR 0.25, 95% CI 0.13 to 0.47), and neonatal ventilation or neonatal intensive care unit admission; and a trend towards reduced perinatal mortality (RR 0.37, 95% CI 0.13 to 1.01). In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced. Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Effectiveness of an automatic manual wheelchair braking system in the prevention of falls.

PubMed

Martorello, Laura; Swanson, Edward

2006-01-01

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t (18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.

Suicide risk in long-term care facilities: a systematic review.

PubMed

Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

2014-12-01

Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

Suicide risk in long-term care facilities: A systematic review

PubMed Central

Mezuk, Briana; Rock, Andrew; Lohman, Matthew C.; Choi, Moon

2014-01-01

Objective Suicide risk is highest in later life, however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes, assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Methods Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4,073 unique research articles identified, 36 were selected for inclusion in this review. Results Of the included reports, 20were cross-sectional, 10 were longitudinal, three qualitative, and five were intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5 – 33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size, staffing) may also be relevant. Conclusions Existing research on suicide risk in long-term care facilities is limited, but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. PMID:24854089

Improving Transitions to Postacute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO-Care Transitions.

PubMed

Moore, Amber B; Krupp, J Elyse; Dufour, Alyssa B; Sircar, Mousumi; Travison, Thomas G; Abrams, Alan; Farris, Grace; Mattison, Melissa L P; Lipsitz, Lewis A

2017-10-01

Within 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization, and high-cost health care. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team with clinicians at skilled nursing facilities reduces patient mortality, hospital readmission, skilled nursing facility length of stay, and 30-day health care costs. We undertook a prospective cohort study comparing cost and health care utilization outcomes between ECHO-CT facilities and matched comparisons from January 2014-December 2014. Thirty-day readmission rates were significantly lower in the intervention group (odds ratio 0.57; 95% CI, 0.34-0.96; P-value .04), as were the 30-day total health care cost ($2602.19 lower; 95% CI, -$4133.90 to -$1070.48; P-value <.001) and the average length of stay at the skilled nursing facility (-5.52 days; 95% CI, -9.61 to -1.43; P = .001). The 30-day mortality rate was not significantly lower in the intervention group (odds ratio 0.38; 95% CI, 0.11-1.24; P = .11). Patients discharged to skilled nursing facilities participating in the ECHO-CT program had shorter lengths of stay, lower 30-day rehospitalization rates, and lower 30-day health care costs compared with those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to postacute care at lower overall cost. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis

PubMed Central

Hawkins, Summer Sherburne; Stern, Ariel Dora; Baum, Christopher F; Gillman, Matthew W

2014-01-01

Objective To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Design Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Setting Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Subjects Mothers (n 11723) who gave birth in BFHI hospitals and mothers (n 13604) from nineteen matched non-BFHI facilities. Results Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0.024; 95 % CI −0.00, 0.51), breast-feeding initiation increased by 3.8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0.05), but not among mothers with higher education (adjusted coefficient = 0.002; 95 % CI −0.04, 0.05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4.5 percentage points (P=0.02) among mothers with lower education who delivered in BFHI facilities. Conclusions By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding. PMID:24625787

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis.

PubMed

Hawkins, Summer Sherburne; Stern, Ariel Dora; Baum, Christopher F; Gillman, Matthew W

2015-02-01

To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Mothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities. Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0·024; 95 % CI -0·00, 0·51), breast-feeding initiation increased by 3·8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0·05), but not among mothers with higher education (adjusted coefficient = 0·002; 95 % CI -0·04, 0·05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4·5 percentage points (P = 0·02) among mothers with lower education who delivered in BFHI facilities. By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.

A Site Characterization Protocol for Evaluating the Potential for Triggered or Induced Seismicity Resulting from Wastewater Injection and Hydraulic Fracturing

NASA Astrophysics Data System (ADS)

Walters, R. J.; Zoback, M. D.; Gupta, A.; Baker, J.; Beroza, G. C.

2014-12-01

Regulatory and governmental agencies, individual companies and industry groups and others have recently proposed, or are developing, guidelines aimed at reducing the risk associated with earthquakes triggered by waste water injection or hydraulic fracturing. While there are a number of elements common to the guidelines proposed, not surprisingly, there are also some significant differences among them and, in a number of cases, important considerations that are not addressed. The goal of this work is to develop a comprehensive protocol for site characterization based on a rigorous scientific understanding of the responsible processes. Topics addressed will include the geologic setting (emphasizing faults that might be affected), historical seismicity, hydraulic characterization of injection and adjacent intervals, geomechanical characterization to identify potentially active faults, plans for seismic monitoring and reporting, plans for monitoring and reporting injection (pressure, volumes, and rates), other factors contributing to risk (potentially affected population centers, structures, and facilities), and implementing a modified Probabilistic Seismic Hazard Analysis (PSHA). The guidelines will be risk based and adaptable, rather than prescriptive, for a proposed activity and region of interest. They will be goal oriented and will rely, to the degree possible, on established best practice procedures, referring to existing procedures and recommendations. By developing a risk-based site characterization protocol, we hope to contribute to the development of rational and effective measures for reducing the risk posed by activities that potentially trigger earthquakes.

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

PubMed

Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane

2017-06-01

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

A Proposed Approach for Prioritizing Maintenance at NASA Centers

NASA Technical Reports Server (NTRS)

Dunn, Steven C.; Sawyer, Melvin H.

2013-01-01

The National Aeronautics and Space Administration (NASA) manages a vast array of infrastructure assets across ten National Centers with a worth of at least 30 billion dollars. Eighty percent of this infrastructure is greater than 40 years old and is in degraded condition. Maintenance budgets are typically less than one percent of current replacement value (CRV), much less than the 2-4% recommended by the National Research Council. The maintenance backlog was 2.55 billion dollars in FY10 and growing. NASA s annual budgets have flattened and are at risk of being reduced, so the problem is becoming even more difficult. NASA Centers utilize various means to prioritize and accomplish maintenance within available budgets, though data is suspect and processes are variable. This paper offers a structured means to prioritize maintenance based on mission criticality and facility performance (ability of the facility to deliver on its purpose). Mission alignment is assessed using the current timeframe Mission Dependence Index and a measure of facility alignment with the 2011 NASA Strategic Plan for the long-term perspective. Facility performance is assessed by combining specific findings from a structured facility condition assessment and an assessment of actual functional output. These are then combined in a matrix to identify the facilities most critical to mission and able to deliver services. The purpose of this approach is to provide the best benefits for the available funding. Additionally, this rationale can also be applied to the prioritization of investment (recapitalization) projects so that the ultimate customers of this paper, the senior infrastructure managers at each NASA Center, are better able to strategically manage their capabilities.

Asphyxiation Incidents by Hydrogen Sulfide at Manure Storage Facilities of Swine Livestock Farms in Korea.

PubMed

Park, Jihoon; Kang, Taesun; Jin, Suhyun; Heo, Yong; Kim, Kyungran; Lee, Kyungsuk; Tsai, Perngjy; Yoon, Chungsik

2016-01-01

Livestock workers are involved in a variety of tasks, such as caring for animals, maintaining the breeding facilities, cleaning, and manure handling, and are exposed to health and safety risks. Hydrogen sulfide is considered the most toxic by-product of the manure handling process at livestock facilities. Except for several reports in developed countries, the statistics and cause of asphyxiation incidents in farms have not been collected and reported systematically, although the number of these incidents is expected to increase in developing and underdeveloped countries. In this study, the authors compiled the cases of work-related asphyxiation incidents at livestock manure storage facilities and analyzed the main causes. In this survey, a total of 17 incidents were identified through newspapers or online searches and public reports. Thirty workers died and eight were injured due to work-related tasks and rescue attempts from 1998 to 2013 in Korea. Of the 30 fatalities, 18 occurred during manure handling/maintenance tasks and 12 during rescue attempts. All incidents except for one case occurred during the warm season from the late spring (April) to early autumn (September) when manure is likely to decompose rapidly. It is important to train employees involved in the operation of the facilities (i.e., owners, managers, employees) regarding the appropriate prevention strategies for confined space management, such as hazard identification before entry, periodical facility inspection, restriction of unnecessary access, proper ventilation, and health and safety. Sharing information or case reports on previous incidents could also help prevent similar cases from occurring and reduce the number of fatalities and injuries.

Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture.

PubMed

Holmberg, Teresa; Bech, Mickael; Gram, Jeppe; Hermann, Anne Pernille; Rubin, Katrine Hass; Brixen, Kim

2016-03-01

Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61-81 years). Correlation between the two methods was estimated using correlation coefficient (r) and Bland-Altman plots. A moderate correlation between phalangeal BMD versus total hip (r = 0.47) and lumbar spine (r = 0.51), and an AUC on 0.80 was found. The mean difference between phalangeal T score and total hip T score/lumbar spine T score was low, and ranged from -0.26 SD to -0.31 SD depending on site and reference database used for calculation of T scores, but, large variation was seen at an individual level. When applying a triage approach approx. one-third of all DXA scan could be avoided and only 6 % of women in the low-risk group would be false negatives.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Demmer, Rick; Fox, Don; Reese, Stephen

The Idaho National Laboratory (INL) and the United Kingdom (UK) National Nuclear Laboratory (NNL) have been collaborating for several years on materials and methods for the fogged/misted introduction of fixatives into radiologically contaminated facilities. The objective of the project is to deliver a process for reducing airborne radiological and/or mercury contamination and affixing loose contamination in place, thereby reducing contamination risk to employees and decreasing D&D cost and schedule. The developed process provides a reliable, unmanned method of introducing a coating that captures and fixes contamination in place within facilities. The INL coating, termed FX2, has undergone extensive non-radiological testing,more » including determination that it is non-flammable, affixes contamination and flows well through unusual geometries (testing at Florida International University). A series of non-active fogging trials for activity knock/tie-down application have been completed at NNL Workington on behalf of Idaho National Laboratory (INL). These trials performed by the NNL employed commercially available agricultural fogging equipment and the INL’s knock/tie-down latex formulation (FX-2). This testing successfully demonstrated the ability of the fogging devices to successfully spray the FX-2 formulation within various scenarios, and prepared the project for a radioactive trial. The INL has also developed a mercury vapor reducing form of the coating termed FX-Hg, which has shown great promise in laboratory studies.« less

Capabilities and constraints of NASA's ground-based reduced gravity facilities

NASA Technical Reports Server (NTRS)

Lekan, Jack; Neumann, Eric S.; Sotos, Raymond G.

1993-01-01

The ground-based reduced gravity facilities of NASA have been utilized to support numerous investigations addressing various processes and phenomina in several disciplines for the past 30 years. These facilities, which include drop towers, drop tubes, aircraft, and sounding rockets are able to provide a low gravity environment (gravitational levels that range from 10(exp -2)g to 10(exp -6)g) by creating a free fall or semi-free fall condition where the force of gravity on an experiment is offset by its linear acceleration during the 'fall' (drop or parabola). The low gravity condition obtained on the ground is the same as that of an orbiting spacecraft which is in a state of perpetual free fall. The gravitational levels and associated duration times associated with the full spectrum of reduced gravity facilities including spaced-based facilities are summarized. Even though ground-based facilities offer a relatively short experiment time, this available test time has been found to be sufficient to advance the scientific understanding of many phenomena and to provide meaningful hardware tests during the flight experiment development process. Also, since experiments can be quickly repeated in these facilities, multistep phenomena that have longer characteristic times associated with them can sometimes be examined in a step-by-step process. There is a large body of literature which has reported the study results achieved through using reduced-gravity data obtained from the facilities.

Assessment of radiological protection systems among diagnostic radiology facilities in North East India.

PubMed

Singh, Thokchom Dewan; Jayaraman, T; Arunkumar Sharma, B

2017-03-01

This study aims to assess the adequacy level of radiological protection systems available in the diagnostic radiology facilities located in three capital cities of North East (NE) India. It further attempts to understand, using a multi-disciplinary approach, how the safety codes/standards in diagnostic radiology framed by the Atomic Energy Regulatory Board (AERB) and the International Atomic Energy Agency (IAEA) to achieve adequate radiological protection in facilities, have been perceived, conceptualized, and applied accordingly in these facilities. About 30 diagnostic radiology facilities were randomly selected from three capitals of states in NE India; namely Imphal (Manipur), Shillong (Meghalaya) and Guwahati (Assam). A semi-structured questionnaire developed based on a multi-disciplinary approach was used for this study. It was observed that radiological practices undertaken in these facilities were not exactly in line with safety codes/standards in diagnostic radiology of the AERB and the IAEA. About 50% of the facilities had registered/licensed x-ray equipment with the AERB. More than 80% of the workers did not use radiation protective devices, although these devices were available in the facilities. About 85% of facilities had no institutional risk management system. About 70% of the facilities did not carry out periodic quality assurance testing of their x-ray equipment or surveys of radiation leakage around the x-ray room, and did not display radiation safety indicators in the x-ray rooms. Workers in these facilities exhibited low risk perception about the risks associated with these practices. The majority of diagnostic radiology facilities in NE India did not comply with the radiological safety codes/standards framed by the AERB and IAEA. The study found inadequate levels of radiological protection systems in the majority of facilities. This study suggests a need to establish firm measures that comply with the radiological safety codes/standards of the AERB and IAEA to protect patients, workers and the public of this region.

Analyses in Support of Risk-Informed Natural Gas Vehicle Maintenance Facility Codes and Standards: Phase II.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blaylock, Myra L.; LaFleur, Chris Bensdotter; Muna, Alice Baca

Safety standards development for maintenance facilities of liquid and compressed natural gas fueled vehicles is required to ensure proper facility design and operating procedures. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase II work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest using risk ranking. Detailed simulations and modeling were performed to estimate the location and behaviormore » of natural gas releases based on these scenarios. Specific code conflicts were identified, and ineffective code requirements were highlighted and resolutions proposed. These include ventilation rate basis on area or volume, as well as a ceiling offset which seems ineffective at protecting against flammable gas concentrations. ACKNOWLEDGEMENTS The authors gratefully acknowledge Bill Houf (SNL -- Retired) for his assistance with the set-up and post-processing of the numerical simulations. The authors also acknowledge Doug Horne (retired) for his helpful discussions. We would also like to acknowledge the support from the Clean Cities program of DOE's Vehicle Technology Office.« less

OEM Emergency Prevention and Mitigation Information

EPA Pesticide Factsheets

The Office of Emergency Management maintains information relevant to preventing emergencies before they occur, and/or mitigating the effects of emergency when they do occur. A principal element of this data asset is the information managed by the System for Risk Management Plans (SRMP), which compiles risk management plans submitted by facilities in accordance with the Clean Air Act, Section 112(r). Affected facilities are to develop risk management programs which will prevent and minimize consequences of accidental releases of certain hazardous chemicals that could harm public health and the environment.Another component of this data asset are the results generated by the Priority Assessment Model (PAM), which analyzes information concerning low-level chronic emissions from facilities and sets priorities (low, medium, high) for proactive controls on releases that do not necessarily pose imminent threats, but which may under adverse circumstances create unacceptable health or ecological risks.Also included are inspection records compiled by the Oil Inspection Program. Under the Clean Water Act Section 311, EPA regulates oil storage that meets a specific regulatory threshold. Facilities that store oil and meet the regulatory threshold need to prepare and implement a Spill Prevention, Control, and Countermeasures (SPCC) Plan which needs to be reviewed and approved by a professional engineer. Additionally, facilities with larger oil storage capacity may have to pre

Water safety in healthcare facilities. The Vieste Charter.

PubMed

Bonadonna, L; Cannarozzi de Grazia, M; Capolongo, S; Casini, B; Cristina, M L; Daniele, G; D'Alessandro, D; De Giglio, O; Di Benedetto, A; Di Vittorio, G; Ferretti, E; Frascolla, B; La Rosa, G; La Sala, L; Lopuzzo, M G; Lucentini, L; Montagna, M T; Moscato, U; Pasquarella, C; Prencipe, R; Ricci, M L; Romano Spica, V; Signorelli, C; Veschetti, E

2017-01-01

The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

Reducing environmental risk associated with laboratory decommissioning and property transfer.

PubMed

Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

2000-12-01

The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness.

Reducing environmental risk associated with laboratory decommissioning and property transfer.

PubMed Central

Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

2000-01-01

The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness. PMID:11121365

DEVELOPMENT OF THE METAL FINISHING FACILITY RISK SCREENING TOOL

EPA Science Inventory

Enhancement of the US Environmental Protection Agency's
Metal Finishing Facility Risk Screening Tool (MFFRST)

William M. Barrett Jr, Ph.D., P.E. , P.E.; Paul Harten, Ph.D.1, Matt Lorber , Charles Peck , and Steve Schwartz, P.E., Q.E.P.3

Recently, the US Environ...

Risk and Resilience: Girls' Experiences Navigating Space and Relationships in a Secure Residential Facility

ERIC Educational Resources Information Center

Simonsen, Amy E.

2010-01-01

The purpose of this qualitative study was to examine how adolescent girls with diagnosed learning and emotional disabilities described themselves as they negotiated various environments and relationships within a secure residential facility. The goal was to explore how conditions and interactions in these environments promoted both risk and…

Preliminary risk assessment for nuclear waste disposal in space, volume 2

NASA Technical Reports Server (NTRS)

Rice, E. E.; Denning, R. S.; Friedlander, A. L.

1982-01-01

Safety guidelines are presented. Waste form, waste processing and payload fabrication facilities, shipping casks and ground transport vehicles, payload primary container/core, radiation shield, reentry systems, launch site facilities, uprooted space shuttle launch vehicle, Earth packing orbits, orbit transfer systems, and space destination are discussed. Disposed concepts and risks are then discussed.

Evaluating Potential Human Health Risks Associated with the Development of Utility-Scale Solar Energy Facilities on Contaminated Sites

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, J. -J.; Chang, Y. -S.; Hartmann, H.

2013-09-01

This report presents a general methodology for obtaining preliminary estimates of the potential human health risks associated with developing a utility-scale solar energy facility on a contaminated site, based on potential exposures to contaminants in soils (including transport of those contaminants into the air).

The initial electrocardiogram during admission for myocardial infarction. Use as a predictor of clinical course and facility utilization.

PubMed

Stark, M E; Vacek, J L

1987-05-01

The first electrocardiogram obtained on presentation for suspected myocardial infarction was examined for its usefulness in predicting clinical course and facility use. We studied 221 patients consecutively admitted to a nonuniversity hospital coronary care unit. High-risk patients were identified if the electrocardiographic diagnoses included myocardial infarction, ischemia, left ventricular hypertrophy, left bundle-branch block, or paced rhythm. These 63 patients (29% of total) had significantly greater incidences of serious events, need for procedures, and death than low-risk patients whose initial electrocardiograms did not carry the above diagnoses. Patients with a low-risk initial electrocardiogram may not require the facilities of a coronary care unit and perhaps could be safely observed in an intermediate care area. However, many hospitals do not have an intermediate care facility available, and in those that do, daily costs may not be markedly different than for treatment in a coronary care unit. Whether these low-risk patients could be safely treated in general medicine beds, where potential cost savings would be much greater, is unknown.

Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point.

PubMed

Mendis, Shanthi; Abegunde, Dele; Oladapo, Olulola; Celletti, Francesca; Nordet, Porfirio

2004-01-01

Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertension. A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities. One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed. About two-thirds of hypertensives utilized primary-care centers both for diagnosis and for follow-up. Laboratory and other investigations to exclude secondary hypertension or to assess target organ damage were not available in the majority of facilities, particularly in primary care. A considerable knowledge and awareness gap related to hypertension and its complications was found, both among patients and health-care providers. Blood pressure control rates were poor (28% with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg] and drug prescription patterns were not evidence based and cost effective. The majority of patients (73%) in this low socio-economic group (mean monthly income 73 US dollars) had to pay fully, out of their own pocket, for consultations and medications. If the absolute risk approach for assessment of risk and effective management of hypertension is to be implemented in low-resource settings, appropriate policy measures need to be taken to improve the competency of health-care providers, to provide basic laboratory facilities and to develop affordable financing mechanisms.

Risk, media, and stigma at Rocky Flats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flynn, J.; Peters, E.; Mertz, C.K.

1998-12-01

Public responses to nuclear technologies are often strongly negative. Events, such as accidents or evidence of unsafe conditions at nuclear facilities, receive extensive and dramatic coverage by the news media. These news stories affect public perceptions of nuclear risks and the geographic areas near nuclear facilities. One result of these perceptions, avoidance behavior, is a form of technological stigma that leads to losses in property values near nuclear facilities. The social amplification of risk is a conceptual framework that attempts to explain how stigma is created through media transmission of information about hazardous places and public perceptions and decisions. Thismore » paper examines stigma associated with the US Department of energy`s Rocky Flats facility, a major production plant in the nation`s nuclear weapons complex, located near Denver, Colorado. This study, based upon newspaper analyses and a survey of Denver area residents, finds that the social amplification theory provides a reasonable framework for understanding the events and public responses that took place in regard to Rocky Flats during a 6-year period, beginning with an FBI raid of the facility in 1989.« less

Sustainable Cities Programme: a joint UN-HABITAT-UNEP facility on the urban environment with participation of the Dutch government.

PubMed

Gebre-Egziabher, Axumite

2004-06-01

The fundamental objective of the Sustainable Cities Programme is to promote environmentally sustainable local development to more fully realize the vital contributions that urban areas make to over-all social and economic development by: (1) enhancing efficiency in the use of local environmental resources, reducing environmental risks, and strengthening application of environmental conventions and agreements with growing regard to the Climate Change Protocol; (2) reducing poverty by promoting more equitable access to resources and environmental services; (3) mobilizing and strengthening local capacities to plan, co-ordinate, and manage sustainable local development in partnership; and (4) combining the complementary strengths of UN-HABITAT, UNEP, and other partners in support of Agenda 21, and the Habitat Agenda sustainable development commitments including improved local environmental governance.

Heap leach cyanide irrigation and risk to wildlife: Ramifications for the international cyanide management code.

PubMed

Donato, D B; Madden-Hallett, D M; Smith, G B; Gursansky, W

2017-06-01

Exposed cyanide-bearing solutions associated with gold and silver recovery processes in the mining industry pose a risk to wildlife that interact with these solutions. This has been documented with cyanide-bearing tailings storage facilities, however risks associated with heap leach facilities are poorly documented, monitored and audited. Gold and silver leaching heap leach facilities use cyanide, pH-stabilised, at concentrations deemed toxic to wildlife. Their design and management are known to result in exposed cyanide-bearing solutions that are accessible to and present a risk to wildlife. Monitoring of the presence of exposed solutions, wildlife interaction, interpretation of risks and associated wildlife deaths are poorly documented. This paper provides a list of critical monitoring criteria and attempts to predict wildlife guilds most at risk. Understanding the significance of risks to wildlife from exposed cyanide solutions is complex, involving seasonality, relative position of ponding, temporal nature of ponding, solution palatability, environmental conditions, in situ wildlife species inventory and provision of alternative drinking sources for wildlife. Although a number of heap leach operations are certified as complaint with the International Cyanide Management Code (Cyanide Code), these criteria are not considered by auditors nor has systematic monitoring regime data been published. Without systematic monitoring and further knowledge, wildlife deaths on heap leach facilities are likely to remain largely unrecorded. This has ramifications for those operations certified as compliance with the Cyanide Code. Copyright © 2017 Elsevier Inc. All rights reserved.

Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis.

PubMed

Tak, SangWoo; Sweeney, Marie Haring; Alterman, Toni; Baron, Sherry; Calvert, Geoffrey M

2010-10-01

We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.

Workplace Assaults on Nursing Assistants in US Nursing Homes: A Multilevel Analysis

PubMed Central

Sweeney, Marie Haring; Alterman, Toni; Baron, Sherry; Calvert, Geoffrey M.

2010-01-01

Objectives. We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. Methods. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Results. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Conclusions. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients. PMID:20724680

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Doering, Kimberly B; Meadows, Robert G.; Lariviere, Brian W.; Graham, Jerry B.

2015-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS; and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. For NASA's SLS ABEDRR procurement, Dynetics and AR formed a team to offer a series of full-scale risk mitigation hardware demonstrations for an affordable booster approach that meets the evolved capabilities of the SLS. To establish a basis for the risk reduction activities, the Dynetics Team developed a booster design that takes advantage of the flight-proven Apollo-Saturn F-1. Using NASA's vehicle assumptions for the SLS Block 2, a two-engine, F-1-based booster design delivers 150 mT (331 klbm) payload to LEO, 20 mT (44 klbm) above NASA's requirements. This enables a low-cost, robust approach to structural design. During the ABEDRR effort, the Dynetics Team has modified proven Apollo-Saturn components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the objectives of this work are to demonstrate combustion stability and measure performance of a 500,000 lbf class Oxidizer-Rich Staged Combustion (ORSC) cycle main injector. A trade study was completed to investigate the feasibility, cost effectiveness, and technical maturity of a domestically produced Atlas V engine that could also potentially satisfy NASA SLS payload-to-orbit requirements via an advanced booster application. Engine physical dimensions and performance parameters resulting from this study provide the system level requirements for the ORSC risk reduction test article. The test article is scheduled to complete critical design review this fall and begin testing in 2017. Dynetics has also designed, developed, and built innovative tank and structure assemblies using friction stir welding to leverage recent NASA investments in manufacturing tools, facilities, and processes, significantly reducing development and recurring costs. The full-scale cryotank assembly was used to verify the structural design and prove affordable processes. Dynetics performed hydrostatic and cryothermal proof tests on the assembly to verify the assembly meets performance requirements. This paper will discuss the ABEDRR engine task and structures task achievements to date and the remaining effort through the end of the contract.

Clostridium difficile Infection in Older Adults: Systematic Review of Efforts to Reduce Occurrence and Improve Outcomes.

PubMed

Marshall, Leisa L; Peasah, Samuel; Stevens, Gregg A

2017-01-01

Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults. PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used. A second search of PubMed, CINAHL, National Guideline Clearinghouse, and TRIP databases was conducted for primary, secondary, and tertiary literature for CDI epidemiology, burden, and management in adults of all ages, and prevention and management guidelines. Of the 2,263 articles located, 105 were selected for full review: 55 primary and 50 secondary, tertiary. Primary literature selected for full review included studies of interventions to prevent, reduce occurrence, control, manage, or improve outcomes in adults 65 years of age and older. Patient settings included the community, assisted living, nursing facility, subacute care, or hospital. The main outcome measures for research studies were whether the studied intervention prevented, reduced occurrence, controlled, managed, or improved outcomes. Studies were conducted in acute or long-term hospitals, with a few in nursing facilities. Interventions that prevented or reduced CDI included antibiotic policy changes, education, procedure changes, infection control, and multi-intervention approaches. There were few management studies for adults 65 years of age and older or for all adults with results stratified by age. Treatments studied included efficacy of fidaxomicin, metronidazole, vancomycin, and fecal microbiota transplant. Though clinical outcomes were slightly less robust in those 65 years of age and older, age was not an independent predictor of success or failure. The current prevention and management guidelines for adults of all ages, as well as special considerations in skilled nursing facilities, extracted from the secondary/tertiary literature selected, are summarized. There are a limited number of studies designed for older adults. Our findings suggest that guideline recommendations for adults are adequate and appropriate for older adults. Exposure to antibiotics and Clostridium difficile remain the two major risk factors for CDI, reinforcing the importance of antibiotic stewardship and infection control.

The Careful Puppet Master: Reducing risk and fortifying acceptance testing with Jenkins CI

NASA Astrophysics Data System (ADS)

Smith, Jason A.; Richman, Gabriel; DeStefano, John; Pryor, James; Rao, Tejas; Strecker-Kellogg, William; Wong, Tony

2015-12-01

Centralized configuration management, including the use of automation tools such as Puppet, can greatly increase provisioning speed and efficiency when configuring new systems or making changes to existing systems, reduce duplication of work, and improve automated processes. However, centralized management also brings with it a level of inherent risk: a single change in just one file can quickly be pushed out to thousands of computers and, if that change is not properly and thoroughly tested and contains an error, could result in catastrophic damage to many services, potentially bringing an entire computer facility offline. Change management procedures can—and should—be formalized in order to prevent such accidents. However, like the configuration management process itself, if such procedures are not automated, they can be difficult to enforce strictly. Therefore, to reduce the risk of merging potentially harmful changes into our production Puppet environment, we have created an automated testing system, which includes the Jenkins CI tool, to manage our Puppet testing process. This system includes the proposed changes and runs Puppet on a pool of dozens of RedHat Enterprise Virtualization (RHEV) virtual machines (VMs) that replicate most of our important production services for the purpose of testing. This paper describes our automated test system and how it hooks into our production approval process for automatic acceptance testing. All pending changes that have been pushed to production must pass this validation process before they can be approved and merged into production.

Commercial Decommissioning at DOE's Rocky Flats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Freiboth, C.; Sandlin, N.; Schubert, A.

2002-02-25

Due in large part to the number of nuclear facilities that make up the DOE complex, DOE-EM work has historically been paperwork intensive and driven by extensive regulations. Requirements for non-nuclear facilities are often grouped with those of nuclear facilities, driving up costs. Kaiser-Hill was interested in applying a commercial model to demolition of these facilities and wanted to apply necessary and sufficient standards to the work activities, but avoid applying unnecessary requirements. Faced with demolishing hundreds of uncontaminated or non-radiologically contaminated facilities, Kaiser-Hill has developed a subcontracting strategy to drastically reduce the cost of demolishing these facilities at Rockymore » Flats. Aiming to tailor the demolition approach of such facilities to more closely follow commercial practices, Kaiser-Hill recently released a Request for Proposals (RFP) for the demolition of the site's former central administration facility. The RFP significantly reduced requirements for compliance with specific DOE directives. Instead, the RFP required subcontractors to comply with health and safety requirements commonly found in the demolition of similar facilities in a commercial setting. This resulted in a number of bids from companies who have normally not bid on DOE work previously and at a reduced cost over previous approaches. This paper will discuss the details of this subcontracting strategy.« less

Injector element characterization methodology

NASA Technical Reports Server (NTRS)

Cox, George B., Jr.

1988-01-01

Characterization of liquid rocket engine injector elements is an important part of the development process for rocket engine combustion devices. Modern nonintrusive instrumentation for flow velocity and spray droplet size measurement, and automated, computer-controlled test facilities allow rapid, low-cost evaluation of injector element performance and behavior. Application of these methods in rocket engine development, paralleling their use in gas turbine engine development, will reduce rocket engine development cost and risk. The Alternate Turbopump (ATP) Hot Gas Systems (HGS) preburner injector elements were characterized using such methods, and the methodology and some of the results obtained will be shown.

Remedial Investigation/Feasibility Study (RI/FS) process, elements and techniques guidance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This manual provides detailed guidance on Remedial Investigation/Feasibility Studies (RI/FSs) conducted pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) at Department of Energy (DOE) facilities. The purpose of the RI/FS, to assess the risk posed by a hazardous waste site and to determine the best way to reduce that risk, and its structure (site characterization, risk assessment, screening and detailed analysis of alternatives, etc.) is defined in the National Oil and Hazardous Substances Pollution Contingency Plan (NCP) and further explained in the Environmental Protection Agency`s (EPA`s) Guidance for Conducting Remedial Investigations and Feasibility Studies Under CERCLA (Interimmore » Final) 540/G-89/004, OSWER Directive 9355.3-01, October 1988. Though issued in 1988, the EPA guidance remains an excellent source of information on the conduct and structure of an RI/FS. This document makes use of supplemental RI/FS-related guidance that EPA has developed since its initial document was issued in 1988, incorporates practical lessons learned in more than 12 years of experience in CERCLA hazardous site remediation, and drawing on those lessons, introduces the Streamlined Approach For Environmental Restoration (SAFER), developed by DOE as a way to proceed quickly and efficiently through the RI/FS process at DOE facilities. Thus as its title implies, this guidance is intended to describe in detail the process and component elements of an RI/FS, as well as techniques to manage the RI/FS effectively.« less

Incidence, Risks, and Types of Infections in Pediatric Long-term Care Facilities.

PubMed

Saiman, Lisa; Maykowski, Philip; Murray, Meghan; Cohen, Bevin; Neu, Natalie; Jia, Haomioa; Hutcheon, Gordon; Simpser, Edwin; Mosiello, Linda; Alba, Luis; Larson, Elaine

2017-09-01

The population of infants, children, and adolescents cared for at pediatric long-term care facilities is increasing in complexity and size and thus consumes substantial health care resources. Infections are a significant cause of morbidity and mortality in this population, but few recent data describe their incidence and effects. To describe the types of infections diagnosed in residents of pediatric long-term care facilities, calculate infection rates, and identify risk factors for respiratory tract infections (RTIs). This prospective cohort study, which was part of a larger trial called Keep It Clean for Kids, was conducted from September 1, 2012, to December 31, 2015, at 3 pediatric long-term care facilities in New York. Residents of the facilities who were 21 years or younger and either residents or admitted during the study period (n = 717) were enrolled in the study. Medical records were reviewed to identify infections diagnosed by site clinicians. Incidence of infections, such as RTIs; skin and soft-tissue infections; chronic comorbid conditions, including neurologic and respiratory disorders; and device use, including gastrostomy tubes and tracheostomies, was determined. Risk factors for RTIs were assessed by generalized linear mixed method regression modeling. The 717 residents had a median (interquartile range) age at enrollment of 2.6 (0.4-9.1) years; 358 (49.9%) were male. Four hundred twenty-eight residents (59.7%) had feeding tubes and 215 (30.0%) had tracheostomies. Most chronic comorbid conditions were musculoskeletal or ambulation (532 residents [74.2%]), neurologic (505 [70.4%]), respiratory (361 [50.3%]), and gastrointestinal (230 [32.1%]) disorders, and 460 residents (64.2%) had 4 or more chronic comorbid conditions. Site clinicians diagnosed 2052 infections during the 3-year study period. Respiratory tract infections were most common and were diagnosed in 1291 residents (62.9%). The overall infection rate was 5.3 infections per 1000 resident-days, and RTI rates were 3.3 infections per 1000 resident-days. Overall infection rates and rates of RTI, skin and soft-tissue infection, urinary tract infection, and bloodstream infection varied among the 3 sites. In the multivariable model, younger age (incidence rate ratio [IRR], 1.05; 95% CI, 1.03-1.06), increased number of chronic comorbid conditions (IRR, 1.12; 95% CI, 1.06-1.19), and the use of feeding tubes (IRR, 1.34; 95% CI, 1.03-1.64) and tracheostomies (IRR, 1.40; 95% CI, 1.17-1.69) were associated with RTIs. In this study, RTIs were the most common infections diagnosed, but modifiable risk factors for RTIs were not identified. Future work should focus on optimizing infection prevention and control strategies to reduce infections, particularly RTIs, in the pediatric long-term care population.

Airborne Infectious Agents and Other Pollutants in Automobiles for Domestic Use: Potential Health Impacts and Approaches to Risk Mitigation

PubMed Central

Zargar, Bahram; Rubino, Joseph R.

2016-01-01

The world total of passenger cars is expected to go from the current one billion to >2.5 billion by 2050. Cars for domestic use account for ~74% of the world's yearly production of motorized vehicles. In North America, ~80% of the commuters use their own car with another 5.6% travelling as passengers. With the current life-expectancy of 78.6 years, the average North American spends 4.3 years driving a car! This equates to driving 101 minutes/day with a lifetime driving distance of nearly 1.3 million km inside the confined and often shared space of the car with exposure to a mix of potentially harmful pathogens, allergens, endotoxins, particulates, and volatile organics. Such risks may increase in proportion to the unprecedented upsurge in the numbers of family cars globally. Though new technologies may reduce the levels of air pollution from car exhausts and other sources, they are unlikely to impact our in-car exposure to pathogens. Can commercial in-car air decontamination devices reduce the risk from airborne infections and other pollutants? We lack scientifically rigorous protocols to verify the claims of such devices. Here we discuss the essentials of a customized aerobiology facility and test protocols to assess such devices under field-relevant conditions. PMID:28042302

Airborne Infectious Agents and Other Pollutants in Automobiles for Domestic Use: Potential Health Impacts and Approaches to Risk Mitigation.

PubMed

Sattar, Syed A; Wright, Kathryn E; Zargar, Bahram; Rubino, Joseph R; Ijaz, M Khalid

2016-01-01

The world total of passenger cars is expected to go from the current one billion to >2.5 billion by 2050. Cars for domestic use account for ~74% of the world's yearly production of motorized vehicles. In North America, ~80% of the commuters use their own car with another 5.6% travelling as passengers. With the current life-expectancy of 78.6 years, the average North American spends 4.3 years driving a car! This equates to driving 101 minutes/day with a lifetime driving distance of nearly 1.3 million km inside the confined and often shared space of the car with exposure to a mix of potentially harmful pathogens, allergens, endotoxins, particulates, and volatile organics. Such risks may increase in proportion to the unprecedented upsurge in the numbers of family cars globally. Though new technologies may reduce the levels of air pollution from car exhausts and other sources, they are unlikely to impact our in-car exposure to pathogens. Can commercial in-car air decontamination devices reduce the risk from airborne infections and other pollutants? We lack scientifically rigorous protocols to verify the claims of such devices. Here we discuss the essentials of a customized aerobiology facility and test protocols to assess such devices under field-relevant conditions.

An optimization-based approach for facility energy management with uncertainties, and, Power portfolio optimization in deregulated electricity markets with risk management

NASA Astrophysics Data System (ADS)

Xu, Jun

Topic 1. An Optimization-Based Approach for Facility Energy Management with Uncertainties. Effective energy management for facilities is becoming increasingly important in view of the rising energy costs, the government mandate on the reduction of energy consumption, and the human comfort requirements. This part of dissertation presents a daily energy management formulation and the corresponding solution methodology for HVAC systems. The problem is to minimize the energy and demand costs through the control of HVAC units while satisfying human comfort, system dynamics, load limit constraints, and other requirements. The problem is difficult in view of the fact that the system is nonlinear, time-varying, building-dependent, and uncertain; and that the direct control of a large number of HVAC components is difficult. In this work, HVAC setpoints are the control variables developed on top of a Direct Digital Control (DDC) system. A method that combines Lagrangian relaxation, neural networks, stochastic dynamic programming, and heuristics is developed to predict the system dynamics and uncontrollable load, and to optimize the setpoints. Numerical testing and prototype implementation results show that our method can effectively reduce total costs, manage uncertainties, and shed the load, is computationally efficient. Furthermore, it is significantly better than existing methods. Topic 2. Power Portfolio Optimization in Deregulated Electricity Markets with Risk Management. In a deregulated electric power system, multiple markets of different time scales exist with various power supply instruments. A load serving entity (LSE) has multiple choices from these instruments to meet its load obligations. In view of the large amount of power involved, the complex market structure, risks in such volatile markets, stringent constraints to be satisfied, and the long time horizon, a power portfolio optimization problem is of critical importance but difficulty for an LSE to serve the load, maximize its profit, and manage risks. In this topic, a mid-term power portfolio optimization problem with risk management is presented. Key instruments are considered, risk terms based on semi-variances of spot market transactions are introduced, and penalties on load obligation violations are added to the objective function to improve algorithm convergence and constraint satisfaction. To overcome the inseparability of the resulting problem, a surrogate optimization framework is developed enabling a decomposition and coordination approach. Numerical testing results show that our method effectively provides decisions for various instruments to maximize profit, manage risks, and is computationally efficient.

Risk assessment as standard work in design.

PubMed

Morrill, Patricia W

2013-01-01

This case study article examines a formal risk assessment as part of the decision making process for design solutions in high risk areas. The overview of the Failure Modes and Effects Analysis (FMEA) tool with examples of its application in hospital building projects will demonstrate the benefit of those structured conversations. This article illustrates how two hospitals used FMEA when integrating operational processes with building projects: (1) adjacency decision for Intensive Care Unit (ICU); and (2) distance concern for handling of specimens from Surgery to Lab. Both case studies involved interviews that exposed facility solution concerns. Just-in-time studies using the FMEA followed the same risk assessment process with the same workshop facilitator involving structured conversations in analyzing risks. In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps. While the focus of this article is not the actual design solution, it is apparent that the risk assessment brought clarity to the situations resulting in prompt decision making about facility solutions. Hospitals are inherently risky environments; therefore, use of the formal risk assessment process, FMEA, is an opportunity for design professionals to apply more rigor to design decision making when facility solutions impact operations in high risk areas. Case study, decision making, hospital, infection control, strategy, work environment.

6 CFR 27.215 - Security vulnerability assessments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Security vulnerability assessments. 27.215... FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.215 Security vulnerability...-risk, the facility must complete a Security Vulnerability Assessment. A Security Vulnerability...

RELEASE OF DRIED RADIOACTIVE WASTE MATERIALS TECHNICAL BASIS DOCUMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

KOZLOWSKI, S.D.

2007-05-30

This technical basis document was developed to support RPP-23429, Preliminary Documented Safety Analysis for the Demonstration Bulk Vitrification System (PDSA) and RPP-23479, Preliminary Documented Safety Analysis for the Contact-Handled Transuranic Mixed (CH-TRUM) Waste Facility. The main document describes the risk binning process and the technical basis for assigning risk bins to the representative accidents involving the release of dried radioactive waste materials from the Demonstration Bulk Vitrification System (DBVS) and to the associated represented hazardous conditions. Appendices D through F provide the technical basis for assigning risk bins to the representative dried waste release accident and associated represented hazardous conditionsmore » for the Contact-Handled Transuranic Mixed (CH-TRUM) Waste Packaging Unit (WPU). The risk binning process uses an evaluation of the frequency and consequence of a given representative accident or represented hazardous condition to determine the need for safety structures, systems, and components (SSC) and technical safety requirement (TSR)-level controls. A representative accident or a represented hazardous condition is assigned to a risk bin based on the potential radiological and toxicological consequences to the public and the collocated worker. Note that the risk binning process is not applied to facility workers because credible hazardous conditions with the potential for significant facility worker consequences are considered for safety-significant SSCs and/or TSR-level controls regardless of their estimated frequency. The controls for protection of the facility workers are described in RPP-23429 and RPP-23479. Determination of the need for safety-class SSCs was performed in accordance with DOE-STD-3009-94, Preparation Guide for US. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses, as described below.« less

Data development technical support document for the aircraft crash risk analysis methodology (ACRAM) standard

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kimura, C.Y.; Glaser, R.E.; Mensing, R.W.

1996-08-01

The Aircraft Crash Risk Analysis Methodology (ACRAM) Panel has been formed by the US Department of Energy Office of Defense Programs (DOE/DP) for the purpose of developing a standard methodology for determining the risk from aircraft crashes onto DOE ground facilities. In order to accomplish this goal, the ACRAM panel has been divided into four teams, the data development team, the model evaluation team, the structural analysis team, and the consequence team. Each team, consisting of at least one member of the ACRAM plus additional DOE and DOE contractor personnel, specializes in the development of the methodology assigned to thatmore » team. This report documents the work performed by the data development team and provides the technical basis for the data used by the ACRAM Standard for determining the aircraft crash frequency. This report should be used to provide the generic data needed to calculate the aircraft crash frequency into the facility under consideration as part of the process for determining the aircraft crash risk to ground facilities as given by the DOE Standard Aircraft Crash Risk Assessment Methodology (ACRAM). Some broad guidance is presented on how to obtain the needed site-specific and facility specific data but this data is not provided by this document.« less

A Collaborative Study of Disproportionate Chemical Risks in Seven Delaware Communities

NASA Astrophysics Data System (ADS)

Dryden, O.; Goldman, G. T.; White, R.; Moore, D.; Roberts, M.; Thomas, J.; Johnson, C.

2017-12-01

Studies have found that, compared to national averages, a significantly greater percentage of Blacks (African-Americans), Latinos (Hispanics), and people at or near poverty levels tend to live near industrial facilities that use large quantities of toxic chemicals and present a risk of major chemical disasters with potentially severe consequences for nearby communities. The Union of Concerned Scientists, the Environmental Justice Health Alliance for Chemical Policy Reform, and Delaware Concerned Residents for Environmental Justice collaborated on a study to examine the potential for cumulative impacts from health and safety risks for seven Delaware communities with a percentage of people of color and/or poverty levels greater than the Delaware average located along an industrial corridor in the northern portion of Delaware's New Castle County. These risks include close proximity to major industrial sources, as well as facilities that use large quantities of toxic, flammable or explosive chemicals and pose a high risk of a major chemical release or catastrophic incident. Additionally, proximity to contaminated waste sites was assessed, as well as the risk of cancer and potential for respiratory disease impacts from exposure to toxic air pollution. We found that people in these seven communities face a substantial cumulative health risk from exposure to toxic air pollution, proximity to polluting industrial facilities and hazardous chemical facilities, as well as contaminated waste sites. These health risks are substantially greater when compared to a wealthier and predominantly White Delaware community and for Delaware as a whole. Significant and expedited improvements in regulatory and public policy are needed at the national, state, and municipal levels to address the health and well-being of at-risk communities in Delaware and elsewhere.

Integrated Component-based Data Acquisition Systems for Aerospace Test Facilities

NASA Technical Reports Server (NTRS)

Ross, Richard W.

2001-01-01

The Multi-Instrument Integrated Data Acquisition System (MIIDAS), developed by the NASA Langley Research Center, uses commercial off the shelf (COTS) products, integrated with custom software, to provide a broad range of capabilities at a low cost throughout the system s entire life cycle. MIIDAS combines data acquisition capabilities with online and post-test data reduction computations. COTS products lower purchase and maintenance costs by reducing the level of effort required to meet system requirements. Object-oriented methods are used to enhance modularity, encourage reusability, and to promote adaptability, reducing software development costs. Using only COTS products and custom software supported on multiple platforms reduces the cost of porting the system to other platforms. The post-test data reduction capabilities of MIIDAS have been installed at four aerospace testing facilities at NASA Langley Research Center. The systems installed at these facilities provide a common user interface, reducing the training time required for personnel that work across multiple facilities. The techniques employed by MIIDAS enable NASA to build a system with a lower initial purchase price and reduced sustaining maintenance costs. With MIIDAS, NASA has built a highly flexible next generation data acquisition and reduction system for aerospace test facilities that meets customer expectations.

Fire safety knowledge and practices among residents of an assisted living facility.

PubMed

Jaslow, David; Ufberg, Jacob; Yoon, Russell; McQueen, Clay; Zecher, Derek; Jakubowski, Greg

2005-01-01

Assisted living facilities (ALFs) pose unique fire risks to the elderly that may be linked to specific fire safety (FS) practices. To evaluate self-reported FS practices among ALF residents. All residents of a small ALF were surveyed regarding actual and hypothetical FS behaviors, self-perceived fire risk, and FS preparedness. Fifty-eight ALF residents completed the survey. Thirty-three (58%) individuals reported one or more disabilities. Seven (12%) residents ignored the fire alarm and 21 (35%) could not hear it clearly. Sixteen (28%) residents would attempt to locate the source of a fire rather than escape from the building. Only 24 (42%) residents were familiar with the building fire plan. Twenty-three (40%) people surveyed believed that they were not at risk of fire in the study facility. Residents of an ALF may be at increased fire injury risk due to their FS practices and disabilities.

Terrorism-related risk management for health care facilities.

PubMed

Reid, Daniel J; Reid, William H

2005-01-01

Clinicians should have a basic understanding of the physical and financial risk to mental health facilities related to external threat, such as (but not necessarily limited to) terrorism. Patient care and accessibility to mental health services rest not only on clinical skills, but on a place to practice them and an organized system supported by staff, physical facilities and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or serving at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state, and national standards for hospital safety, or insurance providers' individual facility requirements.

32 CFR 766.5 - Conditions governing use of aviation facilities by civil aircraft.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Conditions governing use of aviation facilities... OF THE NAVY MISCELLANEOUS RULES USE OF DEPARTMENT OF THE NAVY AVIATION FACILITIES BY CIVIL AIRCRAFT § 766.5 Conditions governing use of aviation facilities by civil aircraft. (a) Risk. The use of Navy or...

32 CFR 766.5 - Conditions governing use of aviation facilities by civil aircraft.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Conditions governing use of aviation facilities... OF THE NAVY MISCELLANEOUS RULES USE OF DEPARTMENT OF THE NAVY AVIATION FACILITIES BY CIVIL AIRCRAFT § 766.5 Conditions governing use of aviation facilities by civil aircraft. (a) Risk. The use of Navy or...

32 CFR 766.5 - Conditions governing use of aviation facilities by civil aircraft.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Conditions governing use of aviation facilities... OF THE NAVY MISCELLANEOUS RULES USE OF DEPARTMENT OF THE NAVY AVIATION FACILITIES BY CIVIL AIRCRAFT § 766.5 Conditions governing use of aviation facilities by civil aircraft. (a) Risk. The use of Navy or...

Design and Implementation of a Centralized Model of Clinical Education Within a Statewide Health System.

PubMed

Elzy, Pamela Smith

2016-01-01

Today's dynamic health care environment is exceedingly complex, and health care facilities across the United States are struggling to respond to changes in technology, health care reimbursement, the Affordable Care Act, and the much-anticipated nursing shortage. Mergers, acquisitions, and integrations are the current health care reality. These are proposed to increase efficiency, efficacy, quality, satisfaction, and safety while effectively reducing cost to the consumer and stabilizing the economy of the health care system. Many of these projects fail to achieve objectives, even years after the formal change in status. Clinical education departments in merged organizations are often operated in the single-facility mindset, or contain an element of the shared services model. They are not truly integrated. Development of skills in complex analysis of current state, identification of desired scope of service and expectations of performance, and articulation of the benefits of the desired future state are all essential to nursing executive practice. This article describes an experience integrating 3 legacy education departments across 21 facilities into a centralized education system. The complexity of integration activities is illustrated and outcome measures of success are discussed. Barriers, facilitators, and risks of the project are identified and evaluated.

Risk-based Prioritization of Facility Decommissioning and Environmental Restoration Projects in the National Nuclear Legacy Liabilities Program at the Chalk River Laboratory - 13564

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, Jerel G.; Kruzic, Michael; Castillo, Carlos

2013-07-01

Chalk River Laboratory (CRL), located in Ontario Canada, has a large number of remediation projects currently in the Nuclear Legacy Liabilities Program (NLLP), including hundreds of facility decommissioning projects and over one hundred environmental remediation projects, all to be executed over the next 70 years. Atomic Energy of Canada Limited (AECL) utilized WorleyParsons to prioritize the NLLP projects at the CRL through a risk-based prioritization and ranking process, using the WorleyParsons Sequencing Unit Prioritization and Estimating Risk Model (SUPERmodel). The prioritization project made use of the SUPERmodel which has been previously used for other large-scale site prioritization and sequencing ofmore » facilities at nuclear laboratories in the United States. The process included development and vetting of risk parameter matrices as well as confirmation/validation of project risks. Detailed sensitivity studies were also conducted to understand the impacts that risk parameter weighting and scoring had on prioritization. The repeatable prioritization process yielded an objective, risk-based and technically defendable process for prioritization that gained concurrence from all stakeholders, including Natural Resources Canada (NRCan) who is responsible for the oversight of the NLLP. (authors)« less

Evaluation of the public health risks associated with semivolatile metal and dioxin emissions from hazardous waste incinerators.

PubMed Central

Sedman, R M; Esparza, J R

1991-01-01

The public health impacts associated with stack emissions from hazardous waste incinerators have become a major concern in recent years. Most evaluations of incinerator stack emissions have focused on three classes of compounds: metals, semivolatile, and volatile compounds. These investigations have been complicated by the difficulty and expense of analyzing the emissions and the limited amount of toxicity information for many of the compounds that have been detected. The results of over 20 trial burns at hazardous waste incinerators were assembled in an attempt to determine which compounds may pose a significant threat to the public health. The risks associated with semivolatile emissions were found to be inconsequential, although further study of dioxins and dibenzofurans emissions appears to be warranted. The risk associated with the emission of cadmium and perhaps chromium (VI) may pose a significant risk to public health at certain facilities. Controls on waste feed or air pollution control devices should be employed to reduce the emission of these metals. Any monitoring of metal emissions from hazardous waste incinerators should focus on cadmium and chromium (VI). PMID:1954929

Environmental audits and process flow mapping to assess management of solid waste and wastewater from a healthcare facility: an Italian case study.

PubMed

Vaccari, Mentore; Montasser, Waleed; Tudor, Terry; Leone, Luigi

2017-05-01

In Europe, there are an increasing number of policy and legislative drivers for a more sustainable approach to the management of natural resources as well as for the mitigation of environmental health risks. However, despite significant progress in recent years, there is still some way to go to achieve circularity of process, as well as risk mitigation within organisations. Using a case study of the Gardone Val Trompia hospital in northern Italy, this manuscript offers a novel holistic examination of strategies to enhance resource efficiency and environmental health within a key sector, i.e. the healthcare sector. Through the use of environmental audits and process flow mapping, trends in waste and wastewater arisings and the associated financial and environmental costs and risks were identified. Recommendations for developing more resource efficient approaches as well as mitigating the environmental and public health risks are suggested. These include strategies for improved resource efficiency (including reduction in the hazardous waste) and reduced environmental impacts during the containment, transport and treatment of the waste.

Grand Junction projects office mixed-waste treatment program, VAC*TRAX mobile treatment unit process hazards analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bloom, R.R.

1996-04-01

The objective of this report is to demonstrate that a thorough assessment of the risks associated with the operation of the Rust Geotech patented VAC*TRAX mobile treatment unit (MTU) has been performed and documented. The MTU was developed to treat mixed wastes at the US Department of Energy (DOE) Albuquerque Operations Office sites. The MTU uses an indirectly heated, batch vacuum dryer to thermally desorb organic compounds from mixed wastes. This process hazards analysis evaluated 102 potential hazards. The three significant hazards identified involved the inclusion of oxygen in a process that also included an ignition source and fuel. Changesmore » to the design of the MTU were made concurrent with the hazard identification and analysis; all hazards with initial risk rankings of 1 or 2 were reduced to acceptable risk rankings of 3 or 4. The overall risk to any population group from operation of the MTU was determined to be very low; the MTU is classified as a Radiological Facility with low hazards.« less

Transfusion-related acute lung injury risk mitigation: an update.

PubMed

Otrock, Z K; Liu, C; Grossman, B J

2017-11-01

Transfusion-related acute lung injury (TRALI) is a life-threatening complication of transfusion. Greater understanding of the pathophysiology of this syndrome has much improved during the last two decades. Plasma-containing components from female donors with leucocyte antibodies were responsible for the majority of TRALI fatalities before mitigation strategies were implemented. Over the past 15 years, measures to mitigate risk for TRALI have been implemented worldwide and they continued to evolve with time. The AABB requires that all plasma containing components and whole blood for transfusion must be collected from men, women who have not been pregnant, or women who have tested negative for human leucocyte antigen antibodies. Although the incidence of TRALI has decreased following the institution of TRALI mitigation strategies, TRALI is still the most common cause of transfusion-associated death in the United States. In this review, we focus on TRALI risk mitigation strategies. We describe the measures taken by blood collection facilities to reduce the risk of TRALI in the United States, Canada and European countries. We also review the literature for the effectiveness of these measures. © 2017 International Society of Blood Transfusion.

Use of geographic information systems technology to track critical health code violations in retail facilities available to populations of different socioeconomic status and demographics.

PubMed

Darcey, Valerie L; Quinlan, Jennifer J

2011-09-01

Research shows that community socioeconomic status (SES) predicts, based on food service types available, whether a population has access to healthy food. It is not known, however, if a relationship exists between SES and risk for foodborne illness (FBI) at the community level. Geographic information systems (GIS) give researchers the ability to pinpoint health indicators to specific geographic locations and detect resulting environmental gradients. It has been used extensively to characterize the food environment, with respect to access to healthy foods. This research investigated the utility of GIS in determining whether community SES and/or demographics relate to access to safe food, as measured by food service critical health code violations (CHV) as a proxy for risk for FBI. Health inspection records documenting CHV for 10,859 food service facilities collected between 2005 and 2008 in Philadelphia, PA, were accessed. Using an overlay analysis through GIS, CHV were plotted over census tracts of the corresponding area. Census tracts (n = 368) were categorized into quintiles, based on poverty level. Overall, food service facilities in higher poverty areas had a greater number of facilities (with at least one CHV) and had more frequent inspections than facilities in lower poverty areas. The facilities in lower poverty areas, however, had a higher average number of CHV per inspection. Analysis of CHV rates in census tracts with high concentrations of minority populations found Hispanic facilities had more CHV than other demographics, and Hispanic and African American facilities had fewer days between inspections. This research demonstrates the potential for utilization of GIS mapping for tracking risks for FBI. Conversely, it sheds light on the subjective nature of health inspections, and indicates that underlying factors might be affecting inspection frequency and identification of CHV, such that CHV might not be a true proxy for risk for FBI.

Does closure of children's medical home impact their immunization coverage?

PubMed

Kolasa, M S; Stevenson, J; Ossa, A; Lutz, J

2014-12-01

Little is known about the impact closing a health care facility has on immunization coverage of children utilizing that facility as a medical home. The authors assessed the impact of closing a Medicaid managed care facility in Philadelphia on immunization coverage of children, primarily low income children from racial/ethnic minority groups, utilizing that facility for routine immunizations. Observational longitudinal cohort case study. Eligible children were born 03/01/05-06/30/07, present in Philadelphia's immunization information system (IIS), and were active clients of the facility before it closed in September 2007. IIS-recorded immunization coverage at ages 5, 7, 13, 16 and 19 months through January 2009 was compared between clinic children age-eligible to receive specific vaccines before clinic closing (preclosure cohorts) and children not age-eligible to receive those vaccines prior to closing (postclosure cohorts). Of 630 eligible children, 99 (16%) had no additional IIS-recorded immunizations. Third dose DTaP vaccine coverage at age seven months among preclosure cohorts was 54.4% vs. 40.3% among postclosure cohorts [risk ratio 1.31 (1.15,1.49)]. Fourth dose DTaP coverage at 19 months was 65.9% vs. 57.7% [risk ratio 1.24 (1.08,1.42)]. MMR coverage at 16 months was 79.5% vs. 69.9% [risk ratio 1.47 (1.22, 1.76)]. Coverage for the 431331 vaccination series at 19 months was 63.8% vs. 53.8% [risk ratio 1.28 (1.12,1.88)]. Immunization coverage declined at key age milestones for active clients of a Medicaid managed care that closed as compared with preclosure cohorts of clients from the same facility. When a primary health care facility closes, efforts should be made to ensure that children who had received vaccinations at that facility quickly establish a new medical home. Published by Elsevier Ltd.

Mitigating risks related to facilities management.

PubMed

O'Neill, Daniel P; Scarborough, Sydney

2013-07-01

By looking at metrics focusing on the functionality, age, capital investment, transparency, and sustainability (FACTS) of their organizations' facilities, facilities management teams can build potential business cases to justify upgrading the facilities. A FACTS analysis can ensure that capital spent on facilities will produce a higher or more certain ROI than alternatives. A consistent process for managing spending helps to avoid unexpected spikes that cost the enterprise more in the long run.

Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

DTIC Science & Technology

2016-10-01

1 AWARD NUMBER: W81XWH-15-1-0506 TITLE: Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guard... Suicide Risk, and Treatment seeking among Formerly Deployed National Guard and Reserve Service Member seen in Non-VA Facilities 5b. GRANT NUMBER W81XWH...and Reserve veterans. The prevalence of current PTSD was 7% (95% CI = 5.7-8.5). Preliminary analyses indicated that PTSD, depression , mental health

NASA's Agency-Wide Strategy for Environmental Regulatory Risk Analysis and Communication

NASA Technical Reports Server (NTRS)

Scroggins, Sharon

2008-01-01

NASA's Agency-wide.resource for identifying and managing risks associated with changing environmental regulations Goals of the RRAC PC: 1) Proactively. detect, analyze and communicate environmental regulatory risks to NASA Programs and facilities; 2) Communicate with regulators and participate in the mitigation of such risks; and 3) Provide centralized support on emerging regulations to NASA HQ Environmental Management Division. When significant regulatory changes are identified, timely communication is essential. Communication of changing requirements to the regulatory stakeholders - NASA Programs and Facilities. Communication of potential issues to management and, when appropriate, back to the regulating agency.

Occupational injury among cooks and food service workers in the healthcare sector.

PubMed

Alamgir, Hasanat; Swinkels, Helena; Yu, Shicheng; Yassi, Annalee

2007-07-01

Incidence of occupational injury is anticipated to be high among cooks and food service workers (CFSWs) because of the nature of their work and the types of raw and finished materials that they handle. Incidents of occupational injury, resulting in lost time or medical care over a period of 1 year in two health regions were extracted from a standardized operational database and with person years obtained from payroll data, detailed analysis was conducted using Poisson regression modeling. Among the CFSWs the annual injury rate was 38.1 per 100 person years. The risk of contusions [RR, 95% CI 9.66 (1.04, 89.72)], burns [1.79 (1.39, 2.31)], and irritations or allergies [3.84 (2.05, 7.18)] was found to be significantly higher in acute care facilities compared to long-term care facilities. Lower risk was found among older workers for irritations or allergies. Female CFSWs, compared to their male counterparts, were respectively 8 and 20 times more likely to report irritations or allergies and contusions. In respect to outcome, almost all irritations or allergies required medical visits. For MSI incidents, about 67.4% resulted in time-loss from work. Prevention policies should be developed to reduce the hazards present in the workplace to promote safer work practices for cooks and food service workers.

Design of Lesehan Chair by Using Kansei Engineering Method And Anthropometry Approach

NASA Astrophysics Data System (ADS)

Pambudi, A. T.; Suryoputro, M. R.; Sari, A. D.; Kurnia, R. D.

2016-01-01

Special Region of Yogyakarta (DIY) is known as city for academic. Many people come to get some education in college. They live in boarding house with some supporting facilities. The most common facilities is low table which lead students have to sit on the floor while studying on table which could cause higher risk of back pain and musculoskeletal disorder. To identify the solution to reduce back pain and musculoskeletal risk, it is needed to design a lesehan chair which also appropriate to customer needs. Kansei engineering method was used with a total of 30 respondents participated, 15 kansei words collected, and 12 kansei words selected by doing validation and reliability test. The result of this study showed that quality, aesthetics, and comfort level influence the design of lesehan chair. A design of lesehan chair was created by considering the suitable concept and merging it with the physical design and its anthropometry measurement. In this case, marginal homogeneity test is needed to identify the differences between each kansei words attribute and the design or product recommendation. The marginal homogeneity test results show that the design and product recommendation has fulfilled customer's desires and needs. For further research, it is needed to analyse and evaluate the posture of lesehan chair users in order to develop and improve its performance.

A case study of a real-time evaluation of the risk of disease transmission associated with a failure to follow recommended sterilization procedures

PubMed Central

2014-01-01

Background Failures to follow recommendations for reprocessing of surgical instruments may place patients at risk for exposure to pathogenic microorganisms. When such failures occur, medical facilities often face considerable uncertainty and challenges in assessing the actual risks of disease transmission. Methods In 2011, staff at an Ohio hospital determined that surgical instruments inside a Steriset Container had inadvertently been autoclaved on a gravity cycle rather than on the recommended pre-vacuum cycle, potentially exposing 72 patients who underwent surgery with the instruments to risk of infection. To provide an assessment of the level of risk, we tested the effectiveness of the machine washer/disinfector step and of the sterilization process inside the Steriset Container on the gravity cycle for killing of Geobacillus stearothermophilus spores, Clostridium difficile spores, and methicillin-resistant Staphylococcus aureus (MRSA). Based on the test results, the risk of transmission of MRSA by the instruments was calculated and the risk of transmission of hepatitis B virus was estimated. Results The machine washer/disinfector consistently reduced MRSA recovery by a factor of 1:100,000. The sterilization process inside the Steriset Container consistently reduced MRSA concentrations by a factor of >1:10,000,000 and killed 105C. difficile spores and 105G. stearothermophilus spores. The risk of MRSA transmission due to the incident was calculated to be 1 in 100 trillion. Conclusions The risk for transmission of infection due to the failure to follow recommended sterilization processes was negligible based upon complete killing of G. stearothermophilus biological indicator spores, C. difficile spores, and MRSA under conditions that replicated the incident where proper procedures were not followed. Such real-time assessments of the risks associated with specific incidents may provide evidence-based information that can be used to inform decisions regarding disclosure of the incident to patients. PMID:24447336

A case study of a real-time evaluation of the risk of disease transmission associated with a failure to follow recommended sterilization procedures.

PubMed

Donskey, Curtis J; Yowler, Marian; Falck-Ytter, Yngve; Kundrapu, Sirisha; Salata, Robert A; Rutala, William A

2014-01-21

Failures to follow recommendations for reprocessing of surgical instruments may place patients at risk for exposure to pathogenic microorganisms. When such failures occur, medical facilities often face considerable uncertainty and challenges in assessing the actual risks of disease transmission. In 2011, staff at an Ohio hospital determined that surgical instruments inside a Steriset Container had inadvertently been autoclaved on a gravity cycle rather than on the recommended pre-vacuum cycle, potentially exposing 72 patients who underwent surgery with the instruments to risk of infection. To provide an assessment of the level of risk, we tested the effectiveness of the machine washer/disinfector step and of the sterilization process inside the Steriset Container on the gravity cycle for killing of Geobacillus stearothermophilus spores, Clostridium difficile spores, and methicillin-resistant Staphylococcus aureus (MRSA). Based on the test results, the risk of transmission of MRSA by the instruments was calculated and the risk of transmission of hepatitis B virus was estimated. The machine washer/disinfector consistently reduced MRSA recovery by a factor of 1:100,000. The sterilization process inside the Steriset Container consistently reduced MRSA concentrations by a factor of >1:10,000,000 and killed 105C. difficile spores and 105G. stearothermophilus spores. The risk of MRSA transmission due to the incident was calculated to be 1 in 100 trillion. The risk for transmission of infection due to the failure to follow recommended sterilization processes was negligible based upon complete killing of G. stearothermophilus biological indicator spores, C. difficile spores, and MRSA under conditions that replicated the incident where proper procedures were not followed. Such real-time assessments of the risks associated with specific incidents may provide evidence-based information that can be used to inform decisions regarding disclosure of the incident to patients.

Prevention and management of silica scaling in membrane distillation using pH adjustment

DOE PAGES

Bush, John A.; Vanneste, Johan; Gustafson, Emily M.; ...

2018-02-27

Membrane scaling by silica is a major challenge in desalination, particularly for inland desalination of brackish groundwater or geothermal resources, which often contain high concentrations of silica and dissolved solids. Adjustment of feed pH may reduce silica scaling risk, which is important for inland facilities that operate at high water recoveries to reduce brine disposal costs. However, water recovery of reverse osmosis is also limited due to increased osmotic pressure with feed water concentration. Membrane distillation (MD) is a thermally driven membrane desalination technique that is not limited by increased osmotic pressure of the feed. In this investigation, pH adjustmentmore » was tested as a strategy to reduce silica scaling risk in the MD process. With feed water pH less than 5 or higher than 10, scaling impacts were negligible at silica concentrations up to 600 mg/L. Scaling rates were highest at neutral pH between 6 and 8. Cleaning strategies were also explored to remove silica scale from membranes. Cleaning using NaOH solutions at pH higher than 11 to induce dissolution of silica scale was effective at temporarily restoring performance; however, some silica remained on membrane surfaces and scaling upon re-exposure to supersaturated silica concentrations occurred faster than with new membranes.« less

The state of the art in raptor electrocution research: A global review

USGS Publications Warehouse

Lehman, Robert N.; Kennedy, P.L.; Savidge, J.A.

2007-01-01

We systematically reviewed the raptor electrocution literature to evaluate study designs and methods used in raptor electrocution research, mitigation, and monitoring, emphasizing original research published in English. Specifically, we wondered if three decades of effort to reduce raptor electrocutions has had positive effects. The majority of literature examined came from North America, western Europe, and South Africa. In spite of intensive and often sustained effort by industry and governments across three continents for 30 years, reductions in the incidence of electrocution have been demonstrated in only a few studies. Reliable rate estimates of electrocution mortality generally are unavailable, with some exceptions. Nearly half of 110 studies we analyzed in detail were retrospective reviews of historical mortality records, banding data, or results of necropsies on dead birds received at pathology and veterinary facilities. Among prospective studies, less than half used unbiased approaches to sampling and many did not provide enough detail to assess the sampling design used. At this time, few researchers can demonstrate the reliability of standardized retrofitting procedures or the effectiveness of monitoring techniques. Future progress in reducing raptor mortalities on power lines will benefit from properly designed studies that generate rate estimates of mortality, address biasing factors, and include predictions concerning risk and techniques to reduce risk that can be tested in the field or laboratory.

Action plan to reduce perinatal mortality.

PubMed

Bhakoo, O N; Kumar, R

1990-01-01

The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

Prevention and management of silica scaling in membrane distillation using pH adjustment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bush, John A.; Vanneste, Johan; Gustafson, Emily M.

Membrane scaling by silica is a major challenge in desalination, particularly for inland desalination of brackish groundwater or geothermal resources, which often contain high concentrations of silica and dissolved solids. Adjustment of feed pH may reduce silica scaling risk, which is important for inland facilities that operate at high water recoveries to reduce brine disposal costs. However, water recovery of reverse osmosis is also limited due to increased osmotic pressure with feed water concentration. Membrane distillation (MD) is a thermally driven membrane desalination technique that is not limited by increased osmotic pressure of the feed. In this investigation, pH adjustmentmore » was tested as a strategy to reduce silica scaling risk in the MD process. With feed water pH less than 5 or higher than 10, scaling impacts were negligible at silica concentrations up to 600 mg/L. Scaling rates were highest at neutral pH between 6 and 8. Cleaning strategies were also explored to remove silica scale from membranes. Cleaning using NaOH solutions at pH higher than 11 to induce dissolution of silica scale was effective at temporarily restoring performance; however, some silica remained on membrane surfaces and scaling upon re-exposure to supersaturated silica concentrations occurred faster than with new membranes.« less

Risk-Screening Environmental Indicators (RSEI)

EPA Pesticide Factsheets

EPA's Risk-Screening Environmental Indicators (RSEI) is a geographically-based model that helps policy makers and communities explore data on releases of toxic substances from industrial facilities reporting to EPA??s Toxics Release Inventory (TRI). By analyzing TRI information together with simplified risk factors, such as the amount of chemical released, its fate and transport through the environment, each chemical??s relative toxicity, and the number of people potentially exposed, RSEI calculates a numeric score, which is designed to only be compared to other scores calculated by RSEI. Because it is designed as a screening-level model, RSEI uses worst-case assumptions about toxicity and potential exposure where data are lacking, and also uses simplifying assumptions to reduce the complexity of the calculations. A more refined assessment is required before any conclusions about health impacts can be drawn. RSEI is used to establish priorities for further investigation and to look at changes in potential impacts over time. Users can save resources by conducting preliminary analyses with RSEI.

A Risk-Based Approach for Aerothermal/TPS Analysis and Testing

NASA Technical Reports Server (NTRS)

Wright, Michael J.; Grinstead, Jay H.; Bose, Deepak

2007-01-01

The current status of aerothermal and thermal protection system modeling for civilian entry missions is reviewed. For most such missions, the accuracy of our simulations is limited not by the tools and processes currently employed, but rather by reducible deficiencies in the underlying physical models. Improving the accuracy of and reducing the uncertainties in these models will enable a greater understanding of the system level impacts of a particular thermal protection system and of the system operation and risk over the operational life of the system. A strategic plan will be laid out by which key modeling deficiencies can be identified via mission-specific gap analysis. Once these gaps have been identified, the driving component uncertainties are determined via sensitivity analyses. A Monte-Carlo based methodology is presented for physics-based probabilistic uncertainty analysis of aerothermodynamics and thermal protection system material response modeling. These data are then used to advocate for and plan focused testing aimed at reducing key uncertainties. The results of these tests are used to validate or modify existing physical models. Concurrently, a testing methodology is outlined for thermal protection materials. The proposed approach is based on using the results of uncertainty/sensitivity analyses discussed above to tailor ground testing so as to best identify and quantify system performance and risk drivers. A key component of this testing is understanding the relationship between the test and flight environments. No existing ground test facility can simultaneously replicate all aspects of the flight environment, and therefore good models for traceability to flight are critical to ensure a low risk, high reliability thermal protection system design. Finally, the role of flight testing in the overall thermal protection system development strategy is discussed.

Availability of tanning beds on US college campuses.

PubMed

Pagoto, Sherry L; Lemon, Stephenie C; Oleski, Jessica L; Scully, Jonathan M; Olendzki, Gin-Fei; Evans, Martinus M; Li, Wenjun; Florence, L Carter; Kirkland, Brittany; Hillhouse, Joel J

2015-01-01

Indoor tanning is widespread among young adults in the United States despite evidence establishing it as a risk factor for skin cancer. The availability of tanning salons on or near college campuses has not been formally evaluated. To evaluate the availability of indoor tanning facilities on US college and university campuses (colleges) and in off-campus housing surrounding but not owned by the college. This observational study sampled the top 125 US colleges and universities listed in US News and World Report. Investigators searched websites of the colleges and nearby housing and contacted them by telephone inquiring about tanning services. Frequency of indoor tanning facilities on college campus and in off-campus housing facilities, as well as payment options for tanning. Of the 125 colleges, 48.0% had indoor tanning facilities either on campus or in off-campus housing, and 14.4% of colleges allow campus cash cards to be used to pay for tanning. Indoor tanning was available on campus in 12.0% of colleges and in off-campus housing in 42.4% of colleges. Most off-campus housing facilities with indoor tanning (96%) provide it free to tenants. Midwestern colleges had the highest prevalence of indoor tanning on campus (26.9%), whereas Southern colleges had the highest prevalence of indoor tanning in off-campus housing facilities (67.7%). Presence of on-campus tanning facilities was significantly associated with enrollment (P = .01), region (P = .02), and presence of a school of public health (P = .01) but not private vs public status (P = .18) or presence of a tobacco policy (P = .16). Presence of tanning facilities in off-campus housing was significantly associated with region (P = .002) and private vs public status (P = .01) but not enrollment (P = .38), tobacco policy (P = .80), or presence of a school of public health (P = .69). Reducing the availability of indoor tanning on and around college campuses is an important public health target.

Occupational exposure in the fluorescent lamp recycling sector in France

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zimmermann, François, E-mail: francois.zimmermann@inrs.fr; Lecler, Marie-Thérèse; Clerc, Frédéric

Highlights: • Chemical risks were assessed in the five fluorescent lamp recycling facilities. • The main hazardous agents are mercury vapors and dust containing lead and yttrium. • Exposure and pollutant levels were correlated with steps and processes. • All the stages and processes are concerned by worrying levels of pollutants. • We suggest recommendations to reduce chemical risk. - Abstract: The fluorescent lamp recycling sector is growing considerably in Europe due to increasingly strict regulations aimed at inciting the consumption of low energy light bulbs and their end-of-life management. Chemical risks were assessed in fluorescent lamp recycling facilities bymore » field measurement surveys in France, highlighting that occupational exposure and pollutant levels in the working environment were correlated with the main recycling steps and processes. The mean levels of worker exposure are 4.4 mg/m{sup 3}, 15.4 μg/m{sup 3}, 14.0 μg/m{sup 3}, 247.6 μg/m{sup 3}, respectively, for total inhalable dust, mercury, lead and yttrium. The mean levels of airborne pollutants are 3.1 mg/m{sup 3}, 9.0 μg/m{sup 3}, 9.0 μg/m{sup 3}, 219.2 μg/m{sup 3}, respectively, for total inhalable dust, mercury, lead and yttrium. The ranges are very wide. Surface samples from employees’ skin and granulometric analysis were also carried out. The overview shows that all the stages and processes involved in lamp recycling are concerned by the risk of hazardous substances penetrating into the bodies of employees, although exposure of the latter varies depending on the processes and tasks they perform. The conclusion of this study strongly recommends the development of a new generation of processes in parallel with more information sharing and regulatory measures.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

MATALUCCI,RUDOLPH V.; O'CONNOR,SHARON

The mission of the Architectural Surety{trademark} program at Sandia National Laboratories is to assure the performance of buildings, facilities, and other infrastructure systems under normal, abnormal, and malevolent threat conditions. Through educational outreach efforts in the classroom, at conferences, and presentations such as this one, public and professional awareness of the need to defuse and mitigate such threats is increased. Buildings, airports, utilities, and other kinds of infrastructure deteriorate over time, as evidenced most dramatically by the crumbling cities and aging buildings, bridges, and other facility systems. Natural disasters such as tornadoes, earthquakes, hurricanes, and flooding also stress the materialsmore » and structural elements of the built environment. In addition, criminals, vandals, and terrorists attack federal buildings, dams, bridges, tunnels, and other public and private facilities. Engineers and architects are beginning to systematically consider these threats during the design, construction, and retrofit phases of buildings and infrastructures and are recommending advanced research in new materials and techniques. Existing building codes and standards do not adequately address nor protect the infrastructure or the public from many of these emerging threats. The activities in Sandia National Laboratories' Architectural Surety{trademark} efforts take a risk management approach to enhancing the safety, security, and reliability of the constructed environment. The technologies and techniques developed during Sandia's 50 years as the nation's lead laboratory for nuclear weapons surety are now being applied to assessing and reducing the vulnerability of dams, to enhancing the safety and security of staff in foreign embassies, and assuring the reliability of other federal facilities. High consequence surety engineering and design brings together technological advancements, new material requirements, systems integration, and risk management to improve the safety, security, and reliability of the as-built environment. The thrust of this paper is the role that new materials can play in protecting the infrastructure. Retrofits of existing buildings, innovative approaches to the design and construction of new facilities, and the mitigation of consequences in the event of an unpreventable disaster are some of the areas that new construction materials can benefit the Architectural Surety{trademark} of the constructed environment.« less

Development of a Quality of Meals and Meal Service Set of Indicators for Residential Facilities for Elderly.

PubMed

Van Damme, N; Buijck, B; Van Hecke, A; Verhaeghe, S; Goossens, E; Beeckman, D

2016-01-01

To develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents' food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service. The indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group's expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care. A preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals. The 'quality of meals and meal service' set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice are completed, the indicator set can be used to guide meal and meal service quality improvement projects in collaboration with kitchen staff and health care professionals. These improvement projects will help to improve food intake and reduce the risk of malnutrition among elders living in residential facilities.

Association of hematological variables and castration status at the time of arrival at a research facility with the risk of bovine respiratory disease in beef calves

USDA-ARS?s Scientific Manuscript database

The objective of this study was to analyze the association between hematological parameters (CBC) and gender at stocker receiving facility arrival and the risk of subsequent clinical bovine respiratory disease (BRD) diagnosis, and (2) to determine and evaluate the accuracy of CBC parameter threshold...

Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

PubMed

Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

2009-05-01

Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging.

Risk Factors for Fecal Colonization with Multiple Distinct Strains of Escherichia coli Among Long-Term Care Facility Residents

PubMed Central

Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N.

2009-01-01

Of 49 long-term care facility residents, 21 (43%) were colonized with two or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest future efforts to efficiently identify diversity of colonizing strains will be challenging. PMID:19292660

An assessment of risk posed by a Campylobacter-positive puppy living in an Australian residential aged-care facility.

PubMed

Moffatt, Cameron; Appuhamy, Ranil; Andrew, Will; Wynn, Sandy; Roberts, Jan; Kennedy, Karina

2014-01-01

In April and June 2012, two outbreaks of Campylobacter gastroenteritis were investigated in an Australian aged-care facility (ACF); a Campylobacter-positive puppy was identified as a potential source of infection. An expert panel was convened to assess transmission risk from the puppy to elderly residents and to guide further public health action. Criteria considered as part of the panel's assessment included the puppy's infectivity, the bacterium's transmissibility, puppy-resident contact, infection control and cleaning practices and animal management at the facility. A literature review was used to assist the panel, with a final risk being determined using a likelihood and consequence matrix. The panel determined that the setting and low infective dose made transmission likely despite varying degrees of contact between the puppy and cases. While infection control practices were generally appropriate, the facility's animal policy did not adequately address potential zoonotic risk. In summary, puppies should not be considered as companion animals in ACFs due to high rates of Campylobacter carriage and the underlying susceptibility of the elderly. Infection control and animal policies in ACFs should reflect an awareness of zoonotic disease potential.

Removal site evaluation report for the Isotope Facilities at Oak Ridge National Laboratory, Oak Ridge, Tennessee

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This removal site evaluation (RmSE) report of the Isotope Facilities at Oak Ridge National Laboratory (ORNL) was prepared to provide the Environmental Restoration Program with information necessary to evaluate whether hazardous and/or radiological contaminants in and around the Isotopes Facility pose a substantial risk to human health or the environment and if remedial site evaluations (RSEs) or removal actions are required. The scope of the project included: (1) a review of historical evidence regarding operations and use of the facility; (2) interviews with facility personnel concerning current and past operating practices; (3) a site inspection; and (4) identification of hazardmore » areas requiring maintenance, removal, or remedial actions. The results of RmSE indicate that no substantial risks exist from contaminants present in the Isotope Facilities because adequate controls and practices exist to protect human health and the environment. The recommended correction from the RmSE are being conducted as maintenance actions; accordingly, this RmSE is considered complete and terminated.« less

Modelling carcinogenesis after radiotherapy using Poisson statistics: implications for IMRT, protons and ions.

PubMed

Jones, Bleddyn

2009-06-01

Current technical radiotherapy advances aim to (a) better conform the dose contours to cancers and (b) reduce the integral dose exposure and thereby minimise unnecessary dose exposure to normal tissues unaffected by the cancer. Various types of conformal and intensity modulated radiotherapy (IMRT) using x-rays can achieve (a) while charged particle therapy (CPT)-using proton and ion beams-can achieve both (a) and (b), but at greater financial cost. Not only is the long term risk of radiation related normal tissue complications important, but so is the risk of carcinogenesis. Physical dose distribution plans can be generated to show the differences between the above techniques. IMRT is associated with a dose bath of low to medium dose due to fluence transfer: dose is effectively transferred from designated organs at risk to other areas; thus dose and risk are transferred. Many clinicians are concerned that there may be additional carcinogenesis many years after IMRT. CPT reduces the total energy deposition in the body and offers many potential advantages in terms of the prospects for better quality of life along with cancer cure. With C ions there is a tail of dose beyond the Bragg peaks, due to nuclear fragmentation; this is not found with protons. CPT generally uses higher linear energy transfer (which varies with particle and energy), which carries a higher relative risk of malignant induction, but also of cell death quantified by the relative biological effect concept, so at higher dose levels the frank development of malignancy should be reduced. Standard linear radioprotection models have been used to show a reduction in carcinogenesis risk of between two- and 15-fold depending on the CPT location. But the standard risk models make no allowance for fractionation and some have a dose limit at 4 Gy. Alternatively, tentative application of the linear quadratic model and Poissonian statistics to chromosome breakage and cell kill simultaneously allows estimation of relative changes in carcinogenesis that incorporate fractionation and relative biological effects (RBE). This alternative modelling approach allows absolute and relative risk estimations per cell and can be extended to tissues. The classical turnover point in carcinogenesis occurring after a single exposure is a feature of the model; also, the dose-response relationship becomes pseudo-linear with extended fractionation and when heterogeneity of the radiosensitivity parameters is introduced; there is also an inverse relationship between dose per fraction and cancer induction. In principle, this new approach might influence the conduct of proton and ion beam therapy, particularly beam placements and fractionation policies. The theoretical implications for future radiotherapy are considerable, but these predictions should be subjected to cellular and tissue experiments that simulate these forms of treatment, including any secondary neutron production in some cases depending on the beam delivery technique, e.g. in tissue equivalent humanoid phantoms using cell transformation techniques. Since the UK has no working high energy particle beam facility over 100 MeV, British scientists would require use of particle beam facilities in Europe, USA or Japan to perform experiments.

[Considering the current state of fire safety in Taiwan's care environment from the perspective of the nation's worst recent hospital fire].

PubMed

Tseng, Wei-Wen; Shih, Chung-Liang; Chien, Shen-Wen

2013-04-01

Taiwan's worst hospital fire in history on October 23rd, 2012 at Sinying Hospital's Bei-Men Branch resulted in 13 elderly patient deaths and over 70 injuries. The heavy casualties were due in part to the serious condition of patients. Some patients on life-support machines were unable to move or be moved. This disaster highlights the issue of fire safety in small-scale hospitals that have transformed existing hospital space into special care environments for elderly patients. Compared with medical centers and general hospitals, these small-scale health facilities are ill equipped to deal properly with fire safety management and emergency response issues due to inadequate fire protection facilities, fire safety equipment, and human resources. Small-scale facilities that offer health care and medical services to mostly immobile patients face fire risks that differ significantly from general health care facilities. This paper focuses on fire risks in small-scale facilities and suggests a strategy for fire prevention and emergency response procedures, including countermeasures for fire risk assessment, management, and emergency response, in order to improve fire safety at these institutions in Taiwan.

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

PubMed

Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia

2015-07-01

We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.

Association Between Travel Distance and Choice of Treatment for Prostate Cancer: Does Geography Reduce Patient Choice?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muralidhar, Vinayak, E-mail: vmuralidhar@partners.org; Rose, Brent S.; Chen, Yu-Wei

Objective: To determine whether the distance between a prostate cancer patient's home and treatment facility was related to the choice of treatment received among those opting for surgery or radiation. Methods and Materials: We identified 222,804 patients diagnosed with National Comprehensive Cancer Network low-, intermediate-, or high-risk N0M0 prostate cancer and treated with local therapy (surgery or radiation alone, with or without hormone therapy) using the National Cancer Database. We used multivariable logistic regression to determine whether the choice of radiation therapy vs radical prostatectomy varied by distance among patients living in rural and urban areas. Analyses were adjusted formore » geographic location within the United States, age, race, Charlson/Deyo comorbidity score, year of diagnosis, income quartile, education quartile, Gleason score, prostate-specific antigen level, and T stage. Results: Patients living in urban or rural areas were less likely to receive radiation compared with surgery if they lived farther from the treatment facility. Among urban patients living ≤5 miles from the treatment facility, 53.3% received radiation, compared with 47.0%, 43.6%, and 33.8% of those living 5 to 10, 10 to 15, or >15 miles away, respectively (P<.001 in all cases). Similarly, rural patients were less likely to receive radiation the farther they lived from the treatment facility (≤25 miles: 62.3%; 25-50 miles: 55.5%; 50-75 miles: 38.4%; >75 miles: 23.8%; P<.05 in all cases). These trends were also present when each risk group was analyzed separately. Conclusion: Patients with prostate cancer in both urban and rural settings were less likely to receive radiation therapy rather than surgery the farther away they lived from a treatment center. These findings raise the possibility that the geographic availability of radiation treatment centers may be an important determinant of whether patients are able to choose radiation rather than surgery for localized prostate cancer.« less

Association Between Travel Distance and Choice of Treatment for Prostate Cancer: Does Geography Reduce Patient Choice?

PubMed

Muralidhar, Vinayak; Rose, Brent S; Chen, Yu-Wei; Nezolosky, Michelle D; Nguyen, Paul L

2016-10-01

To determine whether the distance between a prostate cancer patient's home and treatment facility was related to the choice of treatment received among those opting for surgery or radiation. We identified 222,804 patients diagnosed with National Comprehensive Cancer Network low-, intermediate-, or high-risk N0M0 prostate cancer and treated with local therapy (surgery or radiation alone, with or without hormone therapy) using the National Cancer Database. We used multivariable logistic regression to determine whether the choice of radiation therapy vs radical prostatectomy varied by distance among patients living in rural and urban areas. Analyses were adjusted for geographic location within the United States, age, race, Charlson/Deyo comorbidity score, year of diagnosis, income quartile, education quartile, Gleason score, prostate-specific antigen level, and T stage. Patients living in urban or rural areas were less likely to receive radiation compared with surgery if they lived farther from the treatment facility. Among urban patients living ≤5 miles from the treatment facility, 53.3% received radiation, compared with 47.0%, 43.6%, and 33.8% of those living 5 to 10, 10 to 15, or >15 miles away, respectively (P<.001 in all cases). Similarly, rural patients were less likely to receive radiation the farther they lived from the treatment facility (≤25 miles: 62.3%; 25-50 miles: 55.5%; 50-75 miles: 38.4%; >75 miles: 23.8%; P<.05 in all cases). These trends were also present when each risk group was analyzed separately. Patients with prostate cancer in both urban and rural settings were less likely to receive radiation therapy rather than surgery the farther away they lived from a treatment center. These findings raise the possibility that the geographic availability of radiation treatment centers may be an important determinant of whether patients are able to choose radiation rather than surgery for localized prostate cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Health Care Facilities Resilient to Climate Change Impacts

PubMed Central

Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

2014-01-01

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. PMID:25522050

Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study.

PubMed

Anggondowati, Trisari; El-Mohandes, Ayman A E; Qomariyah, S Nurul; Kiely, Michele; Ryon, Judith J; Gipson, Reginald F; Zinner, Benjamin; Achadi, Anhari; Wright, Linda L

2017-03-28

We investigated associations between maternal characteristics, access to care, and obstetrical complications including near miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons. We prospectively collected data on inborn singletons at two hospitals in East Java. Data included socio-demographics, reproductive, obstetric and neonatal variables. Reduced multivariable models were constructed. Outcomes of interest included low and very low birthweight (LBW/VLBW), asphyxia and death. Referral from a care facility was associated with a reduced risk of LBW and VLBW [AOR = 0.28, 95% CI = 0.11-0.69, AOR = 0.18, 95% CI = 0.04-0.75, respectively], stillbirth [AOR = 0.41, 95% CI = 0.18-0.95], and neonatal death [AOR = 0.2, 95% CI = 0.05-0.81]. Mothers age <20 years increased the risk of VLBW [AOR = 6.39, 95% CI = 1.82-22.35] and neonatal death [AOR = 4.10, 95% CI = 1.29-13.02]. Malpresentation on admission increased the risk of asphyxia [AOR = 4.65, 95% CI = 2.23-9.70], stillbirth [AOR = 3.96, 95% CI = 1.41-11.15], and perinatal death [AOR = 3.89 95% CI = 1.42-10.64], as did poor prenatal care (PNC) [AOR = 11.67, 95%CI = 2.71-16.62]. Near-miss on admission increased the risk of neonatal [AOR = 11.67, 95% CI = 2.08-65.65] and perinatal death [AOR = 13.08 95% CI = 3.77-45.37]. Mothers in labor should be encouraged to seek care early and taught to identify early danger signs. Adequate PNC significantly reduced perinatal deaths. Improved hospital management of malpresentation may significantly reduce perinatal morbidity and mortality. The importance of hospital-based prospective studies helps evaluate specific areas of need in training of obstetrical care providers.

Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

PubMed

Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

2016-01-01

Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-serodiscordant couples.

Firefighting to Innovation: Using Human Factors and Ergonomics to Tackle Slip, Trip, and Fall Risks in Hospitals.

PubMed

Hignett, Sue; Wolf, Laurie; Taylor, Ellen; Griffiths, Paula

2015-11-01

The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior-based approach to explore and understand patient perspectives of STF events. The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event-the patient. This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside). © 2015, Human Factors and Ergonomics Society.

Hygiene and health: systematic review of handwashing practices worldwide and update of health effects.

PubMed

Freeman, Matthew C; Stocks, Meredith E; Cumming, Oliver; Jeandron, Aurelie; Higgins, Julian P T; Wolf, Jennyfer; Prüss-Ustün, Annette; Bonjour, Sophie; Hunter, Paul R; Fewtrell, Lorna; Curtis, Valerie

2014-08-01

To estimate the global prevalence of handwashing with soap and derive a pooled estimate of the effect of hygiene on diarrhoeal diseases, based on a systematic search of the literature. Studies with data on observed rates of handwashing with soap published between 1990 and August 2013 were identified from a systematic search of PubMed, Embase and ISI Web of Knowledge. A separate search was conducted for studies on the effect of hygiene on diarrhoeal disease that included randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined. The search used Cochrane Library, Global Health, BIOSIS, PubMed, and Embase databases supplemented with reference lists from previously published systematic reviews to identify studies published between 1970 and August 2013. Results were combined using multilevel modelling for handwashing prevalence and meta-regression for risk estimates. From the 42 studies reporting handwashing prevalence we estimate that approximately 19% of the world population washes hands with soap after contact with excreta (i.e. use of a sanitation facility or contact with children's excreta). Meta-regression of risk estimates suggests that handwashing reduces the risk of diarrhoeal disease by 40% (risk ratio 0.60, 95% CI 0.53-0.68); however, when we included an adjustment for unblinded studies, the effect estimate was reduced to 23% (risk ratio 0.77, 95% CI 0.32-1.86). Our results show that handwashing after contact with excreta is poorly practiced globally, despite the likely positive health benefits. © 2014 John Wiley & Sons Ltd.

How to implement security controls for an information security program at CBRN facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lenaeus, Joseph D.; O'Neil, Lori Ross; Leitch, Rosalyn M.

This document was prepared by PNNL within the framework of Project 19 of the European Union Chemical Biological Radiological and Nuclear Risk Mitigation Centres of Excellence Initiative entitled, ''Development of procedures and guidelines to create and improve secure information management systems and data exchange mechanisms for CBRN materials under regulatory control.'' It provides management and workers at CBRN facilities, parent organization managers responsible for those facilities, and regulatory agencies (governmental and nongovernmental) with guidance on the best practices for protecting information security. The security mitigation approaches presented in this document were chosen because they present generally accepted guidance in anmore » easy-to-understand manner, making it easier for facility personnel to grasp key concepts and envision how security controls could be implemented by the facility. This guidance is presented from a risk management perspective.« less

Comparison of x ray computed tomography number to proton relative linear stopping power conversion functions using a standard phantom.

PubMed

Moyers, M F

2014-06-01

Adequate evaluation of the results from multi-institutional trials involving light ion beam treatments requires consideration of the planning margins applied to both targets and organs at risk. A major uncertainty that affects the size of these margins is the conversion of x ray computed tomography numbers (XCTNs) to relative linear stopping powers (RLSPs). Various facilities engaged in multi-institutional clinical trials involving proton beams have been applying significantly different margins in their patient planning. This study was performed to determine the variance in the conversion functions used at proton facilities in the U.S.A. wishing to participate in National Cancer Institute sponsored clinical trials. A simplified method of determining the conversion function was developed using a standard phantom containing only water and aluminum. The new method was based on the premise that all scanners have their XCTNs for air and water calibrated daily to constant values but that the XCTNs for high density/high atomic number materials are variable with different scanning conditions. The standard phantom was taken to 10 different proton facilities and scanned with the local protocols resulting in 14 derived conversion functions which were compared to the conversion functions used at the local facilities. For tissues within ±300 XCTN of water, all facility functions produced converted RLSP values within ±6% of the values produced by the standard function and within 8% of the values from any other facility's function. For XCTNs corresponding to lung tissue, converted RLSP values differed by as great as ±8% from the standard and up to 16% from the values of other facilities. For XCTNs corresponding to low-density immobilization foam, the maximum to minimum values differed by as much as 40%. The new method greatly simplifies determination of the conversion function, reduces ambiguity, and in the future could promote standardization between facilities. Although it was not possible from these experiments to determine which conversion function is most appropriate, the variation between facilities suggests that the margins used in some facilities to account for the uncertainty in converting XCTNs to RLSPs may be too small.

Buffet test in the National Transonic Facility

NASA Technical Reports Server (NTRS)

Young, Clarence P., Jr.; Hergert, Dennis W.; Butler, Thomas W.; Herring, Fred M.

1992-01-01

A buffet test of a commercial transport model was accomplished in the National Transonic Facility at the NASA Langley Research Center. This aeroelastic test was unprecedented for this wind tunnel and posed a high risk for the facility. Presented here are the test results from a structural dynamics and aeroelastic response point of view. The activities required for the safety analysis and risk assessment are described. The test was conducted in the same manner as a flutter test and employed on-board dynamic instrumentation, real time dynamic data monitoring, and automatic and manual tunnel interlock systems for protecting the model.

The effects of a Pilates-based exercise rehabilitation program on functional outcome and fall risk reduction in an aging adult status-post traumatic hip fracture due to a fall.

PubMed

Stivala, Adam; Hartley, Greg

2014-01-01

Currently, little information describing the relationship of Pilates-based strength and stability exercises with fall risk in the geriatric population exists. The purpose of this report was to examine the impact of a Pilates-based rehabilitation (PBR) program on reducing fall risk in an aging adult status postfall with resulting hip fracture and open reduction and internal fixation. The patient was an 84-year-old woman admitted to a skilled nursing facility (SNF) after a right hip fracture resulting from a fall at home. The patient's relevant medical history included frequent falls due to loss of balance, a previous left hip fracture with resultant arthroplasty, and a stroke roughly 20 years prior. The patient received physical therapy and occupational therapy 6 days per week for 26 days in an SNF. The physical therapy intervention consisted of gait and transfer training, neuromuscular reeducation, and an adjunct of specialized PBR exercises for the following impairments: decreased core strength and awareness and poor dynamic stabilization during functional activities. The patient demonstrated increases in lower extremity strength and active range of motion, ambulation distance and speed, and transfer ability. The patient was able to return home and live with her husband while requiring only incidental assistance with activities of daily living. She was able to independently ambulate around her home with her rolling walker. Her fall risk was also reduced from initial evaluation based on several fall risk assessments, including the Four Square Step Test, the Berg Balance Scale, and the Timed Up and Go. This case illustrates the benefit of integrating PBR exercises into a standard SNF rehabilitation program, which may contribute to decreased fall risk.

Special Considerations for Mass Violence Events in Senior Living Facilities: A Case Report on the Pinelake Health and Rehab Center Shooting.

PubMed

Martin, Cody; Powell, David

2017-02-01

The 2009 Pinelake Health and Rehab Center shooting in Carthage, North Carolina, presents a unique case study for examining the specific considerations for mass violence events in senior living facilities. A variety of factors, including reduced sensory perception, reduced mobility, and cognitive decline, may increase the vulnerability of the populations of senior living facilities during mass violence events. Management of response aspects such as evacuation, relocation, and reunification also require special consideration in the context of mass violence at senior living facilities. Better awareness of these vulnerabilities and response considerations can assist facility administrators and emergency managers when preparing for potential mass violence events at senior living facilities. (Disaster Med Public Health Preparedness. 2017;11:150-152).

Tobacco Use by Male Prisoners Under an Indoor Smoking Ban

PubMed Central

Ferketich, Amy K.; Murray, David M.; Bellair, Paul E.; Wewers, Mary Ellen

2011-01-01

Introduction: Most correctional facilities have implemented tobacco restrictions in an effort to reduce costs and improve prisoner health, but little has been done to evaluate the impact of these policy changes. Patterns of tobacco use among prisoners were explored to determine the impact of incarceration in a facility with an indoor smoking ban on tobacco use behaviors. Methods: Recently incarcerated male inmates (n = 200) were surveyed about their tobacco use prior to and during incarceration. Results: Tobacco use was prevalent prior to arrest (77.5%) and increased during incarceration (81.0%). Though the number of cigarette smokers increased during imprisonment, per-capita cigarette consumption declined by 7.1 cigarettes/day (p < .001). Despite widespread tobacco use, most participants recognized that smoking is a cause of lung cancer (96.0%) and heart disease (75.4%) and that it can be addicting (97.5%). Most tobacco users (70.0%) reported a desire to quit, with 63.0% saying they intended to try quitting in the next year. Conclusions: Indoor smoking bans do not promote cessation in prisons but may reduce the amount of tobacco consumed. Though smoking is commonplace in prisons, most prisoners recognize the risks involved and wish to quit. This creates an ideal setting for intervention. Evidence-based cessation assistance should be made freely available to all incarcerated smokers. PMID:21447838

Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

PubMed

Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

2008-05-01

Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

Biodiesel versus Diesel: A Pilot Study Comparing Exhaust Exposures for Employees at a Rural Municipal Facility

PubMed Central

Traviss, Nora; Thelen, Brett Amy; Ingalls, Jaime Kathryn; Treadwell, Melinda Dawn

2016-01-01

Many organizations interested in renewable, domestic energy have switched from petroleum diesel to biodiesel blends for use in transportation and heavy-duty equipment. Although considerable evidence exists on the negative health effects of petroleum diesel exhaust exposures in occupational settings, there has been little research examining biodiesel exposures. Working collaboratively with a local municipality, concentrations of particulate matter (PM) and other air toxics were measured at a recycling facility in southwestern New Hampshire while heavy equipment operated first on petroleum diesel and then on a B20 blend (20% soy-based biodiesel/80% petroleum diesel). This pilot study used a combination of established industrial hygiene and environmental air monitoring methods to estimate occupational exposure profiles to PM and air toxics from combustion of petroleum diesel and biodiesel. Results indicate that B20 use dramatically reduces work area respirable particle, PM2.5 (PM ≤2.5 µm in aerodynamic diameter), and formaldehyde levels compared with petroleum diesel. Some volatile organic compound concentrations were higher for petroleum diesel and others were higher for the B20 blend. Overall, this study suggests that biodiesel blends reduce worker exposure to and health risk from petroleum diesel exhaust, but additional exposure research is recommended. PMID:20863048

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis

PubMed Central

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-01-01

Objectives To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Setting and participants Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Design and outcome measures Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Results Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI −1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI −8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Conclusions Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. PMID:27381211

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis.

PubMed

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-07-05

To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI -1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI -8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Security culture for nuclear facilities

NASA Astrophysics Data System (ADS)

Gupta, Deeksha; Bajramovic, Edita

2017-01-01

Natural radioactive elements are part of our environment and radioactivity is a natural phenomenon. There are numerous beneficial applications of radioactive elements (radioisotopes) and radiation, starting from power generation to usages in medical, industrial and agriculture applications. But the risk of radiation exposure is always attached to operational workers, the public and the environment. Hence, this risk has to be assessed and controlled. The main goal of safety and security measures is to protect human life, health, and the environment. Currently, nuclear security considerations became essential along with nuclear safety as nuclear facilities are facing rapidly increase in cybersecurity risks. Therefore, prevention and adequate protection of nuclear facilities from cyberattacks is the major task. Historically, nuclear safety is well defined by IAEA guidelines while nuclear security is just gradually being addressed by some new guidance, especially the IAEA Nuclear Security Series (NSS), IEC 62645 and some national regulations. At the overall level, IAEA NSS 7 describes nuclear security as deterrence and detection of, and response to, theft, sabotage, unauthorized access, illegal transfer or other malicious acts involving nuclear, other radioactive substances and their associated facilities. Nuclear security should be included throughout nuclear facilities. Proper implementation of a nuclear security culture leads to staff vigilance and a high level of security posture. Nuclear security also depends on policy makers, regulators, managers, individual employees and members of public. Therefore, proper education and security awareness are essential in keeping nuclear facilities safe and secure.

Active Commuting to School, Weight Status, and Cardiometabolic Risk in Children from Rural Areas: The Cuenca Study

ERIC Educational Resources Information Center

Gutiérrez-Zornoza, Myriam; Sánchez-López, Mairena; García-Hermoso, Antonio; González-García, Alberto; Chillón, Palma; Martínez-Vizcaíno, Vicente

2015-01-01

Purpose: The aim of this study was to examine (a) whether distance from home to school is a determinant of active commuting to school (ACS), (b) the relationship between distance from home to heavily used facilities (school, green spaces, and sports facilities) and the weight status and cardiometabolic risk categories, and (c) whether ACS has a…

Asset Management: Roof Maintenance and Facility Energy Retrofits

DTIC Science & Technology

2012-03-01

vapor low emission coatings. Floor finishes completed in ceramic stone tile were the most efficient floor coverings. Fixed insulated fiberglass window...been coined Asset Management which utilizes organizational levels of service, business case analysis, and risk analysis to address urgent...Force have left a number of facility systems such as roofs at risk to disrepair due to a lack of maintenance. Under the principles of asset

Does public health system provide adequate financial risk protection to its clients? Out of pocket expenditure on inpatient care at secondary level public health institutions: Causes and determinants in an eastern Indian state.

PubMed

Rout, Sarit Kumar; Choudhury, Sarmistha

2018-02-09

This study is undertaken to estimate the out of pocket expenditure (OOPE) for various diseases and its determinants at secondary level public health facilities in Odisha. A cross-sectional survey was conducted among the inpatients utilising secondary level public health facilities in the 2 districts of Odisha. More than 80% of the inpatients were selected conveniently, and data on OOPE and socioeconomic status of patients were collected. The OOPE was estimated separately on surgery, nonsurgery, and child birth conditions. Ordinary least square regression models were developed to explain the factors determining OOPE. The mean OOPE for the secondary care facility was Indian National Rupee 3136.14, (95% CI: 2869.08-3403.19), of which, Indian National Rupee 1622.79 (95% CI: 1462.70-1782.89) was on medicine constituting 79% of total medical expenditure. The mean OOPE on surgery was highest followed by nonsurgery and child birth conditions. The OOPE is mainly influenced by caste and educational status of patients as revealed by the regression results. With increase in social status, the OOPE increases and the results are statistically significant. This evidence should be used to design financial strategies to reduce OOPE at secondary care public health facilities, which is largely due to medicine, diagnostic services, and transport expenditure. Efforts should be made to protect the interest of the poor, who utilise public health facility in a low resource setting in India. Copyright © 2018 John Wiley & Sons, Ltd.

Overview of Opportunities for Co-Location of Solar Energy Technologies and Vegetation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Macknick, Jordan; Beatty, Brenda; Hill, Graham

2013-12-01

Large-scale solar facilities have the potential to contribute significantly to national electricity production. Many solar installations are large-scale or utility-scale, with a capacity over 1 MW and connected directly to the electric grid. Large-scale solar facilities offer an opportunity to achieve economies of scale in solar deployment, yet there have been concerns about the amount of land required for solar projects and the impact of solar projects on local habitat. During the site preparation phase for utility-scale solar facilities, developers often grade land and remove all vegetation to minimize installation and operational costs, prevent plants from shading panels, and minimizemore » potential fire or wildlife risks. However, the common site preparation practice of removing vegetation can be avoided in certain circumstances, and there have been successful examples where solar facilities have been co-located with agricultural operations or have native vegetation growing beneath the panels. In this study we outline some of the impacts that large-scale solar facilities can have on the local environment, provide examples of installations where impacts have been minimized through co-location with vegetation, characterize the types of co-location, and give an overview of the potential benefits from co-location of solar energy projects and vegetation. The varieties of co-location can be replicated or modified for site-specific use at other solar energy installations around the world. We conclude with opportunities to improve upon our understanding of ways to reduce the environmental impacts of large-scale solar installations.« less

Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso.

PubMed

Bila, Blandine; Egrot, Marc

2009-09-01

Anthropological research in Burkina Faso indicates that more HIV-positive women than HIV-positive men are attending care facilities for people living with HIV/AIDS (PLWH) and accessing antiretroviral medicine. This article, situated in the field of study of interactions between gender and AIDS, offers a description of this asymmetry and an anthropological analysis of the socio-cultural determinants, through analysis of data from ethnographic research among PLWH and health actors. Examining social representations of femininity and masculinity in Burkinabe society and the organisation of the healthcare system in connection with gender shed light on the decision-making processes of both sexes around therapeutic choices and the itinerary of care. On the one hand, the social values attached to femininity, maternity and the status of wife create conditions for women that favour their attendance at care facilities for PLWH and encourage a widespread practice where wives take the place of their husbands in healthcare queues. Moreover, health policies and the effects of women's empowerment within the healthcare system strengthen women's access to health services. On the other hand, representations of masculinity are fully implicated in the cultural construction of men's reluctance to attend care facilities for PLWH. The values associated with this masculinity cause men to run great health, economic and social risks, not only for themselves, but also for their wives and children. By better understanding the interaction between gender, the experience of HIV and the institutional organisation of healthcare, we can identify ways to reduce men's reluctance to attend care facilities for PLWH and improve both prevention and treatment-oriented programmes.

Why is continuum of care from home to health facilities essential to improve perinatal survival?

PubMed

Bahl, Rajiv; Qazi, Shamim; Darmstadt, Gary L; Martines, Jose

2010-12-01

The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period. This paper reviews strategies to promote the establishment of this continuum: providing health care within or close to home by frontline workers and increasing the use of services in health facilities through community mobilization and financing strategies. As perinatal care and care for seriously sick children face common challenges and lessons could be learned from successful strategies for management of other illnesses, this paper also reviews intervention models involving community health workers (CHWs) to improve case management of sick children at the household and community levels. Available evidence suggests that the community strategy with the greatest impact on neonatal mortality is home visits by CHWs combined with community mobilization. The same strategy appears to be effective in increasing health facility utilization. An equally effective strategy for increasing health facility utilization seems to be financing health care to remove financial access barriers, particularly using conditional cash transfers or vouchers. Although the availability of information on the effect of community interventions to improve newborn health has increased in the recent past, significant gaps remain. Information on the effectiveness of strategies in different settings, particularly in sub-Saharan Africa, cost-effectiveness and sustainability are particularly needed and should be gathered in future studies. Copyright © 2010 Elsevier Inc. All rights reserved.

Resident and Facility Factors Associated With the Incidence of Urinary Tract Infections Identified in the Nursing Home Minimum Data Set.

PubMed

Castle, Nicholas; Engberg, John B; Wagner, Laura M; Handler, Steven

2017-02-01

This research examined resident and facility-specific factors associated with a diagnosis of a urinary tract infection (UTI) in the nursing home setting. Minimum Data Set and Online Survey, Certification and Reporting system data were used to identify all nursing home residents in the United States on April 1, 2006, who did not have a UTI ( n = 1,138,418). Residents were followed until they contracted a UTI (9.5%), died (8.3%), left the nursing home (33.2%), or the year ended (49.0%). A Cox proportional hazards model was estimated, controlling for resident and facility characteristics and for the state of residence. The presence of an indwelling catheter was the primary predictor of whether a resident contracted a UTI (adjusted incidence ratio = 3.35, p < .001), but only 6.1% of the residents in the sample had such a catheter. Therefore, only one eighth of the UTIs were contracted by residents with a catheter. Thus, subsequent analysis examined the populations with and without catheters separately. Demographic characteristics (such as age) have a much greater association with incidence among residents without catheters. The association with facility factors such as percentage of Medicaid residents, for-profit, and chain status was less significant. Estimates regarding staffing levels indicate that increased contact hours with more highly educated nursing staff are associated with less catheter use. Several facility-specific risk factors are of significance. Of significance, UTIs may be reduced by modifying factors such as staffing levels.

Life Sciences Centrifuge Facility assessment

NASA Technical Reports Server (NTRS)

Benson, Robert H.

1994-01-01

This report provides an assessment of the status of the Centrifuge Facility being developed by ARC for flight on the International Space Station Alpha. The assessment includes technical status, schedules, budgets, project management, performance of facility relative to science requirements, and identifies risks and issues that need to be considered in future development activities.

Indicators of Dysphagia in Aged Care Facilities

ERIC Educational Resources Information Center

Pu, Dai; Murry, Thomas; Wong, May C. M.; Yiu, Edwin M. L.; Chan, Karen M. K.

2017-01-01

Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating…

Real-time range generation for ladar hardware-in-the-loop testing

NASA Astrophysics Data System (ADS)

Olson, Eric M.; Coker, Charles F.

1996-05-01

Real-time closed loop simulation of LADAR seekers in a hardware-in-the-loop facility can reduce program risk and cost. This paper discusses an implementation of real-time range imagery generated in a synthetic environment at the Kinetic Kill Vehicle Hardware-in-the Loop facility at Eglin AFB, for the stimulation of LADAR seekers and algorithms. The computer hardware platform used was a Silicon Graphics Incorporated Onyx Reality Engine. This computer contains graphics hardware, and is optimized for generating visible or infrared imagery in real-time. A by-produce of the rendering process, in the form of a depth buffer, is generated from all objects in view during its rendering process. The depth buffer is an array of integer values that contributes to the proper rendering of overlapping objects and can be converted to range values using a mathematical formula. This paper presents an optimized software approach to the generation of the scenes, calculation of the range values, and outputting the range data for a LADAR seeker.

Risks to health care workers from nano-enabled medical products.

PubMed

Murashov, Vladimir; Howard, John

2015-01-01

Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies critical research needs for ensuring worker protection in the health care industry.

Develop and Manufacture an Ergonomically Sound Glovebox Glove Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lawton, Cindy M.

Ergonomic injury and radiation exposure are two safety concerns for the Plutonium Facility at Los Alamos National Laboratory (LANL). This facility employs the largest number of gloveboxes (GB) at LANL with approximately 6000 gloves installed. The current GB glove design dates back to the 1960’s and is not based on true hand anatomy, revealing several issues: short fingers, inappropriate length from the wrist to finger webbing, nonexistent joint angles and incorrect thumb placement. These design flaws are directly related to elbow (lateral epicondylitis) and thumb (DeQuervain’s tenosynovitis) injuries. The current design also contributes to increased wear on the glove, causingmore » unplanned glove openings (failures) which places workers at risk of exposure. An improved glovebox glove design has three significant benefits: 1) it will reduce the risk of injury, 2) it will improve comfort and productivity, and 3) it will reduce the risk of a glovebox failures. The combination of these three benefits has estimated savings of several million dollars. The new glove design incorporated the varied physical attributes of workers ranging from the 5 th percentile female to the 95th percentile male. Anthropometric hand dimensions along with current GB worker dimensions were used to develop the most comprehensive design specifications for the new glove. Collaboration with orthopedic hand surgeons also provided major contributtions to the design. The new glovebox glove was developed and manufactured incorporating over forty dimensions producing the most comprehensive ergonomically sound design. The new design received a LANL patent (patent attorney docket No: LANS 36USD1 “Protective Glove”, one of 20 highest patents awarded by the Richard P. Feynman Center for Innovation. The glove dimensions were inputed into a solid works model which was used to produce molds. The molds were then shipped to a glove manufacturer for production of the new glovebox gloves. The new glovebox gloves were tested against the presently used glovebox gloves for design validity. The testing included a subjective survey and four dexterity tests. The prototype was statistically significant in 3 dexterity tests and favorable on 8 out of 10 survey questions. The more ergonomically sound glovebox glove will improve worker comfort, mitigate glovebox worker injuries, and reduce glove breaches.« less

THE IMPACT OF EPA'S GREEN POWER PURCHASES

EPA Science Inventory

All federal agencies, including EPA, are required to reduce life-cycle greenhouse gas emissions attributed to facility energy use by 30% below 1990 levels by 2010. A key approach to reducing facility greenhouse gas emissions, employed by EPA, involves the purchase of "green power...

The national one week prevalence audit of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening 2012.

PubMed

Fuller, Christopher; Robotham, Julie; Savage, Joanne; Hopkins, Susan; Deeny, Sarah R; Stone, Sheldon; Cookson, Barry

2013-01-01

The English Department of Health introduced universal MRSA screening of admissions to English hospitals in 2010. It commissioned a national audit to review implementation, impact on patient management, admission prevalence and extra yield of MRSA identified compared to "high-risk" specialty or "checklist-activated" screening (CLAS) of patients with MRSA risk factors. National audit May 2011. Questionnaires to infection control teams in all English NHS acute trusts, requesting number patients admitted and screened, new or previously known MRSA; MRSA point prevalence; screening and isolation policies; individual risk factors and patient management for all new MRSA patients and random sample of negatives. 144/167 (86.2%) trusts responded. Individual patient data for 760 new MRSA patients and 951 negatives. 61% of emergency admissions (median 67.3%), 81% (median 59.4%) electives and 47% (median 41.4%) day-cases were screened. MRSA admission prevalence: 1% (median 0.9%) emergencies, 0.6% (median 0.4%) electives, 0.4% (median 0%) day-cases. Approximately 50% all MRSA identified was new. Inpatient MRSA point prevalence: 3.3% (median 2.9%). 104 (77%) trusts pre-emptively isolated patients with previous MRSA, 63 (35%) pre-emptively isolated admissions to "high-risk" specialties; 7 (5%) used PCR routinely. Mean time to MRSA positive result: 2.87 days (±1.33); 37% (219/596) newly identified MRSA patients discharged before result available; 55% remainder (205/376) isolated post-result. In an average trust, CLAS would reduce screening by 50%, identifying 81% of all MRSA. "High risk" specialty screening would reduce screening by 89%, identifying 9% of MRSA. Implementation of universal screening was poor. Admission prevalence (new cases) was low. CLAS reduced screening effort for minor decreases in identification, but implementation may prove difficult. Cost effectiveness of this and other policies, awaits evaluation by transmission dynamic economic modelling, using data from this audit. Until then trusts should seek to improve implementation of current policy and use of isolation facilities.

The Influence of Process Equipment on the Properties of Suspension Plasma Sprayed Yttria-Stabilized Zirconia Coatings

NASA Astrophysics Data System (ADS)

Marr, Michael; Waldbillig, David; Kesler, Olivera

2013-03-01

Suspension plasma-sprayed YSZ coatings were deposited at lab-scale and production-type facilities to investigate the effect of process equipment on coating properties. The target application for these coatings is solid oxide fuel cell (SOFC) electrolytes; hence, dense microstructures with low permeability values were preferred. Both facilities had the same torch but different suspension feeding systems, torch robots, and substrate holders. The lab-scale facility had higher torch-substrate relative speeds compared with the production-type facility. On porous stainless steel substrates, permeabilities and microstructures were comparable for coatings from both facilities, and no segmentation cracks were observed. Coating permeability was further reduced by increasing substrate temperatures during deposition or reducing suspension feed rates. On SOFC cathode substrates, coatings made in the production-type facility had higher permeabilities and more segmentation cracks compared with coatings made in the lab-scale facility. Increased cracking in coatings from the production-type facility was likely caused mainly by its lower torch-substrate relative speed.

Travel burden to breast MRI and utilization: are risk and sociodemographics related

PubMed Central

Onega, Tracy; Lee, Christoph I.; Benkeser, David; Alford-Teaster, Jennifer; Haas, Jennifer S.; Tosteson, Anna N. A.; Hill, Deirdre; Shi, Xun; Henderson, Louise M.; Hubbard, Rebecca A.

2016-01-01

Background Mammograms, unlike magnetic resonance imaging (MRI), are relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies based on sociodemographic or breast cancer risk factors is unknown. Methods We examine screening mammograms and MRIs between 2005 and 2012 in the Breast Cancer Surveillance Consortium (BCSC) by a) travel time to the closest and actual mammography facility used, and the difference between the two; b) woman's breast cancer risk factors and c) socio-demographic characteristics. We used logistic regression to examine the odds of traveling farther than the closest facility in relation to women's characteristics. Results Among 821,683 screening mammograms, 76.6% occurred at the closest facility compared to 51.9% of screening MRIs (N=3,687). The median differential travel time among women not using the closest facility for mammography was 14 minutes (IQR: 8-25) versus 20 minutes (IQR 11-40) for breast MRI. Differential travel time for both imaging modalities did not vary notably by breast cancer risk factors, but was significantly longer for non-urban residents. For non-Hispanic black, compared to non-Hispanic white women, the adjusted odds of traveling farther than the closest facility were 9% lower for mammography (OR 0.91; 95% CI:0.87-0.95), but more than two times higher for MRI (OR 2.64; 95% CI:1.36-5.13). Conclusions Breast cancer risk factors were not related to excess travel time for screening MRI, but sociodemographic factors were, suggesting the possibility that geographic distribution of advanced imaging may exacerbated disparities for some vulnerable populations. PMID:27026577

Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related?

PubMed

Onega, Tracy; Lee, Christoph I; Benkeser, David; Alford-Teaster, Jennifer; Haas, Jennifer S; Tosteson, Anna N A; Hill, Deirdre; Shi, Xun; Henderson, Louise M; Hubbard, Rebecca A

2016-06-01

Mammography, unlike MRI, is relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies on the basis of sociodemographic or breast cancer risk factors is unknown. The investigators examined screening mammography and MRI between 2005 and 2012 in the Breast Cancer Surveillance Consortium by (1) travel time to the closest and actual mammography facility used and the difference between the two, (2) women's breast cancer risk factors, and (3) sociodemographic characteristics. Logistic regression was used to examine the odds of traveling farther than the closest facility in relation to women's characteristics. Among 821,683 screening mammographic examinations, 76.6% occurred at the closest facility, compared with 51.9% of screening MRI studies (n = 3,687). The median differential travel time among women not using the closest facility for mammography was 14 min (interquartile range, 8-25 min) versus 20 min (interquartile range, 11-40 min) for breast MRI. Differential travel time for both imaging modalities did not vary notably by breast cancer risk factors but was significantly longer for nonurban residents. For non-Hispanic black compared with non-Hispanic white women, the adjusted odds of traveling farther than the closest facility were 9% lower for mammography (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) but more than two times higher for MRI (odds ratio, 2.64; 95% confidence interval, 1.36-5.13). Breast cancer risk factors were not related to excess travel time for screening MRI, but sociodemographic factors were, suggesting the possibility that geographic distribution of advanced imaging may exacerbated disparities for some vulnerable populations. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Environmental risk analysis of oil handling facilities in port areas. Application to Tarragona harbor (NE Spain).

PubMed

Valdor, Paloma F; Gómez, Aina G; Puente, Araceli

2015-01-15

Diffuse pollution from oil spills is a widespread problem in port areas (as a result of fuel supply, navigation and loading/unloading activities). This article presents a method to assess the environmental risk of oil handling facilities in port areas. The method is based on (i) identification of environmental hazards, (ii) characterization of meteorological and oceanographic conditions, (iii) characterization of environmental risk scenarios, and (iv) assessment of environmental risk. The procedure has been tested by application to the Tarragona harbor. The results show that the method is capable of representing (i) specific local pollution cases (i.e., discriminating between products and quantities released by a discharge source), (ii) oceanographic and meteorological conditions (selecting a representative subset data), and (iii) potentially affected areas in probabilistic terms. Accordingly, it can inform the design of monitoring plans to study and control the environmental impact of these facilities, as well as the design of contingency plans. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving Sustainability of Ion Implant Modules

NASA Astrophysics Data System (ADS)

Mayer, Jim

2011-01-01

Semiconductor fabs have long been pressured to manage capital costs, reduce energy consumption and increasingly improve efforts to recycle and recover resources. Ion implant tools have been high-profile offenders on all three fronts. They draw such large volumes of air for heat dissipation and risk reduction that historically, they are the largest consumer of cleanroom air of any process tool—and develop energy usage and resource profiles to match. This paper presents a documented approach to reduce their energy consumption and dramatically downsize on-site facilities support for cleanroom air manufacture and abatement. The combination produces significant capital expenditure savings. The case entails applying SAGS Type 1 (sub-atmospheric gas systems) toxic gas packaging to enable engineering adaptations that deliver the energy savings and cost benefits without any reduction in environmental health and safety. The paper also summarizes benefits as they relate to reducing a fabs carbon emission footprint (and longer range advantages relative to potential cap and trade programs) with existing technology.

Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities.

PubMed

Miller, Suellen; Fathalla, Mohamed M F; Ojengbede, Oladosu A; Camlin, Carol; Mourad-Youssif, Mohammed; Morhason-Bello, Imran O; Galadanci, Hadiza; Nsima, David; Butrick, Elizabeth; Al Hussaini, Tarek; Turan, Janet; Meyer, Carinne; Martin, Hilarie; Mohammed, Aminu I

2010-10-18

Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36). Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings.

Primary prevention of natural rubber latex allergy in the German health care system through education and intervention.

PubMed

Allmers, Henning; Schmengler, Jörg; Skudlik, Christoph

2002-08-01

The development of occupational asthma and allergic skin reactions caused by natural rubber latex (NRL) allergy are risks for health care workers. There are few published studies to suggest that intervention programs to reduce exposure will lead to primary prevention of sensitization. This study assesses the effects of intervention to reduce the incidence of NRL allergy in personnel working in health care facilities insured by the German statutory accident insurance company for health care workers, Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, with approximately 3 million insured employees, by switching to powder-free NRL gloves. The timing of introduction of intervention strategies, such as education of both physicians and administrators, together with regulations demanding that health care facilities only purchase low-protein, powder-free NRL gloves are reported. We reviewed the annual numbers of reported suspected cases of NRL-caused occupational allergies and the amount and type of gloves used in German acute-care hospitals since 1986. The purchase of powder-free NRL examination gloves exceeded that of powdered gloves for the first time in 1998. This only became true for powder-free NRL sterile gloves 2 years later in 2000. The incidence of suspected occupational NRL allergy cases rose until 1998 and has declined steadily since. There was a 2-year lag between the beginning of the decline in the purchase of powdered NRL examination gloves and the beginning of a decline in suspected NRL-caused occupational asthma cases. Despite the effect of increased recognition of NRL allergies, education about NRL allergies in health care facilities combined with the introduction of powder-free gloves with reduced protein levels has been associated with a decline in the number of suspected cases of occupational allergies caused by NRL in Germany on a nationwide scale. These results clearly indicate that primary prevention of occupational NRL allergies can be achieved if these straightforward and practical interventions are properly carried out and maintained.

A historical application of social amplification of risk model: Economic impacts of risk events at nuclear weapons facilities?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Metz, W.C.

1996-12-31

Public perceptions of risk have proven to be a critical barrier to the federal government`s extensive, decade-long, technical and scientific effort to site facilities for the interim storage and permanent disposal of high-level radioactive waste (HLW). The negative imagery, fear, and anxiety that are linked to ``nuclear`` and ``radioactive`` technologies, activities, and facilities by the public originate from the personal realities and experiences of individuals and the information they receive. These perceptions continue to be a perplexing problem for those responsible for making decisions about federal nuclear waste management policies and programs. The problem of understanding and addressing public perceptionsmore » is made even more difficult because there are decidedly different opinions about HLW held by the public and nuclear industry and radiation health experts.« less

Race, region and risk: An examination of minority proximity to noxious facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nieves, A.L.; Nieves, L.A.

1996-04-01

The past decade has given rise to terms like environmental racism, eco-racism, and environmental inequities to characterize a disproportional distribution of environmental disamenities among minority communities. Much of the literature supports the contention that racial and ethnic minorities and low-income groups bear a disproportionate burden of risk from hazardous activities and substances in the environment. This study expands the scope of prior studies by employing county-level data for the entire nation and including a broad range of facility types associated with environmental disamenities. In addition, it addresses the issue of the distribution of noxious facilities among white and non-white populationsmore » in an attempt to determine the relative exposure to risk among different racial and ethnic groups. In addition, the authors also explore the relative importance of nonurban versus urban residence.« less

75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... at Health Care Facilities AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA... Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted at hospitals, medical clinics... drafted a guidance document for health care facilities, which describes: Techniques for reducing or...

Why Integrate Educational and Community Facilities?

ERIC Educational Resources Information Center

Fessas-Emmanouil, Helen D.

1978-01-01

Discusses coordination of educational and community facilities in order to encourage more rational investments and more efficient use of premises. Such coordination may reduce the economic burden imposed upon citizens for the provision of separate facilities for school and community. However, implementation of such a facility presupposes radical…

A proven and highly cost-effective method of early detection of breast cancer for developing countries.

PubMed

Rebentisch, D P; Rebentisch, H D; Thomas, K; Karat, S; Jadhav, A J

1995-12-01

Carcinoma of the breast is the third most common cancer in Indian women. With rapid industrialization and effective control of communicable diseases, better diagnostic and treatment facilities, cancer is emerging as a major health problem. Since early detection is the only way to reduce morbidity and mortality from breast cancer, we undertook a pilot project to evaluate efficacy of using existing manpower and resources for screening women in the high risk group. Methodology pros and cons, results, and recommendations are presented. Our method can be adopted by any developing country interested in a screening programme for malignant disease.

The challenge of the US Space Station

NASA Technical Reports Server (NTRS)

Beggs, J. M.

1985-01-01

The U.S. Space Station program is described. The objectives of the present national space policy are reviewed. International involvement and commercial use of space are the two strategies involved in the development of the Space Station. The Space Station is to be a multifunctional, modular, permanent facility with manned and unmanned platforms. The functions of the Space Station for space research projects, such as material processing and electrophoresis, are examined. The infrastructure required for commercialization of space is analyzed. NASA's space policy aimed at stimulating space commerce is discussed. NASA's plans to reduce the financial, institutional, and technical risks of space research are studied.

Model-Scale Aerodynamic Performance Testing of Proposed Modifications to the NASA Langley Low Speed Aeroacoustic Wind Tunnel

NASA Technical Reports Server (NTRS)

Booth, Earl R., Jr.; Coston, Calvin W., Jr.

2005-01-01

Tests were performed on a 1/20th-scale model of the Low Speed Aeroacoustic Wind Tunnel to determine the performance effects of insertion of acoustic baffles in the tunnel inlet, replacement of the existing collector with a new collector design in the open jet test section, and addition of flow splitters to the acoustic baffle section downstream of the test section. As expected, the inlet baffles caused a reduction in facility performance. About half of the performance loss was recovered by addition the flow splitters to the downstream baffles. All collectors tested reduced facility performance. However, test chamber recirculation flow was reduced by the new collector designs and shielding of some of the microphones was reduced owing to the smaller size of the new collector. Overall performance loss in the facility is expected to be a 5 percent top flow speed reduction, but the facility will meet OSHA limits for external noise levels and recirculation in the test section will be reduced.

Exposures and Health Outcomes in Relation to Bioaerosol Emissions From Composting Facilities: A Systematic Review of Occupational and Community Studies

PubMed Central

Pearson, Clare; Littlewood, Emma; Douglas, Philippa; Robertson, Sarah; Gant, Timothy W.; Hansell, Anna L.

2015-01-01

The number of composting sites in Europe is rapidly increasing, due to efforts to reduce the fraction of waste destined for landfill, but evidence on possible health impacts is limited. This article systematically reviews studies related to bioaerosol exposures within and near composting facilities and associated health effects in both community and occupational health settings. Six electronic databases and bibliographies from January 1960 to July 2014 were searched for studies reporting on health outcomes and/or bioaerosol emissions related to composting sites. Risk of bias was assessed using a customized score. Five hundred and thirty-six papers were identified and reviewed, and 66 articles met the inclusion criteria (48 exposure studies, 9 health studies, 9 health and exposure studies). Exposure information was limited, with most measurements taken in occupational settings and for limited time periods. Bioaerosol concentrations were highest on-site during agitation activities (turning, shredding, and screening). Six studies detected concentrations of either Aspergillus fumigatus or total bacteria above the English Environment Agency’s recommended threshold levels beyond 250 m from the site. Occupational studies of compost workers suggested elevated risks of respiratory illnesses with higher bioaerosol exposures. Elevated airway irritation was reported in residents near composting sites, but this may have been affected by reporting bias. The evidence base on health effects of bioaerosol emissions from composting facilities is still limited, although there is sufficient evidence to support a precautionary approach for regulatory purposes. While data to date are suggestive of possible respiratory effects, further study is needed to confirm this and to explore other health outcomes. PMID:25825807

Hepatitis B virus infection in US correctional facilities: a review of diagnosis, management, and public health implications.

PubMed

Gupta, Shaili; Altice, Frederick L

2009-03-01

Among the blood-borne chronic viral infections, hepatitis B virus (HBV) infection is one that is not only treatable but also preventable by provision of vaccination. Despite the availability of HBV vaccine for the last 15 years, more than 1.25 million individuals in the USA have chronic HBV infection, and about 5,000 die each year from HBV-related complications. From a societal perspective, access to treatment of chronic viral infections, like HIV and viral hepatitis, is highly cost-effective and has lasting benefits by reducing risk behaviors, morbidity, mortality, as well as disease transmission in the community. Individuals in correctional facilities are specially predisposed to such chronic viral infections because of their high-risk behaviors. The explosion of incarceration in the USA over the last few decades and the disproportionate burden of morbidity and mortality from chronic infections among the incarcerated have put incredible strains on an overcrowded system that was not originally designed to provide comprehensive medical care for chronic illnesses. Recently, there has been a call to address medical care for individuals with chronic medical conditions in correctional settings, including those with infectious diseases. The economic and public health burden of chronic hepatitis B and its sequelae, including cirrhosis and hepatocellular carcinoma, is felt most prominently in managed care settings with limited budgets, like correctional facilities. Prevalence of HBV infection among the incarcerated in the USA is fivefold that of the general population. We present a review of diagnosis, prevention, and the recently streamlined treatment guidelines for management of HBV infection in correctional settings, and discuss the implications and public health impact of these measures.

Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries.

PubMed

Edmond, Karen M; Quigley, Maria A; Zandoh, Charles; Danso, Samuel; Hurt, Chris; Owusu Agyei, Seth; Kirkwood, Betty R

2008-09-01

In developing countries many stillbirths and neonatal deaths occur at home and cause of death is not recorded by national health information systems. A community-level verbal autopsy tool was used to obtain data on the aetiology of stillbirths and neonatal deaths in rural Ghana. Objectives were to describe the timing and distribution of causes of stillbirths and neonatal deaths according to site of death (health facility or home). Data were collected from 1 January 2003 to 30 June 2004; 20,317 deliveries, 696 stillbirths and 623 neonatal deaths occurred over that time. Most deaths occurred in the antepartum period (28 weeks gestation to the onset of labour) (33.0%). However, the highest risk periods were during labour and delivery (intrapartum period) and the first day of life. Infections were a major cause of death in the antepartum (10.1%) and neonatal (40.3%) periods. The most important cause of intrapartum death was obstetric complications (59.3%). There were significantly fewer neonatal deaths resulting from birth asphyxia in the home than in the health facilities and more deaths from infection. Only 59 (20.7%) mothers of neonates who died at home reported that they sought care from an appropriate health care provider (doctor, nurse or health facility) during their baby's illness. The results from this study highlight the importance of studying community-level data in developing countries and the high risk of intrapartum stillbirths and infectious diseases in the rural African mother and neonate. Community-level interventions are urgently needed, especially interventions that reduce intrapartum deaths and infection rates in the mother and infant.

Space Shuttle Propulsion Systems Plume Modeling and Simulation for the Lift-Off Computational Fluid Dynamics Model

NASA Technical Reports Server (NTRS)

Strutzenberg, L. L.; Dougherty, N. S.; Liever, P. A.; West, J. S.; Smith, S. D.

2007-01-01

This paper details advances being made in the development of Reynolds-Averaged Navier-Stokes numerical simulation tools, models, and methods for the integrated Space Shuttle Vehicle at launch. The conceptual model and modeling approach described includes the development of multiple computational models to appropriately analyze the potential debris transport for critical debris sources at Lift-Off. The conceptual model described herein involves the integration of propulsion analysis for the nozzle/plume flow with the overall 3D vehicle flowfield at Lift-Off. Debris Transport Analyses are being performed using the Shuttle Lift-Off models to assess the risk to the vehicle from Lift-Off debris and appropriately prioritized mitigation of potential debris sources to continue to reduce vehicle risk. These integrated simulations are being used to evaluate plume-induced debris environments where the multi-plume interactions with the launch facility can potentially accelerate debris particles toward the vehicle.

Serological Susceptibility to Varicella among U.S. Immigration and Customs Enforcement Detainees

PubMed Central

Varan, Aiden K.; Lederman, Edith R.; Stous, Shanon S.; Elson, Diana; Freiman, Jennifer L.; Marin, Mona; Lopez, Adriana S.; Stauffer, William M.; Joseph, Rachael H.; Waterman, Stephen H.

2018-01-01

U.S. Immigration and Customs Enforcement (ICE) is responsible for detaining unauthorized aliens during immigration proceedings. During 2014–2015, adult ICE detainees at a California facility were invited to complete a survey concerning self-reported varicella history and risk factors. Participants underwent serological testing for varicella-zoster virus (VZV) IgG; susceptible individuals were offered varicella vaccination. Among 400 detainees with available serology results, 48 (12%) were susceptible to varicella. Self-reported varicella history was negatively associated with susceptibility (adjusted odds ratio [aOR]=0.16; 95% CI=0.07, 0.35). Among 196 detainees reporting a positive history, 95% had VZV IgG levels suggestive of varicella immunity. Among 44 susceptible detainees offered vaccination, 86% accepted. Given relatively high varicella susceptibility, targeted screening and vaccination among ICE detainees lacking a positive history might reduce varicella transmission risks. PMID:28945148

Credit scoring analysis using kernel discriminant

NASA Astrophysics Data System (ADS)

Widiharih, T.; Mukid, M. A.; Mustafid

2018-05-01

Credit scoring model is an important tool for reducing the risk of wrong decisions when granting credit facilities to applicants. This paper investigate the performance of kernel discriminant model in assessing customer credit risk. Kernel discriminant analysis is a non- parametric method which means that it does not require any assumptions about the probability distribution of the input. The main ingredient is a kernel that allows an efficient computation of Fisher discriminant. We use several kernel such as normal, epanechnikov, biweight, and triweight. The models accuracy was compared each other using data from a financial institution in Indonesia. The results show that kernel discriminant can be an alternative method that can be used to determine who is eligible for a credit loan. In the data we use, it shows that a normal kernel is relevant to be selected for credit scoring using kernel discriminant model. Sensitivity and specificity reach to 0.5556 and 0.5488 respectively.

Peer education programs in corrections: curriculum, implementation, and nursing interventions.

PubMed

Dubik-Unruh, S

1999-01-01

Despite the prevalence of HIV and other infectious diseases in U.S. prisons, and the mix of infected and high-risk prisoners in crowded and volatile living conditions, federal and state prisons have reduced or eliminated prevention education programs addressing HIV and other infectious diseases for incarcerated populations. Nurses' knowledge, education, and licensure place them in a position to influence prison policy in developing and implementing educational programs for inmates and staff. Their role as advocates for patients in prison and their separation from the more punitive aspects of corrections also enable nurses to earn the trust of inmate populations. These factors identify nurses as the staff best suited within corrections to implement inmate prevention education. Training inmate educators to provide peer prevention and strategies for risk reduction have potential to modify inmate behaviors both within the facility and following release. Selection criteria for peer educator recruitment, prison-sensitive issues, and suggested training activities are discussed.

The dose-response of time served in prison on mortality: New York State, 1989-2003.

PubMed

Patterson, Evelyn J

2013-03-01

I investigated the differential impact of the dose-response of length of stay on postprison mortality among parolees. Using 1989-2003 New York State parole administrative data from the Bureau of Justice Statistics on state correctional facilities, I employed multinomial logistic regression analyses and formal demographic techniques that used the life table of the populations to deduce changes in life expectancy. Each additional year in prison produced a 15.6% increase in the odds of death for parolees, which translated to a 2-year decline in life expectancy for each year served in prison. The risk was highest upon release from prison and declined over time. The time to recovery, or the lowest risk level, was approximately two thirds of the time served in prison. Incarceration reduces life span. Future research should investigate the pathways to this higher mortality and the possibilities of recovery.