Mortality in a Combined Cohort of Uranium Enrichment Workers

PubMed Central

Yiin, James H.; Anderson, Jeri L.; Daniels, Robert D.; Bertke, Stephen J.; Fleming, Donald A.; Tollerud, David J.; Tseng, Chih-Yu; Chen, Pi-Hsueh; Waters, Kathleen M.

2017-01-01

Objective To examine the patterns of cause-specific mortality and relationship between internal exposure to uranium and specific causes in a pooled cohort of 29,303 workers employed at three former uranium enrichment facilities in the United States with follow-up through 2011. Methods Cause-specific standardized mortality ratios (SMRs) for the full cohort were calculated with the U.S. population as referent. Internal comparison of the dose-response relation between selected outcomes and estimated organ doses was evaluated using regression models. Results External comparison with the U.S. population showed significantly lower SMRs in most diseases in the pooled cohort. Internal comparison showed positive associations of absorbed organ doses with multiple myeloma, and to a lesser degree with kidney cancer. Conclusion In general, these gaseous diffusion plant workers had significantly lower SMRs than the U.S. population. The internal comparison however, showed associations between internal organ doses and diseases associated with uranium exposure in previous studies. PMID:27753121

Estimate of radon exposure in geothermal spas in Poland.

PubMed

Walczak, Katarzyna; Olszewski, Jerzy; Zmyślony, Marek

2016-01-01

Geothermal waters may contain soluble, radioactive radon gas. Spa facilities that use geothermal water may be a source of an increased radiation dose to people who stay there. It has been necessary to assess the exposure to radon among people: workers and visitors of spa centers that use geothermal waters. In 2013, workers of the Nofer Institute of Occupational Medicine measured concentrations of radon over the geothermal water surfaces in 9 selected Polish spa centers which use geothermal water for recreational and medicinal purposes. The measurements were performed by active dosimetry using Lucas scintillation cells. According to our research, the doses received by the personnel in Polish geothermal spas are < 0.6 mSv/year. In 1 of the investigated spas, the estimated annual dose to the staff may exceed 3 mSv/year. In Polish geothermal spas, neither the workers nor the visitors are at risk of receiving doses that exceed the safe limits. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

[Estimation of effective doses derived from radon in selected SPA centers that use geothermal waters based on the information of radon concentrations].

PubMed

Walczak, Katarzyna; Zmyślony, Marek

2013-01-01

Geothermal waters contain, among other components, soluble radon gas. Alpha radioactive radon is a health hazard to humans, especially when it gets into the respiratory tract. SPA facilities that use geothermal water can be a source of an increased radiation dose to people who stay there. Based on the available literature concerning radon concentrations, we assessed exposure to radon among people - workers and visitors of Spa centers that use geothermal waters. Radon concentrations were analyzed in 17 geothermal centers: in Greece (3 centers), Iran (5), China (4) and India (5). Doses recived by people in the SPA were estimated using the formula that 1 hour exposure to 1 Bq/m3 of radon concentration and equilibrium factor F = 0.4 corresponds to an effective dose of 3.2 nSv. We have found that radon levels in SPAs are from a few to several times higher than those in confined spaces, where geothermal waters are not used (e.g., residential buildings). In 82% of the analyzed SPAs, workers may receive doses above 1 mSv/year. According to the relevant Polish regulations, people receiving doses higher than 1 mSv/year are included in category B of radiation exposure and require regular dosimetric monitoring. Doses received by SPA visitors are much lower because the time of their exposure to radon released from geothermal water is rather short. The analysis of radon concentration in SPA facilities shows that the radiological protection of people working with geothermal waters plays an important role. It seems reasonable to include SPA workers staying close to geotermal waters into a dosimetric monitoring program.

Reliability of eye lens dosimetry in workers of a positron emission tomography radiopharmaceutical production facility.

PubMed

da Silva, Teógenes A; Guimarães, Margarete C; Meireles, Leonardo S; Teles, Luciana L D; Lacerda, Marco Aurélio S

2016-11-01

A new regulatory statement was issued concerning the eye lens radiation protection of persons in planned exposures. A debate was raised on the adequacy of the dosimetric quantity and on its method of measurement. The aim of this work was to establish the individual monitoring procedure with the EYE-D™ holder and a MCP-N LiF:Mg,Cu,P thermoluminescent chip detector for measuring the personal dose equivalent H p (3) in workers of a Positron Emission Tomography Radiopharmaceutical Production Facility. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of the benefits and impacts in the U.S. Nuclear Power Industry of hypothesized lower occupational dose limits

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

Andersen, R.L.; Schmitt, J.F.

1995-03-01

The International Commission on Radiological Protection and the National Council on Radiation Protection and Measurements have issued recommendations that would limit occupational exposure of individuals to doses lower than regulatory limits contained in the Nuclear Regulatory Commission`s 10 CFR Part 20, {open_quotes}Standards for Protection Against Radiation{close_quotes}. Because of this situation, there is interest in the potential benefits and impacts that would be associated with movement of the NRC regulatory limits toward the advisory bodies recommendations. The records of occupational worker doses in the U.S. commercial nuclear power industry show that the vast majority of these workers have doses that aremore » significantly below the regulatory limit of 50 mSv (5 rem) per year. Some workers doses do approach the limits, however. This is most common in the case of specially skilled workers, especially those with skills utilized in support of plant outage work. Any consideration of the potential benefits and impacts of hypothesized lower dose limits must address these workers as an important input to the overall assessment. There are also, of course, many other areas in which the benefits and impacts must be evaluated. To prepare to provide valid, constructive input on this matter, the U.S. nuclear power industry is undertaking an assessment, facilitated by the Nuclear Energy Institute (NEI), of the potential benefits and impacts at its facilities associated with hypothesized lower occupational dose limits. Some preliminary results available to date from this assessment are provided.« less

WORKER INHALATION DOSE COEFFICIENTS FOR RADIONUCLIDES NOT PREVIOUSLY IDENTIFIED IN ICRP PUBLICATION 68

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

McLaughlin, David A; Schwahn, Scott O

2011-01-01

While inhalation dose coefficients are provided for about 800 radionuclides in International Commission on Radiological Protection (ICRP) Publication 68, many radionuclides of practical dosimetric interest for facilities such as high-energy proton accelerators are not specifically addressed, nor are organ-specific dose coefficients tabulated. The ICRP Publication 68 methodology is used, along with updated radiological decay data and metabolic data, to identify committed equivalent dose coefficients [hT(50)] and committed effective dose coefficients [e(50)] for radionuclides produced at the Oak Ridge National Laboratory s Spallation Neutron Source.

INDIVIDUAL DOSIMETRY IN DISPOSAL REPOSITORY OF HEAT-GENERATING NUCLEAR WASTE.

PubMed

Pang, Bo; Saurí Suárez, Héctor; Becker, Frank

2016-09-01

Certain working scenarios in a disposal facility of heat-generating nuclear waste might lead to an enhanced level of radiation exposure for workers in such facilities. Hence, a realistic estimation of the personal dose during individual working scenarios is desired. In this study, the general-purpose Monte Carlo N-Particle code MCNP6 (Pelowitz, D. B. (ed). MCNP6 user manual LA-CP-13-00634, Rev. 0 (2013)) was applied to simulate a representative radiation field in a disposal facility. A tool to estimate the personal dose was then proposed by taking into account the influence of individual motion sequences during working scenarios. As basis for this approach, a movable whole-body phantom was developed to describe individual body gestures of the workers during motion sequences. In this study, the proposed method was applied to the German concept of geological disposal in rock salt. The feasibility of the proposed approach was demonstrated with an example of working scenario in an emplacement drift of a rock salt mine. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

EVALUATION OF PROMPT DOSE ENVIRONMENT IN THE NATIONAL IGNITION FACILITY DURING D-D AND THD SHOTS

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

Khater, H; Dauffy, L; Sitaraman, S

2009-04-28

Evaluation of the prompt dose environment expected in the National Ignition Facility (NIF) during Deuterium-Deuterium (D-D) and Tritium-Hydrogen-Deuterium (THD) shots have been completed. D-D shots resulting in the production of an annual fusion yield of up to 2.4 kJ (200 shots with 10{sup 13} neutrons per shot) are considered. During the THD shot campaign, shots generating a total of 2 x 10{sup 14} neutrons per shot are also planned. Monte Carlo simulations have been performed to estimate prompt dose values inside the facility as well as at different locations outside the facility shield walls. The Target Chamber shielding, along withmore » Target Bay and Switchyard walls, roofs, and shield doors (when needed) will reduce dose levels in occupied areas to acceptable values during these shot campaigns. The calculated dose values inside occupied areas are small, estimated at 25 and 85 {micro}rem per shot during the D-D and THD shots, respectively. Dose values outside the facility are insignificant. The nearest building to the NIF facility where co-located workers may reside is at a distance of about 100 m from the Target Chamber Center (TCC). The dose in such a building is estimated at a fraction of a ?rem during a D-D or a THD shot. Dose at the nearest site boundary location (350 m from TCC), is caused by skyshine and to a lesser extent by direct radiation. The maximum off-site dose during any of the shots considered is less than 10 nano rem.« less

Examining the cost of delivering routine immunization in Honduras.

PubMed

Janusz, Cara Bess; Castañeda-Orjuela, Carlos; Molina Aguilera, Ida Berenice; Felix Garcia, Ana Gabriela; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen C

2015-05-07

Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011. The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars. With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach. These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer-term resource allocation decisions. Copyright © 2015. Published by Elsevier Ltd.

Seasonal influenza vaccination of healthcare employees: results of a 4-year campaign.

PubMed

Hirsch, Pamela; Hodgson, Michael; Davey, Victoria

2011-05-01

To document successful substantial increases in healthcare worker influenza vaccination rates and to identify reasons for success and failure. (1) Four-year longitudinal characterization of facility vaccination rates, (2) Web-based facility-level questionnaire for influenza coordinators to identify success factors in year 3, and (3) semistructured telephone interviews of influenza coordinators at facilities with substantial increases or declines in year 4. National single-payer hospital (healthcare) system with 153 hospitals in 5 levels of complexity. Facility leadership staff. (1) Vaccination data collected from management sources (doses from pharmacies, denominator data from payrolls); (2) a Web-based survey aligned with a previously administered instrument (Wisconsin Health Department), piloted in-house, modified to reflect national strategies and improvements; and (3) semistructured telephone interviews with influenza coordinators at facilities that improved or worsened by more than 20% between the 2007-2008 and 2008-2009 influenza seasons. Vaccination acceptance rates improved from 45% of healthcare workers in 2005-2006 to 66.5% in 2008-2009. Facilities with lower complexity had higher vaccination rates. No individual factors were associated with improved performance. Sustained management attention can lead to improvements in healthcare worker influenza vaccination rates. Wavering of attention, though, may lead to rapid loss of effectiveness. Declination statements in this system did not contribute to vaccine acceptance.

75 FR 10807 - Subcommittee on Procedures Reviews (SPR), Advisory Board on Radiation and Worker Health (ABRWH...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-09

... (``Effect of Threshold Energy and Angular Response of NTA Film on Missed Neutron Dose at the Oak Ridge Y-12... Periods at Atomic Weapons Employer Facilities''); and a continuation of the comment-resolution process for...

Increased occupational radiation doses: nuclear fuel cycle.

PubMed

Bouville, André; Kryuchkov, Victor

2014-02-01

The increased occupational doses resulting from the Chernobyl nuclear reactor accident that occurred in Ukraine in April 1986, the reactor accident of Fukushima that took place in Japan in March 2011, and the early operations of the Mayak Production Association in Russia in the 1940s and 1950s are presented and discussed. For comparison purposes, the occupational doses due to the other two major reactor accidents (Windscale in the United Kingdom in 1957 and Three Mile Island in the United States in 1979) and to the main plutonium-producing facility in the United States (Hanford Works) are also covered but in less detail. Both for the Chernobyl nuclear reactor accident and the routine operations at Mayak, the considerable efforts made to reconstruct individual doses from external irradiation to a large number of workers revealed that the recorded doses had been overestimated by a factor of about two.Introduction of Increased Occupational Exposures: Nuclear Industry Workers. (Video 1:32, http://links.lww.com/HP/A21).

Occupational exposure assessment: Practices in Malaysian nuclear agency

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

Sarowi, S. Muhd, E-mail: suzie@nuclearmalaysia.gov.my; Ramli, S. A.; Kontol, K. Mohamad

Malaysian Nuclear Agency (Nuclear Malaysia) is the leading agency in introducing and promoting the application of nuclear science technology in Malaysia. The agency provides major nuclear facilities purposely for research and commercialisation such as reactor, irradiation plants and radioisotope production laboratory. When dealing with ionizing radiation, there is an obligatory requirement to monitor and assess the radiation exposure to the workers. The personal dose of radiation workers were monitored monthly by assessing their Thermoluminescence Dosimeter (TLD) dose reading. This paper will discuss the current practice in managing, assessing, record keeping and reporting of the occupational exposure in Nuclear Malaysia includingmore » the Health Physic Group roles and challenges. The statistics on occupational radiation exposure of monitored workers working in different fields in Nuclear Malaysia from 2011 - 2013 will also be presented. The results show that the null hypothesis (H{sub 0}) was accepted which the means of every populations are all equal or not differ significantly. This hypothesis states that the dose exposure received by the radiation workers in Nuclear Malaysia is similar and there were no significant changes from 2011 to 2013. The radiation monitoring programme correlate with the requirement of our national law, the Atomic Energy Licensing Act 1984 (Act 304)« less

Occupational exposure assessment: Practices in Malaysian nuclear agency

NASA Astrophysics Data System (ADS)

Sarowi, S. Muhd; Ramli, S. A.; Kontol, K. Mohamad; Rahman, N. A. H. Abd.

2016-01-01

Malaysian Nuclear Agency (Nuclear Malaysia) is the leading agency in introducing and promoting the application of nuclear science technology in Malaysia. The agency provides major nuclear facilities purposely for research and commercialisation such as reactor, irradiation plants and radioisotope production laboratory. When dealing with ionizing radiation, there is an obligatory requirement to monitor and assess the radiation exposure to the workers. The personal dose of radiation workers were monitored monthly by assessing their Thermoluminescence Dosimeter (TLD) dose reading. This paper will discuss the current practice in managing, assessing, record keeping and reporting of the occupational exposure in Nuclear Malaysia including the Health Physic Group roles and challenges. The statistics on occupational radiation exposure of monitored workers working in different fields in Nuclear Malaysia from 2011 - 2013 will also be presented. The results show that the null hypothesis (H₀) was accepted which the means of every populations are all equal or not differ significantly. This hypothesis states that the dose exposure received by the radiation workers in Nuclear Malaysia is similar and there were no significant changes from 2011 to 2013. The radiation monitoring programme correlate with the requirement of our national law, the Atomic Energy Licensing Act 1984 (Act 304).

Analysis of the photoneutron activation effects generated by 9 MeV X-ray in a container cargo inspection facility.

PubMed

Cho, Young Ho; Kang, Bo Sun

2010-06-01

The X-ray container cargo inspection facility is extensively implemented with the key objective to counter international terrorism and illicit smuggling of the contraband items via the ports. However, activation products are generated from photoneutron capture reactions in the high-energy X-ray container cargo inspection facility. The activation products release inherent delayed radiations which occupational workers are exposed to. In this study, the activation products are estimated using Monte Carlo method and radiation safety of the facility in terms of occupational dose is reviewed.

The Russian radiation legacy: its integrated impact and lessons.

PubMed

Goldman, M

1997-12-01

Information about the consequences of human exposure to radiation in the former Soviet Union has recently become available. These data add new insights and provide possible answers to several important questions regarding radiation and its impact on occupational and public health. The 1986 Chernobyl accident initiated a major and early increase in childhood thyroid cancer that resulted from ingestion of iodine-131 (131I) by young children living in the most heavily contaminated areas of Belarus, Ukraine, and Russia. No significant additional cancer or other adverse medical effects have yet been reported in the affected populations and among clean-up workers. Major psychological stress independent of radiation dose has been observed in those people thought to be exposed. During the early days of the atomic energy program in the former Soviet Union, some unfortunate events occurred. The country's first atomic test in Semipalatinsk in 1949 exposed over 25,000 people downwind from the blast to significant doses of fission products, especially 131I. During the late 1940s and the early 1950s nuclear material production facilities were developed near Chelyabinsk in the South Ural Mountains, which resulted in major releases into the environment and significant overexposures for thousands of workers and nearby populations. Chronic radiation sickness was observed early in exposed workers, and increases in leukemia and other cancers were also reported. The series of plutonium inhalation-related lung cancers and fatalities among workers exposed in that first decade appears to be unique. Long-term consequences of chronic radiation sickness and four decades of follow-up are being described for the first time. Villagers downstream from the plant consumed high levels of 137Cs and 90Sr and, it is reported, manifested increases in leukemia from internal and external exposures. Although the 40-year databases for retrospective dosimetry epidemiology studies are just beginning to be integrated and evaluated, preliminary evaluations suggest that there may be graded, significant dose-rate amelioration factors for cancer and leukemia risks in workers and the general population relative to the risk data on the Japanese atomic bomb survivors. Even for plutonium-induced lung cancers in workers, such a dose-rate effect may be evident. These experiences give us insight into the consequences of protracted radiation at high and low doses and rates. If these findings are validated and confirmed, they can provide information that reduces some of the uncertainties in retrospective radiation dosimetry and radiation risk estimates (especially for low-level, chronic exposures) for activities related to medicine as well as the handling of nuclear materials and nuclear facility decommissioning, decontamination, and demilitarization.

Determination of in vitro lung solubility and intake-to-dose conversion factor for tritiated lanthanum nickel aluminum alloy.

PubMed

Farfán, Eduardo B; Labone, Thomas R; Staack, Gregory C; Cheng, Yung-Sung; Zhou, Yue; Varallo, Thomas P

2012-09-01

A sample of tritiated lanthanum nickel aluminum alloy (LaNi4.25Al0.75 or LANA.75) similar to that used at the Savannah River Site Tritium Facilities was analyzed to estimate the particle size distribution of this metal tritide powder and the rate at which this material dissolves in the human respiratory tract after it is inhaled. This information is used to calculate the committed effective dose received by a worker after inhaling the material. These doses, which were calculated using the same methodology given in the U.S. Department of Energy Tritium Handbook, are presented as inhalation intake-to-dose conversion factors (DCF). The DCF for this metal tritide was determined to be 9.4 × 10 Sv Bq, which is less than the DCF for tritiated water. Therefore, the radiation worker bioassay programs designed for tritiated water are adequate to monitor for intakes of this material.

Improving antimicrobial use among health workers in first-level facilities: results from the multi-country evaluation of the Integrated Management of Childhood Illness strategy.

PubMed Central

Gouws, Eleanor; Bryce, Jennifer; Habicht, Jean-Pierre; Amaral, João; Pariyo, George; Schellenberg, Joanna Armstrong; Fontaine, Olivier

2004-01-01

OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries. PMID:15508195

Calculated organ doses for Mayak production association central hall using ICRP and MCNP.

PubMed

Choe, Dong-Ok; Shelkey, Brenda N; Wilde, Justin L; Walk, Heidi A; Slaughter, David M

2003-03-01

As part of an ongoing dose reconstruction project, equivalent organ dose rates from photons and neutrons were estimated using the energy spectra measured in the central hall above the graphite reactor core located in the Russian Mayak Production Association facility. Reconstruction of the work environment was necessary due to the lack of personal dosimeter data for neutrons in the time period prior to 1987. A typical worker scenario for the central hall was developed for the Monte Carlo Neutron Photon-4B (MCNP) code. The resultant equivalent dose rates for neutrons and photons were compared with the equivalent dose rates derived from calculations using the conversion coefficients in the International Commission on Radiological Protection Publications 51 and 74 in order to validate the model scenario for this Russian facility. The MCNP results were in good agreement with the results of the ICRP publications indicating the modeling scenario was consistent with actual work conditions given the spectra provided. The MCNP code will allow for additional orientations to accurately reflect source locations.

Pulmonary deposition modeling with airborne fiber exposure data: a study of workers manufacturing refractory ceramic fibers.

PubMed

Lentz, Thomas J; Rice, Carol H; Succop, Paul A; Lockey, James E; Dement, John M; LeMasters, Grace K

2003-04-01

Increasing production of refractory ceramic fiber (RCF), a synthetic vitreous material with industrial applications (e.g., kiln insulation), has created interest in potential respiratory effects of exposure to airborne fibers during manufacturing. An ongoing study of RCF manufacturing workers in the United States has indicated an association between cumulative fiber exposure and pleural plaques. Fiber sizing data, obtained from electron microscopy analyses of 118 air samples collected in three independent studies over a 20-year period (1976-1995), were used with a computer deposition model to estimate pulmonary dose of fibers of specified dimensions for 652 former and current RCF production workers. Separate dose correction factors reflecting differences in fiber dimensions in six uniform job title groups were used with data on airborne fiber concentration and employment duration to calculate cumulative dose estimates for each worker. From review of the literature, critical dimensions (diameter <0.4 microm, length <10 microm) were defined for fibers that may translocate to the parietal pleura. Each of three continuous exposure/dose metrics analyzed in separate logistic regression models was significantly related to plaques, even after adjusting for possible past asbestos exposure: cumulative fiber exposure, chi(2) = 15.2 (p < 0.01); cumulative pulmonary dose (all fibers), chi(2) = 14.6 (p < 0.01); cumulative pulmonary dose (critical dimension fibers), chi(2) = 12.4 (p < 0.01). Odds ratios (ORs) were calculated for levels of each metric. Increasing ORs were statistically significant for the two highest dose levels of critical dimension fibers (level three, OR = 11, 95%CI = [1.4, 98]; level four, OR = 25, 95%CI = [3.2, 190]). Similar associations existed for all metrics after adjustment for possible asbestos exposure. It was concluded that development of pleural plaques follows exposure- and dose-response patterns, and that airborne fibers in RCF manufacturing facilities include those with critical dimensions associated with pleural plaque formation. Analysis of additional air samples may improve estimates of the dose-response relationship.

75 FR 28626 - Subcommittee on Procedures Review, Advisory Board on Radiation and Worker Health (ABRWH...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

...''), OTIB-0051 (``Effect of Threshold Energy and Angular Response of NTA Film on Missed Neutron Dose at the... Reconstruction During Residual Radioactivity Periods at Atomic Weapons Employer Facilities''), and TBD 6000 (``Site Profile for Atomic Weapons Employers that Worked Uranium and Thorium Metals''); and a continuation...

Frequency and quality of radiation monitoring of construction workers at two gaseous diffusion plants.

PubMed

Bingham, Eula; Ringen, Knut; Dement, John; Cameron, Wilfrid; McGowan, William; Welch, Laura; Quinn, Patricia

2006-09-01

Construction workers were and are considered temporary workers at many construction sites. Since World War II, large numbers of construction workers were employed at U.S. Department of Energy nuclear weapons sites for periods ranging from a few days to over 30 years. These workers performed tasks during new construction and maintenance, repair, renovation, and demolition of existing facilities. Such tasks may involve emergency situations, and may entail opportunities for significant radiation exposures. This paper provides data from interviews with more than 750 construction workers at two gaseous diffusion plants (GDPs) at Paducah, Kentucky, and Portsmouth, Ohio regarding radiation monitoring practices. The aim was to determine the extent to which workers believed they were monitored during tasks involving potential radiation exposures. The adequacy of monitoring practices is important for two reasons: (a) Protecting workers from exposures: Construction workers were employed by sub-contractors, and may frequently been excluded from safety and health programs provided to permanent employees; and (b) Supporting claims for compensation: The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) requires dose reconstruction of radiation exposures for most workers who file a claim regarding cancer. The use of monitoring data for radiation to qualify a worker means that there should be valid and complete monitoring during the work time at the various nuclear plants or workers may be unfairly denied compensation. The worker interviews from Paducah and Portsmouth were considered especially useful because these sites were designated as Special Exposure Cohorts (SECs) and the workers did not have to have a dose reconstruction to qualify for compensation for most cancers. Therefore, their responses were less likely to be affected by compensation concerns. Interview questions included asking for information regarding whether monitoring was performed, how often, and the maintenance (calibration) of monitoring equipment (devices).

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

Podonsky, Glenn S.

The U.S. Department of Energy (DOE) Office of Analysis within the Office of Health, Safety and Security (HSS) publishes the annual DOE Occupational Radiation Exposure Report to provide an overview of the status of radiation protection practices at DOE (including the National Nuclear Security Administration [NNSA]). The DOE 2012 Occupational Radiation Exposure Report provides an evaluation of DOE-wide performance regarding compliance with Title 10, Code of Federal Regulations (C.F.R.), Part 835, Occupational Radiation Protection dose limits and as low as reasonably achievable (ALARA) process requirements. In addition, the report provides data to DOE organizations responsible for developing policies for protectionmore » of individuals from the adverse health effects of radiation. The report provides a summary and an analysis of occupational radiation exposure information from the monitoring of individuals involved in DOE activities. Over the past 5-year period, the occupational radiation exposure information is analyzed in terms of aggregate data, dose to individuals, and dose by site. As an indicator of the overall amount of radiation dose received during the conduct of operations at DOE, the report includes information on collective total effective dose (TED). The TED is comprised of the effective dose (ED) from external sources, which includes neutron and photon radiation, and the internal committed effective dose (CED), which results from the intake of radioactive material into the body. The collective ED from photon exposure decreased by 23% between 2011 and 2012, while the neutron dose increased by 5%. The internal dose components of the collective TED decreased by 7%. Over the past 5-year period, 99.99% of the individuals receiving measurable TED have received doses below the 2 roentgen equivalent in man (rems) (20 millisievert [mSv]) TED administrative control level (ACL), which is well below the DOE regulatory limit of 5 rems (50 mSv) TED annually. The occupational radiation exposure records show that in 2012, DOE facilities continued to comply with DOE dose limits and ACLs and worked to minimize exposure to individuals. The DOE collective TED decreased 17.1% from 2011 to 2012. The collective TED decreased at three of the five sites with the largest collective TED. u Idaho Site – Collective dose reductions were achieved as a result of continuing improvements at the Advanced Mixed Waste Treatment Project (AMWTP) through the planning of drum movements that reduced the number of times a container is handled; placement of waste containers that created highradiation areas in a centralized location; and increased worker awareness of high-dose rate areas. In addition, Idaho had the largest decrease in the total number of workers with measurable TED (1,143 fewer workers). u Hanford Site (Hanford) – An overall reduction of decontamination and decommissioning (D&D) activities at the Plutonium Finishing Plant (PFP) and Transuranic (TRU) retrieval activities resulted in collective dose reductions. u Savannah River Site (SRS) – Reductions were achieved through ALARA initiatives employed site wide. The Solid Waste Management Facility used extended specialty tools, cameras and lead shield walls to facilitate removal of drums. These tools and techniques reduce exposure time through improved efficiency, increase distance from the source of radiation by remote monitoring, shield the workers to lower the dose rate, and reduce the potential for contamination and release of material through repacking of waste. Overall, from 2011 to 2012, there was a 19% decrease in the number of workers with measurable dose. Furthermore, due to a slight decrease in both the DOE workforce (7%) and monitored workers (10%), the ratio of workers with measurable doses to monitored workers decreased to 13%. Another primary indicator of the level of radiation exposure covered in this report is the average measurable dose, which normalizes the collective dose over the population of workers who actually received a measurable dose. The average measurable TED increased by 3% from 2011 to 2012. Additional analyses show that the dose distribution in 2012 was similar to the distribution in 2011. In 2012, 13% of the monitored workers received a measurable TED and the average measurable TED, 0.069 rem, was less than 2% of the DOE limit. From 2011 to 2012, the collective TED and the number of individuals with measurable TED decreased 17.1% and 19%, respectively. These decreases were mainly due to an overall reduction of D&D activities at the PFP and TRU retrieval activities at Hanford; a 78% decrease in the number of targeted waste drums that were processed at the Idaho Site’s Accelerated Retrieval Project (ARP) from 5,566 drums in 2011 to a total of 1,211 drums processed in 2012; and ALARA initiatives employed site wide at SRS. In addition, the decreases were the result of decreased American Recovery and Reinvestment Act (ARRA) activities and continuing D&D, particularly at the DOE sites that comprise the majority of DOE collective dose. Over the past 5 years, the size of the monitored workforce has remained at a fairly stable level (within 12%), while the collective dose has varied up to 37%. No reported doses exceeded the DOE occupational limit of 5 rems TED in 2012 and no reported doses exceeded the DOE ACL of 2 rems TED.« less

Radiation Safety System for SPIDER Neutral Beam Accelerator

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

Sandri, S.; Poggi, C.; Coniglio, A.

2011-12-13

SPIDER (Source for Production of Ion of Deuterium Extracted from RF Plasma only) and MITICA (Megavolt ITER Injector Concept Advanced) are the ITER neutral beam injector (NBI) testing facilities of the PRIMA (Padova Research Injector Megavolt Accelerated) Center. Both injectors accelerate negative deuterium ions with a maximum energy of 1 MeV for MITICA and 100 keV for SPIDER with a maximum beam current of 40 A for both experiments. The SPIDER facility is classified in Italy as a particle accelerator. At present, the design of the radiation safety system for the facility has been completed and the relevant reports havemore » been presented to the Italian regulatory authorities. Before SPIDER can operate, approval must be obtained from the Italian Regulatory Authority Board (IRAB) following a detailed licensing process. In the present work, the main project information and criteria for the SPIDER injector source are reported together with the analysis of hypothetical accidental situations and safety issues considerations. Neutron and photon nuclear analysis is presented, along with special shielding solutions designed to meet Italian regulatory dose limits. The contribution of activated corrosion products (ACP) to external exposure of workers has also been assessed. Nuclear analysis indicates that the photon contribution to worker external exposure is negligible, and the neutron dose can be considered by far the main radiation protection issue. Our results confirm that the injector has no important radiological impact on the population living around the facility.« less

The Russian radiation legacy: its integrated impact and lessons.

PubMed Central

Goldman, M

1997-01-01

Information about the consequences of human exposure to radiation in the former Soviet Union has recently become available. These data add new insights and provide possible answers to several important questions regarding radiation and its impact on occupational and public health. The 1986 Chernobyl accident initiated a major and early increase in childhood thyroid cancer that resulted from ingestion of iodine-131 (131I) by young children living in the most heavily contaminated areas of Belarus, Ukraine, and Russia. No significant additional cancer or other adverse medical effects have yet been reported in the affected populations and among clean-up workers. Major psychological stress independent of radiation dose has been observed in those people thought to be exposed. During the early days of the atomic energy program in the former Soviet Union, some unfortunate events occurred. The country's first atomic test in Semipalatinsk in 1949 exposed over 25,000 people downwind from the blast to significant doses of fission products, especially 131I. During the late 1940s and the early 1950s nuclear material production facilities were developed near Chelyabinsk in the South Ural Mountains, which resulted in major releases into the environment and significant overexposures for thousands of workers and nearby populations. Chronic radiation sickness was observed early in exposed workers, and increases in leukemia and other cancers were also reported. The series of plutonium inhalation-related lung cancers and fatalities among workers exposed in that first decade appears to be unique. Long-term consequences of chronic radiation sickness and four decades of follow-up are being described for the first time. Villagers downstream from the plant consumed high levels of 137Cs and 90Sr and, it is reported, manifested increases in leukemia from internal and external exposures. Although the 40-year databases for retrospective dosimetry epidemiology studies are just beginning to be integrated and evaluated, preliminary evaluations suggest that there may be graded, significant dose-rate amelioration factors for cancer and leukemia risks in workers and the general population relative to the risk data on the Japanese atomic bomb survivors. Even for plutonium-induced lung cancers in workers, such a dose-rate effect may be evident. These experiences give us insight into the consequences of protracted radiation at high and low doses and rates. If these findings are validated and confirmed, they can provide information that reduces some of the uncertainties in retrospective radiation dosimetry and radiation risk estimates (especially for low-level, chronic exposures) for activities related to medicine as well as the handling of nuclear materials and nuclear facility decommissioning, decontamination, and demilitarization. PMID:9467049

Dose equivalent rate constants and barrier transmission data for nuclear medicine facility dose calculations and shielding design.

PubMed

Kusano, Maggie; Caldwell, Curtis B

2014-07-01

A primary goal of nuclear medicine facility design is to keep public and worker radiation doses As Low As Reasonably Achievable (ALARA). To estimate dose and shielding requirements, one needs to know both the dose equivalent rate constants for soft tissue and barrier transmission factors (TFs) for all radionuclides of interest. Dose equivalent rate constants are most commonly calculated using published air kerma or exposure rate constants, while transmission factors are most commonly calculated using published tenth-value layers (TVLs). Values can be calculated more accurately using the radionuclide's photon emission spectrum and the physical properties of lead, concrete, and/or tissue at these energies. These calculations may be non-trivial due to the polyenergetic nature of the radionuclides used in nuclear medicine. In this paper, the effects of dose equivalent rate constant and transmission factor on nuclear medicine dose and shielding calculations are investigated, and new values based on up-to-date nuclear data and thresholds specific to nuclear medicine are proposed. To facilitate practical use, transmission curves were fitted to the three-parameter Archer equation. Finally, the results of this work were applied to the design of a sample nuclear medicine facility and compared to doses calculated using common methods to investigate the effects of these values on dose estimates and shielding decisions. Dose equivalent rate constants generally agreed well with those derived from the literature with the exception of those from NCRP 124. Depending on the situation, Archer fit TFs could be significantly more accurate than TVL-based TFs. These results were reflected in the sample shielding problem, with unshielded dose estimates agreeing well, with the exception of those based on NCRP 124, and Archer fit TFs providing a more accurate alternative to TVL TFs and a simpler alternative to full spectral-based calculations. The data provided by this paper should assist in improving the accuracy and tractability of dose and shielding calculations for nuclear medicine facility design.

Determinants of routine immunization costing in Benin and Ghana in 2011.

PubMed

Ahanhanzo, Césaire Damien; Huang, Xiao Xian; Le Gargasson, Jean-Bernard; Sossou, Justin; Nyonator, Frank; Colombini, Anais; Gessner, Bradford D

2015-05-07

Existing tools to evaluate costs do not always capture the heterogeneity of costs at the facility level. This study seeks to address this issue through an analysis of determinants of health facility immunization costs. A statistical analysis on facility routine delivery and vaccine costs was conducted using ordinary least squares regression. Explanatory variables included the number of doses administered; proportion of time spent by facility staff on immunization; average staff wage; whether the health facility had enough staff; presence of cold chain equipment; distance to a vaccine collection point; and, facility ownership. Data were drawn from representative samples of primary care facilities in Benin and Ghana (46 and 50 facilities, respectively) collected as part of the EPIC studies. Weighted average RI immunization facility cost was US$ 16,459 in Ghana and US$ 14,994 in Benin. The regression found total doses administered to be positively and significantly associated with facility cost in both countries. A 10% increase in doses resulted in a 4% increase in cost in Ghana, and a 7.5% increase in Benin. In Ghana, the proportion of immunization time, presence of cold chain, and sufficiency of staff were positively and significantly associated with total cost. In Benin, facility cost was negatively and significantly related to distance to the vaccine collection point. In the pooled sample, facilities in capital cities were associated with significantly higher costs. This study provides evidence on the importance of the level of scale in determining facility immunization cost, as well as the role of availability of health workers and time they spend on immunization in Ghana and Benin. This type of analysis can provide insights into the costs of scaling up immunization services, and can assist with development of more efficient immunization strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Biological monitoring to determine worker dose in a butadiene processing plant

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

Bechtold, W.E.; Hayes, R.B.

1995-12-01

Butadiene (BD) is a reactive gas used extensively in the rubber industry and is also found in combustion products. Although BD is genotoxic and acts as an animal carcinogen, the evidence for carcinogenicity in humans is limited. Extrapolation from animal studies on BD carcinogenicity to risk in humans has been controversial because of uncertainties regarding relative biologic exposure and related effects in humans vs. experimental animals. To reduce this uncertainty, a study was designed to characterize exposure to BD at a polymer production facility and to relate this exposure to mutational and cytogenetic effects. Biological monitoring was used to bettermore » assess the internal dose of BD received by the workers. Measurement of 1,2-dihydroxy-4-(N-acetylcysteinyl) butane (M1) in urine served as the biomarker in this study. M1 has been shown to correlate with area monitoring in previous studies. Most studies that relate exposure to a toxic chemical with its biological effects rely on exposure concentration as the dose metric; however, exposure concentration may or may not reflect the actual internal dose of the chemical.« less

Integrating workplace exposure databases for occupational medicine services and epidemiologic studies at a former nuclear weapons facility.

PubMed

Ruttenber, A J; McCrea, J S; Wade, T D; Schonbeck, M F; LaMontagne, A D; Van Dyke, M V; Martyny, J W

2001-02-01

We outline methods for integrating epidemiologic and industrial hygiene data systems for the purpose of exposure estimation, exposure surveillance, worker notification, and occupational medicine practice. We present examples of these methods from our work at the Rocky Flats Plant--a former nuclear weapons facility that fabricated plutonium triggers for nuclear weapons and is now being decontaminated and decommissioned. The weapons production processes exposed workers to plutonium, gamma photons, neutrons, beryllium, asbestos, and several hazardous chemical agents, including chlorinated hydrocarbons and heavy metals. We developed a job exposure matrix (JEM) for estimating exposures to 10 chemical agents in 20 buildings for 120 different job categories over a production history spanning 34 years. With the JEM, we estimated lifetime chemical exposures for about 12,000 of the 16,000 former production workers. We show how the JEM database is used to estimate cumulative exposures over different time periods for epidemiological studies and to provide notification and determine eligibility for a medical screening program developed for former workers. We designed an industrial hygiene data system for maintaining exposure data for current cleanup workers. We describe how this system can be used for exposure surveillance and linked with the JEM and databases on radiation doses to develop lifetime exposure histories and to determine appropriate medical monitoring tests for current cleanup workers. We also present time-line-based graphical methods for reviewing and correcting exposure estimates and reporting them to individual workers.

Effective dose in the manufacturing process of rutile covered welding electrodes.

PubMed

Herranz, M; Rozas, S; Pérez, C; Idoeta, R; Núñez-Lagos, R; Legarda, F

2013-03-01

Shielded metal arc welding using covered electrodes is the most common welding process. Sometimes the covering contains naturally occurring radioactive materials (NORMs). In Spain the most used electrodes are those covered with rutile mixed with other materials. Rutile contains some detectable natural radionuclides, so it can be considered a NORM. This paper mainly focuses on the use of MCNP (Monte Carlo N-Particle Transport Code) as a predictive tool to obtain doses in a factory which produces this type of electrode and assess the radiological impact in a specific facility after estimating the internal dose.To do this, in the facility, areas of highest radiation and positions of workers were identified, radioactive content of rutile and rutile covered electrodes was measured, and, considering a worst possible scenario, external dose at working points has been calculated using MCNP. This procedure has been validated comparing the results obtained with those from a pressurised ionisation chamber and TLD dosimeters. The internal dose has been calculated using DCAL (dose and risk calculation). The doses range between 8.8 and 394 μSv yr(-1), always lower than the effective dose limit for the public, 1 mSv yr(-1). The highest dose corresponds to the mixing area.

Radionuclides and radiation doses in heavy mineral sands and other mining operations in Mozambique.

PubMed

Carvalho, Fernando P; Matine, Obete F; Taímo, Suzete; Oliveira, João M; Silva, Lídia; Malta, Margarida

2014-01-01

Sites at the littoral of Mozambique with heavy mineral sands exploited for ilmenite, rutile and zircon and inland mineral deposits exploited for tantalite, uranium and bauxite were surveyed for ambient radiation doses, and samples were collected for the determination of radionuclide concentrations. In heavy mineral sands, (238)U and (232)Th concentrations were 70±2 and 308±9 Bq kg(-1) dry weight (dw), respectively, whereas after separation of minerals, the concentrations in the ilmenite fraction were 2240±64 and 6125±485 Bq kg(-1) (dw), respectively. Tantalite displayed the highest concentrations with 44 738±2474 Bq kg(-1) of (238)U. Radiation exposure of workers in mining facilities is likely to occur at levels above the dose limit for members of the public (1 mSv y(-1)) and therefore radiation doses should be assessed as occupational exposures. Local populations living in these regions in general are not exposed to segregated minerals with high radionuclide concentrations. However, there is intensive artisanal mining and a large number of artisanal miners and their families may be exposed to radiation doses exceeding the dose limit. A radiation protection programme is therefore needed to ensure radiation protection of the public and workers of developing mining projects.

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

NONE

The DOE Occupational Radiation Exposure Report, 1992-1994 reports occupational radiation exposures incurred by individuals at US Department of Energy (DOE) facilities from 1992 through 1994. This report includes occupational radiation exposure information for all DOE employees, contractors, subcontractors, and visitors. This information is analyzed and trended over time to provide a measure of the DOE`s performance in protecting its workers from radiation. Occupational radiation exposure at DOE has been decreasing over the past 5 years. In particular, doses in the higher dose ranges are decreasing, including the number of doses in excess of the DOE limits and doses in excessmore » of the 2 rem Administrative Control Level (ACL). This is an indication of greater attention being given to protecting these individuals from radiation in the workplace.« less

The yellowed archives of yellowcake.

PubMed Central

Silver, K

1996-01-01

Extensive historical documentation of exposures and releases at government-owned energy facilities is a unique and valuable resource for analyzing and communicating health risks. Facilities at all stages of the atomic fuel cycle were the subject of numerous industrial hygiene, occupational health, and environmental assessments during the Cold War period. Uranium mines and mills on the Colorado Plateau were investigated as early as the 1940s. One such facility was the mill in Monticello, Utah, which began operation as a vanadium extraction plant in 1943 and was later adapted to recover uranium from carnotite ores. The mill ceased operation in 1960. The site was added to the federal Superfund list in 1986. ATSDR held public availability sessions in 1993 as part of its public health assessment process, at which several former mill workers voiced health concerns. An extensive literature search yielded several industrial hygiene evaluations of the Monticello mill and health studies that included Monticello workers, only two of which had been published in the peer-reviewed literature. In combination with the broader scientific literature, these historical reports provide a partial basis for responding to mill workers' contemporary health concerns. The strengths and limitations of the available exposure data for analytical epidemiologic studies and dose reconstruction are discussed. As an interim measure, the available historical documentation may be especially helpful in communicating about health risks with workers and communities in ways that acknowledge the historical context of their experience. Images p116-a p117-a p118-a PMID:8606907

Calibration factors for the SNOOPY NP-100 neutron dosimeter

NASA Astrophysics Data System (ADS)

Moscu, D. F.; McNeill, F. E.; Chase, J.

2007-10-01

Within CANDU nuclear power facilities, only a small fraction of workers are exposed to neutron radiation. For these individuals, roughly 4.5% of the total radiation equivalent dose is the result of exposure to neutrons. When this figure is considered across all workers receiving external exposure of any kind, only 0.25% of the total radiation equivalent dose is the result of exposure to neutrons. At many facilities, the NP-100 neutron dosimeter, manufactured by Canberra Industries Incorporated, is employed in both direct and indirect dosimetry methods. Also known as "SNOOPY", these detectors undergo calibration, which results in a calibration factor relating the neutron count rate to the ambient dose equivalent rate, using a standard Am-Be neutron source. Using measurements presented in a technical note, readings from the dosimeter for six different neutron fields in six source-detector orientations were used, to determine a calibration factor for each of these sources. The calibration factor depends on the neutron energy spectrum and the radiation weighting factor to link neutron fluence to equivalent dose. Although the neutron energy spectra measured in the CANDU workplace are quite different than that of the Am-Be calibration source, the calibration factor remains constant - within acceptable limits - regardless of the neutron source used in the calibration; for the specified calibration orientation and current radiation weighting factors. However, changing the value of the radiation weighting factors would result in changes to the calibration factor. In the event of changes to the radiation weighting factors, it will be necessary to assess whether a change to the calibration process or resulting calibration factor is warranted.

Evaluating Environmental, Health and Safety Impacts from Two Nuclear Fuel Cycles: A Comparative Analysis of Once-Through Uranium Use and Plutonium Recycle in Light Water Reactors

NASA Astrophysics Data System (ADS)

Smith, Bethan L.

The work presented in this dissertation represents a systems-level approach to investigate potential net impacts with respect to human health and the environment associated with transitioning to the MOC for the U.S. In Chapter 2, an updated systems-level conceptual model of the OTC is presented to more accurately portray the OTC as currently implemented in the U.S. The conceptual model is the basis for estimating the worker collective doses at each operational stage, and the first demonstration of a quantitative comparative radiological impact assessment from expected normal operations is presented. In the course of evaluating worker collective dose associated with modern OTC practices, it was found that the relative contributions from the two grouped operations (front-end operations for preparing reactor fuel and reactor operations) were substantially different from historical data and conventional wisdom. As a bookend to Chapter 2, a summary is provided that describes the nature of the differences and factors that led to these differences. Detailed information of the work as part of the published journal article based off of this corollary work is included as an Appendix (C). In Chapter 3, the study of worker collective doses from the phased introduction of reprocessing in the MOC scenario, and is presented similarly to the results in Chapter 2. MOC performance was also estimated by evaluating the radioactive waste generated that can be disposed and managed through known disposal practices in shallow-land burial. Relative to the OTC, MOC performance with respect to worker collective dose was not discernibly different; while the volume of radioactive waste generated decreased. It was found that although the sheer volume of radioactive waste avoided is large, the waste disposition pathway is known for the majority of this waste. The radioactive waste that requires disposal at a licensed off-site facility is examined in closer detail. The verification process for this study's comparative impacts of worker collective doses elucidates the dependence of net radiological impacts to workers to fuel-type use. This verification exercise then leads to concluding remarks that fuel-use proportions employed at the end of the hypothetical advanced NFC scenario within the reactor fleet can determine what level of analysis may be required to estimate the net impacts that may be incurred from an advanced NFC. In Chapter 4, a study of potential worker collective doses incurred from carrying out the strategy to manage and dispose of used nuclear fuel outlined by the U.S. Department of Energy (DOE) as part of a comprehensive federal waste management system (FWMS) is discussed. It was estimated that the worker collective dose from repository operations leads to the large part of the radiological impact of the new FWMS. The contribution to worker collective dose was compared to that of the contemporary OTC quantitative model presented in Chapter 2. The additional worker collective dose contributed by FWMS activities is small and when the contributions from each grouped operation of the OTC are renormalized, the FWMS ranges annually from 4-8%. Finally, Chapter 5 offers ideas for future work and provides a summary of the findings of this dissertation.

Radiation protection aspects of the operation in a cyclotron facility

NASA Astrophysics Data System (ADS)

Silva, P. P. N.; Carneiro, J. C. G. G.

2014-02-01

The activated accelerator cyclotron components and the radioisotope production may impact on the personnel radiation exposure of the workers during the routine maintenance and emergency repair procedures and any modification of the equipment. Since the adherence of the principle of ALARA (as low as reasonable achievable) constitutes a major objective of the cyclotron management, it has become imperative to investigate the radiation levels at the workplace and the probable health effects to the worker caused by radiation exposure. The data analysis in this study was based on the individual monitoring records during the period from 2007 to 2011. Monitoring of the workplace was also performed using gamma and neutron detectors to determine the dose rate in various predetermined spots. The results of occupational radiation exposures were analysed and compared with the values established in national standards and international recommendations. Important guidelines have been developed to reduce the individual dose.

Occupational exposures in two industrial plants devoted to the production of ammonium phosphate fertilisers.

PubMed

Bolívar, J P; García-Tenorio, R; Mosqueda, F; Gázquez, M J; López-Coto, I; Adame, J A; Vaca, F

2013-03-01

In order to fill a gap in the open literature, occupational exposures and activity concentrations have been assessed in two NORM industrial plants, located in the south-west of Spain, devoted to the production of mono-ammonium phosphate (MAP) and di-ammonium phosphate (DAP) fertilisers. The annual effective doses received by the workers from these plants are clearly below 1 mSv yr(-1) and the contribution due to external radiation is similar to that due to inhalation. The contribution to the maximum effective doses due to inhalation of particulate matter has been estimated to be about 0.12 mSv yr(-1), while the (222)Rn concentrations inside the plants are of no concern. Consequently, no additional actions or radiological protection measures need to be taken to decrease the natural radiation received by the workers in these facilities.

Impacts Analyses Supporting the National Environmental Policy Act Environmental Assessment for the Resumption of Transient Testing Program

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

Schafer, Annette L.; Brown, LLoyd C.; Carathers, David C.

2014-02-01

This document contains the analysis details and summary of analyses conducted to evaluate the environmental impacts for the Resumption of Transient Fuel and Materials Testing Program. It provides an assessment of the impacts for the two action alternatives being evaluated in the environmental assessment. These alternatives are (1) resumption of transient testing using the Transient Reactor Test Facility (TREAT) at Idaho National Laboratory (INL) and (2) conducting transient testing using the Annular Core Research Reactor (ACRR) at Sandia National Laboratory in New Mexico (SNL/NM). Analyses are provided for radiologic emissions, other air emissions, soil contamination, and groundwater contamination that couldmore » occur (1) during normal operations, (2) as a result of accidents in one of the facilities, and (3) during transport. It does not include an assessment of the biotic, cultural resources, waste generation, or other impacts that could result from the resumption of transient testing. Analyses were conducted by technical professionals at INL and SNL/NM as noted throughout this report. The analyses are based on bounding radionuclide inventories, with the same inventories used for test materials by both alternatives and different inventories for the TREAT Reactor and ACRR. An upper value on the number of tests was assumed, with a test frequency determined by the realistic turn-around times required between experiments. The estimates provided for impacts during normal operations are based on historical emission rates and projected usage rates; therefore, they are bounding. Estimated doses for members of the public, collocated workers, and facility workers that could be incurred as a result of an accident are very conservative. They do not credit safety systems or administrative procedures (such as evacuation plans or use of personal protective equipment) that could be used to limit worker doses. Doses estimated for transportation are conservative and are based on transport of the bounding radiologic inventory that will be contained in any given test. The transportation analysis assumes all transports will contain the bounding inventory.« less

Application of the kurtosis statistic to the evaluation of the risk of hearing loss in workers exposed to high-level complex noise.

PubMed

Zhao, Yi-Ming; Qiu, Wei; Zeng, Lin; Chen, Shan-Song; Cheng, Xiao-Ru; Davis, Robert I; Hamernik, Roger P

2010-08-01

Develop dose-response relations for two groups of industrial workers exposed to Gaussian or non-Gaussian (complex) types of continuous noises and to investigate what role, if any, the kurtosis statistic can play in the evaluation of industrial noise-induced hearing loss (NIHL). Audiometric and noise exposure data were acquired on a population (N = 195) of screened workers from a textile manufacturing plant and a metal fabrication facility located in Henan province of China. Thirty-two of the subjects were exposed to non-Gaussian (non-G) noise and 163 were exposed to a Gaussian (G) continuous noise. Each subject was given a general physical and an otologic examination. Hearing threshold levels (0.5-8.0 kHz) were age adjusted (ISI-1999) and the prevalence of NIHL at 3, 4, or 6 kHz was determined. The kurtosis metric, which is sensitive to the peak and temporal characteristics of a noise, was introduced into the calculation of the cumulative noise exposure metric. Using the prevalence of hearing loss and the cumulative noise exposure metric, a dose-response relation for the G and non-G noise-exposed groups was constructed. An analysis of the noise environments in the two plants showed that the noise exposures in the textile plant were of a Gaussian type with an Leq(A)8hr that varied from 96 to 105 dB whereas the exposures in the metal fabrication facility with an Leq(A)8hr = 95 dB were of a non-G type containing high levels (up to 125 dB peak SPL) of impact noise. The kurtosis statistic was used to quantify the deviation of the non-G noise environment from the Gaussian. The dose-response relation for the non-G noise-exposed subjects showed a higher prevalence of hearing loss for a comparable cumulative noise exposure than did the G noise-exposed subjects. By introducing the kurtosis variable into the temporal component of the cumulative noise exposure calculation, the two dose-response curves could be made to overlap, essentially yielding an equivalent noise-induced effect for the two study groups. For the same exposure level, the prevalence of NIHL is greater in workers exposed to non-G noise environments than for workers exposed to G noise. The kurtosis metric may be a reasonable candidate for use in modifying exposure level calculations that are used to estimate the risk of NIHL from any type of noise exposure environment. However, studies involving a large number of workers with well-documented exposures are needed before a relation between a metric such as the kurtosis and the risk of hearing loss can be refined.

Evaluating malaria case management at public health facilities in two provinces in Angola.

PubMed

Plucinski, Mateusz M; Ferreira, Manzambi; Ferreira, Carolina Miguel; Burns, Jordan; Gaparayi, Patrick; João, Lubaki; da Costa, Olinda; Gill, Parambir; Samutondo, Claudete; Quivinja, Joltim; Mbounga, Eliane; de León, Gabriel Ponce; Halsey, Eric S; Dimbu, Pedro Rafael; Fortes, Filomeno

2017-05-03

Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.

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.

75 FR 11913 - Chrysler, LLC, Sterling Stamping Plant, Including On-Site Leased Workers from Caravan Knight...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... Stamping Plant, Including On-Site Leased Workers from Caravan Knight Facilities Management LLC, Sterling... stampings. New information shows that workers leased from Caravan Knight Facilities Management LLC were... workers leased from Caravan Knight Facilities [[Page 11914

Mortality among workers with chronic radiation sickness

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

Shilnikova, N.S.; Koshurnikova, N.A.; Bolotnikova, M.G.

1996-07-01

This study is based on a registry containing medical and dosimetric data of the employees who began working at different plants of the Mayak nuclear complex between 1948 and 1958 who developed chronic radiation sickness. Mayak is the first nuclear weapons plutonium production enterprise built in Russia and includes nuclear reactors, a radiochemical plant for plutonium separation, and a plutonium production enterprise built in Russia and includes nuclear reactors, a radiochemical plant for plutonium separation, and a plutonium production plant.Workers whose employment began between 1948 and 1958 exhibited a 6-28% incidence of chronic radiation sickness at the different facilities. Theremore » were no cases of chronic radiation sickness among those who began working after 1958. Data on doses of external whole-body gamma-irradiation and mortality in workers with chronic radiation sickness are presented. 6 refs., 5 tabs.« less

[Personal dose monitoring of radiation workers in medical institutions at the municipal level and below in a city from 2011 to 2014].

PubMed

Wang, C; Mo, S F; Zhang, J B; Li, J R; Huang, R L; Tan, H Y

2017-08-20

Objective: To determine the personal dose level of radiation workers in medical institutions at the municipal level and below in a city, and to provide a scientific support for strengthening the radiation protection in the city's medical institutions. Methods: Information of the successful applicants for the "Radiation Worker Permit" from 174 medical institutions at the municipal level and below was collected from October 1, 2011 to December 31, 2014. The annual effective dose was calculated based on the personal dose monitoring report, and indicators including sex, permit application time, hospital level, type of occupational radiation, length of radiation work, blood test, and micronucleated lymphocyte rate were analyzed. Results: Of the 1 143 radiation worker permit applications submitted by medical institutions the municipal level and below in this city from 2011 to 2014, 1 123 provided at least one personal dose monitoring report. The annual effective dose of the radiation workers was 0-4.76 mSv (mean 0.31±0.40 mSv) , and the collective annual effective dose was 351.96 mSv. The annual effective dose was significantly different between radiation workers with different times of permit application, hospital levels, and types of occupational radiation ( P <0.05) . Interventional radiology workers had the highest annual effective dose (0.63 mSv) , and annual effective dose was significantly different between interventional radiology workers with different lengths of radiation work ( H =10.812, P <0.05) . Conclusion: The personal radiation dose of radiation workers in medical institutions at the municipal level and below in this city is maintained at a relatively low level, suggesting that the occupational environment is relatively safe for these workers. However, more focus should be placed on clinical interventional radiology workers.

Assessment of the occupational exposure at a fertiliser industry in the northern part of Greece.

PubMed

Potiriadis, C; Koukouliou, V; Seferlis, S; Kehagia, K

2011-03-01

In the northern part of Greece, close to the city of Kavala, a phosphoric acid production industry has operated since 1965. The raw material used is the phosphate rock imported from the foreign countries. During industrial processes, naturally occurring radioactive materials (NORM) deposits exist in many facilities in the industry, causing increased levels of radiation exposure. Additionally, increased levels of NORM concentrations are also detected in the waste material of the production process, the phosphogypsum. According to the Greek Regulations for Radiation Protection (no. 216B, 5/3/2001), which is in accordance with the 96/29/EURATOM 31/5/1996, the action levels concerning the effective dose to workers at workplaces due to natural radiation sources are 1 mSv y(-1). Work activities where the corresponding doses exceed 6 mSv y(-1) are under the control of the Greek Atomic Energy Commission (GAEC). The mean yearly radon concentration action level at workplaces is 400 Bq m(-3), while the corresponding concentration limit is 3000 Bq m(-3), respectively. GAEC, according to its constitutional law, is the responsible organisation to enforce and to implement the law by means of in situ surveys and laboratory measurements. The first inspection of the area was performed in 2002 and the first measures were proposed. Periodic inspections were performed every 2 y in order to extend the operation licensing of the industry. In this work a dose assessment of the workers based on in situ and laboratory measurements is presented. In order to assess the doses to the workers the external and the internal doses are estimated.

Radon exposure at a radioactive waste storage facility.

PubMed

Manocchi, F H; Campos, M P; Dellamano, J C; Silva, G M

2014-06-01

The Waste Management Department of Nuclear and Energy Research Institute (IPEN) is responsible for the safety management of the waste generated at all internal research centers and that of other waste producers such as industry, medical facilities, and universities in Brazil. These waste materials, after treatment, are placed in an interim storage facility. Among them are (226)Ra needles used in radiotherapy, siliceous cake arising from conversion processes, and several other classes of waste from the nuclear fuel cycle, which contain Ra-226 producing (222)Rn gas daughter.In order to estimate the effective dose for workers due to radon inhalation, the radon concentration at the storage facility has been assessed within this study. Radon measurements have been carried out through the passive method with solid-state nuclear track detectors (CR-39) over a period of nine months, changing detectors every month in order to determine the long-term average levels of indoor radon concentrations. The radon concentration results, covering the period from June 2012 to March 2013, varied from 0.55 ± 0.05 to 5.19 ± 0.45 kBq m(-3). The effective dose due to (222)Rn inhalation was further assessed following ICRP Publication 65.

Olfactory function in chemical workers exposed to acrylate and methacrylate vapors.

PubMed Central

Schwartz, B S; Doty, R L; Monroe, C; Frye, R; Barker, S

1989-01-01

An investigation of the olfactory function of 731 workers at a chemical facility which manufacturers acrylates and methacrylates was undertaken using a standardized quantitative test. In a cross-sectional analysis of the data, no associations of chemical exposure with olfactory test scores were observed. A nested case-control study designed to evaluate the cumulative effects of exposure on olfactory function, however, revealed elevated crude exposure odds ratios (95% confidence interval) of 2.0 (1.1, 3.8) for all workers and 6.0 (1.7, 21.5) for workers who never smoked cigarettes. Logistic regression analysis, adjusting for multiple confounders, revealed exposure odds ratios of 2.8 (1.1, 7.0) and 13.5 (2.1, 87.6) in these same groups, respectively, and a dose-response relationship between olfactory dysfunction and cumulative exposure scores--semi-quantitative indices of lifetime exposure to the acrylates. The data also revealed decreasing exposure odds ratios with increasing duration since last exposure to these chemicals, suggesting that the effects may be reversible. PMID:2784947

Challenges facing effective implementation of co-trimoxazole prophylaxis in children born to HIV-infected mothers in the public health facilities.

PubMed

Kamuhabwa, Appolinary Ar; Manyanga, Vicky

2015-01-01

If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented. In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania. Four hundred and ninety-eight infants' PMTCT (Prevention of Mother-to-Child Transmission of HIV) register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities. Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4%) children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8%) of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8%) received 240 mg per day. Only a small proportion (n=1, 0.2%) of children received 480 mg/day. Dose determination was based on the child's age rather than body weight. Parents and guardians reported that 42 (13.1%) children had missed one or more doses of co-trimoxazole during the course of prophylaxis. The majority of health care workers (89.7%) reported that co-trimoxazole is very effective for the prevention of opportunistic infections among children, but frequent shortage of co-trimoxazole in the health facilities was the main challenge. Most children who were initiated with co-trimoxazole prophylaxis did not experience significant opportunistic infections, and the drug was well tolerated. The major barrier for co-trimoxazole prophylaxis was due to frequent out-of-stocks of pediatric co-trimoxazole formulations in the health facilities. Dose determination was based on the age rather than the weight of children, thus creating potential for under- or over-dosing of children.

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

Cheng, J.-J.; Chen, S.-Y.; Environmental Science Division

This report contains data and analyses to support the approval of authorized release limits for the clearance from radiological control of polychlorinated biphenyl (PCB) capacitors in Buildings 361 and 391 at Argonne National Laboratory, Argonne, Illinois. These capacitors contain PCB oil that must be treated and disposed of as hazardous waste under the Toxic Substances Control Act (TSCA). However, they had been located in radiological control areas where the potential for neutron activation existed; therefore, direct release of these capacitors to a commercial facility for PCB treatment and landfill disposal is not allowable unless authorized release has been approved. Radiologicalmore » characterization found no loose contamination on the exterior surface of the PCB capacitors; gamma spectroscopy analysis also showed the radioactivity levels of the capacitors were either at or slightly above ambient background levels. As such, conservative assumptions were used to expedite the analyses conducted to evaluate the potential radiation exposures of workers and the general public resulting from authorized release of the capacitors; for example, the maximum averaged radioactivity levels measured for capacitors nearest to the beam lines were assumed for the entire batch of capacitors. This approach overestimated the total activity of individual radionuclide identified in radiological characterization by a factor ranging from 1.4 to 640. On the basis of this conservative assumption, the capacitors were assumed to be shipped from Argonne to the Clean Harbors facility, located in Deer Park, Texas, for incineration and disposal. The Clean Harbors facility is a state-permitted TSCA facility for treatment and disposal of hazardous materials. At this facility, the capacitors are to be shredded and incinerated with the resulting incineration residue buried in a nearby landfill owned by the company. A variety of receptors that have the potential of receiving radiation exposures were analyzed. Based on the dose assessment results, it is indicated that, if the disposition activities are completed within a year, the maximum individual dose would be about 0.021 mrem/yr, which is about 0.02% of the primary dose limit of 100 mrem/yr set by U.S. Department of Energy (DOE) for members of the public. The maximum individual dose was associated with a conservative and unlikely scenario involving a hypothetical farmer who intruded the landfill area to set up a subsistence living above the disposal area 30 years after burial of the incineration residue. Potential collective dose for worker and the general public combined was estimated to be less than 4 x 10{sup -4} person-rem/yr, about 0.004% of the DOE authorized release objective of 10 person-rem/yr for collective exposure. In reality, the actual radiation doses incurred by workers and the general public are expected to be at least two orders of magnitude lower than the estimated values. To follow the ALARA (as low as reasonably achievable) principle of reducing potential radiation exposures associated with authorized release of the PCB capacitors, a dose constraint of 1 mrem/yr, corresponding to a small fraction of the 25 mrem/yr limit set by DOE, was initially used as a reference to derive the authorized release limits. On the basis of the dose assessment results, the following authorized release limits are proposed - 0.6 pCi/g for Mn-54, 0.6 pCi/g for Na-22, 0.1 pCi/g for Co-57, and 2.3 pCi/g for Co-60, with a corresponding maximum individual dose of 0.21 mrem/yr. This maximum dose, about 0.2% of the DOE primary dose limit of 100 mrem/yr for members of the public from all sources and exposure pathways, was then selected as the final dose constraint for releasing the PCB capacitors through the authorized process. The proposed authorized release limits would satisfy the DOE requirements for the release of non-real properties to a commercial treatment and disposal facility. In addition, due to the relatively short half-lives (< 5.27 years) of radionuclides of concern, there will be no long-term buildup of doses either in groundwater or through other exposure pathways associated with this particular release action. Contact with Clean Harbors and the State of Texas has been initiated. The radioactivity levels in the PCB capacitors meet the State of Texas radiological exemption limits and would be accepted by Clean Harbors, subject to the approval by DOE for the authorized release process. Cost benefit analysis shows that authorized release of the PCB capacitors would provide significant cost saving over the low-level radioactive waste (LLRW) disposition alternative, i.e. sending the PCB capacitors to a certified LLRW facility for treatment and disposal, and would not cause a significantly different impact in terms of human health protection. Therefore, authorized release is determined to be the preferred alternative for the disposition of Argonne PCB capacitors.« less

Radiation exposure from work-related medical X-rays at the Portsmouth Naval Shipyard.

PubMed

Daniels, Robert D; Kubale, Travis L; Spitz, Henry B

2005-03-01

Previous analyses suggest that worker radiation dose may be significantly increased by routine occupational X-ray examinations. Medical exposures are investigated for 570 civilian workers employed at the Portsmouth Naval Shipyard (PNS) at Kittery, Maine. The research objective was to determine the radiation exposure contribution of work-related chest X-rays (WRX) relative to conventional workplace radiation sources. Methods were developed to estimate absorbed doses to the active (hematopoietic) bone marrow from X-ray examinations and workplace exposures using data extracted from worker dosimetry records (8,468) and health records (2,453). Dose distributions were examined for radiation and non-radiation workers. Photofluorographic chest examinations resulted in 82% of the dose from medical sources. Radiation workers received 26% of their collective dose from WRX and received 66% more WRX exposure than non-radiation workers. WRX can result in a significant fraction of the total dose, especially for radiation workers who were more likely to be subjected to routine medical monitoring. Omission of WRX from the total dose is a likely source of bias that can lead to dose category misclassification and may skew the epidemiologic dose-response assessment for cancers induced by the workplace.

SU-E-T-365: Estimation of Neutron Ambient Dose Equivalents for Radioprotection Exposed Workers in Radiotherapy Facilities Based On Characterization Patient Risk Estimation

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

Irazola, L; Terron, J; Sanchez-Doblado, F

2015-06-15

Purpose: Previous measurements with Bonner spheres{sup 1} showed that normalized neutron spectra are equal for the majority of the existing linacs{sup 2}. This information, in addition to thermal neutron fluences obtained in the characterization procedure{sup 3}3, would allow to estimate neutron doses accidentally received by exposed workers, without the need of an extra experimental measurement. Methods: Monte Carlo (MC) simulations demonstrated that the thermal neutron fluence distribution inside the bunker is quite uniform, as a consequence of multiple scatter in the walls{sup 4}. Although inverse square law is approximately valid for the fast component, a more precise calculation could bemore » obtained with a generic fast fluence distribution map around the linac, from MC simulations{sup 4}. Thus, measurements of thermal neutron fluences performed during the characterization procedure{sup 3}, together with a generic unitary spectra{sup 2}, would allow to estimate the total neutron fluences and H*(10) at any point{sup 5}. As an example, we compared estimations with Bonner sphere measurements{sup 1}, for two points in five facilities: 3 Siemens (15–23 MV), Elekta (15 MV) and Varian (15 MV). Results: Thermal neutron fluences obtained from characterization, are within (0.2–1.6×10{sup 6}) cm−{sup 2}•Gy{sup −1} for the five studied facilities. This implies ambient equivalent doses ranging from (0.27–2.01) mSv/Gy 50 cm far from the isocenter and (0.03–0.26) mSv/Gy at detector location with an average deviation of ±12.1% respect to Bonner measurements. Conclusion: The good results obtained demonstrate that neutron fluence and H*(10) can be estimated based on: (a) characterization procedure established for patient risk estimation in each facility, (b) generic unitary neutron spectrum and (c) generic MC map distribution of the fast component. [1] Radiat. Meas (2010) 45: 1391 – 1397; [2] Phys. Med. Biol (2012) 5 7:6167–6191; [3] Med. Phys (2015) 42:276 - 281. [4] IFMBE (2012) 39: 1245–1248. [5] ICRU Report 57 (1998)« less

Determination of the internal exposure hazard from plutonium work in an open front hood

NASA Astrophysics Data System (ADS)

Olson, Cheryl Lynn

Work with hazardous substances, such as radioactive material, can be done safely when engineered controls are used to maintain the worker effective dose below the International Commission on Radiological Protection ICRP 60 recommendation of 0.02 Sv/year and reduce the worker exposure to material to as low as reasonably achievable (ALARA). A primary engineered control used at a Los Alamos National Laboratory facility is the open-front hood. An open-front hood, also known as an open-front box, is a laboratory containment box that is fully enclosed except for a 15-cm opening along the front of the box. This research involved collection of the aerosol escaping an open-front hood while PuO2 sample digestion was simulated. Sodium chloride was used as a surrogate to mimic the behavior of PuO2. The NaCl aerosol was binned as a function of median aerodynamic diameter using a Micro-orifice Uniform Deposit Impactor (MOUDI, MSP Corporation, Shoreview, MN) cascade impactor. Using neutron activation analysis (NAA) to measure the mass of material in each of the nine bins of the MOUDI, the mass median diameter of the escaping aerosol was determined. Using the mass median diameter and the total mass of the particle distribution, dose was calculated using ICRP 60 methodology. Experimental conditions mimicked a stationary worker and a worker moving her hands in and out of the open front hood. Measurements were also done in the hood for comparison. The effect of the hands moving in and out of the box was modeled. Information necessary for Computational Fluid Dynamics (CFD) modeling is given, such as volumetric flow rates out of the open front hood and into the experimental room, detailed sketches of the experimental set-up, and energy provided by the hot plate and worker. This research is unique as it measures particle size distribution from routine working conditions. Current research uses tracer gases or describes non-routine conditions. It is important to have results that mimic routine conditions to allow for quantitative measurement of worker exposure and determination of the adequacy of the open front hood for this type of work. This work is important as it quantifies the effectiveness of the open front hood for controlling inhalation hazards. This information is crucial for managing the risk to workers. The mass median diameter of particles escaping the hood when a stationary worker sits in front of the hood is 0.54 +/- 3.7 mum. The mass median diameter of particles escaping the hood when a worker performs work in the hood is 0.35 +/- 5.1 mum. These particle sizes are in the range of those seen in the published liturature. (Raabe, et al., 1978; Dorrian and Bailey, 1995; and Cheng, et al., 2004) The effective dose from digestion of PuO2 in an open-front hood while a worker is moving her hands in and out of the hood was estimated to be 5 mSv. Based on the experimental error, this value could be low by a factor of 4. There was little difference between the dose calculated for a worker in motion and a stationary worker. The calculated dose while work was being performed is 5% higher. Comparison of these results to measured worker doses and continuous air monitoring results showed the experimental results may be somewhat higher. The lower limit of detection for urine bioassay is 0.002 Sv (Inkret, et al., 1999). Workers performing the activity mimicked in this experiment are routinely monitored and do not have measurable internal doses. The most likely reason for the high experimental results is the placement of the sample digestion apparatus. For this experiment, the material was placed 10 cm from the hood opening. In practice, the material is typically further back in the hood; placing the material further back in the hood likely decreases the amount of material escaping the hood. The cost-benefit analysis showed the use of the open-front hood as a reasonable protective measure. Although worker exposure may approach the ICRP limit, the cost of previously observed ergonomic injuries caused by work in a glove box is five thousand times greater than the dose received by the worker. Protective measures such as respiratory protection should be evaluated on a case by case basis to keep worker exposure as low as reasonably achievable.

Worker and environmental protection issues in the remediation of an abandoned source manufacturing facility.

PubMed

Hoffman, Daniel E

2003-02-01

The Gulf Nuclear Superfund Site located in Odessa, Texas, was an abandoned radioactive source production facility slated for cleanup as a Removal Action under the U.S. Environmental Protection Agency Region VI Superfund program. Prior to cessation of operations and abandonment of the facility in 1992, it was used for the production of radioactive sources used in the oil and gas industry and nuclear medicine applications. Pangea Group was contracted by the U.S. Army Corps of Engineers (USACE) Kansas City District to perform remediation of the site and other contaminated debris, cleaning of interior building surfaces, building demolition, and excavation/removal of contaminated soils and septic system. The project scope also included loading, containerization and transportation of low-level radioactive wastes for offsite disposal. Primary radionuclides present at the facility were 137Cs, 60Co, and 241Am. The project also included packaging and removal of radioactive sources and mixed waste consisting of radiologically contaminated lead shot and lead source containers. Included in the paper is a discussion of primary worker protection and environmental protection measures employed on the project. Worker protection issues included the control of industrial and construction safety hazards as well as control of external and internal radiation dose. Control of air emissions and contaminated wastewater were also very important, especially due to the location of the site. The site was located in an area containing both residential and commercial properties. Several residences and businesses were located immediately adjacent to the site. The project involved the participation of the USACE Kansas City District, EPA Region 6, and the Texas Bureau of Radiological Health. Field work on the project started in April 2001 and was completed approximately five months later.

Worker and Environmental Protection Issues in the Remediation Of an Abandoned Source Manufacturing Facility.

PubMed

Hoffman, Daniel E.

2003-02-01

The Gulf Nuclear Superfund Site located in Odessa, Texas, was an abandoned radioactive source production facility slated for cleanup as a Removal Action under the U.S. Environmental Protection Agency Region VI Superfund program. Prior to cessation of operations and abandonment of the facility in 1992, it was used for the production of radioactive sources used in the oil and gas industry and nuclear medicine applications. Pangea Group was contracted by the U.S. Army Corps of Engineers (USACE) Kansas City District to perform remediation of the site and other contaminated debris, cleaning of interior building surfaces, building demolition, and excavation/removal of contaminated soils and septic system. The project scope also included loading, containerization and transportation of low-level radioactive wastes for offsite disposal. Primary radionuclides present at the facility were Cs, Co, and Am. The project also included packaging and removal of radioactive sources and mixed waste consisting of radiologically contaminated lead shot and lead source containers. Included in the paper is a discussion of primary worker protection and environmental protection measures employed on the project. Worker protection issues included the control of industrial and construction safety hazards as well as control of external and internal radiation dose. Control of air emissions and contaminated wastewater were also very important, especially due to the location of the site. The site was located in an area containing both residential and commercial properties. Several residences and businesses were located immediately adjacent to the site. The project involved the participation of the USACE Kansas City District, EPA Region 6, and the Texas Bureau of Radiological Health. Field work on the project started in April 2001 and was completed approximately five months later.

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices.

PubMed

Wallace, Aaron S; Willis, Fred; Nwaze, Eric; Dieng, Boubacar; Sipilanyambe, Naawa; Daniels, Danni; Abanida, Emmanuel; Gasasira, Alex; Mahmud, Mustapha; Ryman, Tove K

2017-12-04

The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials. Published by Elsevier Ltd.

Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

PubMed Central

Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

2015-01-01

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

Cancer deaths and occupational exposure in a group of plutonium workers.

PubMed

Fallahian, Naz Afarin; Brey, Richard R; Tivis, Rick D; Piland, Neill F; Simpson, David R

2012-04-01

An exploratory epidemiological study was conducted for 319 deceased nuclear workers who had intakes of transuranic radionuclides and histories of employment during the time period from 1943 to 1995. The workers were employed at various facilities throughout the United States, including the Department of Energy defense facilities and uranium mining and milling sites. The majority of individuals were involved in documented radiological incidents during their careers. All had voluntarily agreed to donate their organs or whole body to the United States Transuranium and Uranium Registries. External and internal dose assessments were performed using occupational exposure histories and postmortem concentrations of transuranic radionuclides in critical organs. Statistical data analyses were performed to investigate the potential relationship between radiation exposure and causes of death within this population due to cancers of the lungs, liver, and all sites combined while controlling for the effects of other confounders. No association was found between radiation exposure and death due to cancer (α = 0.05). However, statistically significant associations were found between death due to any type of cancer and smoking (yes or no) (odds ratio = 5.41; 95% CI: 1.42 to 20.67) and rate of cigarette smoking (packs per day) (odds ratio = 2.70; 95% CI: 1.37 to 5.30).

Bioassay criteria for environmental restoration workers

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

Carbaugh, E.H.; Bihl, D.E.

1993-01-01

Environmental restoration (ER) work at the U. S. Department of Energy Hanford Site posed questions concerning when to perform bioassay monitoring of workers for potential intakes of radioactivity. Application of criteria originally developed for use inside radionuclide processing facilities to ER work resulted in overly restrictive bioassay requirements. ER work typically involves site characterization or, excavating large quantities of potentially contaminated soil, rather than working with concentrated quantities of radioactivity as in a processing facility. An improved approach, tailored to ER work, provided soil contamination concentrations above which worker bioassay would be required. Soil concentrations were derived assuming acute ormore » chronic intakes of 2% of an Annual Limit on Intake (ALI), or a potential committed effective dose equivalent of 100 mrem, and conservative dust loading of air from the work. When planning ER work, the anticipated soil concentration and corresponding need for bioassay could be estimated from work-site historical records. Once site work commenced, soil sampling and work-place surveys could be used to determine bioassay needs. This approach substantially reduced the required number of bioassay samples with corresponding reductions in analytical costs, schedules, and more flexible work-force management. (Work supported by the US Department of Energy under contract DOE-AC06-76RLO 1830.)« less

Lung Cancer Mortality (1950–1999) among Eldorado Uranium Workers: A Comparison of Models of Carcinogenesis and Empirical Excess Risk Models

PubMed Central

Eidemüller, Markus; Jacob, Peter; Lane, Rachel S. D.; Frost, Stanley E.; Zablotska, Lydia B.

2012-01-01

Lung cancer mortality after exposure to radon decay products (RDP) among 16,236 male Eldorado uranium workers was analyzed. Male workers from the Beaverlodge and Port Radium uranium mines and the Port Hope radium and uranium refinery and processing facility who were first employed between 1932 and 1980 were followed up from 1950 to 1999. A total of 618 lung cancer deaths were observed. The analysis compared the results of the biologically-based two-stage clonal expansion (TSCE) model to the empirical excess risk model. The spontaneous clonal expansion rate of pre-malignant cells was reduced at older ages under the assumptions of the TSCE model. Exposure to RDP was associated with increase in the clonal expansion rate during exposure but not afterwards. The increase was stronger for lower exposure rates. A radiation-induced bystander effect could be a possible explanation for such an exposure response. Results on excess risks were compared to a linear dose-response parametric excess risk model with attained age, time since exposure and dose rate as effect modifiers. In all models the excess relative risk decreased with increasing attained age, increasing time since exposure and increasing exposure rate. Large model uncertainties were found in particular for small exposure rates. PMID:22936975

Low back pain among workers in care facilities for the elderly after introducing welfare equipment.

PubMed

Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Liu, Xinxin; Koda, Shigeki

2016-07-29

The purpose of this study was to clarify the causes of low back pain among workers in care facilities for the elderly after the introduction of welfare equipment. We conducted anonymous questionnaire surveys among administrators and care workers in eight elderly care facilities. The questionnaires were designed to investigate the status of both the care workers and facility. In reference to the care facility, the questionnaires were comprised items for investigating basic information, occupational safety, and health activities. For care workers, in addition to basic information, occupational safety, and health activities, the questionnaires also comprised items for investigating resident transfer and bathing methods, low back pain, and occupational stress. Completed questionnaires were returned by eight care facility administrators (response rate: 100%) and 373 care workers (response rate: 92.3%), among which 367 were used for analyses. Many care workers participated in a variety of occupational safety and health activities that were conducted in the facilities. Various types of welfare equipment were introduced into the care facilities and subsequently used by many care workers during resident transfer and bathing. As a result, 89.9% of the care workers reported having only slight or no low back pain. The remaining 10.1% reported having serious low back pain that interfered with their work. On the basis of logistic regression analysis, low back pain was associated with the following variables: failure to provide the appropriate method of care to each resident, failure of colleagues to discuss methods for improving care, lack of instructions regarding the use of welfare equipment, and inappropriate job rotation. An association was also found between low back pain and poor posture, poor resident-lifting technique, insufficient time to complete work, and a shortage of workers to assist with resident transfer or bathing. Although care workers received instructions on the health and safety activities extracted from the surveys, an association was still found between these activities and low back pain. This was thought to result from some care workers not establishing the appropriate method of care for each resident, not discussing methods for improving care with other colleagues, not using the welfare equipment, and failing to practice appropriate job rotation. These results suggest that low back pain among care workers in the facilities for the elderly that have introduced welfare equipment is caused by a failure to sufficiently conduct appropriate care methods.

Requirements for authorisation of internal dosimetry services.

PubMed

Melo, D R; Cunha, P G; Torres, M M C; Lourenço, M C

2003-01-01

In order to ensure that a facility is in compliance with the occupational exposure requirements established by regulatory authorities, the measurements and dose assessments specified in the individual monitoring programme need to be reliable. There are two important questions that shall be addressed here: one is how the licensed facilities can demonstrate to their workers and regulatory bodies compliance with the regulatory limits and the reliability of the results of the individual monitoring programmes; the other concerns the mechanisms used to demonstrate to a facility in another country the reliability of the measurement results of an individual monitoring bioassay programme. The accreditation of the bioassay laboratory, according to ISO/IEC 17025, shall be the basic requirement for obtaining the authorisation granted by the national regulatory authority. For the second question, such confidence can be achieved through International Laboratory Accreditation Cooperation (ILAC).

Cancer Mortality through 2005 among a Pooled Cohort of U.S. Nuclear Workers Exposed to External Ionizing Radiation.

PubMed

Schubauer-Berigan, Mary K; Daniels, Robert D; Bertke, Stephen J; Tseng, Chih-Yu; Richardson, David B

2015-06-01

Nuclear workers worldwide have been studied for decades to estimate associations between their exposure to ionizing radiation and cancer. The low-level exposure of these workers requires pooling of large cohorts studied over many years to obtain risk estimates with appropriate latency and good precision. We assembled a pooled cohort of 119,195 U.S. nuclear workers at four Department of Energy nuclear weapons facilities (Hanford site, Idaho National Laboratory, Oak Ridge National Laboratory and Savannah River site) and at the Portsmouth Naval Shipyard. The cohort was followed at the start of the workers beginning their radiation work (at earliest, between 1944 and 1952) through 2005, and we compared its mortality to that of the U.S. We also conducted regression-modeling analysis to evaluate dose-response associations for external radiation exposure and outcomes: all cancers, smoking- and nonsmoking-related cancers, all lymphatic and hematopoietic cancers, leukemia (excluding chronic lymphocytic), multiple myeloma, cardiovascular disease and others. The mean dose observed among the cohort was 20 mSv. For most outcomes, mortality was below expectation compared to the general population, but mesothelioma and pleura cancers were highly elevated. We found an excess relative risk (ERR) per 10 mSv of 0.14% [95% confidence interval (CI): -0.17%, 0.48%] for all cancers excluding leukemia. Estimates were higher for nonsmoking-related cancers (0.70%, 95% CI: 0.058%, 1.5%) and lower for smoking-related cancers (-0.079%, 95% CI: -0.43%, 0.32%). The ERR per 10 mSv was 1.7% (95% CI: -0.22%, 4.7%) for leukemia, which was similar to the estimate of 1.8% (95% CI: 0.027%, 4.4%) for all lymphatic and hematopoietic cancers. The ERR per 10 mSv for multiple myeloma was 3.9% (95% CI: 0.60%, 9.5%). The ERR per 10 mSv for cardiovascular disease was 0.026% (-0.25%, 0.32%). Little evidence of heterogeneity was seen by facility, birth cohort or sex for most outcomes. The estimates observed here are similar to those found in previous large pooled nuclear worker studies and also (with the exception of multiple myeloma) to those conducted in the Life Span Study of Japanese atomic bomb survivors. The tendency of observed risks to persist many years after exposure for most outcomes illustrates the importance of continued follow-up of nuclear worker cohorts.

Lens of Eye Dosimetry

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

Mallett, Michael Wesley

An analysis of LANL occupational dose measurements was made with respect to lens of eye dose (LOE), in particular, for plutonium workers. Table 1 shows the reported LOE as a ratio of the “deep” (photon only) and “deep+neutron” dose for routine monitored workers at LANL for the past ten years. The data compares the mean and range of these values for plutonium workers* and non-routine plutonium workers. All doses were reported based on measurements with the LANL Model 8823 TLD.

ESTIMATION OF INTERNAL EXPOSURE TO URANIUM WITH UNCERTAINTY FROM URINALYSIS DATA USING THE InDEP COMPUTER CODE

PubMed Central

Anderson, Jeri L.; Apostoaei, A. Iulian; Thomas, Brian A.

2015-01-01

The National Institute for Occupational Safety and Health (NIOSH) is currently studying mortality in a cohort of 6409 workers at a former uranium processing facility. As part of this study, over 220 000 urine samples were used to reconstruct organ doses due to internal exposure to uranium. Most of the available computational programs designed for analysis of bioassay data handle a single case at a time, and thus require a significant outlay of time and resources for the exposure assessment of a large cohort. NIOSH is currently supporting the development of a computer program, InDEP (Internal Dose Evaluation Program), to facilitate internal radiation exposure assessment as part of epidemiological studies of both uranium- and plutonium-exposed cohorts. A novel feature of InDEP is its batch processing capability which allows for the evaluation of multiple study subjects simultaneously. InDEP analyses bioassay data and derives intakes and organ doses with uncertainty estimates using least-squares regression techniques or using the Bayes’ Theorem as applied to internal dosimetry (Bayesian method). This paper describes the application of the current version of InDEP to formulate assumptions about the characteristics of exposure at the study facility that were used in a detailed retrospective intake and organ dose assessment of the cohort. PMID:22683620

75 FR 11914 - Chrysler, LLC, Mack Avenue Engine Plants 1 & 2, Power Train Division, Including On-Site Leased...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... Facilities Management LLC; Detroit, MI; Amended Certification Regarding Eligibility To Apply for Worker... shows that workers leased from Caravan Knight Facilities Management LLC were employed on-site at the... workers leased from Caravan Knight Facilities Management LLC working on-site at the Detroit, Michigan...

75 FR 11913 - Chrysler, LLC; Warren Stamping Plant, Including On-Site Leased Workers From Caravan Knight...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... Stamping Plant, Including On-Site Leased Workers From Caravan Knight Facilities Management LLC; Warren, MI... from Caravan Knight Facilities Management LLC were employed on-site at the Warren, Michigan location of... Department is amending this certification to include workers leased from Caravan Knight Facilities Management...

Iodine-131 in sewage sludge from a small water pollution control plant serving a thyroid cancer treatment facility.

PubMed

Rose, Paula S; Swanson, R Lawrence

2013-08-01

Iodine-131 (half-life = 8.04 d) is the most widely used radionuclide in medicine for therapeutic purposes. It is excreted by patients and is discharged directly to sewer systems. Despite considerable dilution in waste water and the relatively short half-life of I, it is readily measured in sewage. This work presents I concentrations in sewage sludge from three water pollution control plants (WPCPs) on Long Island, NY. Iodine-131 concentrations ranged from 0.027 ± 0.002 to 148 ± 4 Bq g dry weight. The highest concentrations were measured in the Stony Brook WPCP, a relatively small plant (average flow = 6.8 × 10 L d) serving a regional thyroid cancer treatment facility in Stony Brook, NY. Preliminary radiation dose calculations suggested further evaluation of dose to treatment plant workers in the Stony Brook WPCP based on the recommendations of the Interagency Steering Committee on Radiation Standards.

Tuberculosis and latent tuberculosis infection among healthcare workers in Kisumu, Kenya.

PubMed

Agaya, Janet; Nnadi, Chimeremma D; Odhiambo, Joseph; Obonyo, Charles; Obiero, Vincent; Lipke, Virginia; Okeyo, Elisha; Cain, Kevin; Oeltmann, John E

2015-12-01

To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a healthcare setting in western Kenya. We conducted a cross-sectional survey among healthcare workers in western Kenya in 2013. They were recruited from dispensaries, health centres and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among healthcare workers compared to school workers; and among healthcare workers only, we assessed work-related risk factors for latent TB infection. We enrolled 1005 healthcare workers and 411 school workers. Approximately 60% of both groups were female. A total of 22% of 958 healthcare workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among healthcare workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among healthcare workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among healthcare workers than school workers (95% confidence interval 1.2-2.0). Healthcare workers at all three facility types had similar prevalence of latent TB infection (P = 0.72), but increasing years of employment was associated with increased odds of LTBI (P < 0.01). Healthcare workers at facilities in western Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. Implementation of WHO-recommended TB infection control measures are urgently needed in health facilities to protect healthcare workers. © 2015 John Wiley & Sons Ltd.

Establishing bounding internal dose estimates for thorium activities at Rocky Flats.

PubMed

Ulsh, Brant A; Rich, Bryce L; Chew, Melton H; Morris, Robert L; Sharfi, Mutty; Rolfes, Mark R

2008-07-01

As part of an evaluation of a Special Exposure Cohort petition filed on behalf of workers at the Rocky Flats Plant, the National Institute for Occupational Safety and Health (NIOSH) was required to demonstrate that bounding values could be established for radiation doses due to the potential intake of all radionuclides present at the facility. The main radioactive elements of interest at Rocky Flats were plutonium and uranium, but much smaller quantities of several other elements, including thorium, were occasionally handled at the site. Bounding potential doses from thorium has proven challenging at other sites due to the early historical difficulty in detecting this element through urinalysis methods and the relatively high internal dose delivered per unit intake. This paper reports the results of NIOSH's investigation of the uses of thorium at Rocky Flats and provides bounding dose reconstructions for these operations. During this investigation, NIOSH reviewed unclassified reports, unclassified extracts of classified materials, material balance and inventory ledgers, monthly progress reports from various groups, and health physics field logbooks, and conducted interviews with former Rocky Flats workers. Thorium operations included: (1) an experimental metal forming project with 240 kg of thorium in 1960; (2) the use of pre-formed parts in weapons mockups; (3) the removal of Th from U; (4) numerous analytical procedures involving trace quantities of thorium; and (5) the possible experimental use of thorium as a mold coating compound. The thorium handling operations at Rocky Flats were limited in scope, well-monitored and documented, and potential doses can be bounded.

Technical Report for Calculations of Atmospheric Dispersion at Onsite Locations for Department of Energy Nuclear Facilities

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

Levin, Alan; Chaves, Chris

2015-04-04

The Department of Energy (DOE) has performed an evaluation of the technical bases for the default value for the atmospheric dispersion parameter χ/Q. This parameter appears in the calculation of radiological dose at the onsite receptor location (co-located worker at 100 meters) in safety analysis of DOE nuclear facilities. The results of the calculation are then used to determine whether safety significant engineered controls should be established to prevent and/or mitigate the event causing the release of hazardous material. An evaluation of methods for calculation of the dispersion of potential chemical releases for the purpose of estimating the chemical exposuremore » at the co-located worker location was also performed. DOE’s evaluation consisted of: (a) a review of the regulatory basis for the default χ/Q dispersion parameter; (b) an analysis of this parameter’s sensitivity to various factors that affect the dispersion of radioactive material; and (c) performance of additional independent calculations to assess the appropriate use of the default χ/Q value.« less

Radiological Risk Assessments for Occupational Exposure at Fuel Fabrication Facility in AlTuwaitha Site Baghdad – Iraq by using RESRAD Computer Code

NASA Astrophysics Data System (ADS)

Ibrahim, Ziadoon H.; Ibrahim, S. A.; Mohammed, M. K.; Shaban, A. H.

2018-05-01

The purpose of this study is to evaluate the radiological risks for workers for one year of their activities at Fuel Fabrication Facility (FFF) so as to make the necessary protection to prevent or minimize risks resulted from these activities this site now is under the Iraqi decommissioning program (40). Soil samples surface and subsurface were collected from different positions of this facility and analyzed by gamma rays spectroscopy technique High Purity Germanium detector (HPGe) was used. It was found out admixture of radioactive isotopes (232Th 40K 238U 235U137Cs) according to the laboratory results the highest values were (975758) for 238U (21203) for 235U (218) for 232Th (4046) for 40K and (129) for 137Cs in (Bqkg1) unit. The annual total radiation dose and risks were estimated by using RESRAD (onsite) 70 computer code. The highest total radiation dose was (5617μSv/year) in area that represented by soil sample (S7) and the radiological risks morbidity and mortality (118E02 8661E03) respectively in the same area

Unexplained overexposures on physical dosimetry reported by biological dosimetry.

PubMed

Montoro, A; Almonacid, M; Villaescusa, J I; Verdu, G

2009-01-01

The Medical Service of the Radiation Protection Service from the University Hospital La Fe (Valencia, Spain), carries out medical examinations of the workers occupationally exposed to ionising radiation. The Biological Dosimetry Laboratory is developing its activity since 2001. Up to now, the activities have been focused in performing biological dosimetry studies of Interventionists workers from La Fe Hospital. Recently, the Laboratory has been authorized by the Health Authority in the Valencian Community. Unexplained overexposures of workers and patients are also studied. Workers suspected of being overexposed to ionising radiation were referred for investigation by cytogenetic analysis. Two of these were from Hospitals of the Valencian Community and one belonged to an uranium mine from Portugal. Hospital workers had a physical dose by thermoluminiscence dosimeters (TLD) that exceeded the established limit. The worker of the uranium mine received a dose from a lost source of Cesium 137 with an activity of 170 mCi. All three cases showed normal values after the hematological analysis. Finally, the aim of this study consist to determine whether the dose showed by the dosimeter is reliable or not. In the case of workers that wore dosimeter, it is concluded that the doses measured by dosimeter are not corresponding to real doses. Hospital worker with a physical dose of 2.6 Sv and 0.269 Sv had an estimated absorbed dose by biological dosimetry of 0.076 Gy (0-0.165 Gy) and 0 Gy (0-0.089 Gy), respectively. In case of the mine worker an estimated absorbed dose of 0.073 Gy (0-0.159 Gy) was obtained by biological dosimetry. In all cases we used the odds ratio to present the results due to a very low frequency of observed aberrations [1].

Adapting Dry Cask Storage for Aging at a Geologic Repository

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

C. Sanders; D. Kimball

2005-08-02

A Spent Nuclear Fuel (SNF) Aging System is a crucial part of operations at the proposed Yucca Mountain repository in the United States. Incoming commercial SNF that does not meet thermal limits for emplacement will be aged on outdoor pads. U.S. Department of Energy SNF will also be managed using the Aging System. Proposed site-specific designs for the Aging System are closely based upon designs for existing dry cask storage (DCS) systems. This paper evaluates the applicability of existing DCS systems for use in the SNF Aging System at Yucca Mountain. The most important difference between existing DCS facilities andmore » the Yucca Mountain facility is the required capacity. Existing DCS facilities typically have less than 50 casks. The current design for the aging pad at Yucca Mountain calls for a capacity of over 2,000 casks (20,000 MTHM) [1]. This unprecedented number of casks poses some unique problems. The response of DCS systems to off-normal and accident conditions needs to be re-evaluated for multiple storage casks. Dose calculations become more complicated, since doses from multiple or very long arrays of casks can dramatically increase the total boundary dose. For occupational doses, the geometry of the cask arrays and the order of loading casks must be carefully considered in order to meet ALARA goals during cask retrieval. Due to the large area of the aging pad, skyshine must also be included when calculating public and worker doses. The expected length of aging will also necessitate some design adjustments. Under 10 CFR 72.236, DCS systems are initially certified for a period of 20 years [2]. Although the Yucca Mountain facility is not intended to be a storage facility under 10 CFR 72, the operational life of the SNF Aging System is 50 years [1]. Any cask system selected for use in aging will have to be qualified to this design lifetime. These considerations are examined, and a summary is provided of the adaptations that must be made in order to use DCS technologies successfully at a geologic repository.« less

A portable detection system for in vivo monitoring of 131I in routine and emergency situations

NASA Astrophysics Data System (ADS)

Lucena, EA; Dantas, ALA; Dantas, BM

2018-03-01

In vivo monitoring of 131I in human thyroid is often used to evaluate occupational exposure in nuclear medicine facilities and in the case of accidental intakes in nuclear power plants for the monitoring of workers and population. The device presented in this work consists on a Pb-collimated NaI(Tl)3”x3” scintillation detector assembled on a tripod and connected to a portable PC. The evaluation of the applicability and limitations of the system is based on the estimation of the committed effective doses associated to the minimum detectable activities in different facilities. It has been demonstrated that the system is suitable for use in routine and accidental situations.

Assessment of intake and internal dose from iodine-131 for exposed workers handling radiopharmaceutical products.

PubMed

Bitar, A; Maghrabi, M; Doubal, A W

2013-12-01

Two methods for determination of internal dose due to (131)I intake during the preparation and handling of iodine radiopharmaceutical products have been compared. The first method was based on the measurement of (131)I in 24-hour urine samples while the second method was based on the measurement in vivo of (131)I in thyroid. The results have shown that urine analysis method can be used as a screening test but not for internal dose assessment of exposed workers. Thyroid monitoring method was found to be more reliable and accurate method for assessing internal dose from (131)I intake. In addition, the assessed internal dose showed that the annual internal effective dose for some workers was below 1 mSv with no risk classification, whereas the results of other group of workers were between 1 and 6 mSv with low risk classification. Only one worker reached 7.66 mSv with high risk classification; and this worker must be monitored individually. © 2013 Elsevier Ltd. All rights reserved.

Evaluating the risk of death via the hematopoietic syndrome mode for prolonged exposure of nuclear workers to radiation delivered at very low rates.

PubMed

Scott, B R; Lyzlov, A F; Osovets, S V

1998-05-01

During a Phase-I effort, studies were planned to evaluate deterministic (nonstochastic) effects of chronic exposure of nuclear workers at the Mayak atomic complex in the former Soviet Union to relatively high levels (> 0.25 Gy) of ionizing radiation. The Mayak complex has been used, since the late 1940's, to produce plutonium for nuclear weapons. Workers at Site A of the complex were involved in plutonium breeding using nuclear reactors, and some were exposed to relatively large doses of gamma rays plus relatively small neutron doses. The Weibull normalized-dose model, which has been set up to evaluate the risk of specific deterministic effects of combined, continuous exposure of humans to alpha, beta, and gamma radiations, is here adapted for chronic exposure to gamma rays and neutrons during repeated 6-h work shifts--as occurred for some nuclear workers at Site A. Using the adapted model, key conclusions were reached that will facilitate a Phase-II study of deterministic effects among Mayak workers. These conclusions include the following: (1) neutron doses may be more important for Mayak workers than for Japanese A-bomb victims in Hiroshima and can be accounted for using an adjusted dose (which accounts for neutron relative biological effectiveness); (2) to account for dose-rate effects, normalized dose X (a dimensionless fraction of an LD50 or ED50) can be evaluated in terms of an adjusted dose; (3) nonlinear dose-response curves for the risk of death via the hematopoietic mode can be converted to linear dose-response curves (for low levels of risk) using a newly proposed dimensionless dose, D = X(V), in units of Oklad (where D is pronounced "deh"), and V is the shape parameter in the Weibull model; (4) for X < or = Xo, where Xo is the threshold normalized dose, D = 0; (5) unlike absorbed dose, the dose D can be averaged over different Mayak workers in order to calculate the average risk of death via the hematopoietic mode for the population exposed at Site A; and (6) the expected cases of death via the hematopoietic syndrome mode for Mayak workers chronically exposed during work shifts at Site A to gamma rays and neutrons can be predicted using ln(2)B M[D]; where B (pronounced "beh") is the number of workers at risk (criticality accident victims excluded); and M[D] is the average (mean) value of D (averaged over the worker population at risk, for Site A, for the time period considered). These results can be used to facilitate a Phase II study of deterministic radiation effects among Mayak workers chronically exposed to gamma rays and neutrons.

Tritium glovebox stripper system seismic design evaluation

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

Grinnell, J. J.; Klein, J. E.

2015-09-01

The use of glovebox confinement at US Department of Energy (DOE) tritium facilities has been discussed in numerous publications. Glovebox confinement protects the workers from radioactive material (especially tritium oxide), provides an inert atmosphere for prevention of flammable gas mixtures and deflagrations, and allows recovery of tritium released from the process into the glovebox when a glovebox stripper system (GBSS) is part of the design. Tritium recovery from the glovebox atmosphere reduces emissions from the facility and the radiological dose to the public. Location of US DOE defense programs facilities away from public boundaries also aids in reducing radiological dosesmore » to the public. This is a study based upon design concepts to identify issues and considerations for design of a Seismic GBSS. Safety requirements and analysis should be considered preliminary. Safety requirements for design of GBSS should be developed and finalized as a part of the final design process.« less

Finger doses for staff handling radiopharmaceuticals in nuclear medicine.

PubMed

Pant, Gauri S; Sharma, Sanjay K; Rath, Gaura K

2006-09-01

Radiation doses to the fingers of occupational workers handling 99mTc-labeled compounds and 131I for diagnostic and therapeutic procedures in nuclear medicine were measured by thermoluminescence dosimetry. The doses were measured at the base of the ring finger and the index finger of both hands in 2 groups of workers. Group 1 (7 workers) handled 99mTc-labeled radiopharmaceuticals, and group 2 (6 workers) handled 131I for diagnosis and therapy. Radiation doses to the fingertips of 3 workers also were measured. Two were from group 1, and 1 was from group 2. The doses to the base of the fingers for the radiopharmacy staff and physicians from group 1 were observed to be 17+/-7.5 (mean+/-SD) and 13.4+/-6.5 microSv/GBq, respectively. Similarly, the dose to the base of the fingers for the 3 physicians in group 2 was estimated to be 82.0+/-13.8 microSv/GBq. Finger doses for the technologists in both groups could not be calculated per unit of activity because they did not handle the radiopharmaceuticals directly. Their doses were reported in millisieverts that accumulated in 1 wk. The doses to the fingertips of the radiopharmacy worker and the physician in group 1 were 74.3+/-19.8 and 53.5+/-21.9 microSv/GBq, respectively. The dose to the fingertips of the physician in group 2 was 469.9+/-267 microSv/GBq. The radiation doses to the fingers of nuclear medicine staff at our center were measured. The maximum expected annual dose to the extremities appeared to be less than the annual limit (500 mSv/y), except for a physician who handled large quantities of 131I for treatment. Because all of these workers are on rotation and do not constantly handle radioactivity throughout the year, the doses to the base of the fingers or the fingertips should not exceed the prescribed annual limit of 500 mSv.

The role of institutions on the effectiveness of malaria treatment in the Ghanaian health sector.

PubMed

Amporfu, Eugenia; Nonvignon, Justice

2015-04-19

The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extent does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care? The objective of this study is to find the effect of institutional factors on the quality of care. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction. The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The quality indicator used was effectiveness of treatment as determined by the patient. Ordered logit regression was run for the indicator with patient and health facility characteristics as well as institutional factors as independent variables. The sample size was 2248. The results showed that the patient's level of formal education had a strong influence on the effectiveness of treatment. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment. Decentralization, the flow of information from government to health facilities and from health facility administrators to health workers are important in ensuring effectiveness. The study recommends further decentralization between health facilities as well as between health workers and administrators. In addition, the study recommends the involvement of health facilities in malaria programs to ensure the flow of information needed for effectiveness of treatment.

Survey on low-dose medical radiation exposure in occupational workers: the effect on hematological change

NASA Astrophysics Data System (ADS)

Ryu, J. K.; Cho, S. M.; Cho, J. H.; Dong, K. R.; Chung, W. K.; Lee, J. W.

2013-03-01

This study examined the changes in the hematological index caused by low-dose medical radiation exposure in workers in a medical radiation-exposed environment. The cumulative dose was obtained using thermoluminescent dosimeters over a 9-year period, and the changes in hematological index count (red blood cells (RBCs), hemoglobin, platelets, white blood cells (WBCs), monocytes, lymphocytes, neutrophils, basophils, and eosinophils) were examined in both the occupational workers and controls. In total, 370 occupational workers and 335 controls were compared. The analysis led to the following observations: (1) The average cumulative dose in males and females was 9.65±15.2 and 4.82±5.55 mSv, respectively. (2) In both males and females, there was a very low correlation between the occupation period and the cumulative dose (r<±0.25). (3) When the occupation period was longer, the WBC counts both decreased and increased in the male workers and the RBC counts were lower in the workers than in the control group (p<0.05). In females, the WBC counts both decreased and increased in the workers and the eosinophil counts were lower in the workers than in the control group (p<0.01). (4) When the cumulative dose was large, the lymphocyte counts decreased in male workers and the platelet count was lower in the workers than in the control group (p<0.05). In females, the lymphocyte count and RBC count were lower in the workers than in the control group (p<0.05). Abnormal distributions of some blood indices were observed in the occupational radiation workers compared with the controls. Attempts were made to limit radiation exposure to personnel, but the employees did not always follow the preset rules. Actually, the adverse effects of low-level radiation were attributed to probability. Overall, workers should obey the radiation protection regulations provided by the government and a national system of radiation protection is needed.

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.

PubMed

Nakanishi, Miharu; Imai, Hisato

2012-01-01

The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Association between health worker motivation and healthcare quality efforts in Ghana.

PubMed

Alhassan, Robert Kaba; Spieker, Nicole; van Ostenberg, Paul; Ogink, Alice; Nketiah-Amponsah, Edward; de Wit, Tobias F Rinke

2013-08-14

Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation. This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities. The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety. The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic's effort towards quality improvement and patient safety (P <0.05). As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst.

Radiation Dose to Post-Chernobyl Cleanup Workers

Cancer.gov

Radiation dose calculation for post-Chernobyl Cleanup Workers in Ukraine - both external radiation exposure due to fallout and internal doses due to inhalation (I131 intake) or ingestion of contaminated foodstuffs.

A New Approach to Construct Pathway Connected Networks and Its Application in Dose Responsive Gene Expression Profiles of Rat Liver Regulated by 2,4DNT

DTIC Science & Technology

2010-12-01

differentially expressed genes after 2,4DNT treatment. The most affected pathways included: long term depression, breast cancer regulation by stathmin1, WNT...toxic to reproductive organs in rats [2] and cause genetic toxicity in munitions facility workers and copper miners using explosives [3,4]. DNTs...including 2,4DNT are listed as a priority pollutant by the U.S. Environmental Protection Agency [3]. It is therefore important to develop methods to

Assessing infection control practices to protect health care workers and patients in Malawi from nosocomial transmission of Mycobacterium tuberculosis.

PubMed

Flick, Robert J; Munthali, Adamson; Simon, Katherine; Hosseinipour, Mina; Kim, Maria H; Mlauzi, Lameck; Kazembe, Peter N; Ahmed, Saeed

2017-01-01

Transmission of Mycobacterium tuberculosis (TB) in health settings threatens health care workers and people living with HIV in sub-Saharan Africa. Nosocomial transmission is reduced with implementation of infection control (IC) guidelines. The objective of this study is to describe implementation of TB IC measures in Malawi. We conducted a cross-sectional study utilizing anonymous health worker questionnaires, semi-structured interviews with facility managers, and direct observations at 17 facilities in central Malawi. Of 592 health care workers surveyed, 34% reported that all patients entering the facility were screened for cough and only 8% correctly named the four most common signs and symptoms of TB in adults. Of 33 managers interviewed, 7 (21%) and 1 (3%) provided the correct TB screening questions for use in adults and children, respectively. Of 592 health workers, only 2.4% had been screened for TB in the previous year. Most (90%) reported knowing their HIV status, 53% were tested at their facility of employment, and half reported they would feel comfortable receiving ART or TB treatment at their facility of employment. We conclude that screening is infrequently conducted and knowledge gaps may undercut its effectiveness. Further, health care workers do not routinely access TB and HIV diagnostic and treatment services at their facility of employment.

RCRA Refresher Self-Study, Course 28582

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

Simpson, Lewis Edward

Federal and state regulations require hazardous and mixed waste facility workers at treatment and storage facilities (TSFs) and <90-day accumulation areas to be trained in hazardous and mixed waste management. This course will refamiliarize and update <90-day accumulation area workers, TSF workers, and supervisors of TSF workers regarding waste identification, pollution prevention, storage area requirements, emergency response procedures, and record-keeping requirements.

RCRA Personnel Training, Course 7488

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

Simpson, Lewis Edward

Federal and state regulations require hazardous and mixed waste facility workers at treatment and storage facilities (TSFs) and <90-day accumulation areas to be trained in hazardous and mixed waste management. This course will refamiliarize and update <90-day accumulation area workers, TSF workers, and supervisors of TSF workers regarding waste identification, pollution prevention, storage area requirements, emergency response procedures, and record-keeping requirements.

Enhanced preventive programme at a beryllium oxide ceramics facility reduces beryllium sensitisation among new workers

PubMed Central

Cummings, Kristin J; Deubner, David C; Day, Gregory A; Henneberger, Paul K; Kitt, Margaret M; Kent, Michael S; Kreiss, Kathleen; Schuler, Christine R

2007-01-01

Background A 1998 survey at a beryllium oxide ceramics manufacturing facility found that 10% of workers hired in the previous 6 years had beryllium sensitisation as determined by the beryllium lymphocyte proliferation test (BeLPT). In response, the facility implemented an enhanced preventive programme to reduce sensitisation, including increased respiratory and dermal protection and particle migration control. Aim To assess the programme's effectiveness in preventing sensitisation. Methods In 2000, the facility began testing newly hired workers for beryllium sensitisation with the BeLPT at time of hire and during employment. The sensitisation rate and prevalence for workers hired from 2000 to 2004 were compared with that for workers hired from 1993 to 1998, who were tested in the 1998 survey. Facility environmental conditions for both time periods were evaluated. Results Newly hired workers in both cohorts worked for a mean of 16 months. Of the 97 workers hired from 2000 to 2004 with at least one employment BeLPT result, four had abnormal results at time of hire and one became sensitised during employment. Of the 69 workers hired from 1993 to 1998 and tested in 1998, six were found to be sensitised. The sensitisation rate for the 2000–4 workers was 0.7–2.7/1000 person‐months of employment, and that for the 1993–8 workers was 5.6/1000 person‐months, at least 2.1 (95% confidence interval (CI) 0.6 to 8.4) and up to 8.2 (95% CI 1.2 to 188.8) times higher than that for the 2000–4 workers. The sensitisation prevalence for the 2000–4 workers was 1% and that for the 1993–8 workers was 8.7%, 8.4 (95% CI 1.04 to 68.49) times higher than that for the 2000–4 workers. Airborne beryllium levels for production workers for the two time periods were similar. Conclusions A comprehensive preventive programme reduced beryllium sensitisation in new workers during the first years of employment, despite airborne beryllium levels for production workers that were similar to pre‐programme levels. PMID:17043076

Low-Dose N,N-Dimethylformamide Exposure and Liver Injuries in a Cohort of Chinese Leather Industry Workers.

PubMed

Qi, Cong; Gu, Yiyang; Sun, Qing; Gu, Hongliang; Xu, Bo; Gu, Qing; Xiao, Jing; Lian, Yulong

2017-05-01

We assessed the risk of liver injuries following low doses of N,N-dimethylformamide (DMF) below threshold limit values (20 mg/m) among leather industry workers and comparison groups. A cohort of 429 workers from a leather factory and 466 non-exposed subjects in China were followed for 4 years. Poisson regression and piece-wise linear regression were used to examine the relationship between DMF and liver injury. Workers exposed to a cumulative dose of DMF were significantly more likely than non-exposed workers to develop liver injury. A nonlinear relationship between DMF and liver injury was observed, and a threshold of the cumulative DMF dose for liver injury was 7.30 (mg/m) year. The findings indicate the importance of taking action to reduce DMF occupational exposure limits for promoting worker health.

Dose inspection and risk assessment on radiation safety for the use of non-medical X-ray machines in Taiwan

NASA Astrophysics Data System (ADS)

Hsu, Fang-Yuh; Hsu, Shih-Ming; Chao, Jiunn-Hsing

2017-11-01

The subject of this study is the on-site visits and inspections of facilities commissioned by the Atomic Energy Council (AEC) in Taiwan. This research was conducted to evaluate the possible dose and dose rate of cabinet-type X-ray equipment with nominal voltages of 30-150 kV and open-beam (portable or handheld) equipment, taking both normal operation and possibly abnormal operation conditions into account. Doses and dose rates were measured using a plastic scintillation survey meter and an electronic personal dosimeter. In total, 401 X-ray machines were inspected, including 139 units with nominal voltages of 30-50 kV X-ray equipment, 140 units with nominal voltages of 50-150 kV, and 122 open-beam (portable or handheld) X-ray equipment. The investigated doses for radiation workers and non-radiation workers operating cabinet-type X-ray equipment under normal safety conditions were all at the background dose level. Several investigated dose rates at the position of 10 cm away from the surface of open-beam (portable or handheld) X-ray equipment were very high, such X-ray machines are used by aeronautical police for the detection of suspected explosives, radiation workers are far away (at least 10 m away) from the X-ray machine during its operation. The doses per operation in X-ray equipment with a 30-50 kV nominal voltage were less than 1 mSv in all cases of abnormal use. Some doses were higher than 1 mSv per operation for X-ray equipment of 50-150 kV nominal voltage X-ray. The maximum dose rates at the beam exit have a very wide range, mostly less than 100 μSv/s and the largest value is about 3.92 mSv/s for open-beam (portable or handheld) X-ray devices. The risk induced by operating X-ray devices with nominal voltages of 30-50 kV is extremely low. The 11.5 mSv dose due to one operation at nominal voltage of 50-150 kV X-ray device is equivalent to the exposure of taking 575 chest X-rays. In the abnormal use of open-beam (portable or handheld) X-ray equipment, the effective dose of 3.92 mSv/s is equivalent to taking 196 chest radiographs within 1 s. This work assessed the annual doses (equivalent and effective doses) and risks of X-ray operator staff as reasonably as possible. The results of this research are helpful to the AEC (competent authority of ionization radiation) to improve the management and perform the safe control of X-ray equipment.

Fluence-to-dose conversion coefficients for neutrons and protons calculated using the PHITS code and ICRP/ICRU adult reference computational phantoms.

PubMed

Sato, Tatsuhiko; Endo, Akira; Zankl, Maria; Petoussi-Henss, Nina; Niita, Koji

2009-04-07

The fluence to organ-dose and effective-dose conversion coefficients for neutrons and protons with energies up to 100 GeV was calculated using the PHITS code coupled to male and female adult reference computational phantoms, which are to be released as a common ICRP/ICRU publication. For the calculation, the radiation and tissue weighting factors, w(R) and w(T), respectively, as revised in ICRP Publication 103 were employed. The conversion coefficients for effective dose equivalents derived using the radiation quality factors of both Q(L) and Q(y) relationships were also estimated, utilizing the functions for calculating the probability densities of the absorbed dose in terms of LET (L) and lineal energy (y), respectively, implemented in PHITS. By comparing these data with the corresponding data for the effective dose, we found that the numerical compatibilities of the revised w(R) with the Q(L) and Q(y) relationships are fairly established. The calculated data of these dose conversion coefficients are indispensable for constructing the radiation protection systems based on the new recommendations given in ICRP103 for aircrews and astronauts, as well as for workers in accelerators and nuclear facilities.

Case Management of Severe Malaria - A Forgotten Practice: Experiences from Health Facilities in Uganda

PubMed Central

Achan, Jane; Tibenderana, James; Kyabayinze, Daniel; Mawejje, Henry; Mugizi, Rukaaka; Mpeka, Betty; Talisuna, Ambrose; D'Alessandro, Umberto

2011-01-01

Introduction Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. There is paucity of published information on current practices of severe malaria case management in sub-Saharan Africa; we evaluated the management practices for severe malaria in Ugandan health facilities Methods and Findings We did a cross sectional survey, using multi-stage sampling methods, of health facilities in 11 districts in the eastern and mid-western parts of Uganda. The study instruments were adapted from the WHO hospital care assessment tools. Between June and August 2009, 105 health facilities were surveyed and 181 health workers and 868 patients/caretakers interviewed. None of the inpatient facilities had all seven components of a basic care package for the management of severe malaria consistently available during the 3 months prior to the survey. Referral practices were appropriate for <10% (18/196) of the patients. Prompt care at any health facility was reported by 29% (247/868) of patients. Severe malaria was correctly diagnosed in 27% of patients (233).Though the quinine dose and regimen was correct in the majority (611/868, 70.4%) of patients, it was administered in the correct volumes of 5% dextrose in only 18% (147/815). Most patients (80.1%) had several doses of quinine administered in one single 500 ml bottle of 5% dextrose. Medications were purchased by 385 (44%) patients and medical supplies by 478 patients (70.6%). Conclusions Management of severe malaria in Ugandan health facilities was sub-optimal. These findings highlight the challenges of correctly managing severe malaria in resource limited settings. Priority areas for improvement include triage and emergency care, referral practises, quality of diagnosis and treatment, availability of medicines and supplies, training and support supervision. PMID:21390301

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

MGMT hypomethylation is associated with DNA damage in workers exposed to low-dose benzene.

PubMed

Li, Jie; Zhang, Xinjie; He, Zhini; Sun, Qing; Qin, Fei; Huang, Zhenlie; Zhang, Xiao; Sun, Xin; Liu, Linhua; Chen, Liping; Gao, Chen; Wang, Shan; Wang, Fangping; Li, Daochuan; Zeng, Xiaowen; Deng, Qifei; Wang, Qing; Zhang, Bo; Tang, Huanwen; Chen, Wen; Xiao, Yongmei

2017-07-01

This study aims to assess the effects of low-dose benzene on DNA damage and O 6 -methylguanine-DNA methyltransferase (MGMT) methylation in occupational workers. We recruited 96 nonsmoking male petrochemical industry workers exposed to low-dose benzene and 100 matched control workers. Urinary S-phenylmercapturic acid (SPMA) and S-benzylmercapturic acid (SBMA) were measured for indicating internal exposure of benzene and toluene. The degree of DNA damage was determined by the Comet assay. The levels of MGMT methylation were detected quantitatively by bisulphite-PCR pyrosequencing assay. The benzene-exposed workers had significantly higher levels of urinary SPMA, degree of DNA damage but decreased MGMT methylation than the controls (all p < 0.05). In contrast, the level of urinary SBMA does not differ between benzene-exposed workers and the controls. In all participants, MGMT methylation was negatively associated with the urinary SPMA and the degree of DNA damage, indicating that epigenetic regulation might be involved in response to low-dose benzene exposure-induced genetic damage. MGMT methylation could be a potent biomarker associated with low-dose benzene exposure and benzene-induced DNA damage.

Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment.

PubMed

Rockers, Peter C; Jaskiewicz, Wanda; Wurts, Laura; Kruk, Margaret E; Mgomella, George S; Ntalazi, Francis; Tulenko, Kate

2012-07-23

Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes. Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice. In Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility.

Health worker perspectives on the possible use of intramuscular artesunate for the treatment of severe malaria at lower-level health facilities in settings with poor access to referral facilities in Nigeria: a qualitative study.

PubMed

Adesoro, Olatunde; Shumba, Constance; Kpamor, John; Achan, Jane; Kivumbi, Harriet; Dada, John; Maxwell, Kolawole; Tibenderana, James; Marasciulo, Madeline; Hamade, Prudence; Oresanya, Olusola; Nankabirwa, Joanita; Baba, Ebenezer

2016-10-12

Innovative strategies are needed to reduce malaria mortality in high burden countries like Nigeria. Given that one of the important reasons for this high malaria mortality is delay in receiving effective treatment, improved access to such treatment is critical. Intramuscular artesunate could be used at lower-level facilities given its proven efficacy, ease of use and excellent safety profile. The objective of this study was therefore to explore health workers' perspectives on the possible use of intramuscular artesunate as definitive treatment for severe malaria at lower-level facilities, especially when access to referral facilities is challenging. The study was to provide insight as a formative step into the conduct of future experimental studies to ascertain the feasibility of the use of intramuscular artesunate for definitive treatment of severe malaria in lower level facilities where access to referral care is limited. This qualitative study was done across three southern States in Nigeria (Oyo, Cross River and Enugu). Key informant interviews were conducted over a period of three months between October and December 2014 among 90 purposively selected health workers with different roles in malaria case management from primary care to policy level. A thematic content analysis was used to analyse data. Overall, most of health workers and other key informant groups thought that the use of intramuscular artesunate for definitive treatment of severe malaria at lower-level facilities was possible. They however reported human resource and infrastructure constraints as factors affecting the feasibility of intramuscular artesunate use as definitive treatment for severe malaria in lower-level facilities.. Specifically identified barriers included limited numbers of skilled health workers available to manage potential complications of severe malaria and poorly equipped facilities for supportive treatment. Intramuscular artesunate was considered easy to administer and the proximity of lower-level facilities to communities was deemed important in considering the possibility of its use at lower-level facilities. Health workers also emphasised the important role of operational research to provide additional evidence to guide the implementation of existing policy recommendations and inform future policy revisions. From the perspective of health workers, use of intramuscular artesunate for definitive treatment of severe malaria at lower-level health facilities in Nigeria is possible but dependent on availability of skilled workers, well-equipped lower-level facilities to provide supportive treatment There is need for further operational research to establish feasibility and guide the implementation of such an intervention.

Disability rates for cardiovascular and psychological disorders among autoworkers by job category, facility type, and facility overtime hours.

PubMed

Landsbergis, Paul A; Janevic, Teresa; Rothenberg, Laura; Adamu, Mohammed T; Johnson, Sylvia; Mirer, Franklin E

2013-07-01

We examined the association between long work hours, assembly line work and stress-related diseases utilizing objective health and employment data from an employer's administrative databases. A North American automobile manufacturing company provided data for claims for sickness, accident and disability insurance (work absence of at least 4 days) for cardiovascular disease (CVD), hypertension and psychological disorders, employee demographics, and facility hours worked per year for 1996-2001. Age-adjusted claim rates and age-adjusted rate ratios were calculated using Poisson regression, except for comparisons between production and skilled trades workers owing to lack of age denominator data by job category. Associations between overtime hours and claim rates by facility were examined by Poisson regression and multi-level Poisson regression. Claims for hypertension, coronary heart disease, CVD, and psychological disorders were associated with facility overtime hours. We estimate that a facility with 10 more overtime hours per week than another facility would have 4.36 more claims for psychological disorders, 2.33 more claims for CVD, and 3.29 more claims for hypertension per 1,000 employees per year. Assembly plants had the highest rates of claims for most conditions. Production workers tended to have higher rates of claims than skilled trades workers. Data from an auto manufacturer's administrative databases suggest that autoworkers working long hours, and assembly-line workers relative to skilled trades workers or workers in non-assembly facilities, have a higher risk of hypertension, CVD, and psychological disorders. Occupational disease surveillance and disease prevention programs need to fully utilize such administrative data. Copyright © 2013 Wiley Periodicals, Inc.

Study of a selection of 10 historical types of dosemeter: variation of the response to Hp(10) with photon energy and geometry of exposure.

PubMed

Thierry-Chef, I; Pernicka, F; Marshall, M; Cardis, E; Andreo, P

2002-01-01

An international collaborative study of cancer risk among workers in the nuclear industry is tinder way to estimate direetly the cancer risk following protracted low-dose exposure to ionising radiation. An essential aspect of this study is the characterisation and quantification of errors in available dose estimates. One major source of errors is dosemeter response in workplace exposure conditions. Little information is available on energy and geometry response for most of the 124 different dosemeters used historically in participating facilities. Experiments were therefore set up to assess this. using 10 dosemeter types representative of those used over time. Results show that the largest errors were associated with the response of early dosemeters to low-energy photon radiation. Good response was found with modern dosemeters. even at low energy. These results are being used to estimate errors in the response for each dosemeter type, used in the participating facilities, so that these can be taken into account in the estimates of cancer risk.

Experimental study of radiation dose rate at different strategic points of the BAEC TRIGA Research Reactor.

PubMed

Ajijul Hoq, M; Malek Soner, M A; Salam, M A; Haque, M M; Khanom, Salma; Fahad, S M

2017-12-01

The 3MW TRIGA Mark-II Research Reactor of Bangladesh Atomic Energy Commission (BAEC) has been under operation for about thirty years since its commissioning at 1986. In accordance with the demand of fundamental nuclear research works, the reactor has to operate at different power levels by utilizing a number of experimental facilities. Regarding the enquiry for safety of reactor operating personnel and radiation workers, it is necessary to know the radiation level at different strategic points of the reactor where they are often worked. In the present study, neutron, beta and gamma radiation dose rate at different strategic points of the reactor facility with reactor power level of 2.4MW was measured to estimate the rising level of radiation due to its operational activities. From the obtained results high radiation dose is observed at the measurement position of the piercing beam port which is caused by neutron leakage and accordingly, dose rate at the stated position with different reactor power levels was measured. This study also deals with the gamma dose rate measurements at a fixed position of the reactor pool top surface for different reactor power levels under both Natural Convection Cooling Mode (NCCM) and Forced Convection Cooling Mode (FCCM). Results show that, radiation dose rate is higher for NCCM in compared with FCCM and increasing with the increase of reactor power. Thus, concerning the radiological safety issues for working personnel and the general public, the radiation dose level monitoring and the experimental analysis performed within this paper is so much effective and the result of this work can be utilized for base line data and code verification of the nuclear reactor. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Dose Response Relationship between In Ear Occupational Noise Exposure and Hearing Loss

PubMed Central

Rabinowitz, Peter M.; Galusha, Deron; Dixon-Ernst, Christine; Clougherty, Jane E.; Neitzel, Richard L.

2014-01-01

Objectives Current understanding of the dose-response relationship between occupational noise and hearing loss is based on cross-sectional studies prior to the widespread use hearing protection and with limited data regarding noise exposures below 85dBA. We report on the hearing loss experience of a unique cohort of industrial workers with daily monitoring of noise inside of hearing protection devices. Methods At an industrial facility, workers exhibiting accelerated hearing loss were enrolled in a mandatory program to monitor daily noise exposures inside of hearing protection. We compared these noise measurements (as time-weighted LAVG) to interval rates of high frequency hearing loss over a six year period using a mixed effects model, adjusting for potential confounders. Results Workers’ high frequency hearing levels at study inception averaged more than 40 dB hearing threshold level (HTL). Most noise exposures were less than 85dBA (mean LAVG 76 dBA, interquartile range 74 to 80 dBA). We found no statistical relationship between LAvg and high frequency hearing loss (p = 0.53). Using a metric for monthly maximum noise exposure did not improve model fit. Conclusion At-ear noise exposures below 85dBA did not show an association with risk of high frequency hearing loss among workers with substantial past noise exposure and hearing loss at baseline. Therefore, effective noise control to below 85dBA may lead to significant reduction in occupational hearing loss risk in such individuals. Further research is needed on the dose response relationship of noise and hearing loss in individuals with normal hearing and little prior noise exposure. PMID:23825197

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

PubMed

Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

PubMed Central

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

Assessing infection control practices to protect health care workers and patients in Malawi from nosocomial transmission of Mycobacterium tuberculosis

PubMed Central

Simon, Katherine; Hosseinipour, Mina; Kim, Maria H.; Mlauzi, Lameck; Kazembe, Peter N.; Ahmed, Saeed

2017-01-01

Transmission of Mycobacterium tuberculosis (TB) in health settings threatens health care workers and people living with HIV in sub-Saharan Africa. Nosocomial transmission is reduced with implementation of infection control (IC) guidelines. The objective of this study is to describe implementation of TB IC measures in Malawi. We conducted a cross-sectional study utilizing anonymous health worker questionnaires, semi-structured interviews with facility managers, and direct observations at 17 facilities in central Malawi. Of 592 health care workers surveyed, 34% reported that all patients entering the facility were screened for cough and only 8% correctly named the four most common signs and symptoms of TB in adults. Of 33 managers interviewed, 7 (21%) and 1 (3%) provided the correct TB screening questions for use in adults and children, respectively. Of 592 health workers, only 2.4% had been screened for TB in the previous year. Most (90%) reported knowing their HIV status, 53% were tested at their facility of employment, and half reported they would feel comfortable receiving ART or TB treatment at their facility of employment. We conclude that screening is infrequently conducted and knowledge gaps may undercut its effectiveness. Further, health care workers do not routinely access TB and HIV diagnostic and treatment services at their facility of employment. PMID:29211793

Mortality among mound workers exposed to polonium-210 and other sources of radiation, 1944-1979.

PubMed

Boice, John D; Cohen, Sarah S; Mumma, Michael T; Ellis, Elizabeth Dupree; Cragle, Donna L; Eckerman, Keith F; Wallace, Phillip W; Chadda, Bandana; Sonderman, Jennifer S; Wiggs, Laurie D; Richter, Bonnie S; Leggett, Richard W

2014-02-01

Polonium-210 is a naturally occurring radioactive element that decays by emitting an alpha particle. It is in the air we breathe and also a component of tobacco smoke. Polonium-210 is used as an anti-static device in printing presses and gained widespread notoriety in 2006 after the poisoning and subsequent death of a Russian citizen in London. More is known about the lethal effects of polonium-210 at high doses than about late effects from low doses. Cancer mortality was examined among 7,270 workers at the Mound nuclear facility near Dayton, OH where polonium-210 was used (1944-1972) in combination with beryllium as a source of neutrons for triggering nuclear weapons. Other exposures included external gamma radiation and to a lesser extent plutonium-238, tritium and neutrons. Vital status and cause of death was determined through 2009. Standardized mortality ratios (SMRs) were computed for comparisons with the general population. Lifetime occupational doses from all places of employment were sought and incorporated into the analysis. Over 200,000 urine samples were analyzed to estimate radiation doses to body organs from polonium and other internally deposited radionuclides. Cox proportional hazards models were used to evaluate dose-response relationships for specific organs and tissues. Vital status was determined for 98.7% of the workers of which 3,681 had died compared with 4,073.9 expected (SMR 0.90; 95% CI 0.88-0.93). The mean dose from external radiation was 26.1 mSv (maximum 939.1 mSv) and the mean lung dose from external and internal radiation combined was 100.1 mSv (maximum 17.5 Sv). Among the 4,977 radiation workers, all cancers taken together (SMR 0.86; 95% CI 0.79-0.93), lung cancer (SMR 0.85; 95% CI 0.74-0.98), and other types of cancer were not significantly elevated. Cox regression analysis revealed a significant positive dose-response trend for esophageal cancer [relative risk (RR) and 95% confidence interval at 100 mSv of 1.54 (1.15-2.07)] and a negative dose-response trend for liver cancer [RR (95% CI) at 100 mSv of 0.55 (0.23-1.32)]. For lung cancer the RR at 100 mSv was 1.00 (95% CI 0.97-1.04) and for all leukemias other than chronic lymphocytic leukemia (CLL) it was 1.04 (95% CI 0.63-1.71). There was no evidence that heart disease was associated with exposures [RR at 100 mSv of 1.06 (0.95-1.18)]. Assuming a relative biological effectiveness factor of either 10 or 20 for polonium and plutonium alpha particle emissions had little effect on the dose-response analyses. Polonium was the largest contributor to lung dose, and a relative risk of 1.04 for lung cancer at 100 mSv could be excluded with 95% confidence. A dose related increase in cancer of the esophagus was consistent with a radiation etiology but based on small numbers. A dose-related decrease in liver cancer suggests the presence of other modifying factors of risk and adds caution to interpretations. The absence of a detectable increase in total cancer deaths and lung cancer in particular associated with occupational exposures to polonium (mean lung dose 159.8 mSv), and to plutonium to a lesser extent (mean lung dose 13.7 mSv), is noteworthy but based on small numbers. Larger combined studies of U.S. workers are needed to clarify radiation risks following prolonged exposures and radionuclide intakes.

Mortality Among Mound Workers Exposed to Polonium-210 and Other Sources of Radiation, 1944–1979

DOE PAGES

Boice, John D.; Cohen, Sarah S.; Mumma, Michael T.; ...

2014-02-14

Polonium-210 is a naturally occurring radioactive element that decays by emitting an alpha particle. It is in the air we breathe and also a component of tobacco smoke. Polonium-210 is used as an anti-static device in printing presses and gained widespread notoriety in 2006 after the poisoning and subsequent death of a Russian citizen in London. More is known about the lethal effects of polonium-210 at high doses than about late effects from low doses. In this paper, cancer mortality was examined among 7,270 workers at the Mound nuclear facility near Dayton, OH where polonium-210 was used (1944–1972) in combinationmore » with beryllium as a source of neutrons for triggering nuclear weapons. Other exposures included external gamma radiation and to a lesser extent plutonium-238, tritium and neutrons. Vital status and cause of death was determined through 2009. Standardized mortality ratios (SMRs) were computed for comparisons with the general population. Lifetime occupational doses from all places of employment were sought and incorporated into the analysis. Over 200,000 urine samples were analyzed to estimate radiation doses to body organs from polonium and other internally deposited radionuclides. Cox proportional hazards models were used to evaluate dose-response relationships for specific organs and tissues. Vital status was determined for 98.7% of the workers of which 3,681 had died compared with 4,073.9 expected (SMR 0.90; 95% CI 0.88–0.93). The mean dose from external radiation was 26.1 mSv (maximum 939.1 mSv) and the mean lung dose from external and internal radiation combined was 100.1 mSv (maximum 17.5 Sv). Among the 4,977 radiation workers, all cancers taken together (SMR 0.86; 95% CI 0.79–0.93), lung cancer (SMR 0.85; 95% CI 0.74–0.98), and other types of cancer were not significantly elevated. Cox regression analysis revealed a significant positive dose-response trend for esophageal cancer [relative risk (RR) and 95% confidence interval at 100 mSv of 1.54 (1.15–2.07)] and a negative dose-response trend for liver cancer [RR (95% CI) at 100 mSv of 0.55 (0.23–1.32)]. For lung cancer the RR at 100 mSv was 1.00 (95% CI 0.97–1.04) and for all leukemias other than chronic lymphocytic leukemia (CLL) it was 1.04 (95% CI 0.63–1.71). There was no evidence that heart disease was associated with exposures [RR at 100 mSv of 1.06 (0.95–1.18)]. Assuming a relative biological effectiveness factor of either 10 or 20 for polonium and plutonium alpha particle emissions had little effect on the dose-response analyses. Polonium was the largest contributor to lung dose, and a relative risk of 1.04 for lung cancer at 100 mSv could be excluded with 95% confidence. A dose related increase in cancer of the esophagus was consistent with a radiation etiology but based on small numbers. A dose-related decrease in liver cancer suggests the presence of other modifying factors of risk and adds caution to interpretations. The absence of a detectable increase in total cancer deaths and lung cancer in particular associated with occupational exposures to polonium (mean lung dose 159.8 mSv), and to plutonium to a lesser extent (mean lung dose 13.7 mSv), is noteworthy but based on small numbers. Finally, larger combined studies of U.S. workers are needed to clarify radiation risks following prolonged exposures and radionuclide intakes.« less

Mortality Among Mound Workers Exposed to Polonium-210 and Other Sources of Radiation, 1944–1979

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

Boice, John D.; Cohen, Sarah S.; Mumma, Michael T.

Polonium-210 is a naturally occurring radioactive element that decays by emitting an alpha particle. It is in the air we breathe and also a component of tobacco smoke. Polonium-210 is used as an anti-static device in printing presses and gained widespread notoriety in 2006 after the poisoning and subsequent death of a Russian citizen in London. More is known about the lethal effects of polonium-210 at high doses than about late effects from low doses. In this paper, cancer mortality was examined among 7,270 workers at the Mound nuclear facility near Dayton, OH where polonium-210 was used (1944–1972) in combinationmore » with beryllium as a source of neutrons for triggering nuclear weapons. Other exposures included external gamma radiation and to a lesser extent plutonium-238, tritium and neutrons. Vital status and cause of death was determined through 2009. Standardized mortality ratios (SMRs) were computed for comparisons with the general population. Lifetime occupational doses from all places of employment were sought and incorporated into the analysis. Over 200,000 urine samples were analyzed to estimate radiation doses to body organs from polonium and other internally deposited radionuclides. Cox proportional hazards models were used to evaluate dose-response relationships for specific organs and tissues. Vital status was determined for 98.7% of the workers of which 3,681 had died compared with 4,073.9 expected (SMR 0.90; 95% CI 0.88–0.93). The mean dose from external radiation was 26.1 mSv (maximum 939.1 mSv) and the mean lung dose from external and internal radiation combined was 100.1 mSv (maximum 17.5 Sv). Among the 4,977 radiation workers, all cancers taken together (SMR 0.86; 95% CI 0.79–0.93), lung cancer (SMR 0.85; 95% CI 0.74–0.98), and other types of cancer were not significantly elevated. Cox regression analysis revealed a significant positive dose-response trend for esophageal cancer [relative risk (RR) and 95% confidence interval at 100 mSv of 1.54 (1.15–2.07)] and a negative dose-response trend for liver cancer [RR (95% CI) at 100 mSv of 0.55 (0.23–1.32)]. For lung cancer the RR at 100 mSv was 1.00 (95% CI 0.97–1.04) and for all leukemias other than chronic lymphocytic leukemia (CLL) it was 1.04 (95% CI 0.63–1.71). There was no evidence that heart disease was associated with exposures [RR at 100 mSv of 1.06 (0.95–1.18)]. Assuming a relative biological effectiveness factor of either 10 or 20 for polonium and plutonium alpha particle emissions had little effect on the dose-response analyses. Polonium was the largest contributor to lung dose, and a relative risk of 1.04 for lung cancer at 100 mSv could be excluded with 95% confidence. A dose related increase in cancer of the esophagus was consistent with a radiation etiology but based on small numbers. A dose-related decrease in liver cancer suggests the presence of other modifying factors of risk and adds caution to interpretations. The absence of a detectable increase in total cancer deaths and lung cancer in particular associated with occupational exposures to polonium (mean lung dose 159.8 mSv), and to plutonium to a lesser extent (mean lung dose 13.7 mSv), is noteworthy but based on small numbers. Finally, larger combined studies of U.S. workers are needed to clarify radiation risks following prolonged exposures and radionuclide intakes.« less

75 FR 26791 - Chrysler, LLC, Trenton Engine Plant, Including On-Site Leased Workers from Caravan Knight...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-64,550] Chrysler, LLC, Trenton Engine Plant, Including On-Site Leased Workers from Caravan Knight Facilities Management LLC and Devon Facility Management, Trenton, MI, Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance and Alternative Trade...

75 FR 74022 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... DEFENSE NUCLEAR FACILITIES SAFETY BOARD [Recommendation 2010-1] Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers AGENCY: Defense Nuclear Facilities Safety Board... Nuclear Facilities Safety Board has made a recommendation to the Secretary of Energy requesting an...

Association between health worker motivation and healthcare quality efforts in Ghana

PubMed Central

2013-01-01

Background Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation. Purpose This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities. Methods The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety. Results The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic’s effort towards quality improvement and patient safety (P <0.05). Conclusion As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst. PMID:23945073

Low Prevalence of Chronic Beryllium Disease among Workers at a Nuclear Weapons Research and Development Facility

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

Arjomandi, M; Seward, J P; Gotway, M B

2010-01-11

To study the prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) in a cohort of workers from a nuclear weapons research and development facility. We evaluated 50 workers with BeS with medical and occupational histories, physical examination, chest imaging with HRCT (N=49), and pulmonary function testing. Forty of these workers also underwent bronchoscopy for bronchoalveolar lavage (BAL) and transbronchial biopsies. The mean duration of employment at the facility was 18 yrs and the mean latency (from first possible exposure) to time of evaluation was 32 yrs. Five of the workers had CBD at the time of evaluation (basedmore » on histology or HRCT); three others had evidence of probable CBD. These workers with BeS, characterized by a long duration of potential Be exposure and a long latency, had a low prevalence of CBD.« less

Low Prevalence of Chronic Beryllium Disease Among Workers at aNuclearWeaponsResearchandDevelopmentFacility

PubMed Central

Arjomandi, Mehrdad; Seward, James; Gotway, Michael B.; Nishimura, Stephen; Fulton, George P.; Thundiyil, Josef; King, Talmadge E.; Harber, Philip; Balmes, John R.

2012-01-01

Objective To study the prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) in a cohort of workers from a nuclear weapons research and development facility. Methods We evaluated 50 workers with BeS with medical and occupational histories, physical examination, chest imaging with high-resolution computed tomography (N = 49), and pulmonary function testing. Forty of these workers also underwent bronchoscopy for bronchoalveolar lavage and transbronchial biopsies. Results The mean duration of employment at the facility was 18 years and the mean latency (from first possible exposure) to time of evaluation was 32 years. Five of the workers had CBD at the time of evaluation (based on histology or high-resolution computed tomography); three others had evidence of probable CBD. Conclusions These workers with BeS, characterized by a long duration of potential Be exposure and a long latency, had a low prevalence of CBD. PMID:20523233

Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria.

PubMed

Bhatnagar, Aarushi; George, Asha S

2016-09-01

In 2012, the Nigerian government launched performance-based financing (PBF) in three districts providing financial incentives to health workers based on the quantity and quality of service provision. They were given autonomy to use funds for operational costs and performance bonuses. This study aims to understand changes in perceived motivation among health workers with the introduction of PBF in Wamba district, Nigeria. The study used a qualitative research design to compare perceptions of health workers in facilities receiving PBF payments in the pilot district of Wamba to those that were not. In-depth semi-structured interviews (n = 39) were conducted with health workers from PBF and non-PBF facilities along with managers of the PBF project. Framework analysis was used to identify patterns and variations in responses. Facility records were collated and triangulated with qualitative data. Health workers receiving PBF payments reported to be 'awakened' by performance bonuses and improved working environments including routine supportive supervision and availability of essential drugs. They recounted being more punctual, hard working and proud of providing better services to their communities. In comparison, health workers in non-PBF facilities complained about the dearth of basic equipment and lack of motivating strategies. However, health workers from both sets of facilities considered there to be a severe shortage of manpower resulting in excessive workload, fatigue and general dissatisfaction. PBF strategies can succeed in motivating health workers by bringing about a change in incentives and working conditions. However, such programmes need to be aligned with human resource reforms including timely recruitment and appropriate distribution of health workers to prevent burn out and attrition. As people working on the frontline of constrained health systems, health workers are responsive to improved incentives and working conditions, but need more comprehensive support. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The social integration of healthcare agency workers in long-term care facilities: A cross-sectional study.

PubMed

Lapalme, Marie-Ève; Doucet, Olivier

2018-06-01

Patient care quality is a key concern for long-term care facilities and is directly related to effective collaboration between healthcare professionals. The use of agency staff in long-term care facilities creates important challenges in terms of coordination and communication within work units. The purpose of this study is to assess the mediating effect of common in-group identity in the relationship between permanent employees' perceptions regarding the use of agency workers -namely distributive justice, perceptions of threat, perceived similarities with agency workers, and leader inclusiveness toward agency staff- and the permanent employees' adoption of collaborative behaviours. Cross-sectional study. Three long-term care facilities. 290 regular healthcare employees (nurses and care attendants). Data were obtained through questionnaires filled out by employees. Hypotheses were tested using structural equation analyses. The results showed the indirect effects of perceived distributive justice, perceived similarity and leader inclusiveness toward agency workers on permanent employees' cooperation behaviours through common group identification. Perceptions of threat were not related to common group identification or collaborative behaviours. The results also showed that common in-group identification is related to cooperation behaviours only for employees without previous experience as agency workers. This study suggests that permanent healthcare employees who feel they are fairly compensated relative to agency workers, who consider these workers as similar to them, and who believe their supervisor appreciates agency workers' contributions tend to develop a common in-group identity, which fosters collaborative behaviours. Managers of long-term care facilities who wish to foster collaboration among their blended workforce should thus create an environment conducive of a more inclusive identity, particularly if their employees have no previous experience as agency workers. Copyright © 2018 Elsevier Ltd. All rights reserved.

Retrospective study of the iodine-131 contamination of workers in the radiopharmaceutical industry.

PubMed

Gaburo, J C; Lipsztein, J L; Rabelo, D M; Stabin, M

2003-01-01

A dose reconstruction study was performed for personnel occupationally exposed to 131I in radiopharmaceutical production, during the years 1981 to 1994, with the objective of estimating committed effective doses and critically reviewing the main causes of their exposures. The workers were selected from a group responsible for the production, labelling and distribution of all radiopharmaceutical material in Brazil. Best estimates of intakes and doses were derived from the examination of the individual monitoring records and the reports from the radiation protection supervisor, complemented by interviews with the workers and with radiation protection officers. Over this time period workers had chronic as well as acute intakes of 131I. Committed effective doses were found to be dependent on the task performed by the worker and the site of operation and inversely correlated with the amounts of iodine handled. Intakes in general were a consequence of inadequate radiation protection control.

Small Active Radiation Monitor

NASA Technical Reports Server (NTRS)

Badhwar, Gautam D.

2004-01-01

A device, named small active radiation monitor, allows on-orbit evaluations during periods of increased radiation, after extravehicular activities, or at predesignated times for crews on such long-duration space missions as on the International Space Station. It also permits direct evaluation of biological doses, a task now performed using a combination of measurements and potentially inaccurate simulations. Indeed the new monitor can measure a full array of radiation levels, from soft x-rays to hard galactic cosmic-ray particles. With refinement, it will benefit commercial (nuclear power-plant workers, airline pilots, medical technicians, physicians/dentists, and others) and military personnel as well as the astronauts for whom thermoluminescent dosimeters are inadequate. Civilian and military personnel have long since graduated from film badges to thermoluminescent dosimeters. Once used, most dosimeters must be returned to a central facility for processing, a step that can take days or even weeks. While this suffices for radiation workers for whom exposure levels are typically very low and of brief duration, it does not work for astronauts. Even in emergencies and using express mail, the results can often be delayed by as much as 24 hours. Electronic dosimeters, which are the size of electronic oral thermometers, and tattlers, small electronic dosimeters that sound an alarm when the dose/dose rate exceeds preset values, are also used but suffer disadvantages similar to those of thermoluminescent dosimeters. None of these devices fully answers the need of rapid monitoring during the space missions. Instead, radiation is monitored by passive detectors, which are read out after the missions. Unfortunately, these detectors measure only the absorbed dose and not the biologically relevant dose equivalent. The new monitor provides a real-time readout, a time history of radiation exposures (both absorbed dose and biologically relevant dose equivalent), and a count of the number of particles passing through a unit area. Better still, the monitor can be used anywhere.

Leukemia risk associated with chronic external exposure to ionizing radiation in a French cohort of nuclear workers.

PubMed

Metz-Flamant, C; Samson, E; Caër-Lorho, S; Acker, A; Laurier, D

2012-11-01

Leukemia is one of the earliest cancer effects observed after acute exposure to relatively high doses of ionizing radiation. Leukemia mortality after external exposure at low doses and low-dose rates has been investigated at the French Atomic Energy Commission (CEA) and Nuclear Fuel Company (AREVA NC) after an additional follow-up of 10 years. The cohort included radiation-monitored workers employed for at least one year during 1950-1994 at CEA or AREVA NC and followed during 1968-2004. Association between external exposure and leukemia mortality was estimated with excess relative risk (ERR) models and time-dependent modifying factors were investigated with time windows. The cohort included 36,769 workers, followed for an average of 28 years, among whom 73 leukemia deaths occurred. Among the workers with a positive recorded dose, the mean cumulative external dose was 21.7 mSv. Results under a 2-year lag assumption suggested that the risk of leukemia (except chronic lymphatic leukemia) increased significantly by 8% per 10 mSv. The magnitude of the association for myeloid leukemia was larger. The higher ERR/Sv for doses received 2-14 years earlier suggest that time since exposure modifies the effect. The ERR/Sv also appeared higher for doses received at exposure rates ≥20 mSv per year. These results are consistent with those found in other studies of nuclear workers. However, confidence intervals are still wide. Further analyses should be conducted in pooled cohorts of nuclear workers.

Addressing as low as reasonably achievable (ALARA) issues: investigation of worker collective external and extremity dose data

DOE PAGES

Cournoyer, Michael Edward; Costigan, Stephen Andrew; Schreiber, Stephen Bruce

2017-03-17

Plutonium emits both neutrons and photons and when it is stored or handled inside a glovebox, both photons and neutrons are significant external radiation hazards. Doses to the extremities are usually dominated by gamma radiation in typical plutonium glovebox operations. Excess external dose can generates stochastic effects consisting of cancer and benign tumors in some organs. Direct doses from radiation sources external to the body are measured by thermoluminescent dosimeters (TLDs) placed on the glovebox worker between the neck and waist. Wrist dosimeters are used to assess externally penetrating radiation including neutrons and provide an estimate of neutron radiation exposuremore » to the extremities. Both TLDs and wrist dosimeters are processed monthly for most glovebox workers. Here, worker collective extremity and external dose data have been analyzed to prevent and mitigate external radiation events through the use of Lean Manufacturing and Six Sigma business practices (LSS). Employing LSS, statistically significant variations (trends) are identified in worker collective extremity and external dose data. Finally, the research results presented in this paper are pivotal to the ultimate focus of this program, which is to minimize external radiation events.« less

Addressing as low as reasonably achievable (ALARA) issues: investigation of worker collective external and extremity dose data

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

Cournoyer, Michael Edward; Costigan, Stephen Andrew; Schreiber, Stephen Bruce

Plutonium emits both neutrons and photons and when it is stored or handled inside a glovebox, both photons and neutrons are significant external radiation hazards. Doses to the extremities are usually dominated by gamma radiation in typical plutonium glovebox operations. Excess external dose can generates stochastic effects consisting of cancer and benign tumors in some organs. Direct doses from radiation sources external to the body are measured by thermoluminescent dosimeters (TLDs) placed on the glovebox worker between the neck and waist. Wrist dosimeters are used to assess externally penetrating radiation including neutrons and provide an estimate of neutron radiation exposuremore » to the extremities. Both TLDs and wrist dosimeters are processed monthly for most glovebox workers. Here, worker collective extremity and external dose data have been analyzed to prevent and mitigate external radiation events through the use of Lean Manufacturing and Six Sigma business practices (LSS). Employing LSS, statistically significant variations (trends) are identified in worker collective extremity and external dose data. Finally, the research results presented in this paper are pivotal to the ultimate focus of this program, which is to minimize external radiation events.« less

Stochastic Modeling of Radioactive Material Releases

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

Andrus, Jason; Pope, Chad

2015-09-01

Nonreactor nuclear facilities operated under the approval authority of the U.S. Department of Energy use unmitigated hazard evaluations to determine if potential radiological doses associated with design basis events challenge or exceed dose evaluation guidelines. Unmitigated design basis events that sufficiently challenge dose evaluation guidelines or exceed the guidelines for members of the public or workers, merit selection of safety structures, systems, or components or other controls to prevent or mitigate the hazard. Idaho State University, in collaboration with Idaho National Laboratory, has developed a portable and simple to use software application called SODA (Stochastic Objective Decision-Aide) that stochastically calculatesmore » the radiation dose associated with hypothetical radiological material release scenarios. Rather than producing a point estimate of the dose, SODA produces a dose distribution result to allow a deeper understanding of the dose potential. SODA allows users to select the distribution type and parameter values for all of the input variables used to perform the dose calculation. SODA then randomly samples each distribution input variable and calculates the overall resulting dose distribution. In cases where an input variable distribution is unknown, a traditional single point value can be used. SODA was developed using the MATLAB coding framework. The software application has a graphical user input. SODA can be installed on both Windows and Mac computers and does not require MATLAB to function. SODA provides improved risk understanding leading to better informed decision making associated with establishing nuclear facility material-at-risk limits and safety structure, system, or component selection. It is important to note that SODA does not replace or compete with codes such as MACCS or RSAC, rather it is viewed as an easy to use supplemental tool to help improve risk understanding and support better informed decisions. The work was funded through a grant from the DOE Nuclear Safety Research and Development Program.« less

Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India.

PubMed

Ghosh, Arpita; Laxminarayan, Ramanan

2017-02-15

Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08). Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres. Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

75 FR 10395 - Attestation Applications by Facilities Temporarily Employing H-1C Nonimmigrant Foreign Workers as...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... Applications by Facilities Temporarily Employing H-1C Nonimmigrant Foreign Workers as Registered Nurses; Final... Nurses; Final Rule AGENCY: Employment and Training Administration, Labor, in collaboration with Wage and... registered nurses in health professional shortage areas on a temporary basis under the H-1C visa. Facilities...

75 FR 69648 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

... DEFENSE NUCLEAR FACILITIES SAFETY BOARD [Recommendation 2010-1] Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers AGENCY: Defense Nuclear Facilities Safety Board... Facilities Safety Board has made a recommendation to the Secretary of Energy requesting an amendment to the...

An Updated Performance Assessment For A New Low-Level Radioactive Waste Disposal Facility In West Texas - 12192

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

Dornsife, William P.; Kirk, J. Scott; Shaw, Chris G.

2012-07-01

This Performance Assessment (PA) submittal is an update to the original PA that was developed to support the licensing of the Waste Control Specialists LLC Low-Level Radioactive Waste (LLRW) disposal facility. This update includes both the Compact Waste Facility (CWF) and the Federal Waste Facility (FWF), in accordance with Radioactive Material License (RML) No. R04100, License Condition (LC) 87. While many of the baseline assumptions supporting the initial license application PA were incorporated in this update, a new transport code, GoldSim, and new deterministic groundwater flow codes, including HYDRUS and MODFLOWSURFACT{sup TM}, were employed to demonstrate compliance with the performancemore » objectives codified in the regulations and RML No. R04100, LC 87. A revised source term, provided by the Texas Commission on Environmental Quality staff, was used to match the initial 15 year license term. This updated PA clearly confirms and demonstrates the robustness of the characteristics of the site's geology and the advanced engineering design of the disposal units. Based on the simulations from fate and transport models, the radiation doses to members of the general public and site workers predicted in the initial and updated PA were a small fraction of the criterion doses of 0.25 mSv and 50 mSv, respectively. In a comparison between the results of the updated PA against the one developed in support of the initial license, both clearly demonstrated the robustness of the characteristics of the site's geology and engineering design of the disposal units. Based on the simulations from fate and transport models, the radiation doses to members of the general public predicted in the initial and updated PA were a fraction of the allowable 25 mrem/yr (0.25 m sievert/yr) dose standard for tens-of-thousands of years into the future. Draft Texas guidance on performance assessment (TCEQ, 2004) recommends a period of analysis equal to 1,000 years or until peak doses from the more mobile radionuclides occur. The EPA National Emissions Standards for Hazardous Air Pollutants limits radionuclide doses through the air pathway to 10 mrem/yr. Gaseous radionuclide doses from the CWF and the FWF, due to decomposition gases, are a small fraction of the dose limit. The radon flux from the CWF and FWF were compared to the flux limit of 20 pCi/m{sup 2}-s from 40 CFR 192. Because of the thick cover system, the calculated radon flux was a very small fraction of the limit. (authors)« less

Safeguards by Design Challenge

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

Alwin, Jennifer Louise

The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA’s limited budget. Dose to workers should always bemore » as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).« less

Facility-specific radiation exposure risks and their implications for radiation workers at Department of Energy laboratories

NASA Astrophysics Data System (ADS)

Davis, Adam Christopher

This research develops a new framework for evaluating the occupational risks of exposure to hazardous substances in any setting where As Low As Reasonably Achievable (ALARA) practices are mandated or used. The evaluation is performed by developing a hypothesis-test-based procedure for evaluating the homogeneity of various epidemiological cohorts, and thus the appropriateness of the application of aggregate data-pooling techniques to those cohorts. A statistical methodology is then developed as an alternative to aggregate pooling for situations in which individual cohorts show heterogeneity between them and are thus unsuitable for pooled analysis. These methods are then applied to estimate the all-cancer mortality risks incurred by workers at four Department-of-Energy nuclear weapons laboratories. Both linear, no-threshold and dose-bin averaged risks are calculated and it is further shown that aggregate analysis tends to overestimate the risks with respect to those calculated by the methods developed in this work. The risk estimates developed in Chapter 2 are, in Chapter 3, applied to assess the risks to workers engaged in americium recovery operations at Los Alamos National Laboratory. The work described in Chapter 3 develops a full radiological protection assessment for the new americium recovery project, including development of exposure cases, creation and modification of MCNP5 models, development of a time-and-motion study, and the final synthesis of all data. This work also develops a new risk-based method of determining whether administrative controls, such as staffing increases, are ALARA-optimized. The EPA's estimate of the value of statistical life is applied to these risk estimates to determine a monetary value for risk. The rate of change of this "risk value" (marginal risk) is then compared with the rate of change of workers' compensations as additional workers are added to the project to reduce the dose (and therefore, presumably, risk) to each individual.

Daily radionuclide ingestion and internal radiation doses in Aomori prefecture, Japan.

PubMed

Ohtsuka, Yoshihito; Kakiuchi, Hideki; Akata, Naofumi; Takaku, Yuichi; Hisamatsu, Shun'ichi

2013-10-01

To assess internal annual dose in the general public in Aomori Prefecture, Japan, 80 duplicate cooked diet samples, equivalent to the food consumed over a 400-d period by one person, were collected from 100 volunteers in Aomori City and the village of Rokkasho during 2006–2010 and were analyzed for 11 radionuclides. To obtain average rates of ingestion of radionuclides, the volunteers were selected from among office, fisheries, agricultural, and livestock farm workers. Committed effective doses from ingestion of the diet over a 1-y period were calculated from the analytical results and from International Commission on Radiological Protection dose coefficients; for 40K, an internal effective dose rate from the literature was used. Fisheries workers had significantly higher combined internal annual dose than the other workers, possibly because of high rates of ingestion of marine products known to have high 210Po concentrations. The average internal dose rate, weighted by the numbers of households in each worker group in Aomori Prefecture, was estimated at 0.47 mSv y-1. Polonium-210 contributed 49% of this value. The sum of committed effective dose rates for 210Po, 210Pb, 228Ra, and 14C and the effective dose rate of 40K accounted for approximately 99% of the average internal dose rate.

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.

Radon and Thoron Measured in Petrol and Gas-oil Exhaust Fumes by Using CR-39 and LR-115 II Nuclear Track Detectors: Radiation Doses to the Respiratory Tract of Mechanic Workers.

PubMed

Misdaq, M A; Chaouqi, A; Ouguidi, J; Touti, R; Mortassim, A

2015-06-01

Mechanic workers are exposed to exhaust fumes when controlling vehicle engines in motion inside repair shops. To assess radiation doses due to radon short-lived progeny from the inhalation of exhaust fumes by mechanic workers, concentrations of these radionuclides were measured in petrol (gasoline) and gas-oil exhaust fumes by evaluating mean critical angles of etching of the CR-39 and LR-115 type II SSNTDs for alpha particles emitted by the radon and thoron decay series. Committed effective doses due to ²¹⁸Po and ²¹⁴Po short-lived radon decay products from the inhalation of petrol and gas-oil exhaust fumes by workers were evaluated. A maximum value of 1.35 mSv y⁻¹ due to radon short-lived decay products from the inhalation of gas-oil exhaust fumes by mechanic workers was found, which is lower than the (3-10 mSv y⁻¹) dose limit interval for workers.

Improving Allocation And Management Of The Health Workforce In Zambia.

PubMed

Walsh, Fiona J; Musonda, Mutinta; Mwila, Jere; Prust, Margaret Lippitt; Vosburg, Kathryn Bradford; Fink, Günther; Berman, Peter; Rockers, Peter C

2017-05-01

Building a health workforce in low-income countries requires a focused investment of time and resources, and ministries of health need tools to create staffing plans and prioritize spending on staff for overburdened health facilities. In Zambia a demand-based workload model was developed to calculate the number of health workers required to meet demands for essential health services and inform a rational and optimized strategy for deploying new public-sector staff members to the country's health facilities. Between 2009 and 2011 Zambia applied this optimized deployment policy, allocating new health workers to areas with the greatest demand for services. The country increased its health worker staffing in districts with fewer than one health worker per 1,000 people by 25.2 percent, adding 949 health workers to facilities that faced severe staffing shortages. At facilities that had had low staffing levels, adding a skilled provider was associated with an additional 103 outpatient consultations per quarter. Policy makers in resource-limited countries should consider using strategic approaches to identifying and deploying a rational distribution of health workers to provide the greatest coverage of health services to their populations. Project HOPE—The People-to-People Health Foundation, Inc.

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

2008-06-01

Located in Area 25 of the Nevada Test Site (NTS), the Test Cell A (TCA) Facility (Figure 1) was used in the early to mid-1960s for 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. The TCA facility, known as Corrective Action Unit 115, was decontaminated and decommissioned (D&D) from December 2004 to July 2005 using the Streamlined Approach for Environmental Restoration (SAFER) process, under the Federal Facility Agreement and Consentmore » 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. Facility closure involved a seven-step decommissioning strategy. First, preliminary investigation activities were performed, including review of process knowledge documentation, targeted facility radiological and hazardous material surveys, concrete core drilling and analysis, shield wall radiological characterization, and discrete sampling, which proved to be very useful and cost-effective in subsequent decommissioning planning and execution and worker safety. Second, site setup and mobilization of equipment and personnel were completed. Third, early removal of hazardous materials, including asbestos, lead, cadmium, and oil, was performed ensuring worker safety during more invasive demolition activities. Process piping was to be verified void of contents. Electrical systems were de-energized and other systems were rendered free of residual energy. Fourth, areas of high radiological contamination were decontaminated using multiple methods. Contamination levels varied across the facility. Fixed beta/gamma contamination levels ranged up to 2 million disintegrations per minute (dpm)/100 centimeters squared (cm2) beta/gamma. Removable beta/gamma contamination levels seldom exceeded 1,000 dpm/100 cm2, but, in railroad trenches on the reactor pad containing soil on the concrete pad in front of the shield wall, the beta dose rates ranged up to 120 milli-roentgens per hour from radioactivity entrained in the soil. General area dose rates were less than 100 micro-roentgens per hour. Prior to demolition of the reactor shield wall, removable and fixed contaminated surfaces were decontaminated to the best extent possible, using traditional decontamination methods. Fifth, large sections of the remaining structures were demolished by mechanical and open-air controlled explosive demolition (CED). Mechanical demolition methods included the use of conventional demolition equipment for removal of three main buildings, an exhaust stack, and a mobile shed. The 5-foot (ft), 5-inch (in.) thick, neutron-activated reinforced concrete shield was demolished by CED, which had never been performed at the NTS.« less

Leukemia, lymphoma and multiple myeloma mortality (1950–1999) and incidence (1969–1999) in the Eldorado uranium workers cohort

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

Zablotska, Lydia B., E-mail: Lydia.Zablotska@ucsf.edu; Lane, Rachel S.D.; Frost, Stanley E.

Uranium workers are chronically exposed to low levels of radon decay products (RDP) and gamma (γ) radiation. Risks of leukemia from acute and high doses of γ-radiation are well-characterized, but risks from lower doses and dose-rates and from RDP exposures are controversial. Few studies have evaluated risks of other hematologic cancers in uranium workers. The purpose of this study was to analyze radiation-related risks of hematologic cancers in the cohort of Eldorado uranium miners and processors first employed in 1932–1980 in relation to cumulative RDP exposures and γ-ray doses. The average cumulative RDP exposure was 100.2 working level months andmore » the average cumulative whole-body γ-radiation dose was 52.2 millisievert. We identified 101 deaths and 160 cases of hematologic cancers in the cohort. Overall, male workers had lower mortality and cancer incidence rates for all outcomes compared with the general Canadian male population, a likely healthy worker effect. No statistically significant association between RDP exposure or γ-ray doses, or a combination of both, and mortality or incidence of any hematologic cancer was found. We observed consistent but non-statistically significant increases in risks of chronic lymphocytic leukemia (CLL) and Hodgkin lymphoma (HL) incidence and non-Hodgkin lymphoma (NHL) mortality with increasing γ-ray doses. These findings are consistent with recent studies of increased risks of CLL and NHL incidence after γ-radiation exposure. Further research is necessary to understand risks of other hematologic cancers from low-dose exposures to γ-radiation. - Highlights: • We analyzed long-term follow-up for hematologic cancers of the Eldorado uranium workers. • Workers were exposed to a unique combination of radon decay products (RDP) and gamma (γ) ray doses. • Exposures to RDP and γ-ray doses were not associated with significantly increased risks of cancers. • Radiation risks of chronic lymphocytic leukemia (CLL) and Hodgkin lymphoma were increased. • Study findings provide additional support for radiation-related risks of CLL.« less

Stable and unstable chromosomal aberrations among Finnish nuclear power plant workers.

PubMed

Lindholm, C

2001-01-01

Twenty nuclear power plant workers with relatively high recorded cumulative doses were studied using FISH chromosome painting and dicentric analysis after solid Giemsa staining. The results indicated that chronic exposure to ionising radiation can be detected on the group level using translocation analysis after chromosome painting, although the mean cumulative dose was approximately 100 mSv. A significant association between translocation frequency and cumulative dose was observed. Variability in the translocation yields among workers with similar recorded doses was large, resulting in a poor correlation between translocation frequencies and documented doses on the individual level. The yields of dicentric and acentric chromosomes were not correlated with the cumulative dose, indicating the inability of unstable aberrations to monitor long-term exposures. It was also shown that the unstable aberrations were not correlated with the most recent annual dose.

Heat stress and inadequate sanitary facilities at workplaces - an occupational health concern for women?

PubMed

Venugopal, Vidhya; Rekha, Shanmugam; Manikandan, Krishnamoorthy; Latha, Perumal Kamalakkannan; Vennila, Viswanathan; Ganesan, Nalini; Kumaravel, Perumal; Chinnadurai, Stephen Jeremiah

2016-01-01

Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014-2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=-2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ (2)=4.03, p=0.0444), and prevalence of genitourinary issues (χ (2)=42.92, p=0.0005×10(-7)) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to empower women, avert further health risks, and also enhance productivity for the few million women workers who contribute largely to the country's economy.

78 FR 28627 - TA-W-80,340; TA-W-80,340A; TA-W-80,340B

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

...] Bush Industries, Inc., Mason Drive Facility, Including On-Site Leased Workers From Morris Security...., Mason Drive Facility, Jamestown, New York (TA-W-80,340) and Bush Industries, Inc., Allen Street Facility... applicable to TA-W-80,340 is hereby issued as follows: All workers of Bush Industries, Inc., Mason Drive...

76 FR 37799 - DOE Final Decision in Response to Recommendation 2010-1 of the Defense Nuclear Facilities Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... the public, workers, and the environment. For example, the Board clarified that use of the term.... Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses, as a safe harbor methodology..., our workers, and the environment at all of our facilities. We share your conviction that a clear set...

Radiation dose to workers due to the inhalation of dust during granite fabrication.

PubMed

Zwack, L M; McCarthy, W B; Stewart, J H; McCarthy, J F; Allen, J G

2014-03-01

There has been very little research conducted to determine internal radiation doses resulting from worker exposure to ionising radiation in granite fabrication shops. To address this issue, we estimated the effective radiation dose of granite workers in US fabrication shops who were exposed to the maximum respirable dust and silica concentrations allowed under current US regulations, and also to concentrations reported in the literature. Radiation doses were calculated using standard methods developed by the International Commission on Radiological Protection. The calculated internal doses were very low, and below both US occupational standards (50 mSv yr(-1)) and limits applicable to the general public (1 mSv yr(-1)). Workers exposed to respirable granite dust concentrations at the US Occupational Safety and Health Administration (OSHA) respirable dust permissible exposure limit (PEL) of 5 mg m(-3) over a full year had an estimated radiation dose of 0.062 mSv yr(-1). Workers exposed to respirable granite dust concentrations at the OSHA silica PEL and at the American Conference of Governmental Industrial Hygienists Threshold Limit Value for a full year had expected radiation doses of 0.007 mSv yr(-1) and 0.002 mSv yr(-1), respectively. Using data from studies of respirable granite dust and silica concentrations measured in granite fabrication shops, we calculated median expected radiation doses that ranged from <0.001 to 0.101 mSv yr(-1).

Migrant workers’ occupation and healthcare-seeking preferences for TB-suspicious symptoms and other health problems: a survey among immigrant workers in Songkhla province, southern Thailand

PubMed Central

2012-01-01

Background Much of the unskilled and semi-skilled workforce in Thailand comprises migrant workers from neighbouring countries. While, in principle, healthcare facilities in the host country are open to those migrants registered with the Ministry of Labour, their actual healthcare-seeking preferences and practices, as well as those of unregistered migrants, are not well documented. This study aimed to describe the patterns of healthcare-seeking behaviours of immigrant workers in Thailand, emphasizing healthcare practices for TB-suspicious symptoms, and to identify the role of occupation and other factors influencing these behaviours. Methods A survey was conducted among 614 immigrant factory workers (FW), rubber tappers (RT) and construction workers (CW), in which information was sought on socio-demography, history of illness and related healthcare-seeking behaviour. Mixed effects logistic regression modeling was employed in data analysis. Results Among all three occupations, self-medication was the most common way of dealing with illnesses, including the development of TB-suspicious symptoms, for which inappropriate drugs were used. Only for GI symptoms and obstetric problems did migrant workers commonly seek healthcare at modern healthcare facilities. For GI illness, FW preferred to attend the in-factory clinic and RT a private facility over government facilities owing to the quicker service and greater convenience. For RT, who were generally wealthier, the higher cost of private treatment was not a deterrent. CW preferentially chose a government healthcare facility for their GI problems. For obstetric problems, including delivery, government facilities were utilized by RT and CW, but most FW returned to their home country. After adjusting for confounding, having legal status in the country was associated with overall greater use of government facilities and being female and being married with use of both types of modern healthcare facility. One-year estimated period prevalence of TB-suspicious symptoms was around 6% among FW but around 27% and 30% in RT and CW respectively. However, CW were the least likely to visit a modern healthcare facility for these symptoms. Conclusions Self medication is the predominant mode of healthcare seeking among these migrant workers. When accessing a modern healthcare facility the choice is influenced by occupation and its attendant lifestyle and socioeconomic conditions. Utilization of modern facilities could be improved by reducing the current barriers by more complete registration coverage and better provision of healthcare information, in which local vendors of the same ethnicity could play a useful role. Active surveillance for TB among migrant workers, especially CW, may lead to better TB control. PMID:23031509

Environmental hazards of automobile mechanics in Ibadan, Nigeria.

PubMed

Omokhodion, F O

1999-01-01

A cross sectional survey was conducted among automobile mechanics and technicians in Ibadan to determine the socio-demographic characteristics and environmental hazards of these workers. Three hundred workers were interviewed. All respondents were males aged between 13 and 72 years of age. Educational attainment was poor, with only 20% of respondents having completed secondary education. Sanitation facilities were inadequate. Forty percent of workshops provided facilities for refuse disposal. Of the 33 workshops visited, only 1 provided toilet facilities. Most workers used facilities in neighbouring residential premises. Only three workshops (9%) had designated eating areas. Occupational exposure to petrol was common to all trades. Other occupational exposures were to petrochemicals such as engine oil and brake oil. Protective clothing was not used by the majority of workers. Only 25 (8%) respondents were wearing overalls at the time of our visit. This findings illustrate the typical work conditions of workers in small scale industries. There is a need for health education programmes about occupational and non-occupational diseases. This and other health promotion activities can be organized through the unions.

Violations of the international code of marketing of breast milk substitutes: prevalence in four countries

PubMed Central

Taylor, Anna

1998-01-01

Objective: To estimate the prevalence of violations of the international code of marketing of substitutes for breast milk in one city in each of Bangladesh, Poland, South Africa, and Thailand. Design: Multistage random sampling was used to select pregnant women and mothers of infants ⩽6 months old to interview at health facilities. Women were asked whether they had received free samples of substitutes for breast milk (including infant formula designed to meet the nutritional needs of infants from birth to 4 to 6 months of age, follow on formula designed to replace infant formula at the age of 4 to 6 months, and complementary foods for infants aged ⩽6 months), bottles, or teats. The source of the free sample and when it had been given to the women was also determined. 3 health workers were interviewed at each facility to assess whether the facility had received free samples, to determine how they had been used, and to determine whether gifts had been given to health workers by companies that manufactured or distributed breast milk substitutes. Compliance with the marketing code for information given to health workers was evaluated using a checklist. Setting: Health facilities in Dhaka, Bangladesh; Warsaw, Poland; Durban, South Africa; and Bangkok, Thailand. Subjects: 1468 pregnant women, 1582 mothers of infants aged ⩽6 months, and 466 health workers at 165 health facilities. Main outcome measures: Number of free samples received by pregnant women, mothers, and health workers; number of gifts given to health workers; and availability of information that violated the code in health facilities. Results: 97 out of 370 (26%) mothers in Bangkok reported receiving free samples of breast milk substitutes, infant formula, bottles, or teats compared with only 1 out of 385 mothers in Dhaka. Across the four cities from 3 out of 40 (8%) to 20 out of 40 (50%) health facilities had received free samples which were not being used for research or professional evaluation; from 2 out of 123 (2%) to 21 out of 119 (18%) health workers had received gifts from companies involved in the manufacturing or distribution of breast milk substitutes. From 6 out of 40 (15%) to 22 out of 39 (56%) health facilities information that violated the code had been provided by companies and was available to staff. Conclusion: Violations of the code were detected with a simple survey instrument in all of the four countries studied. Governmental and non-governmental agencies should monitor the prevalence of code violations using the simple methodology developed for this study. Key messages A simple multistage random sampling procedure can be used to interview women and health professionals to assess whether violations of the international code of marketing of substitutes for breast milk are occurring 3050 women and 466 health professionals were interviewed at 165 health facilities in Bangladesh, Poland, South Africa, and Thailand 97 out of 370 mothers in Bangkok reported receiving free samples of breast milk substitutes, infant formula, bottles, or teats compared with only 1 out of 385 mothers in Dhaka. In Bangkok health workers reported that 20 out of 40 health facilities had also received free samples. Most free samples were distributed by health facilities In Warsaw 56% of facilities surveyed were found to have information available for health workers that had been provided by manufacturers or distributors of breast milk substitutes in contravention of the code; 18% of health workers in Warsaw had received free gifts from manufacturers PMID:9552947

Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities.

PubMed

Boakye-Dankwa, Ernest; Teeple, Erin; Gore, Rebecca; Punnett, Laura

2017-11-01

We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.

A nested case-control study of leukemia mortality and ionizing radiation at the Portsmouth Naval Shipyard.

PubMed

Kubale, Travis L; Daniels, Robert D; Yiin, James H; Couch, James; Schubauer-Berigan, Mary K; Kinnes, Gregory M; Silver, Sharon R; Nowlin, Susan J; Chen, Pi-Hsueh

2005-12-01

A nested case-control study using conditional logistic regression was conducted to evaluate the exposure-response relationship between external ionizing radiation exposure and leukemia mortality among civilian workers at the Portsmouth Naval Shipyard (PNS), Kittery, Maine. The PNS civilian workers received occupational radiation exposure while performing construction, overhaul, repair and refueling activities on nuclear-powered submarines. The study age-matched 115 leukemia deaths with 460 controls selected from a cohort of 37,853 civilian workers employed at PNS between 1952 and 1992. In addition to radiation doses received in the workplace, a secondary analysis incorporating doses from work-related medical X rays and other occupational radiation exposures was conducted. A significant positive association was found between leukemia mortality and external radiation exposure, adjusting for gender, radiation worker status, and solvent exposure duration (OR = 1.08 at 10 mSv of exposure; 95% CI = 1.01, 1.16). Solvent exposure (including benzene and carbon tetrachloride) was also significantly associated with leukemia mortality adjusting for radiation dose, radiation worker status, and gender. Incorporating doses from work-related medical X rays did not change the estimated leukemia risk per unit of dose.

A reanalysis of cancer mortality in Canadian nuclear workers (1956-1994) based on revised exposure and cohort data.

PubMed

Zablotska, L B; Lane, R S D; Thompson, P A

2014-01-07

A 15-country study of nuclear workers reported significantly increased radiation-related risks of all cancers excluding leukaemia, with Canadian data a major factor behind the pooled results. We analysed mortality (1956-1994) in the updated Canadian cohort and provided revised risk estimates. Employment records were searched to verify and revise exposure data and to restore missing socioeconomic status. Excess relative risks per sievert (ERR/Sv) of recorded radiation dose and 95% confidence intervals (CIs) were estimated using Poisson regression. A significant heterogeneity of the dose-response for solid cancer was identified (P=0.02), with 3088 early (1956-1964) Atomic Energy of Canada Limited (AECL) workers having a significant increase (ERR/Sv=7.87, 95% CI: 1.88, 19.5), and no evidence of radiation risk for 42,228 workers employed by three nuclear power plant companies and post-1964 AECL (ERR/Sv=-1.20, 95% CI: <-1.47, 2.39). Radiation risks of leukaemia were negative in early AECL workers and non-significantly increased in other workers. In analyses with separate terms for tritium and gamma doses, there was no evidence of increased risk from tritium exposure. All workers had mortality lower than the general population. Significantly increased risks for early AECL workers are most likely due to incomplete transfer of AECL dose records to the National Dose Registry. Analyses of the remainder of the Canadian nuclear workers (93.2%) provided no evidence of increased risk, but the risk estimate was compatible with estimates that form the basis of radiation protection standards. Study findings suggest that the revised Canadian cohort, with the exclusion of early AECL workers, would likely have an important effect on the 15-country pooled risk estimate of radiation-related risks of all cancer excluding leukaemia by substantially reducing the size of the point estimate and its significance.

Using classification tree modelling to investigate drug prescription practices at health facilities in rural Tanzania.

PubMed

Kajungu, Dan K; Selemani, Majige; Masanja, Irene; Baraka, Amuri; Njozi, Mustafa; Khatib, Rashid; Dodoo, Alexander N; Binka, Fred; Macq, Jean; D'Alessandro, Umberto; Speybroeck, Niko

2012-09-05

Drug prescription practices depend on several factors related to the patient, health worker and health facilities. A better understanding of the factors influencing prescription patterns is essential to develop strategies to mitigate the negative consequences associated with poor practices in both the public and private sectors. A cross-sectional study was conducted in rural Tanzania among patients attending health facilities, and health workers. Patients, health workers and health facilities-related factors with the potential to influence drug prescription patterns were used to build a model of key predictors. Standard data mining methodology of classification tree analysis was used to define the importance of the different factors on prescription patterns. This analysis included 1,470 patients and 71 health workers practicing in 30 health facilities. Patients were mostly treated in dispensaries. Twenty two variables were used to construct two classification tree models: one for polypharmacy (prescription of ≥3 drugs) on a single clinic visit and one for co-prescription of artemether-lumefantrine (AL) with antibiotics. The most important predictor of polypharmacy was the diagnosis of several illnesses. Polypharmacy was also associated with little or no supervision of the health workers, administration of AL and private facilities. Co-prescription of AL with antibiotics was more frequent in children under five years of age and the other important predictors were transmission season, mode of diagnosis and the location of the health facility. Standard data mining methodology is an easy-to-implement analytical approach that can be useful for decision-making. Polypharmacy is mainly due to the diagnosis of multiple illnesses.

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey

PubMed Central

Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi’s Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers. PMID:28301484

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

PubMed

Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

ADVANTG Shielding Analysis for Closure Operations in an Open-Mode Repository

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

Bevill, Aaron M; Radulescu, Georgeta; Scaglione, John M

2013-01-01

en-mode repository concepts could require worker entry into access drifts after placement of fuel casks in order to perform activities related to backfill, plug emplacement, routine maintenance, or performance confirmation. An ideal emplacement-drift shielding configuration would minimize dose to workers while maximizing airflow through the emplacement drifts. This paper presents a preliminary investigation of the feasibility and effectiveness of radiation shielding concepts that could be employed to facilitate worker operations in an open-mode repository. The repository model for this study includes pressurized-water reactor fuel assemblies (60 GWd/MTU burnup, 40 year post-irradiation cooldown) in packages of 32 assemblies. The closest fuelmore » packages are 5 meters from dosimetry voxels in the access drift. The unshielded dose to workers in the access drift is 73.7 rem/hour. Prior work suggests that open-mode repository concepts similar to this one would require 15 m3/s of ventilation airflow. Shielding concepts considered here include partial concrete plugs, labyrinthine shields, and stainless steel photon attenuator grids. Maximum dose to workers in the access drift was estimated for each shielding concept using MCNP5 with variance reduction parameters generated by ADVANTG. Because airflow through the shielding is important for open-mode repositories, a semi-empirical estimate of the head loss due to each shielding configuration was also calculated. Airflow and shielding performance vary widely among the proposed shielding configurations. Although the partial plug configuration had the best airflow performance, it allowed dose rates 1500 greater than the specified target. Labyrinthine shielding concepts yield doses on the order of 1 mrem/hour with configurations that impose 3 to 11 J/kg head loss. Adding 1 cm lead lining to the airflow channels of labyrinthine designs further reduces the worker dose by 65% to 95%. Photon-attenuator concepts may reduce worker dose to as low as 29 mrem/hour with head loss on the order of 1.9 J/kg.« less

The epidemiology of tuberculosis in health care workers in South Africa: a systematic review.

PubMed

Grobler, Liesl; Mehtar, Shaheen; Dheda, Keertan; Adams, Shahieda; Babatunde, Sanni; van der Walt, Martie; Osman, Muhammad

2016-08-20

In South Africa, workplace acquired tuberculosis (TB) is a significant occupational problem among health care workers. In order to manage the problem effectively it is important to know the burden of TB in health care workers. This systematic review describes the epidemiology of TB in South African health care workers. A comprehensive search of electronic databases [MEDLINE, EMBASE, Web of Science (Social Sciences Citation Index/Science Citation Index), Cochrane Library (including CENTRAL register of Controlled Trials), CINAHL and WHO International Clinical Trials Registry Platform (ICTRP)] was conducted up to April 2015 for studies reporting on any aspect of TB epidemiology in health care workers in South Africa. Of the 16 studies included in the review, ten studies reported on incidence of active TB disease in health care workers, two report on the prevalence of active TB disease, two report on the incidence of latent TB infection, three report on the prevalence of latent TB infection and four studies report on the number of TB cases in health care workers in various health care facilities in South Africa. Five studies provide information on risk factors for TB in health care workers. All of the included studies were conducted in publicly funded health care facilities; predominately located in KwaZulu-Natal and Western Cape provinces. The majority of the studies reflect a higher incidence and prevalence of active TB disease in health care workers, including drug-resistant TB, compared to the surrounding community or general population. There is relatively little research on the epidemiology of TB in health care workers in South Africa, despite the importance of the issue. To determine the true extent of the TB epidemic in health care workers, regular screening for TB disease should be conducted on all health care workers in all health care facilities, but future research is required to investigate the optimal approach to TB screening in health care workers in South Africa. The evidence base shows a high burden of both active and latent TB in health care workers in South Africa necessitating an urgent need to improve existing TB infection, prevention and control measures in South African health care facilities.

LEUKEMIA, LYMPHOMA AND MULTIPLE MYELOMA MORTALITY (1950–1999) AND INCIDENCE (1969–1999) IN THE ELDORADO URANIUM WORKERS COHORT

PubMed Central

Zablotska, Lydia B.; Lane, Rachel S.D.; Frost, Stanley E.; Thompson, Patsy A.

2014-01-01

Uranium workers are chronically exposed to low levels of radon decay products (RDP) and gamma (γ) radiation. Risks of leukemia from acute and high doses of γ-radiation are well-characterized, but risks from lower doses and dose-rates and from RDP exposures are controversial. Few studies have evaluated risks of other hematologic cancers in uranium workers. The purpose of this study was to analyze radiation-related risks of hematologic cancers in the cohort of Eldorado uranium miners and processors first employed in 1932–1980 in relation to cumulative RDP exposures and γ-ray doses. The average cumulative RDP exposure was 100.2 working level months and the average cumulative whole-body γ-radiation dose was 52.2 millisievert. We identified 101 deaths and 160 cases of hematologic cancers in the cohort. Overall, male workers had lower mortality and cancer incidence rates for all outcomes compared with the general Canadian male population, a likely healthy worker effect. No statistically significant association between RDP exposure or γ-ray doses, or a combination of both, and mortality or incidence of any hematologic cancer was found. We observed consistent but non-statistically significant increases in risks of chronic lymphocytic leukemia (CLL) and Hodgkin lymphoma (HL) incidence and non-Hodgkin lymphoma (NHL) mortality with increasing γ-ray doses. These findings are consistent with recent studies of increased risks of CLL and NHL incidence after γ-radiation exposure. Further research is necessary to understand risks of other hematologic cancers from low-dose exposures to γ-radiation. PMID:24583244

Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey.

PubMed

Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-02-20

Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, health facility survey was conducted in Malawi to assess patient-, health worker-, and health facility-level factors associated with malaria case management quality using multivariate Poisson regression models. Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (p<0.0001). Complaint of cough was associated with a 27% decreased likelihood of correct malaria treatment (p=0.001). Lower-level cadres of health workers were more likely to prescribe anti-malarials for patients, increasing the likelihood of both correct treatment and overtreatment, but no other health worker or health facility-level factors were significantly associated with case management quality. Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools.

The Past Informs the Future: An Overview of the Million Worker Study and the Mallinckrodt Chemical Works Cohort.

PubMed

Boice, John D; Ellis, Elizabeth D; Golden, Ashley P; Girardi, David J; Cohen, Sarah S; Chen, Heidi; Mumma, Michael T; Shore, Roy E; Leggett, Richard W

2018-04-01

The purpose of this paper is to present an overview of ongoing work on the Million Worker Study (MWS), highlighting some of the key methods and progress so far as exemplified by the study of workers at the Mallinckrodt Chemical Works (MCW). The MWS began nearly 25 y ago and continues in a stepwise fashion, evaluating one study cohort at a time. It includes workers from U.S. Department of Energy (DOE) Manhattan Project facilities, U.S. Nuclear Regulatory Commission (NRC) regulated nuclear power plants, industrial radiographers, U.S. Department of Defense (DoD) nuclear weapons test participants, and physicians and technologists working with medical radiation. The purpose is to fill the major gap in radiation protection and science: What is the risk when exposure is received gradually over time rather than briefly as for the atomic bomb survivors? Studies published or planned in 2018 include leukemia (and dosimetry) among atomic veterans, leukemia among nuclear power plant workers, mortality among workers at the MCW, and a comprehensive National Council on Radiation Protection and Measurements (NCRP) Report on dosimetry for the MWS. MCW has a singular place in history: the 40 tons (T) of uranium oxide produced at MCW were used by Enrico Fermi on 2 December 1942 to produce the first manmade sustained and controlled nuclear reaction, and the atomic age was born. Seventy-six years later, the authors followed the over 2,500 MCW workers for mortality and reconstructed dose from six sources of exposure: external gamma rays from the radioactive elements in pitchblende; medical x rays from occupationally required chest examinations; intakes of pitchblende (uranium, radium, and silica) measured by urine samples; radon breath analyses and dust surveys overseen by Robley Evans and Merril Eisenbud; occupational exposures received before and after employment at MCW; and cumulative radon concentrations and lung dose from the decay of radium in the work environment. The unique exposure reconstructions allow for multiple evaluations, including estimates of silica dust. The study results are relevant today. For example, NASA is interested that radium, deposited in the brain, releases high-LET alpha particles - the only human analogue, though limited, for high energy, high-Z particles (galactic cosmic rays) traveling through space that might affect astronauts on Mars missions. Don't discount the past; it's the prologue to the future!

DOSE ASSESSMENTS FROM THE DISPOSAL OF LOW ...

EPA Pesticide Factsheets

Modeling the long-term performance of the RCRA-C disposal cell and potential doses to off-site receptors is used to derive maximum radionuclide specific concentrations in the wastes that would enable these wastes to be disposed of safely using the RCRA-C disposal cell technology. Modeling potential exposures to derive these waste acceptance concentrations involves modeling exposures to workers during storage, treatment and disposal of the wastes, as well as exposures to individuals after disposal operations have ceased. Post facility closure exposures can result from the slow expected degradation of the disposal cell over long time periods (one thousand years after disposal) and in advertent human intrusion. Provide a means of determining waste acceptance radionuclide concentrations for disposal of debris from radiological dispersal device incidents as well as low-activity wastes generated in commercial, medical and research activities, potentially serve as the technical basis for guidance on disposal of these materials.

Heat stress and inadequate sanitary facilities at workplaces – an occupational health concern for women?

PubMed Central

Venugopal, Vidhya; Rekha, Shanmugam; Manikandan, Krishnamoorthy; Latha, Perumal Kamalakkannan; Vennila, Viswanathan; Ganesan, Nalini; Kumaravel, Perumal; Chinnadurai, Stephen Jeremiah

2016-01-01

Background Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. Objective The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. Design A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014–2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. Results Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=−2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ2=4.03, p=0.0444), and prevalence of genitourinary issues (χ2=42.92, p=0.0005×10−7) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. Conclusions The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to empower women, avert further health risks, and also enhance productivity for the few million women workers who contribute largely to the country's economy. PMID:27633034

Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa, Ethiopia: A cross-sectional study.

PubMed

Demissie Gizaw, Girma; Aderaw Alemu, Zewdie; Kibret, Kelemu Tilahun

2015-01-01

Tuberculosis is the leading causes of mortality among infectious diseases worldwide. The risk of transmission from patients to health workers is doubles that of the general population. The close contact to the infectious case before diagnosis is the major risk for tuberculosis infection. The aim of the study was to assess knowledge and practice of health professionals towards tuberculosis infection control and its associated factors in health facilities of Addis Ababa, Ethiopia. A cross-sectional study was conducted from February 29 to April 15/2014 in selected health facilities in Addis Ababa. Five hundred ninety health workers were included in the study. The sample size was assigned to each health facility proportional to their number of health workers. Study subjects were selected from each stratum by simple random sampling technique. Interviewer administered structured questionnaire was used to collect information. Logistic regression was used to identify factors associated with knowledge and practice of health workers towards tuberculosis infection control. Five hundred eighty two participants with 98.6% response rate were involved in the study. Of these, 36.1% had poor knowledge and 51.7% unsatisfactory practice score towards tuberculosis infection control. Having more than six years working experience in health facility (AOR = 2.51; 95% CI: 1.5-4.1) and tuberculosis related training (AOR = 2.51 95% CI; 1.5, 4.1) were significantly associated with knowledge on tuberculosis infection control. Having experience in tuberculosis clinic (AOR =1.93; 95% CI: 1.12, 3.34) and tuberculosis related training (AOR = 1.48; 95% CI: 1.87, 2.51) were significantly associated with practice on tuberculosis infection control. One third of health workers had relatively poor knowledge and nearly half of them had unsatisfactory practice on tuberculosis infection control. Tuberculosis training and work experiences in health facility are determinant factor to knowledge. Whereas tuberculosis related training and experience in tuberculosis clinic are predictor to practice. So, training of the health professionals, on job orientations of junior health workers, and farther study including private health workers are recommended.

[Usage survey of care equipment in care service facilities for the elderly].

PubMed

Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Hirata, Mamoru; Hisanaga, Naomi

2007-01-01

Musculoskeletal disorders(MSD)have been increasing recently among care workers. Since providing care workers with appropriate equipment is effective for preventing MSD, we conducted a questionnaire survey in two nursing homes and a healthcare facility for the elderly to clarify equipment usage, problems and points for improvement. A total of 81 care workers(average age 32.2 yr; 63 females, 18 males)participated in the survey. The average number of residents and the average resident's care level were 70.0 and 3.6, respectively. Wheelchair and height adjustable beds were fully available and always used in all facilities. Portable lifts, ceiling lifts and transfer boards were, however, few in all 3 facilities and the proportion of use was 14.8%, 16.0%, and 23.5%, respectively. Participants reported that it is time consuming to move residents from place to place with lifts and there is a danger of dropping a resident. Although approximately 90% of care workers had received education and training on care techniques, the workload on the low back was found to be great. Therefore, we thought that care workers must consistently use care equipment. To achieve such increased usage, we must improve the usability of the equipment.

Dust exposure in workers from grain storage facilities in Costa Rica.

PubMed

Rodríguez-Zamora, María G; Medina-Escobar, Lourdes; Mora, Glend; Zock, Jan-Paul; van Wendel de Joode, Berna; Mora, Ana M

2017-08-01

About 12 million workers are involved in the production of basic grains in Central America. However, few studies in the region have examined the occupational factors associated with inhalable dust exposure. (i) To assess the exposure to inhalable dust in workers from rice, maize, and wheat storage facilities in Costa Rica; (ii) to examine the occupational factors associated with this exposure; and (iii) to measure concentrations of respirable and thoracic particles in different areas of the storage facilities. We measured inhalable (<100μm) dust concentrations in 176 personal samples collected from 136 workers of eight grain storage facilities in Costa Rica. We also measured respirable (<4μm) and thoracic (<10μm) dust particles in several areas of the storage facilities. Geometric mean (GM) and geometric standard deviation (GSD) inhalable dust concentrations were 2.0mg/m 3 and 7.8 (range=<0.2-275.4mg/m 3 ). Personal inhalable dust concentrations were associated with job category [GM for category/GM for administrative staff and other workers (95% CI)=4.4 (2.6, 7.2) for packing; 20.4 (12.3, 34.7) for dehulling; 109.6 (50.1, 234.4) for unloading in flat bed sheds; 24.0 (14.5, 39.8) for unloading in pits; and 31.6 (18.6, 52.5) for drying], and cleaning task [15.8 (95% CI: 10.0, 26.3) in workers who cleaned in addition to their regular tasks]. Higher area concentrations of thoracic dust particles were found in wheat (GM and GSD=4.3mg/m 3 and 4.5) and maize (3.0mg/m 3 and 3.9) storage facilities, and in grain drying (2.3mg/m 3 and 3.1) and unloading (1.5mg/m 3 and 4.8) areas. Operators of grain storage facilities showed elevated inhalable dust concentrations, mostly above international exposure limits. Better engineering and administrative controls are needed. Copyright © 2017 Elsevier GmbH. All rights reserved.

HIGHLIGHTS OF THE RUSSIAN HEALTH STUDIES PROGRAM AND UPDATED RESEARCH FINDINGS

PubMed Central

Fountos, Barrett N.

2017-01-01

Abstract Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction studies and a worker biorepository. National and international standard-setting organizations use cancer risk estimates computed from epidemiological and historical dose reconstruction studies to validate or revise radiation protection standards. An overview of the most important research results will be presented. PMID:27885077

The Concentration Of Tritium In Urine And Internal Radiation Dose Estimation Of PTNBR Radiation Workers

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

Tjahaja, Poppy Intan; Sukmabuana, Putu; Aisyah, Neneng Nur

2010-12-23

The operation of Triga 2000 reactor in Nuclear Technology Center for Materials and Radiometry (PTNBR BATAN) normally produce tritium radionuclide which is the activation product of deuterium atom in reactor primary cooling water. According to previous monitoring, tritium was detected with the concentration of 8.236{+-}0.677 kBq/L and 1.704{+-}0.046 Bq/L in the primary cooling water and in reactor hall air, respectively. The tritium in reactor hall air chronically can be inhaled by the workers. In this research, tritium content in radiation workers' urine was determined to estimate the internal radiation doses received by the workers. About 50-100 mL of urine samplesmore » were collected from 48 PTNBR workers that is classified as 24 radiation workers and 24 administration staffs as a control. Urine samples of 25 mL were then prepared by active charcoal and KMnO{sub 4} addition and followed with complete distillation. The 2 mL of distillate was added with 13 mL scintillator, shaked vigorously and remained in cool and dark condition for about 24 hours. The tritium in the samples was then measured using liquid scintillation counter (LSC) for 1 hour. From the measurement results it was obtained that the tritium concentration in the urine of radiation workers were in the range of not detected and 5.191 Bq/mL, whereas in the administration staffs the concentration were between not detected and 4.607 Bq/mL. Internally radiation doses were calculated using the tritium concentration data, and it was found the averages about 0.602 {mu}Sv/year and 0.532 {mu}Sv/year for radiation workers and administration staffs, respectively. The doses received by the workers were lower than that of the permissible doses from tritium, i.e. 40 {mu}Sv/year.« less

Airborne Exposures to Polycyclic Aromatic Compounds Among Workers in Asphalt Roofing Manufacturing Facilities.

PubMed

Trumbore, David C; Osborn, Linda V; Johnson, Kathleen A; Fayerweather, William E

2015-01-01

We studied exposure of 151 workers to polycyclic aromatic compounds and asphalt emissions during the manufacturing of asphalt roofing products-including 64 workers from 10 asphalt plants producing oxidized, straight-run, cutback, and wax- or polymer-modified asphalts, and 87 workers from 11 roofing plants producing asphalt shingles and granulated roll roofing. The facilities were located throughout the United States and used asphalt from many refiners and crude oils. This article helps fill a gap in exposure data for asphalt roofing manufacturing workers by using a fluorescence technique that targets biologically active 4-6 ring polycyclic aromatic compounds and is strongly correlated with carcinogenic activity in animal studies. Worker exposures to polycyclic aromatic compounds were compared between manufacturing plants, at different temperatures and using different raw materials, and to important external benchmarks. High levels of fine limestone particulate in the plant air during roofing manufacturing increased polycyclic aromatic compound exposure, resulting in the hypothesis that the particulate brought adsorbed polycyclic aromatic compounds to the worker breathing zone. Elevated asphalt temperatures increased exposures during the pouring of asphalt. Co-exposures in these workplaces which act as confounders for both the measurement of total organic matter and fluorescence were detected and their influence discussed. Exposures to polycyclic aromatic compounds in asphalt roofing manufacturing facilities were lower than or similar to those reported in hot-mix paving application studies, and much below those reported in studies of hot application of built-up roofing asphalt. These relatively low exposures in manufacturing are primarily attributed to air emission controls in the facilities, and the relatively moderate temperatures, compared to built-up roofing, used in these facilities for oxidized asphalt. The exposure to polycyclic aromatic compounds was a very small part of the overall worker exposure to asphalt fume, on average less than 0.07% of the benzene-soluble fraction. Measurements of benzene-soluble fraction were uniformly below the American Conference of Governmental Industrial Hygienists' Threshold Limit Value for asphalt fume.

Reconstruction of Internal Doses for the Alpha-Risk Case-Control Study of Lung Cancer and Leukaemia Among European Nuclear Workers.

PubMed

Bingham, Derek; Bérard, Philippe; Birchall, Alan; Bull, Richard; Cardis, Elisabeth; Challeton-de Vathaire, Cécile; Grellier, James; Hurtgen, Christian; Puncher, Matthew; Riddell, Anthony; Thierry-Chef, Isabelle

2017-05-01

The Alpha-Risk study required the reconstruction of doses to lung and red bone marrow for lung cancer and leukaemia cases and their matched controls from cohorts of nuclear workers in the UK, France and Belgium. The dosimetrists and epidemiologists agreed requirements regarding the bioassay data, biokinetic and dosimetric models and dose assessment software to be used and doses to be reported. The best values to use for uncertainties on the monitoring data, setting of exposure regimes and characteristics of the exposure material, including lung solubility, were the responsibility of the dosimetrist responsible for each cohort. Among 1721 subjects, the median absorbed dose to the lung from alpha radiations was 2.1 mGy, with a maximum dose of 316 mGy. The lung doses calculated reflect the higher levels of exposure seen among workers in the early years of the nuclear industry compared to today. © Crown copyright 2016.

Radiation exposure to nuclear medicine staffs during 18F-FDG PET/CT procedures at Ramathibodi Hospital

NASA Astrophysics Data System (ADS)

Donmoon, T.; Chamroonrat, W.; Tuntawiroon, M.

2016-03-01

The aim of this study is to estimate the whole body and finger radiation doses per study received by nuclear medicine staff involved in dispensing, administration of 18F-FDG and interacting with radioactive patients during PET/CT imaging procedures in a PET/CT facility. The whole-body doses received by radiopharmacists, technologists and nurses were measured by electronic dosimeter and the finger doses by ring dosimeter during a period of 4 months. In 70 PET/CT studies, the mean whole-body dose per study to radiopharmacist, technologist, and nurse were 1.07±0.09, 1.77±0.46, μSv, and not detectable respectively. The mean finger doses per study received by radiopharmacist, technologist, and nurse were 265.65±107.55, 4.84±1.08 and 19.22±2.59 μSv, respectively. The average time in contact with 18F-FDG was 5.88±0.03, 39.06±1.89 and 1.21±0.02 minutes per study for radiopharmacist, technologist and nurse respectively. Technologists received highest mean effective whole- body dose per study and radiopharmacist received the highest finger dose per study. When compared with the ICRP dose limit, each individual worker can work with many more 18F- FDG PET/CT studies for a whole year without exceeding the occupational dose limits. This study confirmed that low levels of radiation does are received by our medical personnel involved in 18F-FDG PET/CT procedures.

Dose Reconstruction for the Million Worker Study: Status and Guidelines

DOE PAGES

Bouville, André; Toohey, Richard E.; Boice, John D.; ...

2015-02-01

The primary aim of the epidemiologic study of one million U.S. radiation workers and veterans (the Million-Worker study) is to provide scientifically valid information on the level of radiation risk when exposures are received gradually over time, and not acutely as was the case for Japanese atomic bomb survivors. The primary outcome of the epidemiological study is cancer mortality but other causes of death such as cardiovascular disease and cerebrovascular disease will be evaluated. The success of the study is tied to the validity of the dose reconstruction approaches to provide unbiased estimates of organ-specific radiation absorbed doses and theirmore » accompanying uncertainties. The dosimetry aspects for the Million-Worker study are challenging in that they address diverse exposure scenarios for diverse occupational groups being studied over a period of up to 70 years. The dosimetric issues differ among the varied exposed populations that are considered: atomic veterans, DOE workers exposed to both penetrating radiation and intakes of radionuclides, nuclear power plant workers, medical radiation workers, and industrial radiographers. While a major source of radiation exposure to the study population comes from external gamma-ray or x-ray sources, for certain of the study groups there is a meaningful component of radionuclide intakes that require internal radiation dosimetry measures. Scientific Committee 6-9 has been established by NCRP to produce a report on the comprehensive organ dose assessment (including uncertainty analysis) for the Million-Worker study. The Committee’s report will cover the specifics of practical dose reconstruction for the ongoing epidemiologic studies with uncertainty analysis discussions and will be a specific application of the guidance provided in NCRP Reports 158, 163, 164, and 171. The main role of the Committee is to provide guidelines to the various groups of dosimetrists involved in the various components of the Million-Worker study to make sure that certain dosimetry criteria are respected: calculation of annual absorbed doses in the organs of interest, separation of low-LET and high-LET components, evaluation of uncertainties, and quality assurance and quality control. Lastly, we recognize that the Million-Worker study and its approaches to dosimetry are a work in progress and that there will be flexibility and changes in direction as new information is obtained, both with regard to dosimetry and with regard to the epidemiologic features of the study components.« less

Dose Reconstruction for the Million Worker Study: Status and Guidelines

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

Bouville, André; Toohey, Richard E.; Boice, John D.

The primary aim of the epidemiologic study of one million U.S. radiation workers and veterans (the Million-Worker study) is to provide scientifically valid information on the level of radiation risk when exposures are received gradually over time, and not acutely as was the case for Japanese atomic bomb survivors. The primary outcome of the epidemiological study is cancer mortality but other causes of death such as cardiovascular disease and cerebrovascular disease will be evaluated. The success of the study is tied to the validity of the dose reconstruction approaches to provide unbiased estimates of organ-specific radiation absorbed doses and theirmore » accompanying uncertainties. The dosimetry aspects for the Million-Worker study are challenging in that they address diverse exposure scenarios for diverse occupational groups being studied over a period of up to 70 years. The dosimetric issues differ among the varied exposed populations that are considered: atomic veterans, DOE workers exposed to both penetrating radiation and intakes of radionuclides, nuclear power plant workers, medical radiation workers, and industrial radiographers. While a major source of radiation exposure to the study population comes from external gamma-ray or x-ray sources, for certain of the study groups there is a meaningful component of radionuclide intakes that require internal radiation dosimetry measures. Scientific Committee 6-9 has been established by NCRP to produce a report on the comprehensive organ dose assessment (including uncertainty analysis) for the Million-Worker study. The Committee’s report will cover the specifics of practical dose reconstruction for the ongoing epidemiologic studies with uncertainty analysis discussions and will be a specific application of the guidance provided in NCRP Reports 158, 163, 164, and 171. The main role of the Committee is to provide guidelines to the various groups of dosimetrists involved in the various components of the Million-Worker study to make sure that certain dosimetry criteria are respected: calculation of annual absorbed doses in the organs of interest, separation of low-LET and high-LET components, evaluation of uncertainties, and quality assurance and quality control. Lastly, we recognize that the Million-Worker study and its approaches to dosimetry are a work in progress and that there will be flexibility and changes in direction as new information is obtained, both with regard to dosimetry and with regard to the epidemiologic features of the study components.« less

Supportive supervision for medicines management in government health facilities in Kiambu County, Kenya: a health workers' perspective.

PubMed

Agoro, Oscar Otieno; Osuga, Ben Onyango; Adoyo, Maureen

2015-01-01

Effective supportive supervision is widely recognized as essential for optimal management of medicines in government health facilities and also in contributing towards improved access and utilization of health services. This study sought to examine the extent supportive supervision for medicines management in government health facilities from a health worker perspective. A cross-sectional study was done targeting health workers managing medicines in government health facilities in Kiambu County. One hundred and thirty eight respondents took part in the study which explored the quality of supportive supervision from a health worker's perspective, and also examined the factors influencing their contentment with the level of supervision received. A statistical analysis was done using SPSS 21 and Excel 2013. Supervisory visits from all levels of health management were not regularly done, standard checklists were not routinely used, and action plans irregularly developed and followed up. Only 54 (38.6%) respondents were satisfied with the levels of supportive supervision that they received, with satisfaction significantly differing across the professional cadres, χ (2) (12, n = 138) = 29.762, p = .003; across the different tiers of health facilities, r s (138) = 0.341, p < .001; and with the education levels of the respondents, r s (138) = 0.381, p < .001. The study concluded that supportive supervision for medicines management that government health facilities received was still inadequate, and health workers were dissatisfied with the level of supervision that they received. The study recommends a review of the support supervision policy at the county level to address the unearthed inefficiencies and improve supervision for medicines management in government health facilities.

Risk ranking of LANL nuclear material storage containers for repackaging prioritization.

PubMed

Smith, Paul H; Jordan, Hans; Hoffman, Jenifer A; Eller, P Gary; Balkey, Simon

2007-05-01

Safe handling and storage of nuclear material at U.S. Department of Energy facilities relies on the use of robust containers to prevent container breaches and subsequent worker contamination and uptake. The U.S. Department of Energy has no uniform requirements for packaging and storage of nuclear materials other than those declared excess and packaged to DOE-STD-3013-2000. This report describes a methodology for prioritizing a large inventory of nuclear material containers so that the highest risk containers are repackaged first. The methodology utilizes expert judgment to assign respirable fractions and reactivity factors to accountable levels of nuclear material at Los Alamos National Laboratory. A relative risk factor is assigned to each nuclear material container based on a calculated dose to a worker due to a failed container barrier and a calculated probability of container failure based on material reactivity and container age. This risk-based methodology is being applied at LANL to repackage the highest risk materials first and, thus, accelerate the reduction of risk to nuclear material handlers.

Effects of a psycho-educational intervention on direct care workers' communicative behaviors with residents with dementia.

PubMed

Barbosa, Ana; Marques, Alda; Sousa, Liliana; Nolan, Mike; Figueiredo, Daniela

2016-01-01

This study assessed the effects of a person-centered care-based psycho-educational intervention on direct care workers' communicative behaviors with people with dementia living in aged-care facilities. An experimental study with a pretest-posttest control-group design was conducted in four aged-care facilities. Two experimental facilities received an 8-week psycho-educational intervention aiming to develop workers' knowledge about dementia, person-centered care competences, and tools for stress management. Control facilities received education only, with no support to deal with stress. In total, 332 morning care sessions, involving 56 direct care workers (female, mean age 44.72 ± 9.02 years), were video-recorded before and 2 weeks after the intervention. The frequency and duration of a list of verbal and nonverbal communicative behaviors were analyzed. Within the experimental group there was a positive change from pre- to posttest on the frequency of all workers' communicative behaviors. Significant treatment effects in favor of the experimental group were obtained for the frequency of inform (p < .01, η(2)partial = 0.09) and laugh (p < .01, η(2)partial = 0.18). Differences between groups emerged mainly in nonverbal communicative behaviors. The findings suggest that a person-centered care-based psycho-educational intervention can positively affect direct care workers' communicative behaviors with residents with dementia. Further research is required to determine the extent of the benefits of this approach.

Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts.

PubMed

Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens; Magnussen, Pascal; Bygbjerg, Ib C; Hansen, Kristian S

2012-02-18

Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed. The study shows conditions related to staffing levels, health infrastructure and essential supplies being among the key determinants or drivers of frontline HWs' motivation to deliver ANC services in both private and public HFs. Efforts of the government to meet the maternal health related Millennium Development Goals and targets for specific interventions need to address challenges related to HWs' motivation to perform their duties at their work-places.

Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

PubMed Central

2012-01-01

Background Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed. Conclusion The study shows conditions related to staffing levels, health infrastructure and essential supplies being among the key determinants or drivers of frontline HWs' motivation to deliver ANC services in both private and public HFs. Efforts of the government to meet the maternal health related Millennium Development Goals and targets for specific interventions need to address challenges related to HWs' motivation to perform their duties at their work-places. PMID:22340941

Leukemia, lymphoma and multiple myeloma mortality (1950-1999) and incidence (1969-1999) in the Eldorado uranium workers cohort.

PubMed

Zablotska, Lydia B; Lane, Rachel S D; Frost, Stanley E; Thompson, Patsy A

2014-04-01

Uranium workers are chronically exposed to low levels of radon decay products (RDP) and gamma (γ) radiation. Risks of leukemia from acute and high doses of γ-radiation are well-characterized, but risks from lower doses and dose-rates and from RDP exposures are controversial. Few studies have evaluated risks of other hematologic cancers in uranium workers. The purpose of this study was to analyze radiation-related risks of hematologic cancers in the cohort of Eldorado uranium miners and processors first employed in 1932-1980 in relation to cumulative RDP exposures and γ-ray doses. The average cumulative RDP exposure was 100.2 working level months and the average cumulative whole-body γ-radiation dose was 52.2 millisievert. We identified 101 deaths and 160 cases of hematologic cancers in the cohort. Overall, male workers had lower mortality and cancer incidence rates for all outcomes compared with the general Canadian male population, a likely healthy worker effect. No statistically significant association between RDP exposure or γ-ray doses, or a combination of both, and mortality or incidence of any hematologic cancer was found. We observed consistent but non-statistically significant increases in risks of chronic lymphocytic leukemia (CLL) and Hodgkin lymphoma (HL) incidence and non-Hodgkin lymphoma (NHL) mortality with increasing γ-ray doses. These findings are consistent with recent studies of increased risks of CLL and NHL incidence after γ-radiation exposure. Further research is necessary to understand risks of other hematologic cancers from low-dose exposures to γ-radiation. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Doses from radon 222 irradiation for workers of the granite mining industry.

PubMed

Сrygorieva, L; Tomilin, Yu

2017-12-01

determining the integral value of annual effective dose from 222Rn for workers of the granite mining industry and assessment for the expected life effective dose from 222Rn. Materials were the results of measurements of external exposure dose of radiation measurements equiv alent equilibrium volume activity of 222Rn in workrooms and workplaces of major groups of granite quarry workers Mykolaiv region, studies EROA 222Rn air premises of these workers, research content 222Rn in drinking water. Granite quarry workers receive double radiation exposure of 222Rn due to exposure in the workplace and at home. The load in the workplace due to inhalation of 222Rn the air was (2.1 ± 0.2) mSv / year (vari ation 0.9-5.9) in a residential area - (4,1 ± 0,2) mSv/year (variation 1.8-5.9). The total annual effective dose from internal exposure from air flow and working premises and drinking water was on average (6,5 ± 0,2) mSv/year, equal to a maximum value of 20 mSv/year. The expected life for the chronic exposure dose of technological naturally occurring radioactive sources for people who work in the granite quarries and, while living in high risk from radon is in the range of 0.16-1.12 Sv. The research results indicate that in assessing the effects associated with exposure due to radon 222 contingents persons such surveys must take into account all sources of this radionuclide dose. L. Сrygorieva, Yu. Tomilin.

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities.

PubMed

Slaughter, Susan E; Estabrooks, Carole A; Jones, C Allyson; Wagg, Adrian S

2011-12-16

Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease. There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population. This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).

Respirators, internal dose, and Oyster Creek

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

Michal, R.

1996-06-01

This article looks at the experience of Oyster Creek in relaxing the requirements for the use of respirators in all facets of plant maintenance, on the overall dose received by plant maintenance personnel. For Roger Shaw, director of radiological controls for three years at GPU Nuclear Corporation`s Oyster Creek nuclear plant the correct dose balance is determined on a job-by-job basis: Does the job require a respirator, which is an effective means of decreasing worker inhalation of airborne radioactive particles? Will wearing a respirator slow down a worker, consequently increasing whole body radiation exposure by prolonging the time spent inmore » fields of high external radiation? How does respiratory protection affect worker safety and to what degree? While changes to the Nuclear Regulatory Commission`s 10CFR20 have updated the radiation protection requirements for the nuclear industry, certain of the revisions have been directed specifically at reducing worker dose, Shaw said. {open_quotes}It basically delineates that dose is dose,{close_quotes} Shaw said, {open_quotes}regardless of whether it is acquired externally or internally.{close_quotes} The revision of Part 20 changed the industry`s attitude toward internal dose, which had always been viewed negatively. {open_quotes}Internal dose was always seen as preventable by wearing respirators and by using engineering techniques such as ventilation control and decontamination,{close_quotes} Shaw said, {open_quotes}whereas external dose, although reduced where practical, was seen as a fact of the job.{close_quotes}« less

NSR&D Program Fiscal Year 2015 Funded Research Stochastic Modeling of Radioactive Material Releases Final Report

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

Andrus, Jason P.; Pope, Chad; Toston, Mary

2016-12-01

Nonreactor nuclear facilities operating under the approval authority of the U.S. Department of Energy use unmitigated hazard evaluations to determine if potential radiological doses associated with design basis events challenge or exceed dose evaluation guidelines. Unmitigated design basis events that sufficiently challenge dose evaluation guidelines or exceed the guidelines for members of the public or workers, merit selection of safety structures, systems, or components or other controls to prevent or mitigate the hazard. Idaho State University, in collaboration with Idaho National Laboratory, has developed a portable and simple to use software application called SODA (Stochastic Objective Decision-Aide) that stochastically calculatesmore » the radiation dose distribution associated with hypothetical radiological material release scenarios. Rather than producing a point estimate of the dose, SODA produces a dose distribution result to allow a deeper understanding of the dose potential. SODA allows users to select the distribution type and parameter values for all of the input variables used to perform the dose calculation. Users can also specify custom distributions through a user defined distribution option. SODA then randomly samples each distribution input variable and calculates the overall resulting dose distribution. In cases where an input variable distribution is unknown, a traditional single point value can be used. SODA, developed using the MATLAB coding framework, has a graphical user interface and can be installed on both Windows and Mac computers. SODA is a standalone software application and does not require MATLAB to function. SODA provides improved risk understanding leading to better informed decision making associated with establishing nuclear facility material-at-risk limits and safety structure, system, or component selection. It is important to note that SODA does not replace or compete with codes such as MACCS or RSAC; rather it is viewed as an easy to use supplemental tool to help improve risk understanding and support better informed decisions. The SODA development project was funded through a grant from the DOE Nuclear Safety Research and Development Program.« less

NSR&D Program Fiscal Year 2015 Funded Research Stochastic Modeling of Radioactive Material Releases Final Report

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

Andrus, Jason P.; Pope, Chad; Toston, Mary

Nonreactor nuclear facilities operating under the approval authority of the U.S. Department of Energy use unmitigated hazard evaluations to determine if potential radiological doses associated with design basis events challenge or exceed dose evaluation guidelines. Unmitigated design basis events that sufficiently challenge dose evaluation guidelines or exceed the guidelines for members of the public or workers, merit selection of safety structures, systems, or components or other controls to prevent or mitigate the hazard. Idaho State University, in collaboration with Idaho National Laboratory, has developed a portable and simple to use software application called SODA (Stochastic Objective Decision-Aide) that stochastically calculatesmore » the radiation dose distribution associated with hypothetical radiological material release scenarios. Rather than producing a point estimate of the dose, SODA produces a dose distribution result to allow a deeper understanding of the dose potential. SODA allows users to select the distribution type and parameter values for all of the input variables used to perform the dose calculation. Users can also specify custom distributions through a user defined distribution option. SODA then randomly samples each distribution input variable and calculates the overall resulting dose distribution. In cases where an input variable distribution is unknown, a traditional single point value can be used. SODA, developed using the MATLAB coding framework, has a graphical user interface and can be installed on both Windows and Mac computers. SODA is a standalone software application and does not require MATLAB to function. SODA provides improved risk understanding leading to better informed decision making associated with establishing nuclear facility material-at-risk limits and safety structure, system, or component selection. It is important to note that SODA does not replace or compete with codes such as MACCS or RSAC; rather it is viewed as an easy to use supplemental tool to help improve risk understanding and support better informed decisions. The SODA development project was funded through a grant from the DOE Nuclear Safety Research and Development Program.« less

Knowledge about childhood autism and opinion among healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders in Nigeria.

PubMed

Bakare, Muideen O; Ebigbo, Peter O; Agomoh, Ahamefule O; Eaton, Julian; Onyeama, Gabriel M; Okonkwo, Kevin O; Onwukwe, Jojo U; Igwe, Monday N; Orovwigho, Andrew O; Aguocha, Chinyere M

2009-02-12

In designing programs to raise the community level of awareness about childhood autism in sub-Saharan Africa, it is logical to use the primary healthcare workers as contact point for education of the general public. Tertiary healthcare workers could play the role of trainers on childhood autism at primary healthcare level. Assessing their baseline knowledge about childhood autism to detect areas of knowledge gap is an essential ingredient in starting off such programs that would be aimed at early diagnosis and interventions. Knowledge of the healthcare workers on availability of facilities and law that would promote the required interventions is also important. This study assessed the baseline knowledge about childhood autism and opinion among Nigerian healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders. A total of one hundred and thirty four (134) consented healthcare workers working in tertiary healthcare facilities located in south east and south-south regions of Nigeria were interviewed with Socio-demographic, Knowledge about Childhood Autism among Health Workers (KCAHW) and Opinion on availability of Facilities and Law caring for the needs and rights of children with Childhood Autism and other developmental disorders (OFLCA) questionnaires. The total mean score of participated healthcare workers on KCAHW questionnaire was 12.35 +/- 4.40 out of a total score of 19 possible. Knowledge gap was found to be higher in domain 3 (symptoms of obsessive and repetitive pattern of behavior), followed by domains 1 (symptoms of impairments in social interaction), 4 (type of disorder autism is and associated co-morbidity) and 2 (symptoms of communication impairments) of KCAHW respectively among the healthcare workers. Knowledge about childhood autism (KCA) as measured by scores on KCAHW questionnaire was significantly associated with age group distribution of the healthcare workers, with those age group of fourth decades and above more likely to have higher mean score (p = 0.004) and previous experience of managing children with autism spectrum disorders (ASD) (p = 0.000). KCA showed near significant association with area of specialty, with those healthcare workers in psychiatry compared to pediatrics having higher mean score (p = 0.071) and also with years of working experience of the healthcare workers (p = 0.056). More than half of the healthcare workers subscribed to the opinion that facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders are lacking in Nigeria. The correlates of KCA may help in selection of those tertiary healthcare workers that would best fit the role of trainers. It is important to update the knowledge gaps of those healthcare workers who scored low in different domains of KCAHW questionnaire. It is imperative for policy makers in Nigeria to advocate and implement multidisciplinary healthcare service system that would ensure early diagnosis and interventions. Nationally representative baseline epidemiological data that would guide policy and planning are also desirable.

Joint US/Russian Studies of Population Exposures Resulting from Nuclear Production Activities in the Southern Urals

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

Napier, Bruce A.

2014-01-01

Beginning in 1948, the Soviet Union initiated a program for production of nuclear materials for a weapons program. The first facility for production of plutonium was constructed in the central portion of the country east of the southern Ural Mountains, about halfway between the major industrial cities of Ekaterinburg and Chelyabinsk. The facility now known as the Mayak Production Association and its associated town, now known as Ozersk, were built to irradiate uranium in reactors, separate the resulting plutonium in reprocessing plants, and prepare plutonium metal. The rush to production, coupled with inexperience in handling radioactive materials, lead to largemore » radiation exposures, not only to the workers in the facilities, but also to the surrounding public. Fuel processing started with no controls on releases, and fuel dissolution and accidents in reactors resulted in release of about 37 PBq (1015 Bq) of 131I between 1948 and 1967. Designed disposals of low- and intermediate-level liquid radioactive wastes, and accidental releases via cooling water from tank farms of high-level liquid radioactive wastes, into the small Techa River caused significant contamination and exposures to residents of numerous small riverside villages downstream of the site. Discovery of the magnitude of the aquatic contamination in late 1951 caused revisions to the waste handling regimes, but not before over 200 PBq of radionuclides (with large contributions of 90Sr and 137Cs) were released. Liquid wastes were diverted to tiny Lake Karachay (which today holds over 4 EBq); cooling water was stopped in the tank farms. In 1957, one of the tanks in the tank farm overheated and exploded; over 70 PBq, disproportionately 90Sr, was blown over a large area to the northeast of the site; a large area was contaminated and many villages evacuated. This area today is known as the East Urals Radioactive Trace (EURT). Each of these releases was significant; together they have created a group of cohorts unrivaled in the world for their chronic, low-dose-rate radiation exposure. The 26,000 workers at Mayak were highly exposed to external gamma and inhaled plutonium. A cohort of individuals raised as children in Ozersk is under evaluation for their exposures to radioiodine. The Techa River Cohort consists of over 30,000 people who were born before the start of exposure in 1949 and lived along the Techa River. The Techa River Offspring Cohort consists of about 21,000 persons born to one or more exposed parents of this group - many of whom also lived along the contaminated river. The EURT Cohort consists of about 18,000 people who were evacuated from the EURT soon after the 1957 explosion and another 8000 who remained. These groups together are the focus of dose reconstruction and epidemiological studies funded by the US, Russia, and the European Union to address the question “Are doses delivered at low dose rates as effective in producing health effects as the same doses delivered at high dose rates?”« less

KSC-06pd0517

NASA Image and Video Library

2006-03-15

KENNEDY SPACE CENTER, FLA. - At NASA Kennedy Space Center's Shuttle Landing Facility, an emergency rescue worker tends to an "injured astronaut" inside a rescue vehicle. Volunteers and emergency rescue workers are participating in a simulated emergency landing of a shuttle crew. Known as a Mode VI exercise, the operation uses volunteer workers from the Center to pose as astronauts. The purpose of the simulation is to exercise emergency preparedness personnel, equipment and facilities in rescuing astronauts from a downed orbiter and providing immediate medical attention. Photo credit: NASA/Troy Cryder

False-Positive Tuberculin Skin Test Results Among Low-Risk Healthcare Workers Following Implementation of Fifty-Dose Vials of Purified Protein Derivative.

PubMed

Collins, Jeffrey M; Hunter, Mary; Gordon, Wanda; Kempker, Russell R; Blumberg, Henry M; Ray, Susan M

2018-06-01

Following large declines in tuberculosis transmission the United States, large-scale screening programs targeting low-risk healthcare workers are increasingly a source of false-positive results. We report a large cluster of presumed false-positive tuberculin skin test results in healthcare workers following a change to 50-dose vials of Tubersol tuberculin.Infect Control Hosp Epidemiol 2018;39:750-752.

29 CFR 500.135 - Certificate of housing inspection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Motor Vehicle Safety and Insurance for Transportation of Migrant and Seasonal Agricultural Workers, Housing Safety and Health for Migrant Workers Housing... this section, a facility or real property to be used for housing a migrant agricultural worker shall...

[Risk of deterministic effects after exposure to low doses of ionizing radiation: retrospective study among health workers in view of a new publication of International Commission on Radiological Protection].

PubMed

Negrone, Mario; Di Lascio, Doriana

2016-01-01

The new recommended equivalent (publication n. 118 of International Commission on Radiological Protection) dose limit for occupational exposure of the lens of the eye is based on prevention of radiogenic cataracts, with the underlying assumption of a nominal threshold which has been adjusted from 2,5 Gy to 0.5 Gy for acute or protracted exposure. The study aim was to determine the prevalence of ocular lens opacity among healthcare workers (radiologic technologists, physicians, physician assistants) with respect to occupational exposures to ionizing radiations. Therefore, we conducted another retrospective study to explore the relationship between occupational exposure to radiation and opacity lens increase. Healthcare data (current occupational dosimetry, occupational history) are used to investigate risk of increase of opacity lens of eye. The sample of this study consisted of 148 health-workers (64 M and 84 W) aged from 28 to 66 years coming from different hospitals of the ASL of Potenza (clinic, hospital and institute with scientific feature). On the basis of the evaluation of the dosimetric history of the workers (global and effective dose) we agreed to ascribe the group of exposed subjects in cat A (equivalent dose > 2 mSV) and the group of non exposed subjects in cat B (workers with annual absorbed level of dose near 0 mSv). The analisys was conducted using SPSS 15.0 (Statistical Package for Social Science). A trend of increased ocular lens opacity was found with increasing number for workers in highest category of exposure (cat. A, Yates' chi-squared test = 13,7 p = 0,0002); variable significantly related to opacity lens results job: nurse (Χ(2)Y = 14,3 p = 0,0002) physician (Χ(2)Y = 2.2 p = 0,1360) and radiologic technologists (Χ(2)Y = 0,1 p = 0,6691). In conclusion our provides evidence that exposure to relatively low doses of ionizing radiation may be harmful to the lens of the eye and may increase a long-term risk of cataract formation; similary necessary to monitor the "equivalent dose" for the lens for the workers in highest category of exposure.

Fatal chlorine gas exposure at a metal recycling facility: Case report.

PubMed

Harvey, Robert R; Boylstein, Randy; McCullough, Joel; Shumate, Alice; Yeoman, Kristin; Bailey, Rachel L; Cummings, Kristin J

2018-06-01

At least four workers at a metal recycling facility were hospitalized and one died after exposure to chlorine gas when it was accidentally released from an intact, closed-valved cylinder being processed for scrap metal. This unintentional chlorine gas release marks at least the third such incident at a metal recycling facility in the United States since 2010. We describe the fatal case of the worker whose clinical course was consistent with acute respiratory distress syndrome (ARDS) following exposure to high concentrations of chlorine gas. This case report emphasizes the potential risk of chlorine gas exposure to metal recycling workers by accepting and processing intact, closed-valved containers. The metal recycling industry should take steps to increase awareness of this established risk to prevent future chlorine gas releases. Additionally, public health practitioners and clinicians should be aware that metal recycling workers are at risk for chlorine gas exposure. © 2018 Wiley Periodicals, Inc.

The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia.

PubMed

Jackson, Ruth; Hailemariam, Assefa

2016-09-01

Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey

PubMed Central

Horng, L.M.; Unicomb, L.; Alam, M.-U.; Halder, A.K.; Shoab, A.K.; Ghosh, P.K.; Opel, A.; Islam, M.K.; Luby, S.P.

2017-01-01

SUMMARY Background Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. Aim To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. Methods The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. Findings More than 96% of facilities had ‘improved’ water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78–92% of handwashing locations for doctors and nurses, but just 4–30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Conclusion Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi health-care facilities. PMID:27665311

Naturally occurring workplace facilities to increase the leisure time physical activity of workers: A propensity-score weighted population study.

PubMed

Biswas, Aviroop; Smith, Peter M; Gignac, Monique A M

2018-06-01

The benefit of providing access to physical activity facilities at or near work to support the leisure time physical activity (LTPA) of workers is uncertain. We examined the association between access to physical activity facilities at or near work and the LTPA of workers after adjusting for a range of individual and occupational characteristics. Data was obtained from 60,650 respondents to the 2007-2008 Canadian Community Health Survey. Participants were employed adults ≥18 years of age who had no long-term health condition which reduced their participation in physical activity. Latent class analysis determined naturally occurring combinations of physical activity facilities at or near work. Each combination was balanced by 19 individual and occupational covariate characteristics using inverse probability of treatment weights derived from propensity scores. The association between combinations of physical activity facilities at or near work on LTPA level was estimated by multinomial logistic regression. Five different combinations of physical activity facilities were available to respondents at or near work. Data were analyzed in 2017. All possible physical facilities increased the likelihood for LTPA (OR, 2.08, 95% CI, 1.03-4.20) and other combinations were also positively associated. Respondents with no physical activity facilities were characterized as having a low education, low income, high physically demanding work, poor health and mental health, non-white racial background, and being an immigrant. Access to supportive workplace environments can help workers be physically active. Future research should assess a range of personal, social and environmental factors that may be driving this relationship.

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey.

PubMed

Horng, L M; Unicomb, L; Alam, M-U; Halder, A K; Shoab, A K; Ghosh, P K; Opel, A; Islam, M K; Luby, S P

2016-11-01

Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa.

PubMed

Hodes, R; Price, I; Bungane, N; Toska, E; Cluver, L

2017-08-25

Shortages of essential medicines are a daily occurrence in many of South Africa (SA)'s public health facilities. This study focuses on the responses of healthcare workers to stock-outs, investigating how actors at the 'front line' of public health delivery understand, experience and respond to shortages of essential medicines and equipment in their facilities. Findings are based on focus groups, observations and interviews with healthcare workers and patients at healthcare facilities in the Eastern Cape Province of SA, conducted as part of the Mzantsi Wakho study. The research revealed a discrepancy between 'informal' definitions of stock-outs and their reporting through formal stock-out management channels. Front-line healthcare workers had designed their own systems for classifying the severity of stock-outs, based on the product in question, and on their potential to access stocks from other facilities. Beyond formal systems of procurement and supply, healthcare workers had established vast networks of alternative communication and action, often using personal resources to procure medical supplies. Stock-outs were only reported when informal methods of stock-sharing did not secure top-up supplies. These findings have implications for understanding the frequency and severity of stock-outs, and for taking action to prevent and manage stock-outs effectively.

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya

PubMed Central

2011-01-01

Background Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability Methods We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. Results HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. Conclusions There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community. PMID:21936958

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya.

PubMed

Goodman, Catherine; Opwora, Antony; Kabare, Margaret; Molyneux, Sassy

2011-09-22

Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community.

42 CFR 82.2 - What are the basics of dose reconstruction?

Code of Federal Regulations, 2014 CFR

2014-10-01

... reconstructions may use monitoring results for groups of workers with comparable activities and relationships to... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES METHODS FOR CONDUCTING DOSE RECONSTRUCTION UNDER THE... found to be complete and adequate, individual worker monitoring data, such as dosimeter readings and...

42 CFR 82.2 - What are the basics of dose reconstruction?

Code of Federal Regulations, 2011 CFR

2011-10-01

... reconstructions may use monitoring results for groups of workers with comparable activities and relationships to... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES METHODS FOR CONDUCTING DOSE RECONSTRUCTION UNDER THE... found to be complete and adequate, individual worker monitoring data, such as dosimeter readings and...

Health worker performance in the management of paediatric fevers following in-service training and exposure to job aids in Kenya

PubMed Central

2010-01-01

Background Improving the way artemether-lumefantrine (AL) is provided to patients attending clinics is critical to maximize the benefit of this new medicine. In 2007, a new initiative was launched in one part of Kenya to improve malaria case-management through enhanced in-service training and provision of job aids. Methods An evaluation of the intervention using pre- and post-intervention cross sectional health facility surveys was conducted in Bondo district. The surveys included: audit of government health facilities, health worker structured interviews and exit interviews with caretakers of sick children below five years of age. The outcome indicators were the proportions of febrile children who had AL prescribed, AL dispensed, and four different dispensing and counseling tasks performed. Results At baseline 33 government health facilities, 48 health workers and 386 febrile child consultations were evaluated. At follow-up the same health facilities were surveyed and 36 health workers and 390 febrile child consultations evaluated. The findings show: 1) no health facility or health worker was exposed to all components of the intervention; 2) the proportion of health workers who received the enhanced in-service training was 67%; 3) the proportion of febrile children with uncomplicated malaria treated with the first-line anti-malarial drug, artemether-lumefantrine (AL), at health facilities where AL was in stock increased from 76.9% (95%CI: 69.4, 83.1) to 87.6% (95% CI: 82.5, 91.5); 4) there were modest but non-significant improvements in dispensing and counseling practices; and 5) when the analyses were restricted to health workers who received the enhanced in-service training and/or had received new guidelines and job aids, no significant improvements in reported case-management tasks were observed compared to baseline. Conclusion In-service training and provision of job aids alone may not be adequate to improve the prescribing, dispensing and counseling tasks necessary to change malaria case-management practices and the inclusion of supervision and post-training follow-up should be considered in future clinical practice change initiatives. PMID:20849650

Health worker performance in the management of paediatric fevers following in-service training and exposure to job aids in Kenya.

PubMed

Wasunna, Beatrice; Zurovac, Dejan; Bruce, Jane; Jones, Caroline; Webster, Jayne; Snow, Robert W

2010-09-18

Improving the way artemether-lumefantrine (AL) is provided to patients attending clinics is critical to maximize the benefit of this new medicine. In 2007, a new initiative was launched in one part of Kenya to improve malaria case-management through enhanced in-service training and provision of job aids. An evaluation of the intervention using pre- and post-intervention cross sectional health facility surveys was conducted in Bondo district. The surveys included: audit of government health facilities, health worker structured interviews and exit interviews with caretakers of sick children below five years of age. The outcome indicators were the proportions of febrile children who had AL prescribed, AL dispensed, and four different dispensing and counseling tasks performed. At baseline 33 government health facilities, 48 health workers and 386 febrile child consultations were evaluated. At follow-up the same health facilities were surveyed and 36 health workers and 390 febrile child consultations evaluated. The findings show: 1) no health facility or health worker was exposed to all components of the intervention; 2) the proportion of health workers who received the enhanced in-service training was 67%; 3) the proportion of febrile children with uncomplicated malaria treated with the first-line anti-malarial drug, artemether-lumefantrine (AL), at health facilities where AL was in stock increased from 76.9% (95%CI: 69.4, 83.1) to 87.6% (95% CI: 82.5, 91.5); 4) there were modest but non-significant improvements in dispensing and counseling practices; and 5) when the analyses were restricted to health workers who received the enhanced in-service training and/or had received new guidelines and job aids, no significant improvements in reported case-management tasks were observed compared to baseline. In-service training and provision of job aids alone may not be adequate to improve the prescribing, dispensing and counseling tasks necessary to change malaria case-management practices and the inclusion of supervision and post-training follow-up should be considered in future clinical practice change initiatives.

A Critique of Recent Epidemiologic Studies of Cancer Mortality Among Nuclear Workers.

PubMed

Scott, Bobby R

2018-01-01

Current justification by linear no-threshold (LNT) cancer risk model advocates for its use in low-dose radiation risk assessment is now mainly based on results from flawed and unreliable epidemiologic studies that manufacture small risk increases (ie, phantom risks). Four such studies of nuclear workers, essentially carried out by the same group of epidemiologists, are critiqued in this article. Three of the studies that forcibly applied the LNT model (inappropriate null hypothesis) to cancer mortality data and implicated increased mortality risk from any radiation exposure, no matter how small the dose, are demonstrated to manufacture risk increases for doses up to 100 mSv (or 100 mGy). In a study where risk reduction (hormetic effect/adaptive response) was implicated for nuclear workers, it was assumed by the researchers to relate to a "strong healthy worker effect" with no consideration of the possibility that low radiation doses may help prevent cancer mortality (which is consistent with findings from basic radiobiological research). It was found with basic research that while large radiation doses suppress our multiple natural defenses (barriers) against cancer, these barriers are enhanced by low radiation doses, thereby decreasing cancer risk, essentially rendering the LNT model to be inconsistent with the data.

External effective radiation dose to workers in the restricted area of the Fukushima Daiichi Nuclear Power Plant during the third year after the Great East Japan Earthquake

PubMed Central

Sakumi, Akira; Miyagawa, Ryu; Tamari, Yuki; Nawa, Kanabu; Sakura, Osamu; Nakagawa, Keiichi

2016-01-01

Since the Great East Japan Earthquake on 11 March 2011, Iitate Village has continued to be classified as a deliberate evacuation area, in which residents are estimated to receive an annual additional effective radiation dose of >20 mSv. Some companies still operate in Iitate Village, with a special permit from the Cabinet Office Team in Charge of Assisting the Lives of Disaster Victims. In this study, we measured the annual effective radiation dose to workers in Iitate Village from 15 January to 13 December 2013. The workers stayed in Iitate for 10 h and left the village for the remaining 14 h each working day. They worked for 5 days each week in Iitate Village, but stayed outside of the village for the remaining 2 days each week. We found that the effective radiation dose of 70% of the workers was <2 mSv, including natural radiation; the maximum dose was 3.6 mSv. We estimated the potential annual additional effective radiation dose if people returned full-time to Iitate. Our analysis supports the plan for people to return to their home village at the end of 2017. PMID:26661855

Why do health workers in rural Tanzania prefer public sector employment?

PubMed Central

2012-01-01

Background Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required. PMID:22480347

Why do health workers in rural Tanzania prefer public sector employment?

PubMed

Songstad, Nils Gunnar; Moland, Karen Marie; Massay, Deodatus Amadeus; Blystad, Astrid

2012-04-05

Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.

Job satisfaction and motivation among public sector health workers: evidence from Ethiopia.

PubMed

Hotchkiss, David R; Banteyerga, Hailom; Tharaney, Manisha

2015-10-29

Although human resources for health have received increased attention by health systems decision-makers and researchers in recent years, insufficient attention has been paid to understanding the factors that influence the performance of health workers. This empirical study investigates the factors that are associated with health worker motivation over time among public sector primary health care workers in Ethiopia. The study is based on data from public sector health worker surveys collected through a convenience sample of 43 primary health care facilities in four regions (Addis Ababa, Oromia, Amhara, and Somali) at three points in time: 2003/04, 2006, and 2009. Using a Likert scale, respondents were asked to respond to statements regarding job satisfaction, pride in work, satisfaction with financial rewards, self-efficacy, satisfaction with facility resources, and self-perceived conscientiousness. Inter-reliability of each construct was assessed using Cronbach's alpha, and indices of motivational determinants and outcomes were calculated for each survey round. To explore the associations between motivational determinants and outcomes, bivariate and multivariate regression analyses were carried out based on a pooled dataset. Among the sample public sector health workers, several dimensions of health worker motivation significantly increased over the study period, including two indicators of motivational outcomes-overall job satisfaction and self-perceived conscientiousness-and two indicators of motivational determinants-pride and self-efficacy. However, two other dimensions of motivation-satisfaction with financial rewards and satisfaction with facility resources-significantly decreased. The multivariate analyses found that the constructs of pride, self-efficacy, satisfaction with financial rewards, and satisfaction with facility resources were significantly associated with the motivational outcomes, after controlling for other factors. Overall, the findings support the premise that both financial and non-financial factors are important determinants of health worker motivation in the Ethiopian context. Although the findings do not point to specific interventions that should be introduced, they do suggest possible areas that interventions should target to help improve health worker motivation.

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

PubMed Central

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F.

2016-01-01

Background Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. Purpose To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. Methods The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Results Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff. Conclusion Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter. PMID:27439012

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F

2016-01-01

Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff. Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.

Risk of Lung Cancer Mortality in Nuclear Workers from Internal Exposure to Alpha Particle-emitting Radionuclides

PubMed Central

Atkinson, Will; Bérard, Philippe; Bingham, Derek; Birchall, Alan; Blanchardon, Eric; Bull, Richard; Guseva Canu, Irina; Challeton-de Vathaire, Cécile; Cockerill, Rupert; Do, Minh T.; Engels, Hilde; Figuerola, Jordi; Foster, Adrian; Holmstock, Luc; Hurtgen, Christian; Laurier, Dominique; Puncher, Matthew; Riddell, Anthony E.; Samson, Eric; Thierry-Chef, Isabelle; Tirmarche, Margot; Vrijheid, Martine; Cardis, Elisabeth

2017-01-01

Background: Carcinogenic risks of internal exposures to alpha-emitters (except radon) are poorly understood. Since exposure to alpha particles—particularly through inhalation—occurs in a range of settings, understanding consequent risks is a public health priority. We aimed to quantify dose–response relationships between lung dose from alpha-emitters and lung cancer in nuclear workers. Methods: We conducted a case–control study, nested within Belgian, French, and UK cohorts of uranium and plutonium workers. Cases were workers who died from lung cancer; one to three controls were matched to each. Lung doses from alpha-emitters were assessed using bioassay data. We estimated excess odds ratio (OR) of lung cancer per gray (Gy) of lung dose. Results: The study comprised 553 cases and 1,333 controls. Median positive total alpha lung dose was 2.42 mGy (mean: 8.13 mGy; maximum: 316 mGy); for plutonium the median was 1.27 mGy and for uranium 2.17 mGy. Excess OR/Gy (90% confidence interval)—adjusted for external radiation, socioeconomic status, and smoking—was 11 (2.6, 24) for total alpha dose, 50 (17, 106) for plutonium, and 5.3 (−1.9, 18) for uranium. Conclusions: We found strong evidence for associations between low doses from alpha-emitters and lung cancer risk. The excess OR/Gy was greater for plutonium than uranium, though confidence intervals overlap. Risk estimates were similar to those estimated previously in plutonium workers, and in uranium miners exposed to radon and its progeny. Expressed as risk/equivalent dose in sieverts (Sv), our estimates are somewhat larger than but consistent with those for atomic bomb survivors. See video abstract at, http://links.lww.com/EDE/B232. PMID:28520643

A reanalysis of cancer mortality in Canadian nuclear workers (1956–1994) based on revised exposure and cohort data

PubMed Central

Zablotska, L B; Lane, R S D; Thompson, P A

2014-01-01

Background: A 15-country study of nuclear workers reported significantly increased radiation-related risks of all cancers excluding leukaemia, with Canadian data a major factor behind the pooled results. We analysed mortality (1956–1994) in the updated Canadian cohort and provided revised risk estimates. Methods: Employment records were searched to verify and revise exposure data and to restore missing socioeconomic status. Excess relative risks per sievert (ERR/Sv) of recorded radiation dose and 95% confidence intervals (CIs) were estimated using Poisson regression. Results: A significant heterogeneity of the dose–response for solid cancer was identified (P=0.02), with 3088 early (1956–1964) Atomic Energy of Canada Limited (AECL) workers having a significant increase (ERR/Sv=7.87, 95% CI: 1.88, 19.5), and no evidence of radiation risk for 42 228 workers employed by three nuclear power plant companies and post-1964 AECL (ERR/Sv=−1.20, 95% CI: <−1.47, 2.39). Radiation risks of leukaemia were negative in early AECL workers and non-significantly increased in other workers. In analyses with separate terms for tritium and gamma doses, there was no evidence of increased risk from tritium exposure. All workers had mortality lower than the general population. Conclusion: Significantly increased risks for early AECL workers are most likely due to incomplete transfer of AECL dose records to the National Dose Registry. Analyses of the remainder of the Canadian nuclear workers (93.2%) provided no evidence of increased risk, but the risk estimate was compatible with estimates that form the basis of radiation protection standards. Study findings suggest that the revised Canadian cohort, with the exclusion of early AECL workers, would likely have an important effect on the 15-country pooled risk estimate of radiation-related risks of all cancer excluding leukaemia by substantially reducing the size of the point estimate and its significance. PMID:24231946

Narrow beam neutron dosimetry.

PubMed

Ferenci, M Sutton

2004-01-01

Organ and effective doses have been estimated for male and female anthropomorphic mathematical models exposed to monoenergetic narrow beams of neutrons with energies from 10(-11) to 1000 MeV. Calculations were performed for anterior-posterior, posterior-anterior, left-lateral and right-lateral irradiation geometries. The beam diameter used in the calculations was 7.62 cm and the phantoms were irradiated at a height of 1 m above the ground. This geometry was chosen to simulate an accidental scenario (a worker walking through the beam) at Flight Path 30 Left (FP30L) of the Weapons Neutron Research (WNR) Facility at Los Alamos National Laboratory. The calculations were carried out using the Monte Carlo transport code MCNPX 2.5c.

75 FR 39029 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-07

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH), National Institute for Occupational Safety and Health (NIOSH) In accordance with section 10(a)(2) of the.... Background: The Advisory Board was established under the Energy Employees Occupational Illness Compensation...

78 FR 42525 - Meeting; Subcommittee for Dose Reconstruction Reviews, Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-16

...; Subcommittee for Dose Reconstruction Reviews, Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... the Energy Employees Occupational Illness Compensation Program Act of 2000, to advise the President on...

77 FR 14377 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section...

Application of ISO standard 27048: dose assessment for the monitoring of workers for internal radiation exposure.

PubMed

Henrichs, K

2011-03-01

Besides ongoing developments in the dosimetry of incorporated radionuclides, there are various efforts to improve the monitoring of workers for potential or real intakes of radionuclides. The disillusioning experience with numerous intercomparison projects identified substantial differences between national regulations, concepts, applied programmes and methods, and dose assessment procedures. Measured activities were not directly comparable because of significant differences between measuring frequencies and methods, but also results of case studies for dose assessments revealed differences of orders of magnitude. Besides the general common interest in reliable monitoring results, at least the cross-border activities of workers (e.g. nuclear power plant services) require consistent approaches and comparable results. The International Standardization Organization therefore initiated projects to standardise programmes for the monitoring of workers, the requirements for measuring laboratories and the processes for the quantitative evaluation of monitoring results in terms of internal assessed doses. The strength of the concepts applied by the international working group consists in a unified approach defining the requirements, databases and processes. This paper is intended to give a short introduction into the standardization project followed by a more detailed description of the dose assessment standard, which will be published in the very near future.

Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria.

PubMed

Bamiselu, Oluyomi F; Ajayi, IkeOluwapo; Fawole, Olufunmilayo; Dairo, David; Ajumobi, Olufemi; Oladimeji, Abisola; Steven, Yoon

2016-08-19

Malaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. This study assessed factors influencing adherence to malaria diagnosis and treatment guidelines among healthcare workers in public and private sectors in Ogun State, Nigeria. A comparative cross-sectional study was carried out among 432 (216 public and 216 private) healthcare workers selected from nine Local Government Areas using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on availability and use of malaria Rapid Diagnostic Test (mRDT) and artemisinin combination therapy (ACT), for management of uncomplicated malaria. Adherence was defined as when choice of antimalarials for parasitological confirmed malaria cases was restricted to recommended antimalarial medicines. Association between adherence and independent variables were tested using Chi-square at 5 % level of significance. Malaria RDT was available in 81.9 % of the public health facilities and 19.4 % of the private health facilities (p = 0.001). Its use was higher among public healthcare workers (85.2 %) compared to 32.9 % in private facilities (p = 0.000). Presumptive diagnosis of malaria was higher among private healthcare workers (94.9 %) compared to 22.7 % public facilities (p = <0.0001). The main reason for non-usage of mRDT among private healthcare workers was its perceived unreliability of mRDT (40.9 %). Monotherapy including artesunate (58.3 % vs 12.5 %), amodiaquine (38.9 % vs 8.3 %) and chloroquine (26.4 % vs 4.2 %) were significantly more available in private than public health facilities, respectively. Adherence to guidelines was significantly higher among public healthcare workers (60.6 %) compared to those in private facilities (27.3 %). Availability of antimalarial medicine was the main factor that influenced treatment prescription in both healthcare settings (p = 0.27). However, drug promotion by manufactures (45.8 %) has a major influence on private healthcare workers' prescription practice. The findings of this study demonstrate significant difference between public and private healthcare workers on adherence to national malaria diagnosis and treatment guidelines. Interventions to improve private sector engagement in implementation of the guidelines, training and supply of recommended antimalarial medicines should be intensified.

Health care workers in danger zones: a special report on safety and security in a changing environment.

PubMed

Redwood-Campbell, Lynda J; Sekhar, Sharonya N; Persaud, Christine R

2014-10-01

Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed. Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target. This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts. From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration. While there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission.

Workplace assaults on minority health and mental health care workers in Los Angeles.

PubMed Central

Sullivan, C; Yuan, C

1995-01-01

Workplace violence is becoming increasingly recognized as a serious problem in health care settings. All 628 workers' compensation assaults claimed by minority Los Angeles County health care workers from 1986 through 1990 were abstracted. Population-at-risk data from county personnel computer tapes provided denominators by age, sex, race, job classification, and type of facility. Rates varied by type of facility (rate ratio = 38 for psychiatric hospitals vs public health facilities) and varied by job, with inpatient nursing attendants having the highest rate for caregivers. Most assaults were committed by patients (86%), followed by coworkers (8%). The average cost of an assault ($4879) was relatively low but related to the costlier problem of work-related emotional illness. PMID:7604900

Birth Defects in Infants Born to Employees of a Microelectronics and Business Machine Manufacturing Facility

PubMed Central

Silver, Sharon R.; Pinkerton, Lynne E.; Rocheleau, Carissa M.; Deddens, James A.; Michalski, Adrian M.; Van Zutphen, Alissa R.

2017-01-01

Background Concerns about solvent releases from a microelectronics/business machine manufacturing facility in upstate New York led to interest in the health of former workers, including this investigation of birth defects in children of male and female employees. Methods Children born 1983 to 2001 to facility employees were enumerated and matched to New York State’s Congenital Malformations Registry. Reported structural birth defects were compared with numbers expected from state rates (excluding New York City), generating standardized prevalence ratios (SPRs). Exposure assessors classified employees as ever/never potentially exposed at the facility to metals, chlorinated hydrocarbons, and other hydrocarbons during windows critical to organogenesis (female workers) or spermatogenesis (male workers). Among workers, adjusted prevalence ratios were generated to evaluate associations between potential exposures and specific birth defects. Results External comparisons for structural defects were at expectation for infants of male workers (SPR = 1.01; 95% confidence interval [CI], 0.77–1.29; n = 60) and lower for births to female workers (SPR = 0.84; 95% CI, 0.50–1.33; n = 18). Among full-term infants of male workers, ventricular septal defects (VSDs) were somewhat elevated compared with the general population (SPR = 1.58; 95% CI, 0.99–2.39; n = 22). Within the cohort, potential paternal metal exposure was associated with increased VSD risk (adjusted prevalence ratio = 2.70; 95% CI, = 1.09–6.67; n = 7). Conclusion While overall SPRs were near expectation, paternal exposure to metals (primarily lead) appeared to be associated with increased VSD risk in infants. Take-home of occupational exposures, nonoccupational exposures, and chance could not be ruled out as causes. Case numbers for many defects were small, limiting assessment of the role of occupational exposures. PMID:27224896

A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival.

PubMed

Makombe, Simon D; Jahn, Andreas; Tweya, Hannock; Chuka, Stuart; Yu, Joseph Kwong-Leung; Hochgesang, Mindy; Aberle-Grasse, John; Pasulani, Olesi; Schouten, Erik J; Kamoto, Kelita; Harries, Anthony D

2007-11-01

To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.

Current situations and discussions in Japan in relation to the new occupational equivalent dose limit for the lens of the eye.

PubMed

Yokoyama, Sumi; Hamada, Nobuyuki; Hayashida, Toshiyuki; Tsujimura, Norio; Tatsuzaki, Hideo; Kurosawa, Tadahiro; Nabatame, Kuniaki; Ohguchi, Hiroyuki; Ohno, Kazuko; Yamauchi-Kawaura, Chiyo; Iimoto, Takeshi; Ichiji, Takeshi; Hotta, Yutaka; Iwai, Satoshi; Akahane, Keiichi

2017-09-25

Since the International Commission on Radiological Protection recommended reducing the occupational equivalent dose limit for the lens of the eye in 2011, there have been extensive discussions in various countries. This paper reviews the current situation in radiation protection of the ocular lens and the discussions on the potential impact of the new lens dose limit in Japan. Topics include historical changes to the lens dose limit, the current situation with occupational lens exposures (e.g., in medical workers, nuclear workers, and Fukushima nuclear power plant workers) and measurements, and the current status of biological studies and epidemiological studies on radiation cataracts. Our focus is on the situation in Japan, but we believe such information sharing will be useful in many other countries.

Why first-level health workers fail to follow guidelines for managing severe disease in children in the Coast Region, the United Republic of Tanzania

PubMed Central

Lyimo, Thomas; Skarbinski, Jacek; Metta, Emmy; Kahigwa, Elizeus; Flannery, Brendan; Dowell, Scott F; Abdulla, Salim; Kachur, S Patrick

2009-01-01

Abstract Objective To determine why health workers fail to follow integrated management of childhood illness (IMCI) guidelines for severely ill children at first-level outpatient health facilities in rural areas of the United Republic of Tanzania. Methods Retrospective and prospective case reviews of severely ill children aged < 5 years were conducted at health facilities in four districts. We ascertained treatment and examined the characteristics associated with referral, conducted follow-up interviews with parents of severely ill children, and gave health workers questionnaires and interviews. Findings In total, 502 cases were reviewed at 62 facilities. Treatment with antimalarials and antibiotics was consistent with the diagnosis given by health workers. However, of 240 children classified as having “very severe febrile disease”, none received all IMCI-recommended therapies, and only 25% of severely ill children were referred. Lethargy and anaemia diagnoses were independently associated with referral. Most (91%) health workers indicated that certain severe conditions can be managed without referral. Conclusion The health workers surveyed rarely adhered to IMCI treatment and referral guidelines for children with severe illness. They administered therapy based on narrow diagnoses rather than IMCI classifications, disagreed with referral guidelines and often considered referral unnecessary. To improve implementation of IMCI, attention should focus on the reasons for health worker non-adherence. PMID:19274361

Health worker perspectives on user fee removal in Zambia

PubMed Central

2012-01-01

Background User fees for primary care services were removed in rural districts in Zambia in 2006. Experience from other countries has suggested that health workers play a key role in determining the success of a fee removal policy, but also find the implementation of such a policy challenging. The policy was introduced against a backdrop of a major shortage in qualified health staff. Methods As part of a larger study on the experience and effect of user fee removal in Zambia, a number of case studies at the facility level were conducted. As part of these, quantitative and qualitative data were collected to evaluate health workers’ satisfaction and experiences in charging and non-charging facilities. Results Our findings show that health-care workers have mixed feelings about the policy change and its consequences. We found some evidence that personnel motivation was higher in non-charging facilities compared to facilities still charging. Yet it is unclear whether this effect was due to differences in the user fee policy or to the fact that a lot of staff interviewed in non-charging facilities were working in mission facilities, where we found a significantly higher motivation. Health workers expressed satisfaction with an apparent increase in the number of patients visiting the facilities and the removal of a deterring factor for many needy patients, but also complained about an increased workload. Furthermore, working conditions were said to have worsened, which staff felt was linked to the absence of additional resources to deal with the increased demand or replace the loss of revenue generated by fees. Conclusion These findings highlight the need to pay attention to supply-side measures when removing demand-side barriers such as user fees and in particular to be concerned about the burden that increased demand can place on already over-stretched health workers. PMID:23110690

Measurement of 238U and 232Th in Petrol, Gas-oil and Lubricant Samples by Using Nuclear Track Detectors and Resulting Radiation Doses to the Skin of Mechanic Workers.

PubMed

Misdaq, M A; Chaouqi, A; Ouguidi, J; Touti, R; Mortassim, A

2015-10-01

Workers in repair shops of vehicles (cars, buses, truck, etc.) clean carburetors, check fuel distribution, and perform oil changes and greasing. To explore the exposure pathway of (238)U and (232)Th and its decay products to the skin of mechanic workers, these radionuclides were measured inside petrol, gas-oil, and lubricant material samples by means of CR-39 and LR-115 type II solid state nuclear track detectors (SSNTDs), and corresponding annual committed equivalent doses to skin were determined. The maximum total equivalent effective dose to skin due to the (238)U and (232)Th series from the application of different petrol, gas-oil, and lubricant samples by mechanic workers was found equal to 1.2 mSv y(-1) cm(-2).

The impact of the National HIV Health Care Worker Hotline on patient care in South Africa.

PubMed

Chisholm, Briony S; Cohen, Karen; Blockman, Marc; Kinkel, Hans-Friedemann; Kredo, Tamara J; Swart, Annoesjka M

2011-01-26

South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail. A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients. The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.

(32)P measurment of urine samples and internal dose assessment for radiation workers in life science laboratories.

PubMed

Yoon, S; Pak, M-J; Park, S; Yoo, J; Ha, W-H; Jang, H-K; Kim, J K

2014-12-01

(32)P measurements of urine samples and internal dose assessments were conducted for workers in life science laboratories. A procedure for sample pre-treatment was established and validation was performed to exclude interference and to detect (32)P levels accurately. The detection conditions for Cherenkov radiation were evaluated and the accuracy of Cherenkov radiation measurements validated. The analytical and measurement procedures were applied to urine samples collected from 11 workers from life sciences laboratories. The results of the measurements generally indicated very low background radiation levels, but daily urine samples from two workers were above the minimum detectable activity. The (32)P concentrations for two of the workers were 29.3  ±  10.4 Bq•d(-1) and 24.1  ±  11.8 Bq•d(-1), respectively, at intake levels of 4.12 kBq and 2.61 kBq. The effective doses for these two workers were 4.6 μSv and 2.9 μSv. Overall, the results indicate very low levels of radioactivity, except for cases related to specific working conditions.

78 FR 24752 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... Employees Occupational Illness Compensation Program Act of 2000 to advise the President on a variety of...

76 FR 38182 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... Occupational Illness Compensation Program Act of 2000 to advise the President on a variety of policy and...

78 FR 733 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-04

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... Occupational Illness Compensation Program Act of 2000 to advise the President on a variety of policy and...

76 FR 55678 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... Occupational Illness Compensation Program Act of 2000 to advise the President on a variety of policy and...

76 FR 9786 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section... Occupational Illness Compensation Program Act of 2000 to advise the President on a variety of policy and...

A Typology of Social Workers in Long-Term Care Facilities in Israel.

PubMed

Lev, Sagit; Ayalon, Liat

2018-04-01

This article explores moral distress among long-term care facility (LTCF) social workers by examining the relationships between moral distress and environmental and personal features. Based on these features, authors identified a typology of LTCF social workers and how they handle moral distress. Such a typology can assist in the identification of social workers who are in a particular need for assistance. Overall, 216 LTCF social workers took part in the study. A two-step cluster analysis was conducted to identify a typology of LTCF social workers based on features such as ethical environment, support in workplace, mastery, and resilience. The variance of the identified clusters and their associations with moral distress were examined, and four clusters of LTCF social workers were identified. The clusters varied from each other in relation to their personal and environmental features and in relation to their experience of moral distress. The article concludes with a discussion of the importance of developing programs for LTCF social workers that provide support and enhancement of personal resources and an adequate and ethical environment for practice.

Ambient Dose Equivalent in S. Paulo and Bauru cities

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

Umisedo, Nancy K.; Okuno, Emico; Cancio, Francisco S.

2008-08-07

The Laboratory of Dosimetry (Institute of Physics, University of S. Paulo) performs since 1981 the external individual monitoring of workers exposed to X and gamma rays based on thermoluminescent dosimetry (TLD). Personal dose equivalent refers only to the exposure of workers due to the working activities, and the dose due to background radiation, also measured with TLD, must be subtracted to evaluate it. A compilation of ambient dose equivalent was done to evaluate the dose due to the background radiation in the work places, and also to contribute to the knowledge of the level of indoor radiation to which themore » public is exposed.« less

Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward

2016-12-01

The population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015. To ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana. This is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards. Quality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p < 0.05), quality of health care and patient safety standards were relatively better in rural facilities. For Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural-urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.

Environmental data and analyses for the proposed management of spent nuclear fuel on the DOE Oak Ridge Reservation

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

Socolof, M.L.; Curtis, A.H.; Blasing, T.J.

1995-08-01

DOE needs to continue the safe and efficient management of SNF on ORR, based on the requirement for future SNF storage capacity and implementation of the ROD for the PEIS. DOE is proposing to implement the ROD through proper management of SNF on ORR, including the possible construction and operation of a dry cask storage facility. This report describes the potentially affected environment and analyzes impacts on various resources due to the proposed action. The information provided in this report is intended to support the Environmental Assessment being prepared for the proposed activities. Construction of the dry cask storage facilitymore » would result in minimal or no impacts on groundwater, surface water, and ecological resources. Contaminated soils excavated during construction would result in negligible risk to human health and to biota. Except for noise from trucks and equipment, operation of the dry cask storage facility would not be expected to have any impact on vegetation, wildlife, or rare plants or animals. Noise impacts would be minimal. Operation exposures to the average SNF storage facility worker would not exceed approximately 0.40 mSv/year (40 mrem/year). The off-site population dose within an 80-km (50-mile) radius of ORR from SNF operations would be less than 0.052 person-Sv/year (5.2 person-rem/year). Impacts from incident-free transportation on ORR would be less than 1.36 X 10{sup -4} occupational fatal cancers and 4.28 X 10{sup -6} public fatal cancers. Credible accident scenarios that would result in the greatest probable risks would cause less than one in a million cancer fatalities to workers and the public.« less

External effective radiation dose to workers in the restricted area of the Fukushima Daiichi Nuclear Power Plant during the third year after the Great East Japan Earthquake.

PubMed

Sakumi, Akira; Miyagawa, Ryu; Tamari, Yuki; Nawa, Kanabu; Sakura, Osamu; Nakagawa, Keiichi

2016-03-01

Since the Great East Japan Earthquake on 11 March 2011, Iitate Village has continued to be classified as a deliberate evacuation area, in which residents are estimated to receive an annual additional effective radiation dose of >20 mSv. Some companies still operate in Iitate Village, with a special permit from the Cabinet Office Team in Charge of Assisting the Lives of Disaster Victims. In this study, we measured the annual effective radiation dose to workers in Iitate Village from 15 January to 13 December 2013. The workers stayed in Iitate for 10 h and left the village for the remaining 14 h each working day. They worked for 5 days each week in Iitate Village, but stayed outside of the village for the remaining 2 days each week. We found that the effective radiation dose of 70% of the workers was <2 mSv, including natural radiation; the maximum dose was 3.6 mSv. We estimated the potential annual additional effective radiation dose if people returned full-time to Iitate. Our analysis supports the plan for people to return to their home village at the end of 2017. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Chromosome aberrations in workers occupationally exposed to tritium.

PubMed

Tawn, E Janet; Curwen, Gillian B; Riddell, Anthony E

2018-06-01

This paper reports the findings of an historical chromosome analysis for unstable aberrations, undertaken on 34 nuclear workers with monitored exposure to tritium. The mean recorded β-particle dose from tritium was 9.33 mGy (range 0.25-79.71 mGy) and the mean occupational dose from external, mainly γ-ray, irradiation was 1.94 mGy (range 0.00-7.71 mGy). The dicentric frequency of 1.91 ± 0.53 × 10 -3 per cell was significantly raised, in comparison with that of 0.61 ± 0.30 × 10 -3 per cell for a group of 66 comparable worker controls unexposed to occupational radiation. The frequency of total aberrations was also significantly higher in the tritium workers. Comparisons with in vitro studies indicate that at these dose levels an increase in aberration frequency is not expected. However, the available historical tritium dose records were produced for the purposes of radiological protection and based on a methodology that has since been updated, so tritium doses are subject to considerable uncertainty. It is therefore recommended that, if possible, tritium doses are reassessed using information on historical recording practices in combination with current dosimetry methodology, and that further chromosome studies are undertaken using modern FISH techniques to establish stable aberration frequencies, as these will provide information on a cumulative biological effect.

Occupational radiation exposure and its health effects on interventional medical workers: study protocol for a prospective cohort study.

PubMed

Ko, Seulki; Chung, Hwan Hoon; Cho, Sung Bum; Jin, Young Woo; Kim, Kwang Pyo; Ha, Mina; Bang, Ye Jin; Ha, Yae Won; Lee, Won Jin

2017-12-15

Although fluoroscopically guided procedures involve a considerably high dose of radiation, few studies have investigated the effects of radiation on medical workers involved in interventional fluoroscopy procedures. Previous research remains in the early stages and has not reached a level comparable with other occupational studies thus far. Furthermore, the study of radiation workers provides an opportunity to estimate health risks at low doses and dose rates of ionising radiation. Therefore, the objectives of this study are (1) to initiate a prospective cohort study by conducting a baseline survey among medical radiation workers who involve interventional fluoroscopy procedures and (2) to assess the effect of occupational radiation exposure and on the overall health status through an in-depth cross-sectional study. Intervention medical workers in Korea will be enrolled by using a self-administered questionnaire survey, and the survey data will be linked with radiation dosimetry data, National Health Insurance claims data, cancer registry and mortality data. After merging these data, the radiation organ dose, lifetime attributable risk due to cancer and the risk per unit dose will be estimated. For the cross-sectional study, approximately 100 intervention radiology department workers will be investigated for blood tests, clinical examinations such as ultrasonography (thyroid and carotid artery scan) and lens opacity, the validation of badge dose and biodosimetry. This study was reviewed and approved by the institutional review board of Korea University (KU-IRB-12-12-A-1). All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations, and a report will be submitted to the relevant public health authorities in the Korea Centers for Disease Control and Prevention to help with the development of appropriate research and management policies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occupational radiation exposure and its health effects on interventional medical workers: study protocol for a prospective cohort study

PubMed Central

Ko, Seulki; Chung, Hwan Hoon; Cho, Sung Bum; Jin, Young Woo; Kim, Kwang Pyo; Ha, Mina; Bang, Ye Jin; Ha, Yae Won; Lee, Won Jin

2017-01-01

Introduction Although fluoroscopically guided procedures involve a considerably high dose of radiation, few studies have investigated the effects of radiation on medical workers involved in interventional fluoroscopy procedures. Previous research remains in the early stages and has not reached a level comparable with other occupational studies thus far. Furthermore, the study of radiation workers provides an opportunity to estimate health risks at low doses and dose rates of ionising radiation. Therefore, the objectives of this study are (1) to initiate a prospective cohort study by conducting a baseline survey among medical radiation workers who involve interventional fluoroscopy procedures and (2) to assess the effect of occupational radiation exposure and on the overall health status through an in-depth cross-sectional study. Methods and analysis Intervention medical workers in Korea will be enrolled by using a self-administered questionnaire survey, and the survey data will be linked with radiation dosimetry data, National Health Insurance claims data, cancer registry and mortality data. After merging these data, the radiation organ dose, lifetime attributable risk due to cancer and the risk per unit dose will be estimated. For the cross-sectional study, approximately 100 intervention radiology department workers will be investigated for blood tests, clinical examinations such as ultrasonography (thyroid and carotid artery scan) and lens opacity, the validation of badge dose and biodosimetry. Ethics and dissemination This study was reviewed and approved by the institutional review board of Korea University (KU-IRB-12-12-A-1). All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations, and a report will be submitted to the relevant public health authorities in the Korea Centers for Disease Control and Prevention to help with the development of appropriate research and management policies. PMID:29248885

Assessment of eye lens doses for workers during interventional radiology procedures.

PubMed

Urboniene, A; Sadzeviciene, E; Ziliukas, J

2015-07-01

The assessment of eye lens doses for workers during interventional radiology (IR) procedures was performed using a new eye lens dosemeter. In parallel, the results of routine individual monitoring were analysed and compared with the results obtained from measurements with a new eye lens dosemeter. The eye lens doses were assessed using Hp(3) measured at the level of the eyes and were compared with Hp(10) measured with the whole-body dosemeter above the lead collar. The information about use of protective measures, the number of performed interventional procedures per month and their fluoroscopy time was also collected. The assessment of doses to the lens of the eye was done for 50 IR workers at 9 Lithuanian hospitals for the period of 2012-2013. If the use of lead glasses is not taken into account, the estimated maximum annual dose equivalent to the lens of the eye was 82 mSv. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Establishment of the central radiation dose registration system for decontamination work involving radioactive fallout emitted by the Fukushima Daiichi APP accident.

PubMed

Yasui, Shojiro

2016-10-01

With respect to radiation protection for decontamination efforts involving radioactive fallout emitted by the accident at the Fukushima Daiichi Atomic Power Plant, new regulations were established and obligated employers to monitor, record, and store of workers' dose records, and to check their past dose records at the time of employment. However, cumulative doses may not be properly maintained if a worker declares incorrect values for past doses. In response, with facilitation from the Ministry of Health, Labour and Welfare, primary contractors of decontamination works decided to establish a central dose registration system. There are four major issues in the design of the system to be resolved, included the following: primary contractors (a) do not have a legal responsibility to perform dose control for subcontractors, (b) do not have the right to control decontamination sites, (c) often organize joint ventures, and (d) correspond to a wide range of ambient dose rates. To resolve the issues, requirements of the system included the following: (a) centralize the operation of radiation passbooks, which records past doses and the results of medical examinations to each worker; (b) develop a database system that could register all dose data and accept inquiry from primary contractors; (c) establish a permanent data storage system for transferred records; and (d) provide graded type of services that are appropriate to the risk of radiation exposure. The system started its operation in December 2013 and provided dose distributions in April and July 2015. The average yearly dose in 2014 was 0.7 mSv, which increased by 0.2 mSv from 0.5 mSv in 2012 and 2013. However, no cumulative dose from 2012-2014 exceeded 20 mSv, which was far below than the dose limits (100 mSv/5 years and 50 mSv/year). Although current dose distributions of decontamination workers were within appropriate levels, careful monitoring of dose distribution is necessary for preserving the proper implementation of radiation protection prescribed in the regulations.

Lifting the 'violence veil': examining working conditions in long-term care facilities using iterative mixed methods.

PubMed

Daly, Tamara; Banerjee, Albert; Armstrong, Pat; Armstrong, Hugh; Szebehely, Marta

2011-06-01

We conducted a mixed-methods study-- the focus of this article--to understand how workers in long-term care facilities experienced working conditions. We surveyed unionized care workers in Ontario (n = 917); we also surveyed workers in three Canadian provinces (n = 948) and four Scandinavian countries (n = 1,625). In post-survey focus groups, we presented respondents with survey questions and descriptive statistical findings, and asked them: "Does this reflect your experience?" Workers reported time pressures and the frequency of experiences of physical violence and unwanted sexual attention, as we explain. We discuss how iteratively mixing qualitative and quantitative methods to triangulate survey and focus group results led to expected data convergence and to unexpected data divergence that revealed a normalized culture of structural violence in long-term care facilities. We discuss how the finding of structural violence emerged and also the deeper meaning, context, and insights resulting from our combined methods.

Telomere Length in Aged Mayak PA Nuclear Workers Chronically Exposed to Internal Alpha and External Gamma Radiation.

PubMed

Scherthan, Harry; Sotnik, Natalia; Peper, Michel; Schrock, Gerrit; Azizova, Tamara; Abend, Michael

2016-06-01

Telomeres consist of GC-rich DNA repeats and the "shelterin" protein complex that together protect chromosome ends from fusion and degradation. Telomeres shorten with age due to incomplete end replication and upon exposure to environmental and intrinsic stressors. Exposure to ionizing radiation is known to modulate telomere length. However, the response of telomere length in humans chronically exposed to radiation is poorly understood. Here, we studied relative telomere length (RTL) by IQ-FISH to leukocyte nuclei in a group of 100 workers from the plutonium production facility at the Mayak Production Association (PA) who were chronically exposed to alpha-emitting ((239)Pu) radiation and/or gamma (photon) radiation, and 51 local residents serving as controls, with a similar mean age of about 80 years. We applied generalized linear statistical models adjusted for age at biosampling and the second exposure type on a linear scale and observed an age-dependent telomere length reduction. In those individuals with the lowest exposure, a significant reduction of about 20% RTL was observed, both for external gamma radiation (≤1 Gy) and internal alpha radiation (≤0.05-0.1 Gy to the red bone marrow). In highly exposed individuals (>0.1 Gy alpha, 1-1.5 Gy gamma), the RTL was similar to control. Stratification by gender revealed a significant (∼30%) telomere reduction in low-dose-exposed males, which was absent in females. While the gender differences in RTL may reflect different working conditions, lifestyle and/or telomere biology, absence of a dose response in the highly exposed individuals may reflect selection against cells with short telomeres or induction of telomere-protective effects. Our observations suggest that chronic systemic exposure to radiation leads to variable dose-dependent effects on telomere length.

KSC-04pd1697

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers prepare to close the payload bay doors on Atlantis in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1692

NASA Image and Video Library

2004-08-31

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility prepare to stow the landing gear on the orbiter Atlantis in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, and closing their payload bay doors. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1694

NASA Image and Video Library

2004-08-31

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility prepare the wheel bay to stow Atlantis’ landing gear in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, and closing their payload bay doors. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1711

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility finish Hurricane preparations on the payload bay doors of Atlantis. Preparing for the expected impact of Hurricane Frances on Saturday, workers also powered down the Space Shuttle orbiters, and stowed the landing gear. They are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1710

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility cover up areas of Atlantis with plastic, preparing for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, closing the payload bay doors and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1693

NASA Image and Video Library

2004-08-31

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility prepare to stow the landing gear on the orbiter Atlantis in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, and closing their payload bay doors. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1698

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers prepare to close the payload bay doors on Atlantis in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1708

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility cover up areas of Atlantis, preparing for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, closing the payload bay doors and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1701

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, a worker checks out part of Atlantis after payload bay doors were closed in preparation for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1709

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility cover up areas of Atlantis with plastic, preparing for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, closing the payload bay doors and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

Costing analysis and anthropological assessment of the vaccine supply chain system redesign in the Comé District (Benin).

PubMed

Huang, Xiao Xian; Guillermet, Elise; Le Gargasson, Jean-Bernard; Alfa, Daleb Abdoulaye; Gbodja, Romule; Sossou, Adanmavokin Justin; Jaillard, Phillippe

2017-04-19

At the end of 2013, a pilot experiment was carried out in Comé health zone (HZ) in an attempt to optimize the vaccine supply chain. Four commune vaccine storage facilities were replaced by one central HZ facility. This study evaluated the incremental financial needs for the establishment of the new system; compared the economic cost of the supply chain in the Comé HZ before and after the system redesign; and analyzed the changes induced by the pilot project in immunization logistics management. The purposive sampling method was used to draw a sample from 37 health facilities in the zone for costing evaluation. Data on inputs and prices were collected retrospectively for 2013 and 2014. The analysis used an ingredient-based approach. In addition, 44 semi-structured interviews with health workers for anthropological analysis were completed in 2014. The incremental financial costs amounted to US$55,148, including US$50,605 for upfront capital investment and US$4543 for ongoing recurrent costs. Annual economic cost per dose administered (including all vaccines distributed through the Expanded Program on Immunization (EPI)) in the Comé HZ increased from US$0.09 before system redesign to US$0.15 after implementation, mainly due to a high initial investment and the operational cost of HZ mobile warehouse. Interviews with health workers suggested that the redesigned system was associated with improvements in motivation and professional awareness due to training, supportive supervision, and improved work conditions. The system redesign involved a considerable investment at HZ level. Benefits were found in the reduction of transportation costs to health posts (HP) and commune health center (CHC) levels, and the strengthening of health workers professional skills at all levels in Comé. The redesigned system contributed to a decrease in funding needs at HP and CHC levels. The benefits of the investment need to be examined after the introduction of new vaccines and after a longer period. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Factors precipitating outbreaks of measles in district Kangra of North India: A case-control study

PubMed Central

Gupta, Surender Nikhil; Vidya, Ramachandran; Gupta, Naveen; Gupte, Mohan D

2011-01-01

Background: Globally, measles is the fifth killer disease among children under five years of age. Despite high immunization coverage in Himachal, outbreaks are occurring. Upon two outbreaks in a hilly district in North India, a case control study was conducted to identify factors contributing to outbreaks and to recommend remedial measures to prevent further outbreaks. Materials and Methods: Factors were reviewed under three heads: program related, health care providers, and beneficiaries related. Cold chain maintenance was determined and responses were compared between workers from study Shahpur and control Nagrota Bagwan blocks. All 69 mothers of age and sex matched children with measles were enrolled. A pre-designed pre-tested data collection instrument was used. For statistical analysis, the odds ratio (OR) and adjusted odds ratio with 95% confidence interval (C.I.) among women of children exposed and unexposed to selected characteristics were calculated. Results: Poor cold chain maintenance and gaps in knowledge of health workers supplemented with beneficiary-related issues precipitated outbreaks in case area. Univariate analysis yielded strong statistical significance to 17 variables. Important statistically significant variables are educational status; OR 27.63 (C.I. 9.46-85.16); occupation; OR 0.35 (C.I. 0.16-0.75); income; OR 5.49 (C.I. 2.36-13.00); mode of transport to health care facility; OR 8.74 (C.I. 2.90-28.23); spread of illness from one person to another; OR 5.60 (95% C.I. 1.40-25.97); first help for sick child OR 2.12 (C.I. 1.00-4.50), and place of visit after recovery; OR 3.92 (C.I. 1.80-8.63). Multiple logistic regression yielded significant association with educational status, drinking water sources, and time taken to reach the nearest health facility. Conclusion: Measles outbreaks were confirmed in high immunization coverage areas. We recommend 2nd dose opportunity for measles (MR) between 5 and 17 years; refresher trainings to workers; mobile access to health care facility, and Information Education Communication activities for social behavioral change in affected areas. PMID:23776768

Current status of radiological protection at nuclear power stations in Japan.

PubMed

Suzuki, Akira; Hori, Shunsuke

2011-07-01

The radiation dose to workers at nuclear power stations (NPSs) in Japan was drastically reduced between the late-1970s and the early-1990s by continuous dose-reduction programmes. The total collective dose of radiation workers in FY 2008 was 84.04 person Sv, while the average collective dose was 1.5 person Sv per reactor. The average annual individual dose was 1.1 mSv and the maximum annual individual dose was 19.5 mSv. These values are sufficiently lower than the regulatory dose limits. Radioactive effluent released from NPSs is already so trivial that additional protective measures will not be necessary. Experience in radiation protection at NPSs has been accumulated over 40 y and will be very useful in establishing a rational radiation control system in the future.

78 FR 78964 - Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Subcommittee for Dose Reconstruction Reviews (SDRR), Advisory Board on Radiation and Worker Health (ABRWH or the Advisory Board), National Institute for Occupational Safety and Health (NIOSH) In accordance with section 10(a)(2) of the Federal Advisory Committee Ac...

Is task-shifting a solution to the health workers' shortage in Northern Ghana?

PubMed

Okyere, Eunice; Mwanri, Lillian; Ward, Paul

2017-01-01

To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana. Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers' in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting. Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members' are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening. Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised.

Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Chiba, Yumi; Kato, Ayako

2014-06-01

Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Ischaemic heart disease incidence and mortality in an extended cohort of Mayak workers first employed in 1948–1982

PubMed Central

Grigoryeva, Evgeniya S; Haylock, Richard G E; Pikulina, Maria V; Moseeva, Maria B

2015-01-01

Objective: Incidence and mortality from ischaemic heart disease (IHD) was studied in an extended cohort of 22,377 workers first employed at the Mayak Production Association during 1948–82 and followed up to the end of 2008. Methods: Relative risks and excess relative risks per unit dose (ERR/Gy) were calculated based on the maximum likelihood using Epicure software (Hirosoft International Corporation, Seattle, WA). Dose estimates used in analyses were provided by an updated “Mayak Worker Dosimetry System—2008”. Results: A significant increasing linear trend in IHD incidence with total dose from external γ-rays was observed after having adjusted for non-radiation factors and dose from internal radiation {ERR/Gy = 0.10 [95% confidence interval (CI): 0.04 to 0.17]}. The pure quadratic model provided a better fit of the data than did the linear one. No significant association of IHD mortality with total dose from external γ-rays after having adjusted for non-radiation factors and dose from internal alpha radiation was observed in the study cohort [ERR/Gy = 0.06 (95% CI: <0 to 0.15)]. A significant increasing linear trend was observed in IHD mortality with total absorbed dose from internal alpha radiation to the liver after having adjusted for non-radiation factors and dose from external γ-rays in both the whole cohort [ERR/Gy = 0.21 (95% CI: 0.01 to 0.58)] and the subcohort of workers exposed at alpha dose <1.00 Gy [ERR/Gy = 1.08 (95% CI: 0.34 to 2.15)]. No association of IHD incidence with total dose from internal alpha radiation to the liver was found in the whole cohort after having adjusted for non-radiation factors and external gamma dose [ERR/Gy = 0.02 (95% CI: not available to 0.10)]. Statistically significant dose effect was revealed in the subcohort of workers exposed to internal alpha radiation at dose to the liver <1.00 Gy [ERR/Gy = 0.44 (95% CI: 0.09 to 0.85)]. Conclusion: This study provides strong evidence of IHD incidence and mortality association with external γ-ray exposure and some evidence of IHD incidence and mortality association with internal alpha-radiation exposure. Advances in knowledge: It is the first time the validity of internal radiation dose estimates has been shown to affect the risk of IHD incidence. PMID:26224431

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 4. Infective doses and pathogen carriage.

PubMed

Todd, Ewen C D; Greig, Judy D; Bartleson, Charles A; Michaels, Barry S

2008-11-01

In this article, the fourth in a series reviewing the role of food workers in foodborne outbreaks, background information on the presence of enteric pathogens in the community, the numbers of organisms required to initiate an infection, and the length of carriage are presented. Although workers have been implicated in outbreaks, they were not always aware of their infections, either because they were in the prodromic phase before symptoms began or because they were asymptomatic carriers. Pathogens of fecal, nose or throat, and skin origin are most likely to be transmitted by the hands, highlighting the need for effective hand hygiene and other barriers to pathogen contamination, such as no bare hand contact with ready-to-eat food. The pathogens most likely to be transmitted by food workers are norovirus, hepatitis A virus, Salmonella, Shigella, and Staphylococcus aureus. However, other pathogens have been implicated in worker-associated outbreaks or have the potential to be implicated. In this study, the likelihood of pathogen involvement in foodborne outbreaks where infected workers have been implicated was examined, based on infectious dose, carriage rate in the community, duration of illness, and length of pathogen excretion. Infectious dose estimates are based on volunteer studies (mostly early experiments) or data from outbreaks. Although there is considerable uncertainty associated with these data, some pathogens appear to be able to infect at doses as low as 1 to 100 units, including viruses, parasites, and some bacteria. Lengthy postsymptomatic shedding periods and excretion by asymptomatic individuals of many enteric pathogens is an important issue for the hygienic management of food workers.

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...

Estimating the costs of the vaccine supply chain and service delivery for selected districts in Kenya and Tanzania.

PubMed

Mvundura, Mercy; Lorenson, Kristina; Chweya, Amos; Kigadye, Rosemary; Bartholomew, Kathryn; Makame, Mohammed; Lennon, T Patrick; Mwangi, Steven; Kirika, Lydia; Kamau, Peter; Otieno, Abner; Murunga, Peninah; Omurwa, Tom; Dafrossa, Lyimo; Kristensen, Debra

2015-05-28

Having data on the costs of the immunization system can provide decision-makers with information to benchmark the costs when evaluating the impact of new technologies or programmatic innovations. This paper estimated the supply chain and immunization service delivery costs and cost per dose in selected districts in Kenya and Tanzania. We also present operational data describing the supply chain and service delivery points (SDPs). To estimate the supply chain costs, we collected resource-use data for the cold chain, distribution system, and health worker time and per diems paid. We also estimated the service delivery costs, which included the time cost of health workers to provide immunization services, and per diems and transport costs for outreach sessions. Data on the annual quantities of vaccines distributed to each facility, and the occurrence and duration of stockouts were collected from stock registers. These data were collected from the national store, 2 regional and 4 district stores, and 12 SDPs in each country for 2012. Cost per dose for the supply chain and immunization service delivery were estimated. The average annual costs per dose at the SDPs were $0.34 (standard deviation (s.d.) $0.18) for Kenya when including only the vaccine supply chain costs, and $1.33 (s.d. $0.82) when including immunization service delivery costs. In Tanzania, these costs were $0.67 (s.d. $0.35) and $2.82 (s.d. $1.64), respectively. Both countries experienced vaccine stockouts in 2012, bacillus Calmette-Guérin vaccine being more likely to be stocked out in Kenya, and oral poliovirus vaccine in Tanzania. When stockouts happened, they usually lasted for at least one month. Tanzania made investments in 2011 in preparation for planned vaccine introductions, and their supply chain cost per dose is expected to decline with the new vaccine introductions. Immunization service delivery costs are a significant portion of the total costs at the SDPs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania.

PubMed

Roberton, Timothy; Applegate, Jennifer; Lefevre, Amnesty E; Mosha, Idda; Cooper, Chelsea M; Silverman, Marissa; Feldhaus, Isabelle; Chebet, Joy J; Mpembeni, Rose; Semu, Helen; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H; George, Asha S

2015-04-09

Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development. Facility health workers, while important for technical oversight, may not be the best mentors for certain tasks such as community relationship-building. We suggest further exploring CHW supervision innovations, such as an enhanced role for community actors, who may be more suitable to support CHWs engaged primarily in health promotion than scarce and over-worked facility health workers.

Vaccination coverage among social and healthcare workers in ten countries of Samu-social international sites.

PubMed

Marshall, Esaie; Salmon, Dominique; Bousfiha, Nadia; Togola, Yacouba; Ouedraogo, François; Santantonio, Maud; Dieng, Coumba Khadidja; Tartière, Suzanne; Emmanuelli, Xavier

2017-09-18

We aim to determine the vaccination coverage of social and healthcare workers in International sites of Samusocial, providing emergency care to homeless people, and to assess factors associated with having received necessary doses at adulthood. Data on immunization coverage of social and healthcare workers were provided by a cross-sectional survey, conducted from February to April 2015 among 252 Samusocial workers in 10 countries. Vaccination status and characteristics of participants were collected through a self-administered questionnaire. Prevalence rate ratio (PRR) of vaccination status was calculated using Poisson regression models. Among 252 Samusocial social and health workers who felt a questionnaire, median age was 39years, 42.1% were female, 88.9% were in contact with homeless beneficiaries (19.1% health workers). Overall, 90.1% of Samusocial staff felt adult vaccinations was useful and 70.2% wished to receive booster doses in future. Vaccination coverage at adulthood was satisfactory for diphtheria and poliomyelitis (96%), but low for influenza (20.8%), meningococcus (50.5%), hepatitis B (56.3%), yellow fever (58.1%), measles (81.3%) and pertussis (90.7%). The main reasons for not having received vaccination booster doses were forgetting the dates of booster doses (38.4%) and not having received the information (13.5%). In adjusted analysis, prevalence of up-to-date for vaccination schedule was 35% higher among health workers than among social workers (aPRR=1.35, 95%CI: 1.01-1.82, P=0.05) and was 56% higher among workers who had a documentary evidence of vaccination than in those who did not (aPRR=1.56, 95%CI: 1.19-2.02, P=0.001). The Samusocial International workers vaccine coverage at adulthood was insufficient and disparate by region. It is necessary to strengthen the outreach of this staff and increase immunization policy for hepatitis B, diphtheria, tetanus, and measles, as well as for yellow fever, rabies and meningococcal ACYW135 vaccines in at risk regions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study.

PubMed

Aninanya, Gifty Apiung; Howard, Natasha; Williams, John E; Apam, Benjamin; Prytherch, Helen; Loukanova, Svetla; Kamara, Eunice Karanja; Otupiri, Easmon

2016-01-01

Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 ( p =0.40 and p =0.50 respectively), with an overall 0.01 difference in difference ( p =0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. The results contribute evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study.

Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study

PubMed Central

Aninanya, Gifty Apiung; Howard, Natasha; Williams, John E.; Apam, Benjamin; Prytherch, Helen; Loukanova, Svetla; Kamara, Eunice Karanja; Otupiri, Easmon

2016-01-01

Background Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. Objective The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. Design A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. Results PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 (p=0.40 and p=0.50 respectively), with an overall 0.01 difference in difference (p=0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. Conclusions The results contribute evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study. PMID:27741956

Requirements for Emergency Assistance Under the Worker Protection Standard

EPA Pesticide Factsheets

Employers at agricultural establishment must provide emergency assistance to anyone who is or has been employed as a worker or handler if there is reason to believe that the worker or handler has been poisoned or injured by a pesticide at the facility.

Community health workers and home-based care programs for HIV clients.

PubMed Central

Johnson, Becky A.; Khanna, Sunil K.

2004-01-01

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections. PMID:15101670

HIGHLIGHTS OF THE RUSSIAN HEALTH STUDIES PROGRAM AND UPDATED RESEARCH FINDINGS.

PubMed

Fountos, Barrett N

2017-04-01

Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction studies and a worker biorepository. National and international standard-setting organizations use cancer risk estimates computed from epidemiological and historical dose reconstruction studies to validate or revise radiation protection standards. An overview of the most important research results will be presented. Published by Oxford University Press 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Space: The Final Frontier-Research Relevant to Mars.

PubMed

Boice, John D

2017-04-01

A critically important gap in knowledge surrounds the health consequences of exposure to radiation received gradually over time. Much is known about the health effects of brief high-dose exposures, such as from the atomic bombings in Japan, but the concerns today focus on the frequent low-dose exposures received by members of the public, workers, and, as addressed in this paper, astronauts. Additional guidance is needed by the National Aeronautics and Space Administration (NASA) for planning long-term missions where the rate of radiation exposure is gradual over years and the cumulative amounts high. The direct study of low doses and low-dose rates is of immeasurable value in understanding the possible range of health effects from gradual exposures and in providing guidance for radiation protection, not only of workers and the public but also astronauts. The ongoing Million Person Study (MPS) is 10 times larger than the study of the Japanese atomic bomb survivors of 86,000 survivors with estimated doses. The number of workers with >100 mSv career dose is substantially greater. The large study size, broad range of doses, and long follow-up indicate substantial statistical ability to quantify the risk of exposures that are received gradually over time. The study consists of 360,000 U.S. Department of Energy workers from the Manhattan Project; 150,000 nuclear utility workers from the inception of the nuclear age; 115,000 atomic veterans who participated in above-ground atmospheric tests at the Nevada Test Site and the Bikini and Enewetak Atolls and Johnston Island in the Pacific Proving Grounds (PPG); 250,000 radiologists and medical workers; and 130,000 industrial radiographers. NASA uses an individual risk-based system for radiation protection in contrast to the system of dose limits for occupational exposures used by terrestrial-based organizations. The permissible career exposure limit set by NASA for each astronaut is a 3% risk of exposure-induced death (REID) from cancer at a 95% confidence level to account for uncertainties in risk projections. The large size of the MPS will reduce the uncertainty in the risk estimates, narrowing the 95% confidence interval, and thus allow more time in space for astronauts. Further differences between men and women in their response to radiation can be more fully examined, and non-cancer outcomes, such as neurological disorders and cardiovascular disease, can be evaluated in a way not hitherto possible.

Longevity extension of worker honey bees (Apis mellifera) by royal jelly: optimal dose and active ingredient

PubMed Central

Han, Mingfeng

2017-01-01

In the Western honey bee, Apis mellifera, queens and workers have different longevity although they share the same genome. Queens consume royal jelly (RJ) as the main food throughout their life, including as adults, but workers only eat worker jelly when they are larvae less than 3 days old. In order to explore the effect of RJ and the components affecting longevity of worker honey bees, we first determined the optimal dose for prolonging longevity of workers as 4% RJ in 50% sucrose solution, and developed a method of obtaining long lived workers. We then compared the effects of longevity extension by RJ 4% with bee-collected pollen from rapeseed (Brassica napus). Lastly, we determined that a water soluble RJ protein obtained by precipitation with 60% ammonium sulfate (RJP60) contained the main component for longevity extension after comparing the effects of RJ crude protein extract (RJCP), RJP30 (obtained by precipitation with 30% ammonium sulfate), and RJ ethanol extract (RJEE). Understanding what regulates worker longevity has potential to help increase colony productivity and improve crop pollination efficiency. PMID:28367370

Longevity extension of worker honey bees (Apis mellifera) by royal jelly: optimal dose and active ingredient.

PubMed

Yang, Wenchao; Tian, Yuanyuan; Han, Mingfeng; Miao, Xiaoqing

2017-01-01

In the Western honey bee, Apis mellifera , queens and workers have different longevity although they share the same genome. Queens consume royal jelly (RJ) as the main food throughout their life, including as adults, but workers only eat worker jelly when they are larvae less than 3 days old. In order to explore the effect of RJ and the components affecting longevity of worker honey bees, we first determined the optimal dose for prolonging longevity of workers as 4% RJ in 50% sucrose solution, and developed a method of obtaining long lived workers. We then compared the effects of longevity extension by RJ 4% with bee-collected pollen from rapeseed ( Brassica napus ). Lastly, we determined that a water soluble RJ protein obtained by precipitation with 60% ammonium sulfate (RJP 60 ) contained the main component for longevity extension after comparing the effects of RJ crude protein extract (RJCP), RJP 30 (obtained by precipitation with 30% ammonium sulfate), and RJ ethanol extract (RJEE). Understanding what regulates worker longevity has potential to help increase colony productivity and improve crop pollination efficiency.

Development and content validation of a questionnaire to assess moral distress among social workers in long-term care facilities.

PubMed

Lev, Sagit; Ayalon, Liat

2018-03-01

Despite the significance of ethical issues faced by social workers, research on moral distress among social workers has been extremely limited. The aim of the current study is to describe the development and content validation of a unique questionnaire to measure moral distress among social workers in long-term care facilities for older adults in Israel. The construction of the questionnaire was based on a secondary analysis of a qualitative study that addressed the moral dilemma of social workers in nursing homes in Israel. A content validation included review and evaluation by two experts, a cognitive interview with a nursing home social worker, and three focus groups of experts and the target population. The initial questionnaire consisted of 25 items. After the content validation process the questionnaire in its final version, consisted of 17 items and included two scales, measuring the frequency of morally loaded events and the intensity of distress that followed them. We believe that the questionnaire can contribute by broadening and deepening ethics discourse and research, with regard to social workers' obligation dilemmas and conflicts.

"That Is So Common Everyday . . . Everywhere You Go": Sexual Harassment of Workers in Assisted Living.

PubMed

Burgess, Elisabeth O; Barmon, Christina; Moorhead, James R; Perkins, Molly M; Bender, Alexis A

2018-04-01

In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research.

Environmental and biological monitoring for lead exposure in California workplaces.

PubMed Central

Rudolph, L; Sharp, D S; Samuels, S; Perkins, C; Rosenberg, J

1990-01-01

Patterns of environmental and biological monitoring for lead exposure were surveyed in lead-using industries in California. Employer self-reporting indicates a large proportion of potentially lead-exposed workers have never participated in a monitoring program. Only 2.6 percent of facilities have done environmental monitoring for lead, and only 1.4 percent have routine biological monitoring programs. Monitoring practices vary by size of facility, with higher proportions in industries in which larger facilities predominate. Almost 80 percent of battery manufacturing employees work in job classifications which have been monitored, versus only 1 percent of radiator-repair workers. These findings suggest that laboratory-based surveillance for occupational lead poisoning may seriously underestimate the true number of lead poisoned workers and raise serious questions regarding compliance with key elements of the OSHA Lead Standard. PMID:2368850

Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study

PubMed Central

2011-01-01

Background Health worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania. Methods Thirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis. Results The negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system. Conclusion HIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers. PMID:21992700

A paired comparison of tuberculin skin test results in health care workers using 5 TU and 10 TU tuberculin

PubMed Central

Stuart, R.; Bennett, N.; Forbes, A.; Grayson, M

2000-01-01

BACKGROUND—Historically, 10 TU has been employed in Australia and the United Kingdom to perform the tuberculin skin test (TST). However, this makes it difficult to compare the rates of TST positivity with other countries such as the USA who use 5 TU. To assess the impact of the dose of tuberculin on the TST a comparison was made of TST responses in health care workers given a TST with both 5 and 10 TU.
METHODS—Two TSTs were performed simultaneously in each health care worker using 5 and 10 TU. Each dose was randomly assigned in a blinded manner to the right or left forearm and read at 48-72 hours by a single nurse who was blinded to the assignment of the 5 and 10 TU doses.
RESULTS—A total of 128 health care workers were enrolled, 119 (93%) of whom had a past history of BCG vaccination. The overall mean difference in paired reaction sizes for the two doses was 1.5 mm with 95% limits of agreement of -3.6 to 6.5 mm.
CONCLUSION—A slightly larger TST reading was seen with 10 TU than with 5 TU. The mean difference of 1.5 mm between the two doses should be considered when comparing rates of TST positivity between countries who use different doses of tuberculin to perform the tuberculin skin test.

 PMID:10899248

A recommended epidemiological study design for examining the adverse health effects among emergency workers who experienced the TEPCO fukushima daiichi NPP accident in 2011.

PubMed

Yasui, Shojiro

2016-01-01

Results from medical examinations conducted in 2012 of workers who were engaged in radiation work in 2012 as a result of the 2011 Fukushima Daiichi Nuclear Power Plant (NPP) accident showed that the prevalence of abnormal findings was 4.21%, 3.23 points higher than the 0.98% that was found prior to the accident in the jurisdiction area of the labor inspection office which holds jurisdiction over the NPP. The Ministry of Health, Labour and Welfare (MHLW) concluded that the 2010 and 2012 data cannot be easily compared because 70% of the enterprises within the jurisdiction of the office that reported the 2012 results were different from those that did so in 2010. In addition, although the radiation workers' estimated average dose weighted by number of workers was 3.66 times higher than decontamination workers' dose, the prevalence among radiation workers was only 1.14 times higher than that among decontamination workers. Based on the results of the medical examinations, however, the MHLW decided to implement an epidemiological study on the health effects of radiation exposure on all emergency workers. This article explains key issues of the basic design of the study recommended by the expert meeting established in the MHLW and also identifies challenges that could not be resolved and thus required further consideration by the study researchers. The major issues included: (a) study methods and target group; (b) evaluation of cumulative doses; (c) health effects (end points); (d) control of confounding factors; and (e) study implementation framework. Identified key challenges that required further deliberation were: (a) preventing arbitrary partisan analysis; (b) ensuring a high participation rate; (c) inquiry about the medical radiation doses; and (d) the preparedness of new analytical technology. The study team formulated and implemented the pilot study in 2014 and started the full-scale study in April 2015 with funding from a research grant from the MHLW.

A Descriptive Analysis of Interactions between Co-Workers and Supported Employees.

ERIC Educational Resources Information Center

Rusch, Frank R.; And Others

This study describes varying types of nonhandicapped co-worker interactions with supported employees. The sample included 341 supported employees with mental retardation served by community rehabilitation facilities in Illinois. Results indicated that co-workers interact extensively with persons who are mentally retarded. These interactions…

Impact of infection prevention and control training on health facilities during the Ebola virus disease outbreak in Guinea.

PubMed

Keïta, Mory; Camara, Ansoumane Yassima; Traoré, Falaye; Camara, Mohamed ElMady; Kpanamou, André; Camara, Sékou; Tolno, Aminata; Houndjo, Bienvenu; Diallo, Fatimatou; Conté, Fatoumata; Subissi, Lorenzo

2018-04-24

In 2014-2016, West Africa faced the most deadly Ebola Virus Disease (EVD) outbreak in history. A key strategy to overcome this outbreak was continual staff training in Infection Prevention and Control (IPC), with a focus on Ebola. This research aimed to evaluate the impact of IPC training and the quality of IPC performance in health care facilities of one municipality of Conakry, Guinea. This study was conducted in February 2016. All health facilities within Ratoma municipality, Conakry, Guinea, were evaluated based on IPC performance standards developed by the Guinean Ministry of Health. The IPC performance of healthcare facilities was categorised into high or low IPC scores based on the median IPC score of the sample. The Mantel-Haenzsel method and logistic regression were used for statistical analysis. Twenty-five percent of health centres had one IPC-trained worker, 53% had at least two IPC-trained workers, and 22% of health centres had no IPC-trained workers. An IPC score above median was positively associated with the number of trained staff; health centres with two or more IPC-trained workers were eight times as likely to have an IPC score above median, while those with one IPC-trained worker were four times as likely, compared to centres with no trained workers. Health centres that implemented IPC cascade training to untrained medical staff were five times as likely to have an IPC score above median. This research highlights the importance of training healthcare staff in IPC and organising regular cascade trainings. IPC strategies implemented during the outbreak should continue to be reinforced for the better health of patients and medical staff, and be considered a key factor in any outbreak response.

The Mayak Worker Dosimetry System (MWDS-2013): Implementation of the Dose Calculations.

PubMed

Zhdanov, А; Vostrotin, V; Efimov, А; Birchall, A; Puncher, M

2016-07-15

The calculation of internal doses for the Mayak Worker Dosimetry System (MWDS-2013) involved extensive computational resources due to the complexity and sheer number of calculations required. The required output consisted of a set of 1000 hyper-realizations: each hyper-realization consists of a set (1 for each worker) of probability distributions of organ doses. This report describes the hardware components and computational approaches required to make the calculation tractable. Together with the software, this system is referred to here as the 'PANDORA system'. It is based on a commercial SQL server database in a series of six work stations. A complete run of the entire Mayak worker cohort entailed a huge amount of calculations in PANDORA and due to the relatively slow speed of writing the data into the SQL server, each run took about 47 days. Quality control was monitored by comparing doses calculated in PANDORA with those in a specially modified version of the commercial software 'IMBA Professional Plus'. Suggestions are also made for increasing calculation and storage efficiency for future dosimetry calculations using PANDORA. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

In utero exposure to radiation and haematological malignancies: pooled analysis of Southern Urals cohorts

PubMed Central

Schüz, Joachim; Deltour, Isabelle; Krestinina, Lyudmila Y; Tsareva, Yulia V; Tolstykh, Evgenia I; Sokolnikov, Mikhail E; Akleyev, Alexander V

2017-01-01

Background: It is scientifically uncertain whether in utero exposure to low-dose ionising radiation increases the lifetime risk of haematological malignancies. Methods: We pooled two cohorts from the Southern Urals comprising offspring of female workers of a large nuclear facility (the Mayak Production Association) and of women living in areas along the Techa River contaminated by nuclear accidents/waste from the same facility, with detailed dosimetry. Results: The combined cohort totalled 19 536 subjects with 700 504 person-years at risk over the period of incidence follow-up, and slightly more over the period of mortality follow-up, yielding 58 incident cases and 36 deaths up to age 61 years. Risk was increased in subjects who received in utero doses of ⩾80 mGy (excess relative risk (ERR): 1.27; 95% confidence interval (CI): −0.20 to 4.71), and the risk increased consistently per 100 mGy of continuous exposure in utero (ERR: 0.77; CI: 0.02 to 2.56). No association was apparent in mortality-based analyses. Results for leukaemia and lymphoma were similar. A very weak positive association was observed between incidence and postnatal exposure. Conclusions: In summary, the results suggest a positive association between in utero exposure to ionising radiation and risk of haematological malignancies, but the small number of outcomes and inconsistent incidence and mortality findings preclude firm conclusions. PMID:27855443

Peak Dose Assessment for Proposed DOE-PPPO Authorized Limits

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

Maldonado, Delis

2012-06-01

The Oak Ridge Institute for Science and Education (ORISE), a U.S. Department of Energy (DOE) prime contractor, was contracted by the DOE Portsmouth/Paducah Project Office (DOE-PPPO) to conduct a peak dose assessment in support of the Authorized Limits Request for Solid Waste Disposal at Landfill C-746-U at the Paducah Gaseous Diffusion Plant (DOE-PPPO 2011a). The peak doses were calculated based on the DOE-PPPO Proposed Single Radionuclides Soil Guidelines and the DOE-PPPO Proposed Authorized Limits (AL) Volumetric Concentrations available in DOE-PPPO 2011a. This work is provided as an appendix to the Dose Modeling Evaluations and Technical Support Document for the Authorizedmore » Limits Request for the C-746-U Landfill at the Paducah Gaseous Diffusion Plant, Paducah, Kentucky (ORISE 2012). The receptors evaluated in ORISE 2012 were selected by the DOE-PPPO for the additional peak dose evaluations. These receptors included a Landfill Worker, Trespasser, Resident Farmer (onsite), Resident Gardener, Recreational User, Outdoor Worker and an Offsite Resident Farmer. The RESRAD (Version 6.5) and RESRAD-OFFSITE (Version 2.5) computer codes were used for the peak dose assessments. Deterministic peak dose assessments were performed for all the receptors and a probabilistic dose assessment was performed only for the Offsite Resident Farmer at the request of the DOE-PPPO. In a deterministic analysis, a single input value results in a single output value. In other words, a deterministic analysis uses single parameter values for every variable in the code. By contrast, a probabilistic approach assigns parameter ranges to certain variables, and the code randomly selects the values for each variable from the parameter range each time it calculates the dose (NRC 2006). The receptor scenarios, computer codes and parameter input files were previously used in ORISE 2012. A few modifications were made to the parameter input files as appropriate for this effort. Some of these changes included increasing the time horizon beyond 1,050 years (yr), and using the radionuclide concentrations provided by the DOE-PPPO as inputs into the codes. The deterministic peak doses were evaluated within time horizons of 70 yr (for the Landfill Worker and Trespasser), 1,050 yr, 10,000 yr and 100,000 yr (for the Resident Farmer [onsite], Resident Gardener, Recreational User, Outdoor Worker and Offsite Resident Farmer) at the request of the DOE-PPPO. The time horizons of 10,000 yr and 100,000 yr were used at the request of the DOE-PPPO for informational purposes only. The probabilistic peak of the mean dose assessment was performed for the Offsite Resident Farmer using Technetium-99 (Tc-99) and a time horizon of 1,050 yr. The results of the deterministic analyses indicate that among all receptors and time horizons evaluated, the highest projected dose, 2,700 mrem/yr, occurred for the Resident Farmer (onsite) at 12,773 yr. The exposure pathways contributing to the peak dose are ingestion of plants, external gamma, and ingestion of milk, meat and soil. However, this receptor is considered an implausible receptor. The only receptors considered plausible are the Landfill Worker, Recreational User, Outdoor Worker and the Offsite Resident Farmer. The maximum projected dose among the plausible receptors is 220 mrem/yr for the Outdoor Worker and it occurs at 19,045 yr. The exposure pathways contributing to the dose for this receptor are external gamma and soil ingestion. The results of the probabilistic peak of the mean dose analysis for the Offsite Resident Farmer indicate that the average (arithmetic mean) of the peak of the mean doses for this receptor is 0.98 mrem/yr and it occurs at 1,050 yr. This dose corresponds to Tc-99 within the time horizon of 1,050 yr.« less

KSC-04pd1707

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility unwrap plastic for use in covering equipment as part of preparations for the expected impact of Hurricane Frances on Saturday. Other preparations at KSC include powering down the Space Shuttle orbiters, closing the payload bay doors and stowing the landing gear. Workers are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

Field evaluations of the VD max approach for substantiation of a 25 kGy sterilization dose and its application to other preselected doses

NASA Astrophysics Data System (ADS)

Kowalski, John B.; Herring, Craig; Baryschpolec, Lisa; Reger, John; Patel, Jay; Feeney, Mary; Tallentire, Alan

2002-08-01

The International and European standards for radiation sterilization require evidence of the effectiveness of a minimum sterilization dose of 25 kGy but do not provide detailed guidance on how this evidence can be generated. An approach, designated VD max, has recently been described and computer evaluated to provide safe and unambiguous substantiation of a 25 kGy sterilization dose. The approach has been further developed into a practical method, which has been subjected to field evaluations at three manufacturing facilities which produce different types of medical devices. The three facilities each used a different overall evaluation strategy: Facility A used VD max for quarterly dose audits; Facility B compared VD max and Method 1 in side-by-side parallel experiments; and Facility C, a new facility at start-up, used VD max for initial substantiation of 25 kGy and subsequent quarterly dose audits. A common element at all three facilities was the use of 10 product units for irradiation in the verification dose experiment. The field evaluations of the VD max method were successful at all three facilities; they included many different types of medical devices/product families with a wide range of average bioburden and sample item portion values used in the verification dose experiments. Overall, around 500 verification dose experiments were performed and no failures were observed. In the side-by-side parallel experiments, the outcomes of the VD max experiments were consistent with the outcomes observed with Method 1. The VD max approach has been extended to sterilization doses >25 and <25 kGy; verification doses have been derived for sterilization doses of 15, 20, 30, and 35 kGy. Widespread application of the VD max method for doses other than 25 kGy must await controlled field evaluations and the development of appropriate specifications/standards.

UNAVCO facility support of NASA Dynamics of the Solid Earth (DOSE) GPS investigation for years 1995-1996

NASA Technical Reports Server (NTRS)

Ware, Randolph (Principal Investigator)

1996-01-01

This report consists of the following sections: a list of the NASA DOSE (Dynamics of the Solid Earth) Program Global Positioning System (GPS)-based campaigns supported by the UNAVCO (University Navstar Consortium) Boulder Facility; a list of NASA DOSE GPS permanent site installations supported by the UNAVCO Boulder Facility; and example science snapshots indicating the research projects supported with equipment and technical support available to DOSE Principal Investigators via the UNAVCO Boulder Facility.

A Characteristic Dose Model for Historical Internal Dose Reconstruction in the Framework of the IAEC Compensation Programme.

PubMed

Kravchik, T; Abraham, A; Israeli, M; Yahel, E

2017-04-25

A model was developed at the Nuclear Research Centre Negev (NRCN) to assess historical doses from internal exposures by a relatively fast and simple procedure. These assessments are needed in the framework of a compensation programme for the Israeli Atomic Energy Commission (IAEC) workers, which were diagnosed for cancer diseases. This compensation programme was recently recommended by a public committee to avoid lengthy court procedures. The developed model is based on the recorded doses from external exposures of all the workers at the NRCN, who were divided into groups representing their different working environments. Each group of workers was characterised by three parameters: working period, working areas and occupation. The model uses several conservative assumptions in order to calculate the doses to various body organs in certain years, which are relevant to the calculation of the probability of causation (POC). The POC value serves as a main parameter in the compensation programme. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Radiation exposure assessment for portsmouth naval shipyard health studies.

PubMed

Daniels, R D; Taulbee, T D; Chen, P

2004-01-01

Occupational radiation exposures of 13,475 civilian nuclear shipyard workers were investigated as part of a retrospective mortality study. Estimates of annual, cumulative and collective doses were tabulated for future dose-response analysis. Record sets were assembled and amended through range checks, examination of distributions and inspection. Methods were developed to adjust for administrative overestimates and dose from previous employment. Uncertainties from doses below the recording threshold were estimated. Low-dose protracted radiation exposures from submarine overhaul and repair predominated. Cumulative doses are best approximated by a hybrid log-normal distribution with arithmetic mean and median values of 20.59 and 3.24 mSv, respectively. The distribution is highly skewed with more than half the workers having cumulative doses <10 mSv and >95% having doses <100 mSv. The maximum cumulative dose is estimated at 649.39 mSv from 15 person-years of exposure. The collective dose was 277.42 person-Sv with 96.8% attributed to employment at Portsmouth Naval Shipyard.

Health workers' experiences of coping with the Ebola epidemic in Sierra Leone's health system: a qualitative study.

PubMed

Raven, Joanna; Wurie, Haja; Witter, Sophie

2018-04-05

The 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. Health workers play an important role during epidemics but there is limited research on how they cope during health epidemics in fragile states. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts - Bonthe, Kenema, Koinadugu and Western Area - of Sierra Leone. We used a qualitative study design: key informant interviews (n = 19) with members of the District Health Management Teams and local councils, health facility managers and international partners; and in depth interviews with health workers (n = 25) working in public health facilities and international health workers involved with the treatment of Ebola patients. There were several important coping strategies including those that drew upon existing mechanisms: being sustained by religion, a sense of serving their country and community, and peer and family support. Externally derived strategies included: training which built health worker confidence in providing care; provision of equipment to do their job safely; a social media platform which helped health workers deal with challenges; workshops that provided ways to deal with the stigma associated with being a health worker; and the risk allowance, which motivated staff to work in facilities and provided an additional income source. Supportive supervision, peer support networks and better use of communication technology should be pursued, alongside a programme for rebuilding trusting relations with community structures. The challenge is building these mechanisms into routine systems, pre-empting shocks, rather than waiting to respond belatedly to crises.

Perceptions of good and bad death among Korean social workers in elderly long-term care facilities.

PubMed

Kim, Eunkyung

2018-06-20

This qualitative study explored the perception of good and bad death among 15 social workers serving in elderly care facilities in Korea. A good death involved dying peacefully without much suffering, dying with family members present, death following a good life, and believing in a better afterlife. A bad death involved burdening children in the dying process, dying after extensive illness, dying isolated from family, and death from suicide. To ensure a good death and avoid a bad death for elders, social workers are encouraged to closely engage with not only elders but also their families.

Radiological Worker II Training, Course 20301 (Live), Course 12909 (Test)

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

Harris, Jimmy D.

Radiological worker training is the basic building block for any additional radiological training you may receive. Upon completing radiological worker training, you will have the basic knowledge needed to work safely, using proper radiological practices, in areas where radiological hazards exist. You will also have a better understanding of the hazards and responsibilities associated with radiological work to help prevent the carelessness that can occur when working continually with or around radioactive material. This course does not qualify you for any specific radiological work. You may be required to take additional training at individual facilities to address facility- and job-specificmore » hazards and procedures.« less

Shared Dosimetry Error in Epidemiological Dose-Response Analyses

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

Stram, Daniel O.; Preston, Dale L.; Sokolnikov, Mikhail

2015-03-23

Radiation dose reconstruction systems for large-scale epidemiological studies are sophisticated both in providing estimates of dose and in representing dosimetry uncertainty. For example, a computer program was used by the Hanford Thyroid Disease Study to provide 100 realizations of possible dose to study participants. The variation in realizations reflected the range of possible dose for each cohort member consistent with the data on dose determinates in the cohort. Another example is the Mayak Worker Dosimetry System 2013 which estimates both external and internal exposures and provides multiple realizations of "possible" dose history to workers given dose determinants. This paper takesmore » up the problem of dealing with complex dosimetry systems that provide multiple realizations of dose in an epidemiologic analysis. In this paper we derive expected scores and the information matrix for a model used widely in radiation epidemiology, namely the linear excess relative risk (ERR) model that allows for a linear dose response (risk in relation to radiation) and distinguishes between modifiers of background rates and of the excess risk due to exposure. We show that treating the mean dose for each individual (calculated by averaging over the realizations) as if it was true dose (ignoring both shared and unshared dosimetry errors) gives asymptotically unbiased estimates (i.e. the score has expectation zero) and valid tests of the null hypothesis that the ERR slope β is zero. Although the score is unbiased the information matrix (and hence the standard errors of the estimate of β) is biased for β≠0 when ignoring errors in dose estimates, and we show how to adjust the information matrix to remove this bias, using the multiple realizations of dose. Use of these methods for several studies, including the Mayak Worker Cohort and the U.S. Atomic Veterans Study, is discussed.« less

Effects of Epoetin Alfa Titration Practices, Implemented After Changes to Product Labeling, on Hemoglobin Levels, Transfusion Use, and Hospitalization Rates.

PubMed

Molony, Julia T; Monda, Keri L; Li, Suying; Beaubrun, Anne C; Gilbertson, David T; Bradbury, Brian D; Collins, Allan J

2016-08-01

Little is known about epoetin alfa (EPO) dosing at dialysis centers after implementation of the US Medicare prospective payment system and revision of the EPO label in 2011. Retrospective cohort study. Approximately 412,000 adult hemodialysis patients with Medicare Parts A and B as primary payer in 2009 to 2012 to describe EPO dosing and hemoglobin patterns; of these, about 70,000 patients clustered in about 1,300 dialysis facilities to evaluate facility-level EPO titration practices and patient-level outcomes in 2012. Facility EPO titration practices when hemoglobin levels were <10 and >11g/dL (grouped treatment variable) determined from monthly EPO dosing and hemoglobin level patterns. Patient mean hemoglobin levels, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates using a facility-based analysis. Monthly EPO dose and hemoglobin level, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates. Monthly EPO doses declined across all hemoglobin levels, with the greatest decline in patients with hemoglobin levels < 10g/dL (July-October 2011). In 2012, nine distinct facility titration practices were identified. Across groups, mean hemoglobin levels differed slightly (10.5-10.8g/dL) but within-patient hemoglobin standard deviations were similar (∼0.68g/dL). Patients at facilities implementing greater dose reductions and smaller dose escalations had lower hemoglobin levels and higher transfusion rates. In contrast, patients at facilities that implemented greater dose escalations (and large or small dose reductions) had higher hemoglobin levels and lower transfusion rates. There were no clinically meaningful differences in all-cause or cause-specific hospitalization events across groups. Possibly incomplete claims data; excluded small facilities and those without consistent titration patterns; hemoglobin levels reported monthly; inferred facility practice from observed dosing. Following prospective payment system implementation and labeling revisions, EPO doses declined significantly. Under the new label, facility EPO titration practices were associated with mean hemoglobin levels (but not standard deviations) and transfusion use, but not hospitalization rates. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Updated Mortality Analysis of Radiation Workers at Rocketdyne (Atomics International), 1948-2008

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

Boice Jr JD, Colen SS, Mumma MT, Ellis ED, Eckerman DF, Leggett RW, Boecker BB, Brill B, Henderson BE

Updated analyses of mortality data are presented on 46,970 workers employed 1948-1999 at Rocketdyne (Atomics International). Overall, 5,801 workers were involved in radiation activities, including 2,232 who were monitored for intakes of radionuclides, and 41,169 workers were engaged in rocket testing or other non-radiation activities. The worker population is unique in that lifetime occupational doses from all places of employment were sought, updated and incorporated into the analyses. Further, radiation doses from intakes of 14 different radionuclides were calculated for 16 organs or tissues using biokinetic models of the International Commission on Radiation Protection (ICRP). Because only negligible exposures weremore » received by the 247 workers monitored for radiation activities after 1999, the mean dose from external radiation remained essentially the same at 13.5 mSv (maximum 1 Sv) as reported previously, as did the mean lung dose from external and internal radiation combined at 19.0 mSv (maximum 3.6 Sv). An additional 9 years of follow-up, from December 31,1999 through 2008, increased the person-years of observation for the radiation workers by 21.7% to 196,674 (mean 33.9 years) and the number of cancer deaths by 50% to 684. Analyses included external comparisons with the general population and the computation of standardized mortality ratios (SMRs) and internal comparisons using proportional hazards models and the computation of relative risks (RRs). A low SMR for all causes of death (SMR 0.82; 95% CI 0.78-0.85) continued to indicate that the Rocketdyne radiation workers were healthier than the general population and were less likely to die. The SMRs for all cancers taken together (SMR 0.88; 95% CI 0.81-0.95), lung cancer (SMR 0.87; 95% CI 0.76-1.00) and leukemia other than chronic lymphocytic leukemia (CLL) (SMR 1.04; 95% 0.67-1.53) were not significantly elevated. Cox regression analyses revealed no significant dose-response trends for any cancer. For all cancers excluding leukemia, the RR at 100 mSv was estimated as 0.98 (95% CI 0.82-1.17), and for all leukemia other than CLL it was 1.06 (95% CI 0.50-2.23). Uranium was the primary radionuclide contributing to internal exposures, but no significant increases in lung and kidney disease were seen. The extended follow-up reinforces the findings in the previous study in failing to observe a detectable increase in cancer deaths associated with radiation, but strong conclusions still cannot be drawn because of small numbers and relatively low career doses. Larger combined studies of early workers in the United States using similar methodologies are warranted to refine and clarify radiation risks after protracted exposures.« less

Doses of Ukrainian female clean-up workers with diagnosed breast cancer.

PubMed

Chumak, Vadim V; Klymenko, Sergiy V; Zitzelsberger, Horst; Wilke, Christina; Rybchenko, Lyudmila A; Bakhanova, Elena V

2018-05-01

The Chernobyl reactor accident in 1986 has caused significant exposure to ionizing radiation of the Ukrainian population, in particular clean-up workers and evacuees from the exclusion zones. A study aiming at the discovery of radiation markers of the breast cancer was conducted from 2008 to 2015 within a collaborative project by HZM, LMU, and NRCRM. In this study, post-Chernobyl breast cancer cases both in radiation-exposed female patients diagnosed at age less than 60 from 1992 to 2014 and in non-exposed controls matched for residency, tumor type, age at diagnosis, TNM classification as well as tumor grading were investigated for molecular changes with special emphasis to copy number alterations and miRNA profiles. Cancer registry and clinical archive data were used to identify 435 breast cancer patients among female clean-up workers and 14 among evacuees from highly contaminated territories as candidates for the study. Of these, 129 breast cancer patients fit study inclusion criteria and were traced for individual reconstruction of the target organ (breast) doses. The doses were estimated for 71 exposed cases (clean-up workers and evacuees from which biomaterial was available for molecular studies and who agreed to participate in a dosimetric interview) by the use of the well-established RADRUE method, which was adjusted specifically for the assessment of breast doses. The results of 58 female clean-up workers showed a large inter-individual variability of doses in a range of about five orders of magnitude: from 0.03 to 929 mGy, with median of 5.8 mGy. The study provides the first quantitative estimate of exposures received by female clean-up workers, which represent a limited but very important group of population affected by the Chernobyl accident. The doses of 13 women evacuated after the accident who did not take part in the clean-up activities (from 4 to 45 mGy with median of 19 mGy) are in line with the previous estimates for the evacuees from Pripyat and the 30-km zone.

The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities.

PubMed

Kimura, Akiko C; Nguyen, Christine N; Higa, Jeffrey I; Hurwitz, Eric L; Vugia, Duc J

2007-04-01

We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.

Weekly dose of Iron-Folate Supplementation with Vitamin-C in the workplace can prevent anaemia in women employees

PubMed Central

Joseph, Bobby; Ramesh, Naveen

2013-01-01

Objective: To assess if a weekly dose of iron and folic acid along with vitamin C, in the workplace would reduce the prevalence of anaemia. Methodology: A multi-pronged intervention was carried out to reduce the prevalence of anaemia among workers of 7 apparel manufacturing factories using a regime consisting of a supervised single dose of albendazole (400mg) followed by a weekly dose of dried ferrous sulphate (150mg), folic acid (0.5mg) and vitamin C (100mg). Workers were provided information on the causes of anaemia and its prevention. The total duration of the intervention was 16 weeks. Haemoglobin levels of a randomly selected sample of workers were tested before and after the intervention using a computerized non-cyan-meth-haemoglobin method. Results: Of the 10810 workers who were enrolled a sample of 515 workers was randomly selected for the blood investigations. At the end of the intervention (18 weeks after the first blood sample was collected) only 361 out of the 515 who had been enrolled a little more than 16 weeks earlier still remained in the factories and among women 279 out of 385 enrolled were still working in the factories. In the 385 unmatched samples the number of anaemic women had reduced from 141 before the intervention to 79 after - mean haemoglobin increasing from 12.2 to 13.0 (p < 0.001) and in the 279 paired samples prevalence of anaemia had reduced from 105 to 58 - mean haemoglobin increasing from 12.1 to 13.0 (p < 0.001). Conclusions: Our results demonstrated that in resource poor regions, where prevalence of anaemia is high, the workplace may be considered an ideal location to give a weekly supervised dose of iron, folic acid and vitamin C to effectively tackle the problem and probably improve worker efficiency. PMID:24353506

Health Status and Working Condition of Migrant Workers: Major Public Health Problems

PubMed Central

Bener, Abdulbari

2017-01-01

Background: Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. Methods: This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. Results: There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type (P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours (P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms (P < 0.01). Multiple logistic regression was used for predictors’ health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. Conclusions: The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services. PMID:28966757

Health Status and Working Condition of Migrant Workers: Major Public Health Problems.

PubMed

Bener, Abdulbari

2017-01-01

Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type ( P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours ( P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms ( P < 0.01). Multiple logistic regression was used for predictors' health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services.

Decontamination work in the area surrounding Fukushima Dai-ichi Nuclear Power Plant: another occupational health challenge of the nuclear disaster.

PubMed

Wada, Koji; Yoshikawa, Toru; Murata, Masaru

2012-01-01

This article describes occupational health measures for workers involved in decontamination of radioactive material discharged around Fukushima Dai-ichi Nuclear Power Plant after the explosions in 2011. Decontamination is performed by removing radioactive particles (mainly cesium) from surfaces of soil, grass and trees, and buildings. Measurement of radiation doses is necessary to reduce exposure, and to determine whether workers can work below dose limits. Protective equipment for decontamination is determined based on the concentration of radiation in contaminated soil and the exposure to dust. Health examinations by physicians are mandated for decontamination workers upon hiring and every 6 months. While there is no possibility of acute radiation injury from decontamination, workers may be anxious about the unclear effects of chronic low level radiation exposure on health. Measures to protect the decontamination workers are the top priority.

KSC-2012-6409

NASA Image and Video Library

2012-10-29

CAPE CANAVERAL, Fla. – At NASA’s Kennedy Space Center in Florida, workers continue construction of the Antenna Test Bed Array for the Ka-Band Objects Observation and Monitoring, or Ka-BOOM, system. The construction site is near the former Vertical Processing Facility, which has been demolished. Workers are placing the pile foundations for the 40-foot-diameter dish antenna arrays and their associated utilities, and preparing the site for the operations command center facility. Photo credit: NASA/Ben Smegelski

KSC-2012-6406

NASA Image and Video Library

2012-10-29

CAPE CANAVERAL, Fla. – At NASA’s Kennedy Space Center in Florida, workers continue construction of the Antenna Test Bed Array for the Ka-Band Objects Observation and Monitoring, or Ka-BOOM, system. The construction site is near the former Vertical Processing Facility, which has been demolished. Workers are placing the pile foundations for the 40-foot-diameter dish antenna arrays and their associated utilities, and preparing the site for the operations command center facility. Photo credit: NASA/Ben Smegelski

Take immediate action to protect communities and workers.

PubMed

Wilding, Roberta Chase; Lewis, Sharon E

2007-01-01

In many areas throughout America, thousands of industrial and military facilities and agricultural operations put large numbers of people at risk of serious injury or death due to accidental chemical releases, explosions, fires, and grossly inadequate occupational exposure standards. While some companies are moving toward "greener" production, many others do the minimum required by government agencies. As evidenced by the thousands of permit violations and accidental releases of hazardous chemicals, this means that facilities across the country consistently fail to meet regulations, incorporating the cost of fines and penalties into the cost of doing business and passing that cost on to consumers. Workers at such facilities and residents of the surrounding communities cannot wait for the eventual implementation and enforcement of federal environmental laws or adequate testing of the effect chemicals may have on the human population. Immediate action is needed to protect communities and workers at risk from chemical exposures that can compromise their health.

Industrial-hygiene report, walk-through survey, papaya packing/shipping facilities, Hilo, Hawaii, July 1983. [Ethylene dibromide exposure

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

Clapp, D.

1983-07-01

Worker exposure to ethylene dibromide (EDB) was investigated at three papaya packing and shipping facilities in Hilo, Hawaii. Breathing-zone samples were collected in the three facilities over a three day period. Blind spikes were submitted as a control on time and temperature effects. Blank samples were also prepared. Spike results reflected the effects of time and temperature in shipment from Hawaii to Massachusetts. All spikes were roughly comparable and showed a recovery of about 68%. Overnight laboratory results were adjusted upward by 72% and NIOSH laboratory results by 68%. Six out of 38 samples exceeded the NIOSH recommended amount ofmore » 130 ppb. The author concludes that there is a chronic, low-concentration exposure to EDB for all workers in the papaya industry in Hilo. An epidemiological study of reproductive and cytogenetic effects of EDB exposure on these workers is recommended.« less

Improving occupational health care for construction workers: a process evaluation

PubMed Central

2013-01-01

Background To evaluate the process of a job-specific workers’ health surveillance (WHS) in improving occupational health care for construction workers. Methods From January to July 2012 were 899 bricklayers and supervisors invited for the job-specific WHS at three locations of one occupational health service throughout the Netherlands. The intervention aimed at detecting signs of work-related health problems, reduced work capacity and/or reduced work functioning. Measurements were obtained using a recruitment record and questionnaires at baseline and follow-up. The process evaluation included the following: reach (attendance rate), intervention dose delivered (provision of written recommendations and follow-up appointments), intervention dose received (intention to follow-up on advice directly after WHS and remembrance of advice three months later), and fidelity (protocol adherence). The workers scored their increase in knowledge from 0–10 with regard to health status and work ability, their satisfaction with the intervention and the perceived (future) effect of such an intervention. Program implementation was defined as the mean score of reach, fidelity, and intervention dose delivered and received. Results Reach was 9% (77 workers participated), fidelity was 67%, the intervention dose delivered was 92 and 63%, and the intervention dose received was 68 and 49%. The total programme implementation was 58%. The increases in knowledge regarding the health status and work ability of the workers after the WHS were graded as 7.0 and 5.9, respectively. The satisfaction of the workers with the entire intervention was graded as 7.5. The perceived (future) effects on health status were graded as 6.3, and the effects on work ability were graded with a 5.2. The economic recession affected the workers as well as the occupational health service that enacted the implementation. Conclusions Programme implementation was acceptable. Low reach, limited protocol adherence and modest engagement of the workers with respect to the intervention were the most prominent aspects that influenced the intervention process. The increase in the workers’ knowledge about their health status and work ability was substantial, and the workers’ satisfaction with the intervention was good. The perceived effect of the advised preventive actions on health status was sufficient. Trial registration Netherlands Trial Register: http://NTR3012 PMID:23497119

Biomarkers of polycyclic aromatic hydrocarbon exposure in European coke oven workers.

PubMed

Talaska, Glenn; Thoroman, Jeff; Schuman, Brenda; Käfferlein, Heiko Udo

2014-12-01

Biomonitoring is an excellent method for capturing the results of all exposures, regardless of route. Coke oven workers include certain groups that have the potential for high exposure to polycyclic aromatic hydrocarbons (PAH) and other materials. Biomarkers of exposure to these agents include PAH metabolites as markers of internal dose and carcinogen-DNA adducts as measure of effective dose. The purpose of this study was to determine the levels of these biomarkers in persons with different job duties in a modern coke oven plant. We report that the mean levels of 1-hydroxypyrene (1HP) and carcinogen DNA adducts in the exfoliated urothelial cells of coke oven workers are increased the closer a group of workers is to the ovens and highest in the top oven workers with average 1HP level of 11.6 μg/l and 22 adducts per 10(9) unadducted nucleotides. Both 1HP and carcinogen DNA adduct levels increased in supervisors, area workers, side oven workers, top and side oven workers, and top oven workers, respectively. These data are the first to demonstrate an increase in target organ genotoxicity in coke oven workers and a relationship with other biomarkers. Future studies will determine the identity of the DNA adducts, their correlation with 1HP levels and the relationship between levels in individual workers. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Use of cellular phone contacts to increase return rates for immunization services in Kenya.

PubMed

Mokaya, Evans; Mugoya, Isaac; Raburu, Jane; Shimp, Lora

2017-01-01

In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore "false defaulters"). Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce "false defaulters".

Use of cellular phone contacts to increase return rates for immunization services in Kenya

PubMed Central

Mokaya, Evans; Mugoya, Isaac; Raburu, Jane; Shimp, Lora

2017-01-01

Introduction In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. Methods This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. Results In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore “false defaulters”). Conclusion Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce “false defaulters”. PMID:29138660

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

PubMed Central

2012-01-01

Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors. PMID:22551645

Compassion Fatigue and Compassion Satisfaction among Residential Child Care Workers: The Role of Personality Resources

ERIC Educational Resources Information Center

Zerach, Gadi

2013-01-01

This study assessed compassion fatigue (CF) and compassion satisfaction (CS) among Israeli residential child-care workers (RCWs) working in residential treatment facilities for children and youth at risk (N = 147) as compared to educational boarding schools workers (BSWs; N = 74). Furthermore, we assessed the relationship of potential…

75 FR 11915 - Chrysler, LLC, Sterling Heights Vehicle Test Center, Including On-Site Leased Workers From...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-65,672] Chrysler, LLC, Sterling Heights Vehicle Test Center, Including On-Site Leased Workers From Caravan Knight Facilities Management LLC; Sterling Heights, MI; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance and Alternative Trade Adjustment...

75 FR 11915 - Chrysler LLC; Trenton Engine Plant, Including On-Site Leased Workers From Caravan Knight...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... workers are engaged in the production of automotive engines, a substantial portion of which are shipped to..., Michigan location of Chrysler, LLC, Trenton Engine Plant. The Department has determined that these workers... Facilities Management, LLC, working on-site at the Trenton, Michigan location of Chrysler, LLC, Trenton...

Assessing the Relationship Between Work–Family Conflict and Smoking

PubMed Central

Nelson, Candace C.; Sorensen, Glorian

2012-01-01

Objectives. We examined the relationship between smoking and work–family conflict among a sample of New England long-term-care facility workers. Methods. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities. Results. There was a strong association between smoking likelihood and work–family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict. Conclusions. The results of this study indicate that there is a robust relationship between work–family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict. PMID:22720765

Assessing the relationship between work-family conflict and smoking.

PubMed

Nelson, Candace C; Li, Yi; Sorensen, Glorian; Berkman, Lisa F

2012-09-01

We examined the relationship between smoking and work-family conflict among a sample of New England long-term-care facility workers. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities. There was a strong association between smoking likelihood and work-family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict. The results of this study indicate that there is a robust relationship between work-family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.

Polybrominated diphenyl ethers (PBDEs) in floor and road dust from a manual e-waste dismantling facility and adjacent communities in Thailand.

PubMed

Muenhor, Dudsadee; Moon, Hyo-Bang; Lee, Sunggyu; Goosey, Emma

2017-12-06

This study characterizes concentrations of polybrominated diphenyl ethers (PBDEs) in floor and road dust from a manual e-waste dismantling facility and adjacent communities in Thailand. Levels of Σ22 PBDEs in floor dust from the facility varied between 1,200 and 43,000 ng g -1 , whereas those from adjacent communities were in the range 6.6-2,200 ng g -1 . Concentrations of Σ22 PBDEs (43,000 ng g -1 ) were highest in floor dust collected from the facility. Levels of Σ22 PBDEs and all congeners studied, except for BDE-66, BDE-71, BDE-85, BDE-119, BDE-138, BDE-190 and BDE-191 in facility dust were significantly greater than those in residential dust (P = <0.001-0.017). Moreover, PBDE contents decreased with increasing distance from the facility, revealing that the facility may represent a principal source of PBDEs to the surrounding environment. Levels of Σ22 PBDEs in road dust from the facility varied from 27 to 21,000 ng g -1 , while those from the adjacent residences were about 5.4-63 ng g -1 . Concentrations of Σ22 PBDEs (21,000 ng g -1 ) were highest in road dust taken at the facility. The PBDE congener profile for floor dust from the facility was dominated by BDEs 28, 47 and 209, whereas domestic floor dust was predominated by BDEs 206 and 209. Under various scenarios of occupational and environmental exposure to BDE-99 and BDE-209, workers in the facility as well as adults and children in the adjacent communities were exposed below the United States Environmental Protection Agency (US EPA)'s reference doses (RfDs) for BDE-99 (100 ng/kg bw/day) and BDE-209 (7,000 ng/kg bw/day).

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

PubMed Central

2012-01-01

Background Effective malaria case-management based on artemisinin-based combination therapy (ACT) and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy. Methods A cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result. Results We evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 < 5 years and 1,218 ≥ 5 years). Health facility and health worker readiness was variable: chloroquine was available at only 5% of facilities, 73% stocked recommended artesunate and sulfadoxine/pyrimethamine (AS+SP), 51% had the capacity to perform parasitological diagnosis, 53% of health workers had received in-service training on ACTs, 24% were trained in the use of malaria Rapid Diagnostic Tests, and 19% had received a supervisory visit including malaria case-management. At all health facilities 46% of febrile patients were parasitologically tested and 35% of patients were both, tested and treated according to test result. At facilities where AS+SP and malaria diagnostics were available 66% of febrile patients were tested and 51% were both, tested and treated according to test result. Among test positive patients 64% were treated with AS+SP but 24% were treated with artemether monotherapy. Among test negative patients only 17% of patients were treated for malaria. The majority of ACT dispensing and counseling practices were suboptimal. Conclusions Five years following change of the policy from chloroquine to ACTs and 3 years before the end of the new malaria strategic plan chloroquine was successfully phased out from public facilities in Sudan, however, an important gap remained in the availability of ACTs, diagnostic capacities and coverage with malaria case-management activities. The national scale-up of diagnostics, using the findings of this survey as well as future qualitative research, should present an opportunity not only to expand existing testing capacities but also to implement effective support interventions to bridge the health systems gaps and support corrective case-management measures, including the discontinuation of artemether monotherapy treatment. PMID:22221821

20 CFR 655.1150 - What materials must be available to the public?

Code of Federal Regulations, 2010 CFR

2010-04-01

... Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1150 What materials must be... facility employs any H-1C nurse under the Attestation, the facility must maintain a separate file...

Human errors and occupational injuries of older female workers in the residential healthcare facilities for the elderly.

PubMed

Kim, Jun Sik; Jeong, Byung Yong

2018-05-03

The study aimed to describe the characteristics of occupational injuries of female workers in the residential healthcare facilities for the elderly, and analyze human errors as causes of accidents. From the national industrial accident compensation data, 506 female injuries were analyzed by age and occupation. The results showed that medical service worker was the most prevalent (54.1%), followed by social welfare worker (20.4%). Among injuries, 55.7% were <1 year of work experience, and 37.9% were ≥60 years old. Slips/falls were the most common type of accident (42.7%), and proportion of injured by slips/falls increases with age. Among human errors, action errors were the primary reasons, followed by perception errors, and cognition errors. Besides, the ratios of injuries by perception errors and action errors increase with age, respectively. The findings of this study suggest that there is a need to design workplaces that accommodate the characteristics of older female workers.

Implementing the birth dose of hepatitis B vaccine in rural Indonesia.

PubMed

Creati, Mick; Saleh, Asmaniar; Ruff, Tilman A; Stewart, Tony; Otto, Bradley; Sutanto, Agustinus; Clements, C John

2007-08-10

Reaching mothers and their newborn infants around the time of birth with adequate health services has long been a difficult problem in developing countries. In parallel, similar problems have arisen in attempting to deliver hepatitis B (HepB) vaccine to infants born at home in many countries where mother-to-infant transmission is common. It is logical, and supported by experience in Indonesia, to find a combined solution for both problems. The World Health Organization (WHO) recommends that a timely birth dose of HepB vaccine be given, particularly in areas of high vertical transmission of hepatitis B virus (HBV). This can be achieved relatively easily in situations where almost all births occur in health facilities. But where a significant proportion of births occur at home and without birth attendants able to give injections, this is much more difficult. Barriers to the timely administration of the birth dose of HepB vaccine include weakness in policy development and implementation, difficulties in reliably supplying potent vaccine to community level, limited transport, poor communication, limited cold chain capacity, lack of effective training, and lack of a clear delineation of responsibility between health care professionals. Demonstration projects, such as those in Indonesia, suggest that there are significant opportunities to improve the timely delivery of HepB vaccine birth dose in existing maternal and child health programmes where health workers are trained to provide home delivery care.

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.

KSC-2012-6408

NASA Image and Video Library

2012-10-29

CAPE CANAVERAL, Fla. – At NASA’s Kennedy Space Center in Florida, a worker continues construction of the Antenna Test Bed Array for the Ka-Band Objects Observation and Monitoring, or Ka-BOOM, system. The construction site is near the former Vertical Processing Facility, which has been demolished. Workers are placing the pile foundations for the 40-foot-diameter dish antenna arrays and their associated utilities, and preparing the site for the operations command center facility. Photo credit: NASA/Ben Smegelski

Factors Contributing to the Self-Reported Prevalence of Multiple Chemical Sensitivity in Public Facility Workers and the General Population of Korea.

PubMed

Heo, Yong; Kim, Sang-Hoon; Lee, Seok-Ki; Kim, Hyoung-Ah

Multiple chemical sensitivity (MCS), an acquired disorder with multiple recurrent symptoms, has been studied for its association with diverse environmental factors. The present study investigated the factors associated with the self-reported prevalence of MCS in public facility workers and the general population in Korea. The Quick Environmental Exposure Sensitivity Inventory (QEESI) questionnaire was obtained from public facility workers (N=530) and the general population (N=500) to determine the prevalence of MCS and the degree of its risk. Information about demographic characteristics, subjective perceptions of sick building syndrome or sick house syndrome or allergy (SBS/SHS/Allergy), and certain home- or workplace-related events were also obtained. There was not a statistical difference between the public facility workers and the general population in the QEESI scores. The overall prevalence of MCS was 14.4% and there was no statistical difference between the two groups. Regarding the overall degree of risk of MCS, 21.8% of the study subjects were categorized as "very suggestive", and there was no significant difference between the two groups. Gender and the subjective perception of SBS/SHS/Allergy significantly affected the prevalence of MCS and the MCS risk criteria. Considering the absence of diagnostic criteria and/or treatment methods for MCS in Korea, these results can be utilized in establishing future strategies to manage MCS.

Shifting the burden or expanding access to care? Assessing malaria trends following scale-up of community health worker malaria case management and reactive case detection.

PubMed

Larsen, David A; Winters, Anna; Cheelo, Sanford; Hamainza, Busiku; Kamuliwo, Mulakwa; Miller, John M; Bridges, Daniel J

2017-11-02

Malaria is a significant burden to health systems and is responsible for a large proportion of outpatient cases at health facilities in endemic regions. The scale-up of community management of malaria and reactive case detection likely affect both malaria cases and outpatient attendance at health facilities. Using health management information data from 2012 to 2013 this article examines health trends before and after the training of volunteer community health workers to test and treat malaria cases in Southern Province, Zambia. An estimated 50% increase in monthly reported malaria infections was found when community health workers were involved with malaria testing and treating in the community (incidence rate ratio 1.52, p < 0.001). Furthermore, an estimated 6% decrease in outpatient attendance at the health facility was found when community health workers were involved with malaria testing and treating in the community. These results suggest a large public health benefit to both community case management of malaria and reactive case detection. First, the capacity of the malaria surveillance system to identify malaria infections was increased by nearly one-third. Second, the outpatient attendance at health facilities was modestly decreased. Expanding the capacity of the malaria surveillance programme through systems such as community case management and reactive case detection is an important step toward malaria elimination.

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt.

PubMed

Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H

2007-01-01

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

Fear of being tested for HIV at ANC clinics associated with low uptake of intermittent preventive treatment (IPT) of malaria among pregnant women attending Bondo District Hospital, Western Kenya.

PubMed

Sande, John Hafu; Kaseje, Dan; Nyapada, Linet; Owino, Victor O

2010-03-01

Malaria is a major cause of morbidity and mortality in tropical and subtropical regions, affecting mostly the impoverished sections of the population. Pregnant women living in malaria-endemic areas are at higher risk of malaria infection with higher density of parasitaemia than non-pregnant women. The aim of this study was to assess factors affecting the uptake of IPT among women attending antenatal clinics at Bondo District Hospital, Western Kenya. This study was a hospital-based cross-sectional survey among pregnant women attending clinics. Malaria is endemic in Bondo district. Both women from Bondo town (urban) and greater Bondo District (rural) who had been pregnant for at least 35 weeks or had delivered not more than 6 weeks prior to the survey), and had ANC cards were included in the study. The main outcomes were ANC attendance, IPT doses received and client and provider factors. Results showed that women's knowledge on ANC and IPT was high. The uptake of IPT was low among pregnant women with those from urban areas more likely to make more ANC visits and to get more IPT doses than women from the rural areas. ANC attendance was hampered by the fear of being tested for HIV at the clinic. Perceived side effects associated with IPT-SP hindered IPT uptake and were linked to HIV-related symptoms. Negative attitude among health workers towards pregnant women also adversely impacted IPT uptake. Women suggested that IPT drugs be distributed through community health workers instead of the health facility for improved uptake. Retraining of health workers on the administration of IPT, harmonization of health messages, and assessment of alternative community-based IPT distribution channels ought to be urgently considered. More evidence on the influence of HIV pandemic on perceptions and attitudes toward and uptake of other health interventions is urgently needed.

Benefits of a Dedicated Breastfeeding Facility and Support Program for Exclusive Breastfeeding among Workers in Indonesia.

PubMed

Basrowi, Ray W; Sulistomo, Astrid B; Adi, Nuri Purwito; Vandenplas, Yvan

2015-06-01

A mother's working environment is believed to be a major determinant of exclusive breastfeeding (EBF) practice. We aimed to define the influence of a facility dedicated to breastfeeding and a breastfeeding support program at the workplace on breastfeeding practice. A cross-sectional study was performed in five workplaces. The inclusion criteria were female workers whose last child was between 6 and 36 months old. Observational data were obtained and a questionnaire was filled out. The World Health Organization definition for EBF was used. Data from 186 subjects (74 office workers and 112 factory workers) were collected. Just over half (52%) of the mothers were between 20 and 46 years old, 75.3% had graduated from high school and university, 12.9% had more than two children and 36.0% owned a house. The prevalence of EBF during the last 6 months was 32.3%. A proper dedicated breastfeeding facility was available for 21.5% of the mothers, but only 7.5% had been in contact with a breastfeeding support program. The presence of a dedicated breastfeeding facility increased EBF practice almost threefold, by an odds ratio (OR) of 2.74 and a 95% confidence interval (CI) of 1.34-5.64 (p<0.05). Knowledge of the breastfeeding support program increased EBF practice by almost six times (OR, 5.93; 95% CI, 1.78-19.79) (p<0.05). Our findings suggest that Governments should make it obligatory for employers to offer a breastfeeding support program and a dedicated breastfeeding facility at the workplace as these simple measures significantly increase EBF.

The formal electronic recycling industry: Challenges and opportunities in occupational and environmental health research.

PubMed

Ceballos, Diana Maria; Dong, Zhao

2016-10-01

E-waste includes electrical and electronic equipment discarded as waste without intent of reuse. Informal e-waste recycling, typically done in smaller, unorganized businesses, can expose workers and communities to serious chemical health hazards. It is unclear if formalization into larger, better-controlled electronics recycling (e-recycling) facilities solves environmental and occupational health problems. To systematically review the literature on occupational and environmental health hazards of formal e-recycling facilities and discuss challenges and opportunities to strengthen research in this area. We identified 37 publications from 4 electronic databases (PubMed, Web of Science, Environmental Index, NIOSHTIC-2) specific to chemical exposures in formal e-recycling facilities. Environmental and occupational exposures depend on the degree of formalization of the facilities but further reduction is needed. Reported worker exposures to metals were often higher than recommended occupational guidelines. Levels of brominated flame-retardants in worker's inhaled air and biological samples were higher than those from reference groups. Air, dust, and soil concentrations of metals, brominated flame-retardants, dioxins, furans, polycyclic-aromatic hydrocarbons, or polychlorinated biphenyls found inside or near the facilities were generally higher than reference locations, suggesting transport into the environment. Children of a recycler had blood lead levels higher than public health recommended guidelines. With mounting e-waste, more workers, their family members, and communities could experience unhealthful exposures to metals and other chemicals. We identified research needs to further assess exposures, health, and improve controls. The long-term solution is manufacturing of electronics without harmful substances and easy-to-disassemble components. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Solid cancer mortality associated with chronic external radiation exposure at the French atomic energy commission and nuclear fuel company.

PubMed

Metz-Flamant, C; Samson, E; Caër-Lorho, S; Acker, A; Laurier, D

2011-07-01

Studies of nuclear workers make it possible to directly quantify the risks associated with ionizing radiation exposure at low doses and low dose rates. Studies of the CEA (Commissariat à l'Energie Atomique) and AREVA Nuclear Cycle (AREVA NC) cohort, currently the most informative such group in France, describe the long-term risk to nuclear workers associated with external exposure. Our aim is to assess the risk of mortality from solid cancers among CEA and AREVA NC nuclear workers and its association with external radiation exposure. Standardized mortality ratios (SMRs) were calculated and internal Poisson regressions were conducted, controlling for the main confounding factors [sex, attained age, calendar period, company and socioeconomic status (SES)]. During the period 1968-2004, there were 2,035 solid cancers among the 36,769 CEA-AREVA NC workers. Cumulative external radiation exposure was assessed for the period 1950-2004, and the mean cumulative dose was 12.1 mSv. Mortality rates for all causes and all solid cancers were both significantly lower in this cohort than in the general population. A significant excess of deaths from pleural cancer, not associated with cumulative external dose, was observed, probably due to past asbestos exposure. We observed a significant excess of melanoma, also unassociated with dose. Although cumulative external dose was not associated with mortality from all solid cancers, the central estimated excess relative risk (ERR) per Sv of 0.46 for solid cancer mortality was higher than the 0.26 calculated for male Hiroshima and Nagasaki A-bomb survivors 50 years or older and exposed at the age of 30 years or older. The modification of our results after stratification for SES demonstrates the importance of this characteristic in occupational studies, because it makes it possible to take class-based lifestyle differences into account, at least partly. These results show the great potential of a further joint international study of nuclear workers, which should improve knowledge about the risks associated with chronic low doses and provide useful risk estimates for radiation protection.

22. CONSTRUCTION PROGRESS PHOTO SHOWING WORKERS LOWERING CALCINER VESSEL INTO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

22. CONSTRUCTION PROGRESS PHOTO SHOWING WORKERS LOWERING CALCINER VESSEL INTO CELL THROUGH THE HATCH. INEEL PHOTO NUMBER NRTS-60-2485. - Idaho National Engineering Laboratory, Old Waste Calcining Facility, Scoville, Butte County, ID

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

PubMed Central

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-01-01

Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives. PMID:28348194

Tetanus vaccination, antibody persistence and decennial booster: a serosurvey of university students and at-risk workers.

PubMed

Borella-Venturini, M; Frasson, C; Paluan, F; DE Nuzzo, D; DI Masi, G; Giraldo, M; Chiara, F; Trevisan, A

2017-07-01

The aim of the present research is to verify the immune status against tetanus in students and workers exposed to risk and to ascertain whether a decennial booster is necessary. Antibodies against tetanus were measured in 1433 workers and students of Padua University (Italy). The enrolment criterion was the ability to provide a booklet of vaccinations released by a public health office. The influence of age, gender, the number of vaccine doses, and the interval since the last dose was determined. Ten years after the last dose, the majority of subjects (95·0%) displayed an antibody titre above the protective level (⩾0·10 IU/ml), and half of these (49·1%) had a long-term protective level (⩾1·0 IU/ml). According to our data, titre depends on both the number of vaccine doses and the interval since the last dose (P < 0·0001). Five vaccine doses and an interval of at least 10 years since the last dose are predictive of a long-term protective titre in absence of a booster (1·97 IU/ml). These data suggest that when primary series are completed, a decennial booster is unnecessary for up to 20 years. Furthermore, we recommend measuring the antibody level before a new booster is given to prevent problems related to over-immunisation.

A PLANNED COMMUNITY FOR MIGRATORY FARM WORKERS--A PROPOSAL FOR A DEMONSTRATION PROJECT.

ERIC Educational Resources Information Center

PEERY, A.B.

A DEMONSTRATION PROJECT FOR MIGRATORY FARM LABORERS HOME-BASED IN SOUTH TEXAS IS PROPOSED. THE PURPOSE IS TO DESIGN A PLANNED COMMUNITY CONTAINING HOUSING, HEALTH FACILITIES, ORIENTATION AND EDUCATIONAL FACILITIES, JOB-PLACEMENT FACILITIES, AND SOCIAL, RECREATIONAL, AND COMMERCIAL FACILITIES. THE PLANNED COMMUNITY WOULD PROVIDE SAFE, SANITARY, AND…

The DOE/DHHS memorandum of understanding: The DOE perspective

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

Goldsmith, R.

1991-01-01

On March 27, 1990, Secretary James D. Watkins established an Office of Health under the Assistant Secretary for Environment, Safety and Health. All epidemiologic activities throughout the department were consolidated into this office as part of an Office of Epidemiology and Health Surveillance (OEHS) with specific responsibilities for occupational and community health surveillance. The mission and functions of the OEHS include the conduct of epidemiologic studies at US Department of Energy (DOE) facilities, nearby communities, and other populations. These studies comprise retrospective mortality studies of DOE contractor workers, hypothesis-generating studies related to the potential health effects of energy production andmore » use, ecologic studies of off-site populations, quick-response investigations of suspected disease clusters, and others as needed. In addition, OEHS is responsible for providing procedures, technical support, and other resources for the conduct of DOE-sponsored epidemiologic research studies to be managed outside of DOE, including analytic studies to be managed by the Department of Health and Human Service (HHS) under a memorandum of understanding (MOU), dose-reconstruction studies, and studies related to DOE facilities to be conducted through state health departments.« less

Evaluation of storing hepatitis B vaccine outside the cold chain in the Solomon Islands: Identifying opportunities and barriers to implementation.

PubMed

Breakwell, Lucy; Anga, Jenniffer; Dadari, Ibrahim; Sadr-Azodi, Nahad; Ogaoga, Divinal; Patel, Minal

2017-05-15

Monovalent Hepatitis B vaccine (HepB) is heat stable, making it suitable for storage outside cold chain (OCC) at 37°C for 1month. We conducted an OCC project in the Solomon Islands to determine the feasibility of and barriers to national implementation and to evaluate impact on coverage. Healthcare workers at 13 facilities maintained monovalent HepB birth dose (HepB-BD) OCC for up to 28days over 7months. Vaccination data were recorded for children born during the project and those born during 7months before the project. Timely HepB-BD coverage among facility and home births increased from 30% to 68% and from 4% to 24%, respectively. Temperature excursions above 37°C were rare, but vaccine wastage was high and shortages common. Storing HepB OCC can increase HepB-BD coverage in countries with insufficient cold chain capacity or numerous home births. High vaccine wastage and unreliable vaccine supply must be addressed for successful implementation. Published by Elsevier Ltd.

20 CFR 655.1150 - What materials must be available to the public?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1150 What materials must be... thereafter for so long as the facility employs any H-1C nurse under the Attestation, the facility must...

Radiation in the workplace-a review of studies of the risks of occupational exposure to ionising radiation.

PubMed

Wakeford, Richard

2009-06-01

Many individuals are, or have been, exposed to ionising radiation in the course of their work and the epidemiological study of occupationally irradiated groups offers an important opportunity to complement the estimates of risks to health resulting from exposure to radiation that are obtained from other populations, such as the Japanese survivors of the atomic bombings of Hiroshima and Nagasaki in 1945. Moreover, workplace exposure to radiation usually involves irradiation conditions that are of direct relevance to the principal concern of radiological protection: protracted exposure to low level radiation. Further, some workers have been exposed to radioactive material that has been inadvertently taken into the body, and the study of these groups leads to risk estimates derived directly from the experience of those irradiated by these 'internal emitters', intakes of alpha-particle-emitters being of particular interest. Workforces that have been the subject of epidemiological study include medical staff, aircrews, radium dial luminisers, underground hard-rock miners, Chernobyl clean-up workers, nuclear weapons test participants and nuclear industry workers. The first solid epidemiological evidence of the stochastic effects of irradiation came from a study of occupational exposure to medical x-rays that was reported in 1944, which demonstrated a large excess risk of leukaemia among US radiologists; but the general lack of dose records for early medical staff who tended to experience the highest exposures hampers the derivation of risks per unit dose received by medical workers. The instrument dial luminisers who inadvertently ingested large amounts of radium-based paint and underground hard-rock miners who inhaled large quantities of radon and its decay products suffered markedly raised excess risks of, respectively, bone and lung cancers; the miner studies have provided standard risk estimates for radon-induced lung cancer. The large numbers of nuclear industry workers around the world present a possibility of deriving risk coefficients of direct relevance to radiological protection, and the recently published study of workers from 15 countries illustrates what can be achieved by international collaboration. However, it would appear that there are some problems with this study that require attention before reliance can be placed upon the results. Early workers from the Mayak plutonium production facility in Russia were heavily exposed to external sources of penetrating radiation and to plutonium, and appreciable effort has been expended in obtaining dependable risk estimates from this scientifically valuable group of workers. Those occupationally exposed to low levels of radiation also present an opportunity of studying possible somatic health effects other than cancer, such as heart disease and eye cataracts, that are the subject of much discussion at present. Overall, studies of exposure to ionising radiation in the workplace provide a valuable support to studies of those groups exposed under other circumstances, and in some instances (such as exposure to plutonium) effectively offer the only direct source of epidemiological evidence on risks.

Beneficial Effect of Higher Dietary Fiber Intake on Plasma HDL-C and TC/HDL-C Ratio among Chinese Rural-to-Urban Migrant Workers

PubMed Central

Zhou, Quan; Wu, Jiang; Tang, Jie; Wang, Jia-Ji; Lu, Chu-Hong; Wang, Pei-Xi

2015-01-01

Research has shown that high-dose supplemental dietary fiber intake has beneficial effects on cardiovascular risk factors. To clarify such a relationship, we examined the association between daily dietary fiber intake and plasma lipids using a cross-sectional design including 1034 (M 502, F 532) rural-to-urban workers in China. We found a dose-response relationship between increased dietary fiber intakes and increase of HDL cholesterol in male workers. There was also a dose-response relationship between increased dietary fiber intake and decreased total cholesterol to HDL cholesterol (TC/HDL-C) ratio in both male and female workers, after adjusting for potential confounders (p for trend, all p < 0.05). When the average dietary fiber intake increased from less than 18 g/day to over 30 g/day, the average HDL cholesterol level increased by 10.1%, and the TC/HDL-C ratio decreased by 14.4% for males (p = 0.020) and by 11.1% for females (p = 0.048). In conclusion, higher daily dietary fiber consumption is associated with beneficial effect on cholesterol for rural-to-urban workers in China, suggesting its potential beneficial effect on decreasing the risk of cardiovascular diseases. PMID:25938914

Beneficial Effect of Higher Dietary Fiber Intake on Plasma HDL-C and TC/HDL-C Ratio among Chinese Rural-to-Urban Migrant Workers.

PubMed

Zhou, Quan; Wu, Jiang; Tang, Jie; Wang, Jia-Ji; Lu, Chu-Hong; Wang, Pei-Xi

2015-04-29

Research has shown that high-dose supplemental dietary fiber intake has beneficial effects on cardiovascular risk factors. To clarify such a relationship, we examined the association between daily dietary fiber intake and plasma lipids using a cross-sectional design including 1034 (M 502, F 532) rural-to-urban workers in China. We found a dose-response relationship between increased dietary fiber intakes and increase of HDL cholesterol in male workers. There was also a dose-response relationship between increased dietary fiber intake and decreased total cholesterol to HDL cholesterol (TC/HDL-C) ratio in both male and female workers, after adjusting for potential confounders (p for trend, all p < 0.05). When the average dietary fiber intake increased from less than 18 g/day to over 30 g/day, the average HDL cholesterol level increased by 10.1%, and the TC/HDL-C ratio decreased by 14.4% for males (p = 0.020) and by 11.1% for females (p = 0.048). In conclusion, higher daily dietary fiber consumption is associated with beneficial effect on cholesterol for rural-to-urban workers in China, suggesting its potential beneficial effect on decreasing the risk of cardiovascular diseases.

Radiation exposure and lung disease in today's nuclear world.

PubMed

Deas, Steven D; Huprikar, Nikhil; Skabelund, Andrew

2017-03-01

Ionizing radiation poses important health risks. The per capita annual dose rate has increased in the United States and there is increasing concern for the risks posed by low-dose occupational exposure among workers in nuclear industries and healthcare. Recent nuclear accidents and concern for terrorism have heightened concern for catastrophic, high-dose ionizing radiation exposure. This review will highlight recent research into the risks to lung health posed by ionizing radiation exposure and into potential treatments. Angiotensin-converting enzyme inhibitors and some antioxidants have shown promise as mitigators, to decrease pneumonitis and fibrosis when given after exposure. Studies of survivors of nuclear catastrophes have shown increased risk for lung cancer, especially in nonsmokers. There is evidence for increased lung cancer risk in industrial radiation workers, especially those who process plutonium and may inhale radioactive particles. There does not seem to be an increased risk of lung cancer in healthcare workers who perform fluoroscopic procedures. High-dose ionizing radiation exposure causes pneumonitis and fibrosis, and more research is needed to develop mitigators to improve outcomes in nuclear catastrophes. Long-term, low-dose occupational radiation may increase lung cancer risk. More research to better define this risk could lead to improved safety protocols and screening programs.

Catastrophic Health Expenditure and Impoverishment Effects of Out-of-pocket Expenses: A Comparative Study of Tannery and Non-tannery Workers of Kanpur, India.

PubMed

Kashyap, Gyan C; Singh, Shri K; Sharma, Santosh K

2018-01-01

Treatment-seeking behaviors and economic burden because of health expenditure are widely discussed issues in India, and more so in recent times. The aim of this study is to identify health problems of tannery workers and their treatment-seeking behavior and their health expenditure. The primary data used in this article were collected through a cross-sectional household survey of 284 male tannery workers in the Jajmau area of Kanpur city in the state of Uttar Pradesh, during January-June 2015. Findings of the study revealed that around 36% of the tannery workers and 42% of non-tannery workers received treatment as outpatients in government/municipal hospital in the first spell of treatment. The secondary source of treatment was pharmacy/drug stores for 30% of the tannery workers and 24% of the non-tannery workers, an indication that a substantial proportion takes treatment without consulting a qualified medical practitioner; it also highlights that almost one-third of the tannery and non-tannery workers visited private health facility despite poor economic condition. It is evident that a substantial proportion of tannery and non-tannery workers are visiting private/non-governmental organization/trust hospital despite their poor financial situation. There is an urgent need to reinstate people's faith in public health facilities by developing professionalism, integrity, and accountability among different levels of health functionaries and frontline workers with the support of credible, transparent, and responsible regulatory environment.

Is task-shifting a solution to the health workers’ shortage in Northern Ghana?

PubMed Central

Okyere, Eunice; Mwanri, Lillian; Ward, Paul

2017-01-01

Objective To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana. Methods Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers’ in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting. Findings Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members’ are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening. Conclusion Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised. PMID:28358841

KSC-04pd1714

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers cover with plastic the Multi-Purpose Logistics Module Donatello in preparation for the expected impact of Hurricane Frances on Saturday. Other modules and equipment are being covered as well. Workers also have powered down the Space Shuttle orbiters, closed their payload bay doors and stowed the landing gear. They are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The SSPF can withstand sustained winds of 110 mph and wind gusts up to 132 mph. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1712

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers cover with plastic the U.S. Node 2 in preparation for the expected impact of Hurricane Frances on Saturday. Other modules and equipment are being covered as well. Workers also have powered down the Space Shuttle orbiters, closed their payload bay doors and stowed the landing gear. They are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The SSPF can withstand sustained winds of 110 mph and wind gusts up to 132 mph. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

KSC-04pd1713

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers cover with plastic the Multi-Purpose Logistics Module Raffaello in preparation for the expected impact of Hurricane Frances on Saturday. Other modules and equipment are being covered as well. Workers also have powered down the Space Shuttle orbiters, closed their payload bay doors and stowed the landing gear. They are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The SSPF can withstand sustained winds of 110 mph and wind gusts up to 132 mph. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

Health-hazard evaluation report HETA 91-338-2187, IMC Corporation, Sterlington, Louisiana

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

Kiefer, M.; Tepper, A.; Miller, R.

1992-03-01

In response to a request from an authorized representative of the Construction and General Laborers Union, Local 762, an investigation was made of potential hazards for asbestos abatement contract workers at IMC Corporation, (SIC-2869), Sterlington, Louisiana. The IMC facility consisted of two ammonia facilities, a nitroparaffin (NP) facility, and a NP derivatives facility. An explosion occurred on May 1, 1991 in the NP facility, caused by a faulty compressor. During the post explosion renovation activities, an asbestos abatement firm was working on site due to the large amounts of asbestos (1332214) insulation which had been disturbed by the explosion. Recordsmore » indicated that several workers complained of ill effects and odors on June 17 and 19. The incidents were investigated but no chemical exposure explanation was found. Routine and complaint based industrial hygiene monitoring was primarily area monitoring and not substance specific. Of the 25 workers interviewed, 22 had symptoms they felt were related to their work at IMC. The symptoms included those of the upper respiratory tract, central nervous system, and gastrointestinal system. The most common included diarrhea, nausea, headache, dizziness, and cough, each experienced by significantly more than half the subjects. The symptoms could not be linked conclusively to any specific chemical release, job task, work location, or food or drink source.« less

THE RESISTANCE TO $gamma$ RADIATION OF THE WORKER BEE (in French)

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

Courtois, G.; Lecomte, J.

The worker bee which has been subjected to gamma radiation from a Co/ sup 60/ source can withstand without apparent physical damage a dose of 18,000 r. At 90,000 r there is, however, appreciable damage. At a dose of 200,000 r, death is immediate in 100% of the cases. The physiological state of the bee plays an important role in determining its resistance to gamma radiation. (auth)

The effects of emotional intelligence training on the job performance of Australian aged care workers.

PubMed

Karimi, Leila; Leggat, Sandra G; Bartram, Timothy; Rada, Jiri

2018-05-09

Emotional intelligence (EI) training is popular among human resource practitioners, but there is limited evidence of the impact of such training on health care workers. In the current article, we examine the effects of EI training on quality of resident care and worker well-being and psychological empowerment in an Australian aged care facility. We use Bar-On's (1997) conceptualization of EI. We used a quasiexperimental design in 2014-2015 with experimental (training) and control (nontraining) groups of 60 participants in each group in two geographically separate facilities. Our final poststudy sample size was 27 participants for the training group and 17 participants for the control group. Over a 6-month period, we examined whether staff improved their well-being, psychological empowerment, and job performance measured as enhanced quality of care (self-rated and client-rated) by applying skills in EI. The results showed significant improvement among workers in the training group for EI scores, quality of care, general well-being, and psychological empowerment. There were no significant differences for the control group. Through examining the impact of EI training on staff and residents of an aged care facility, we demonstrate the benefits of EI training for higher quality of care delivery. This study demonstrates the practical process through which EI training can improve the work experiences of aged care workers, as well as the quality of care for residents.

Workers' Well-Being and Productivity: The Role of Bargaining.

ERIC Educational Resources Information Center

Mayer, Jean

1983-01-01

Bargaining that makes available facilities for satisfaction of workers' basic needs can contribute to increased productivity, which in turn enhances competitiveness. Such bargaining can be an effective means of extending and reinforcing national economic planning. (SK)

Professional exposure to ionizing radiations in health workers and white blood cells.

PubMed

Caciari, T; Capozzella, A; Tomei, F; Nieto, H A; Gioffrè, P A; Valentini, V; Scala, B; Andreozzi, G; De Sio, S; Chighine, A; Tomei, G; Ciarrocca, M

2012-01-01

The aim of this study is to estimate if low dose of occupational exposure to ionizing radiations can cause alterations of plasma concentrations of total white blood cells, lymphocytes, monocytes and granulocytes (eosinophils, basophils, neutrophils), in the health workers of a big hospital. 266 non smokers subjects of both sexes (133 health workers and 133 controls) were included in this study, compared on the basis of sex, age and working seniority. The complete blood count (CBC) was performed in all included workers. The differences between the mean values were compared using Student T-test for unpaired data. The frequencies of the single variables were compared using Chi (2) test with Yates correction. The differences were considered significant when the P values were < 0.05. The mean values and the distribution of the mean values of total white blood cell were significantly decreased in health workers of both sexes compared to controls. The average values of granulocytes neutrophils were significantly low in female health workers compared to female controls. The obtained results suggest that low dose of occupational exposure to ionizing radiations is able to influence some lines of the hematopoietic system in exposed workers.

78 FR 58543 - Advisory Board on Radiation and Worker Health (ABRWH or Advisory Board), National Institute for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-24

... on Radiation and Worker Health (ABRWH or Advisory Board), National Institute for Occupational Safety... the Energy Employees Occupational Illness Compensation Program Act of 2000 to advise the President on... Subcommittee Report; SEC Issues Work Group Report on ``Sufficient Accuracy''/Co-Worker Dose Modeling; SEC...

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

PubMed Central

2012-01-01

Background In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid. PMID:22697498

KSC-06pd0516

NASA Image and Video Library

2006-03-15

KENNEDY SPACE CENTER, FLA. - At NASA Kennedy Space Center's Shuttle Landing Facility, emergency rescue personnel gently place an "injured astronaut" onto a stretcher. Volunteers and emergency rescue workers are participating in a simulated emergency landing of a shuttle crew. Known as a Mode VI exercise, the operation uses volunteer workers from the Center to pose as astronauts. The purpose of the simulation is to exercise emergency preparedness personnel, equipment and facilities in rescuing astronauts from a downed orbiter and providing immediate medical attention. Photo credit: NASA/Troy Cryder

KSC-2012-6407

NASA Image and Video Library

2012-10-29

CAPE CANAVERAL, Fla. – At NASA’s Kennedy Space Center in Florida, workers pour concrete at the base of the site of the Antenna Test Bed Array for the Ka-Band Objects Observation and Monitoring, or Ka-BOOM system. The construction site is near the former Vertical Processing Facility, which has been demolished. Workers are placing the pile foundations for the 40-foot-diameter dish antenna arrays and their associated utilities, and preparing the site for the operations command center facility. Photo credit: NASA/Ben Smegelski

KSC-2012-6410

NASA Image and Video Library

2012-10-29

CAPE CANAVERAL, Fla. – At NASA’s Kennedy Space Center in Florida, workers pour and spread concrete at the base of the site of the Antenna Test Bed Array for the Ka-Band Objects Observation and Monitoring, Ka-BOOM system. The construction site is near the former Vertical Processing Facility, which has been demolished. Workers are placing the pile foundations for the 40-foot-diameter dish antenna arrays and their associated utilities, and preparing the site for the operations command center facility. Photo credit: NASA/Ben Smegelski

KENNEDY SPACE CENTER, FLA. - STS-114 Mission Specialist Wendy Lawrence autographs the sign presented to workers in the Orbiter Processing Facility. Lawrence is a new addition to the crew. The STS-114 crew is at KSC to take part in crew equipment and orbiter familiarization.

NASA Image and Video Library

2003-10-30

KENNEDY SPACE CENTER, FLA. - STS-114 Mission Specialist Wendy Lawrence autographs the sign presented to workers in the Orbiter Processing Facility. Lawrence is a new addition to the crew. The STS-114 crew is at KSC to take part in crew equipment and orbiter familiarization.

Integrated Biorefinery Research Facility | Bioenergy | NREL

Science.gov Websites

industrial, two-story building with high-bay, piping, and large processing equipment. Three workers in hard intellectual property and helping industrial partners commercialize technologies. Testing Facilities and

Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

PubMed Central

Namazzi, Gertrude; Waiswa, Peter; Nakakeeto, Margaret; Nakibuuka, Victoria K.; Namutamba, Sarah; Najjemba, Maria; Namusaabi, Ruth; Tagoola, Abner; Nakate, Grace; Ajeani, Judith; Peterson, Stefan; Byaruhanga, Romano N.

2015-01-01

Background In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities. PMID:25843496

Age at exposure to ionising radiation and cancer mortality among Hanford workers: follow up through 1994

PubMed Central

Wing, S; Richardson, D

2005-01-01

Background: Studies of workers at the plutonium production factory in Hanford, WA have led to conflicting conclusions about the role of age at exposure as a modifier of associations between ionising radiation and cancer. Aims: To evaluate the influence of age at exposure on radiation risk estimates in an updated follow up of Hanford workers. Methods: A cohort of 26 389 workers hired between 1944 and 1978 was followed through 1994 to ascertain vital status and causes of death. External radiation dose estimates were derived from personal dosimeters. Poisson regression was used to estimate associations between mortality and cumulative external radiation dose at all ages, and in specific age ranges. Results: A total of 8153 deaths were identified, 2265 of which included cancer as an underlying or contributory cause. Estimates of the excess relative risk per Sievert (ERR/Sv) for cumulative radiation doses at all ages combined were negative for all cause and leukaemia and positive for all cancer and lung cancer. Cumulative doses accrued at ages below 35, 35–44, and 45–54 showed little association with mortality. For cumulative dose accrued at ages 55 and above (10 year lag), the estimated ERR/Sv for all cancers was 3.24 (90% CI: 0.80 to 6.17), primarily due to an association with lung cancer (ERR/Sv: 9.05, 90% CI: 2.96 to 17.92). Conclusions: Associations between radiation and cancer mortality in this cohort are primarily a function of doses at older ages and deaths from lung cancer. The association of older age radiation exposures and cancer mortality is similar to observations from several other occupational studies. PMID:15961623

A Bayesian Model and Stochastic Exposure (Dose) Estimation for Relative Exposure Risk Comparison Involving Asbestos-Containing Dropped Ceiling Panel Installation and Maintenance Tasks.

PubMed

Boelter, Fred W; Xia, Yulin; Persky, Jacob D

2017-09-01

Assessing exposures to hazards in order to characterize risk is at the core of occupational hygiene. Our study examined dropped ceiling systems commonly used in schools and commercial buildings and lay-in ceiling panels that may have contained asbestos prior to the mid to late 1970s. However, most ceiling panels and tiles do not contain asbestos. Since asbestos risk relates to dose, we estimated the distribution of eight-hour TWA concentrations and one-year exposures (a one-year dose equivalent) to asbestos fibers (asbestos f/cc-years) for five groups of workers who may encounter dropped ceilings: specialists, generalists, maintenance workers, nonprofessional do-it-yourself (DIY) persons, and other tradespersons who are bystanders to ceiling work. Concentration data (asbestos f/cc) were obtained through two exposure assessment studies in the field and one chamber study. Bayesian and stochastic models were applied to estimate distributions of eight-hour TWAs and annual exposures (dose). The eight-hour TWAs for all work categories were below current and historic occupational exposure limits (OELs). Exposures to asbestos fibers from dropped ceiling work would be categorized as "highly controlled" for maintenance workers and "well controlled" for remaining work categories, according to the American Industrial Hygiene Association exposure control rating system. Annual exposures (dose) were found to be greatest for specialists, followed by maintenance workers, generalists, bystanders, and DIY. On a comparative basis, modeled dose and thus risk from dropped ceilings for all work categories were orders of magnitude lower than published exposures for other sources of banned friable asbestos-containing building material commonly encountered in construction trades. © 2016 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV.

PubMed

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-03-01

Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV

PubMed Central

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-01-01

ABSTRACT Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups. PMID:27392010

Exposure of airport workers to radiation from shipments of radioactive materials. A review of studies conducted at six major airports. Technical report

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

Shapiro, J.

1976-02-01

The radiation exposure of airport workers handling shipments of radioactive materials was studied at six airports. Descriptions were obtained of the handling and arrangement of the packages, dose distributions were mapped around groupings of packages, and doses received by workers were evaluated both on the basis of time-motion studies and through readings of personal monitoring devices. Results of dosimeters worn over extended periods indicated that no workers were expected to receive exposures in excess of 500 millirems per year and most were expected to receive less than 100 millirems per year. No evidence was found in any of the sixmore » airport studies to suggest that members of the public received any exposure of significance relative to the natural background radiation.« less

Investigation of Workplace-like Calibration Fields via a Deuterium-Tritium (D-T) Neutron Generator.

PubMed

Mozhayev, Andrey V; Piper, Roman K; Rathbone, Bruce A; McDonald, Joseph C

2017-04-01

Radiation survey meters and personal dosimeters are typically calibrated in reference neutron fields based on conventional radionuclide sources, such as americium-beryllium (Am-Be) or californium-252 (Cf), either unmodified or heavy-water moderated. However, these calibration neutron fields differ significantly from the workplace fields in which most of these survey meters and dosimeters are being used. Although some detectors are designed to yield an approximately dose-equivalent response over a particular neutron energy range, the response of other detectors is highly dependent upon neutron energy. This, in turn, can result in significant over- or underestimation of the intensity of neutron radiation and/or personal dose equivalent determined in the work environment. The use of simulated workplace neutron calibration fields that more closely match those present at the workplace could improve the accuracy of worker, and workplace, neutron dose assessment. This work provides an overview of the neutron fields found around nuclear power reactors and interim spent fuel storage installations based on available data. The feasibility of producing workplace-like calibration fields in an existing calibration facility has been investigated via Monte Carlo simulations. Several moderating assembly configurations, paired with a neutron generator using the deuterium tritium (D-T) fusion reaction, were explored.

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.

PubMed

Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí

2010-09-17

Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas.

"You have to take action": changing knowledge and attitudes towards newborn care practices during crisis in South Sudan.

PubMed

Sami, Samira; Kerber, Kate; Tomczyk, Barbara; Amsalu, Ribka; Jackson, Debra; Scudder, Elaine; Dimiti, Alexander; Meyers, Janet; Kenneth, Kemish; Kenyi, Solomon; Kennedy, Caitlin E; Ackom, Kweku; Mullany, Luke C

2017-11-01

Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community- and facility-based health workers in displaced person camps in South Sudan. We describe health workers' knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre-post knowledge tests and in-depth interviews. Study participants were community- and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pre-training: 5.8 [SD: 2.3] vs. post-training: 9.6 [SD: 2.1]) and 25 facility-based health workers (pre-training: 14.2 [SD: 2.7] vs. post-training: 17.4 [SD: 2.8]). Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers' knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.

A dose-response relationship between long working hours and unmet need for access to hospital facilities.

PubMed

Soek, Hongdeok; Won, Jong-Uk; Lee, Tae Il; Kim, Yeong-Kwang; Lee, Wanhyung; Lee, June-Hee; Roh, Jaehoon; Yoon, Jin-Ha

2016-03-01

Lack of access to hospital facilities, indicating unmet healthcare need, plays an important role in health inequity in the workplace. We aimed to investigate the association between long working hours and unmet healthcare need. We used data from the Korea National Health and Nutrition Examination Surveys collected during 2007-2012, which included 8369 participants (4765 males, 3604 females) aged 20-54 years, who were paid workers. We used a logistic regression model with gender stratification to investigate the association between working hours and unmet healthcare need. Of the 8369 participants, 855 males (17.94%) and 981 females (27.22%) experienced unmet healthcare need. After adjusting for covariates, and compared to 30-39 working hours per week, the odds ratios (OR) of unmet healthcare need were 1.07 [(95% confidence interval (95% CI) 0.76-1.51], 1.46 (95% CI 1.03-2.07), and 1.57 (95% CI 1.11-2.23) in males, and 1.13 (95% CI 0.92-1.40), 1.30 (95% CI 0.99-1.69), and 1.60 (95% CI 1.21-2.10) in females, for 40-49, 50-59, and ≥ 60 work hours per week, respectively. There was a dose-response relationship between working hours per week and unmet healthcare need in both genders. Those who work long hours are more likely to have unmet healthcare needs, the cause of which seems to be lack of time.

Benzene and leukemia, Pliofilm revisited: I. An historical review of the leukemia deaths among Akron Goodyear Tire and Rubber Company employees.

PubMed

Infante, Peter F

2013-01-01

The cohort study of Pliofilm workers exposed to benzene has been used as a primary data source to estimate quantitative dose response for benzene-leukemia. Little attention has focused on the undercounting of leukemia deaths used in the analyses, nor on the behavior of the company toward the Pliofilm workers who contracted leukemia. An historical review of documents related to the Akron portion of the cohort indicates that between two and five workers diagnosed with acute myelogenous leukemia (AML) could be added to the cohort for alternate dose response analyses. In the late 1950s and early 1960s, the company did not inform Pliofilm workers with AML that they had the disease, concealed from the workers, including those diagnosed with AML, and the treating hematologist that benzene was the solvent being used, and denied compensation for AML cases exposed to benzene until forced to do so by the State of Ohio in 1968.

20 CFR 655.1113 - Element III-What does “facility wage rate” mean?

Code of Federal Regulations, 2010 CFR

2010-04-01

... Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1113 Element III—What does... for registered nurses similarly employed by the facility.” (b) The facility must pay the higher of the...., prevailing wage). (c) Wage obligations for H-1C nurses in nonproductive status—(1) Circumstances where wages...

20 CFR 655.1113 - Element III-What does “facility wage rate” mean?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1113 Element III—What does... for registered nurses similarly employed by the facility.” (b) The facility must pay the higher of the...., prevailing wage). (c) Wage obligations for H-1C nurses in nonproductive status—(1) Circumstances where wages...

Shock wave facilities at Pulter Laboratory of SRI international

NASA Astrophysics Data System (ADS)

Murri, W. J.

1982-04-01

Shock wave research in the Poulter Laboratory covers two broad areas: dynamic material response and dynamic structural response. Workers in both areas use common facilities. The Laboratory has several guns and the facilities to perform various types of high explosive loading experiments. The use of these facilities and experimental techniques is illustrated with examples from research projects.

Comparison of the uncertainties of several European low-dose calibration facilities

NASA Astrophysics Data System (ADS)

Dombrowski, H.; Cornejo Díaz, N. A.; Toni, M. P.; Mihelic, M.; Röttger, A.

2018-04-01

The typical uncertainty of a low-dose rate calibration of a detector, which is calibrated in a dedicated secondary national calibration laboratory, is investigated, including measurements in the photon field of metrology institutes. Calibrations at low ambient dose equivalent rates (at the level of the natural ambient radiation) are needed when environmental radiation monitors are to be characterised. The uncertainties of calibration measurements in conventional irradiation facilities above ground are compared with those obtained in a low-dose rate irradiation facility located deep underground. Four laboratories quantitatively evaluated the uncertainties of their calibration facilities, in particular for calibrations at low dose rates (250 nSv/h and 1 μSv/h). For the first time, typical uncertainties of European calibration facilities are documented in a comparison and the main sources of uncertainty are revealed. All sources of uncertainties are analysed, including the irradiation geometry, scattering, deviations of real spectra from standardised spectra, etc. As a fundamental metrological consequence, no instrument calibrated in such a facility can have a lower total uncertainty in subsequent measurements. For the first time, the need to perform calibrations at very low dose rates (< 100 nSv/h) deep underground is underpinned on the basis of quantitative data.

Shared dosimetry error in epidemiological dose-response analyses

DOE PAGES

Stram, Daniel O.; Preston, Dale L.; Sokolnikov, Mikhail; ...

2015-03-23

Radiation dose reconstruction systems for large-scale epidemiological studies are sophisticated both in providing estimates of dose and in representing dosimetry uncertainty. For example, a computer program was used by the Hanford Thyroid Disease Study to provide 100 realizations of possible dose to study participants. The variation in realizations reflected the range of possible dose for each cohort member consistent with the data on dose determinates in the cohort. Another example is the Mayak Worker Dosimetry System 2013 which estimates both external and internal exposures and provides multiple realizations of "possible" dose history to workers given dose determinants. This paper takesmore » up the problem of dealing with complex dosimetry systems that provide multiple realizations of dose in an epidemiologic analysis. In this paper we derive expected scores and the information matrix for a model used widely in radiation epidemiology, namely the linear excess relative risk (ERR) model that allows for a linear dose response (risk in relation to radiation) and distinguishes between modifiers of background rates and of the excess risk due to exposure. We show that treating the mean dose for each individual (calculated by averaging over the realizations) as if it was true dose (ignoring both shared and unshared dosimetry errors) gives asymptotically unbiased estimates (i.e. the score has expectation zero) and valid tests of the null hypothesis that the ERR slope β is zero. Although the score is unbiased the information matrix (and hence the standard errors of the estimate of β) is biased for β≠0 when ignoring errors in dose estimates, and we show how to adjust the information matrix to remove this bias, using the multiple realizations of dose. The use of these methods in the context of several studies including, the Mayak Worker Cohort, and the U.S. Atomic Veterans Study, is discussed.« less

Cancer in the offspring of radiation workers: a record linkage study.

PubMed Central

Draper, G. J.; Little, M. P.; Sorahan, T.; Kinlen, L. J.; Bunch, K. J.; Conquest, A. J.; Kendall, G. M.; Kneale, G. W.; Lancashire, R. J.; Muirhead, C. R.; O'Connor, C. M.; Vincent, T. J.

1997-01-01

OBJECTIVES: To test the "Gardner hypothesis" that childhood leukaemia and non-Hodgkin lymphoma can be caused by fathers' exposure to ionising radiation before the conception of the child, and, more generally, to investigate whether such radiation exposure of either parent is a cause of childhood cancer. DESIGN: Case-control study. SETTING: Great Britain. SUBJECTS: 35,949 children diagnosed as having cancer, together with matched controls. MAIN OUTCOME MEASURES: Parental employment as radiation worker as defined by inclusion in the National Registry for Radiation Workers and being monitored for external radiation before conception of child; cumulative dose of external ionising radiation for various periods of employment before conception; dose during pregnancy. RESULTS: After cases studied by Gardner and colleagues were excluded, fathers of children with leukaemia or non-Hodgkin lymphoma were significantly more likely than fathers of controls to have been radiation workers (relative risk 1.77, 95% confidence interval 1.05 to 3.03) but there was no dose-response relation for any of the exposure periods studied; indeed, the association was greatest for those with doses below the level of detection. No increased risk was found for fathers with a lifetime preconception dose of 100 mSv or more, or with a dose in the 6 months before conception of 10 mSv or more. There was no increased risk for the group of other childhood cancers. Mothers' radiation work was associated with a significant increase of childhood cancer (relative risk 5.00, 1.42 to 26.94; based on 15 cases and 3 controls). Only four of the case mothers and no controls were radiation workers during pregnancy. CONCLUSIONS: These results do not support the hypothesis that paternal preconception irradiation is a cause of childhood leukaemia and non-Hodgkin lymphoma; the observed associations may be chance findings or results from exposure to infective or other agents. If there is any increased risk for the children of fathers who are radiation workers, it is small in absolute terms: in Britain the average risk by age 15 years is 6.5 per 10,000; our best estimate, using all available data, is that the increase is 5.4 per 10,000. For mothers, the numbers are too small for reliable estimates of the risk, if any, to be made. PMID:9393219

Radiation streaming and skyshine evaluation for a proposed low-level radioactive waste assured isolation facility.

PubMed

Arno, Matthew; Hamilton, Ian S

2003-10-01

Texas is investigating the idea of building a long term waste storage facility, also known as an Assured Isolation Facility. This is an above-ground, retrievable low-level radioactive waste storage facility. A preliminary, scoping-level analysis has been extended to consider more complex scenarios of radiation streaming and skyshine by using MCNP to model the facility in greater detail. Using bounding source term assumptions, the radiation doses and dose rates are found to exceed applicable limits by an order of magnitude. By altering the facility design to fill in the hollow cores of the prefabricated concrete slabs used in the roof over the "high-gamma" rooms where the waste with greatest gamma radiation intensity is stored, dose rates outside the facility decrease by an order of magnitude. With the modified design, the annual dose at the site fenceline is less than the 1 mSv annual limit for exposure of the public. Within the site perimeter, modifying the roof results in an order of magnitude drop in the dose rate for personnel outside the facility and on the facility roof, as well as a significant drop inside the facility. Radiation streaming inside the facility can be lowered almost two orders of magnitude by placing operational restrictions to keep at least two rows of waste containers in front of the high-gamma room to cut down on the size of the path for streaming.

Assessing the health effects associated with occupational radiation exposure in Korean radiation workers: protocol for a prospective cohort study.

PubMed

Seo, Songwon; Lim, Wan Young; Lee, Dal Nim; Kim, Jung Un; Cha, Eun Shil; Bang, Ye Jin; Lee, Won Jin; Park, Sunhoo; Jin, Young Woo

2018-03-30

The cancer risk of radiation exposure in the moderate-to-high dose range has been well established. However, the risk remains unclear at low-dose ranges with protracted low-dose rate exposure, which is typical of occupational exposure. Several epidemiological studies of Korean radiation workers have been conducted, but the data were analysed retrospectively in most cases. Moreover, groups with relatively high exposure, such as industrial radiographers, have been neglected. Therefore, we have launched a prospective cohort study of all Korean radiation workers to assess the health effects associated with occupational radiation exposure. Approximately 42 000 Korean radiation workers registered with the Nuclear Safety and Security Commission from 2016 to 2017 are the initial target population of this study. Cohort participants are to be enrolled through a nationwide self-administered questionnaire survey between 24 May 2016 and 30 June 2017. As of 31 March 2017, 22 982 workers are enrolled in the study corresponding to a response rate of 75%. This enrolment will be continued at 5-year intervals to update information on existing study participants and recruit newly hired workers. Survey data will be linked with the national dose registry, the national cancer registry, the national vital statistics registry and national health insurance data via personal identification numbers. Age-specific and sex-specific standardised incidence and mortality ratios will be calculated for overall comparisons of cancer risk. For dose-response assessment, excess relative risk (per Gy) and excess absolute risk (per Gy) will be estimated with adjustments for birth year and potential confounders, such as lifestyle factors and socioeconomic status. This study has received ethical approval from the institutional review board of the Korea Institute of Radiological and Medical Sciences (IRB No. K-1603-002-034). All participants provided written informed consent prior to enrolment. The findings of the study will be disseminated through scientific peer-reviewed journals and be provided to the public, including radiation workers, via the study website (http://www.rhs.kr/) and onsite radiation safety education. © 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.

Mortality (1950–1999) and cancer incidence (1969–1999) of workers in the Port Hope cohort study exposed to a unique combination of radium, uranium and γ-ray doses

PubMed Central

Zablotska, Lydia B; Lane, Rachel S D; Frost, Stanley E

2013-01-01

Objectives Uranium processing workers are exposed to uranium and radium compounds from the ore dust and to γ-ray radiation, but less to radon decay products (RDP), typical of the uranium miners. We examined the risks of these exposures in a cohort of workers from Port Hope radium and uranium refinery and processing plant. Design A retrospective cohort study with carefully documented exposures, which allowed separation of those with primary exposures to radium and uranium. Settings Port Hope, Ontario, Canada, uranium processors with no mining experience. Participants 3000 male and female workers first employed (1932–1980) and followed for mortality (1950–1999) and cancer incidence (1969–1999). Outcome measures Cohort mortality and incidence were compared with the general Canadian population. Poisson regression was used to evaluate the association between cumulative RDP exposures and γ-ray doses and causes of death and cancers potentially related to radium and uranium processing. Results Overall, workers had lower mortality and cancer incidence compared with the general Canadian population. In analyses restricted to men (n=2645), the person-year weighted mean cumulative RDP exposure was 15.9 working level months (WLM) and the mean cumulative whole-body γ-ray dose was 134.4 millisieverts. We observed small, non-statistically significant increases in radiation risks of mortality and incidence of lung cancer due to RDP exposures (excess relative risks/100 WLM=0.21, 95% CI <−0.45 to 1.59 and 0.77, 95% CI <−0.19 to 3.39, respectively), with similar risks for those exposed to radium and uranium. All other causes of death and cancer incidence were not significantly associated with RDP exposures or γ-ray doses or a combination of both. Conclusions In one of the largest cohort studies of workers exposed to radium, uranium and γ-ray doses, no significant radiation-associated risks were observed for any cancer site or cause of death. Continued follow-up and pooling with other cohorts of workers exposed to by-products of radium and uranium processing could provide valuable insight into occupational risks and suspected differences in risk with uranium miners. PMID:23449746

JPRS Report, Soviet Union Economic Affairs

DTIC Science & Technology

1988-11-01

Shatlykgazstroy [ Shatlyk Gas Construction] Trust and a group of Romanian construc- tion workers. A creative camaraderie was established between the...international collectives, and competition developed for the fastest start-up of the facilities. The Shatlyk gas-construction workers are successfully

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.

20 CFR 655.1210 - What penalties and other remedies may the Administrator impose?

Code of Federal Regulations, 2010 CFR

2010-04-01

... injury or adverse effect upon the workers. (c) The civil money penalty, back wages, and any other remedy..., DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES What are the Department's... facility under the Act and subpart L or M of this part; (2) The number of workers affected by the violation...

Hand-arm vibration syndrome and dose-response relation for vibration induced white finger among quarry drillers and stonecarvers. Italian Study Group on Physical Hazards in the Stone Industry.

PubMed Central

Bovenzi, M

1994-01-01

OBJECTIVES--To investigate the occurrence of disorders associated with the hand arm vibration syndrome in a large population of stone workers in Italy. The dose-response relation for vibration induced white finger (VWF) was also studied. METHODS--The study population consisted of 570 quarry drillers and stonecarvers exposed to vibration and 258 control stone workers who performed only manual activity. Each subject was interviewed with health and workplace assessment questionnaires. Sensorineural and VWF disorders were staged according to the Stockholm workshop scales. Vibration was measured on a representative sample of percussive and rotary tools. The 8 h energy equivalent frequency weighted acceleration (A (8)) and lifetime vibration doses were calculated for each of the exposed stone workers. RESULTS--Sensorineural and musculoskeletal symptoms occurred more frequently in the workers exposed to vibration than in the controls, but trend statistics did not show a linear exposure-response relation for these disorders. The prevalence of VWF was found to be 30.2% in the entire group exposed to vibration. Raynaud's phenomenon was discovered in 4.3% of the controls. VWF was strongly associated with exposure to vibration and a monotonic dose-response relation was found. According to the exposure data of this study, the expected percentage of stone workers affected with VWF tends to increase roughly in proportion to the square root of A(8) (for a particular exposure period) or in proportion to the square root of the duration of exposure (for a constant magnitude of vibration). CONCLUSION--Even although limited to a specific work situation, the dose-response relation for VWF estimated in this study suggests a time dependency such that halving the years of exposure allows a doubling of the energy equivalent vibration. According to these findings, the vibration exposure levels currently under discussion within the European Community seem to represent reasonable exposure limits for the protection of workers against the harmful effects of hand transmitted vibration. PMID:7951792

Measuring radon concentrations and estimating dose in tourist caves.

PubMed

Martín Sánchez, A; de la Torre Pérez, J; Ruano Sánchez, A B; Naranjo Correa, F L

2015-11-01

Caves and mines are considered to be places of especial risk of exposure to (222)Rn. This is particularly important for guides and workers, but also for visitors. In the Extremadura region (Spain), there are two cave systems in which there are workers carrying out their normal everyday tasks. In one, visits have been reduced to maintain the conditions of temperature and humidity. The other comprises several caves frequently visited by school groups. The caves were radiologically characterised in order to estimate the dose received by workers or possible hazards for visitors. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Air quality, mortality, and economic benefits of a smoke - free workplace law for non-smoking Ontario bar workers.

PubMed

Repace, J; Zhang, B; Bondy, S J; Benowitz, N; Ferrence, R

2013-04-01

We estimated the impact of a smoke-free workplace bylaw on non-smoking bar workers' health in Ontario, Canada. We measured bar workers' urine cotinine before (n = 99) and after (n = 91) a 2004 smoke-free workplace bylaw. Using pharmacokinetic and epidemiological models, we estimated workers' fine-particle (PM2.5 ) air pollution exposure and mortality risks from workplace secondhand smoke (SHS). workers' pre-law geometric mean cotinine was 10.3 ng/ml; post-law dose declined 70% to 3.10 ng/ml and reported work hours of exposure by 90%. Pre-law, 97% of workers' doses exceeded the 90th percentile for Canadians of working age. Pre-law-estimated 8-h average workplace PM2.5 exposure from SHS was 419 μg/m(3) or 'Very Poor' air quality, while outdoor PM2.5 levels averaged 7 μg/m(3) , 'Very Good' air quality by Canadian Air Quality Standards. We estimated that the bar workers' annual mortality rate from workplace SHS exposure was 102 deaths per 100000 persons. This was 2.4 times the occupational disease fatality rate for all Ontario workers. We estimated that half to two-thirds of the 10620 Ontario bar workers were non-smokers. Accordingly, Ontario's smoke-free law saved an estimated 5-7 non-smoking bar workers' lives annually, valued at CA $50 million to $68 million (US $49 million to $66 million). © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

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

Benefits of a Dedicated Breastfeeding Facility and Support Program for Exclusive Breastfeeding among Workers in Indonesia

PubMed Central

Basrowi, Ray W; Sulistomo, Astrid B; Adi, Nuri Purwito

2015-01-01

Purpose A mother's working environment is believed to be a major determinant of exclusive breastfeeding (EBF) practice. We aimed to define the influence of a facility dedicated to breastfeeding and a breastfeeding support program at the workplace on breastfeeding practice. Methods A cross-sectional study was performed in five workplaces. The inclusion criteria were female workers whose last child was between 6 and 36 months old. Observational data were obtained and a questionnaire was filled out. The World Health Organization definition for EBF was used. Results Data from 186 subjects (74 office workers and 112 factory workers) were collected. Just over half (52%) of the mothers were between 20 and 46 years old, 75.3% had graduated from high school and university, 12.9% had more than two children and 36.0% owned a house. The prevalence of EBF during the last 6 months was 32.3%. A proper dedicated breastfeeding facility was available for 21.5% of the mothers, but only 7.5% had been in contact with a breastfeeding support program. The presence of a dedicated breastfeeding facility increased EBF practice almost threefold, by an odds ratio (OR) of 2.74 and a 95% confidence interval (CI) of 1.34-5.64 (p<0.05). Knowledge of the breastfeeding support program increased EBF practice by almost six times (OR, 5.93; 95% CI, 1.78-19.79) (p<0.05). Conclusion Our findings suggest that Governments should make it obligatory for employers to offer a breastfeeding support program and a dedicated breastfeeding facility at the workplace as these simple measures significantly increase EBF. PMID:26157694

Characterization of the radiation environment at the UNLV accelerator facility during operation of the Varian M6 linac

NASA Astrophysics Data System (ADS)

Hodges, M.; Barzilov, A.; Chen, Y.; Lowe, D.

2016-10-01

The bremsstrahlung photon flux from the UNLV particle accelerator (Varian M6 model) was determined using MCNP5 code for 3 MeV and 6 MeV incident electrons. Human biological equivalent dose rates due to accelerator operation were evaluated using the photon flux with the flux-to-dose conversion factors. Dose rates were computed for the accelerator facility for M6 linac use under different operating conditions. The results showed that the use of collimators and linac internal shielding significantly reduced the dose rates throughout the facility. It was shown that the walls of the facility, in addition to the earthen berm enveloping the building, provide equivalent shielding to reduce dose rates outside to below the 2 mrem/h limit.

Influence of gamma-ray skyshine on nuclear facilities design

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

Ohta, M.; Tsuji, M.; Kimura, Y.

1986-01-01

In safety analysis of nuclear facilities, skyshine dose rate at site boundary is one of the most important shielding design problems. For nuclear power stations in Japan, the skyshine dose rate at the site boundary has been specified not to exceed 5 mR/yr by the authorities, including total dose contribution from all structures on site, and this guide is commonly applied to other nuclear fuel cycle facilities. Therefore the design criterion dose of each structure on site is, considering plot planning, shielding condition, and so on, defined as a value <5 mR/yr. The purpose of this study is to investigatemore » how skyshine dose standards or other factors have an influence on the design of nuclear facilities, in a parametric survey of gamma-ray skyshine.« less

External radiation dose and cancer mortality among French nuclear workers: considering potential confounding by internal radiation exposure.

PubMed

Fournier, L; Laurent, O; Samson, E; Caër-Lorho, S; Laroche, P; Le Guen, B; Laurier, D; Leuraud, K

2016-11-01

French nuclear workers have detailed records of their occupational exposure to external radiation that have been used to examine associations with subsequent cancer mortality. However, some workers were also exposed to internal contamination by radionuclides. This study aims to assess the potential for bias due to confounding by internal contamination of estimates of associations between external radiation exposure and cancer mortality. A cohort of 59,004 workers employed for at least 1 year between 1950 and 1994 by CEA (Commissariat à l'Energie Atomique), AREVA NC, or EDF (Electricité de France) and badge-monitored for external radiation exposure were followed through 2004 to assess vital status and cause of death. A flag based on a workstation-exposure matrix defined four levels of potential for internal contamination. Standardized mortality ratios were assessed for each level of the internal contamination indicator. Poisson regression was used to quantify associations between external radiation exposure and cancer mortality, adjusting for potential internal contamination. For solid cancer, the mortality deficit tended to decrease as the levels of potential for internal contamination increased. For solid cancer and leukemia excluding chronic lymphocytic leukemia, adjusting the dose-response analysis on the internal contamination indicator did not markedly change the excess relative risk per Sievert of external radiation dose. This study suggests that in this cohort, neglecting information on internal dosimetry while studying the association between external dose and cancer mortality does not generate a substantial bias. To investigate more specifically the health effects of internal contamination, an effort is underway to estimate organ doses due to internal contamination.

THE UKRAINIAN-AMERICAN STUDY OF LEUKEMIA AND RELATED DISORDERS AMONG CHORNOBYL CLEANUP WORKERS FROM UKRAINE: III. RADIATION RISKS

PubMed Central

Romanenko, A.Ye.; Finch, S.; Hatch, M.; Lubin, J.; Bebeshko, V.G.; Bazyka, D.A.; Gudzenko, N.; Dyagil, I.S.; Reiss, R.; Bouville, A.; Chumak, V.V.; Trotsiuk, N.K.; Babkina, N.G.; Belayev, Y.; Masnyk; Ron, E.; Howe, G.R.; Zablotska, L.B.

2010-01-01

Leukemia is one of the cancers most susceptible to induction by ionizing radiation, but the effects of lower doses delivered over time have not been adequately quantified. Following the Chornobyl (Chernobyl) accident in Ukraine in April 1986, several hundred thousand workers who were involved in cleaning up the site and its surroundings received fractionated exposure, primarily from external gamma radiation. To increase our understanding of the role of protracted low-dose radiation exposure in the etiology of leukemia, we conducted a nested case-control study of leukemia in a cohort of cleanup workers identified from the Chornobyl State Registry of Ukraine. The analysis is based on 71 cases of histologically confirmed leukemia diagnosed in 1986–2000 and 501 age- and residence-matched controls selected from the same cohort. Study subjects or their proxies were interviewed about their cleanup activities and other relevant factors. Individual bone marrow radiation doses were estimated by the RADRUE dose reconstruction method (mean dose=76.4 (SD=213.4) milligray (mGy)). We used conditional logistic regression to estimate leukemia risks. The excess relative risk of total leukemia was 3.44 per Gy (95% confidence interval 0.47–9.78, p<0.01). The dose-response was linear and did not significantly differ by calendar period of first work in the 30-km Chornobyl zone, duration or type of work. We found a similar dose-response relationship for chronic and non-chronic lymphocytic leukemia. PMID:19138038

[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.

Practice of skin-to-skin contact, exclusive breastfeeding and other newborn care interventions in Ethiopia following promotion by facility and community health workers: results from a prospective outcome evaluation.

PubMed

Callaghan-Koru, Jennifer A; Estifanos, Abiy Seifu; Sheferaw, Ephrem Daniel; de Graft-Johnson, Joseph; Rosado, Carina; Patton-Molitors, Rachel; Worku, Bogale; Rawlins, Barbara; Baqui, Abdullah

2016-12-01

To assess the effects of a facility and community newborn intervention package on coverage of early skin-to-skin contact (SSC) and exclusive breastfeeding - the therapeutic components of kangaroo mother care. A multilevel community and facility intervention in Ethiopia trained health workers in 10 health centres and the surrounding communities to promote early SSC and exclusive breastfeeding for all babies born at home or in the facility. Changes in SSC and exclusive breastfeeding were assessed by comparing baseline and endline household surveys. Overall practice of SSC at any time following delivery increased significantly from 13.1 to 44.1% of mothers. Coverage of immediate SSC also increased significantly from 8.4 to 24.1%. Breastfeeding within the first hour increased from 51.4 to 67.9% and exclusive breastfeeding within the first three days increased from 86 to 95.8%. At endline, SSC was significantly higher among facility births than home births and community health workers had limited contact with mothers. While targeted behaviours improved overall, the programme did not achieve adequate increases in SSC and exclusive breastfeeding among home deliveries to expect a reduction in mortality for low birthweight babies. Newborn care programs in Ethiopia should continue to encourage facility delivery while strengthening coverage of community programmes. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Influences of mechanical exposure biographies on physical capabilities of workers from automotive industry - a study on possible dose-response relationships and consequences for short and long term job rotation.

PubMed

Rademacher, Holger; Bruder, Ralph; Sinn-Behrendt, Andrea; Landau, Kurt

2012-01-01

This paper describes a field study in production areas of a vehicle manufacturing plant, where 106 male workers (aged from 20 to 63 years) were examined and interviewed by the authors. Aim of study was to identify relationships between specific physical worker capabilities and doses of mechanical exposures using self-developed standardized questionnaires as well as a battery of work-specific tests. The dependent variables are different "physical capabilities", classified using a five-point rating scale with regard to the grade of limitation of the respective capability. Independent variables are "age" and specific "mechanical exposures". Several exposures were combined and multiplied with their respective durations in order to determine doses on three different body regions - back, shoulder-neck and upper limbs. There are significant positive correlations between "age" and "dose of mechanical exposure on back/shoulder-neck/upper limbs region". The analysis of the relationship between dose of exposure and different capabilities to lift or reposition loads (with variable weight) shows weak significant correlations for all three body regions. Data analysis shows no significant correlations between any dose of mechanical exposure and capabilities to work in awkward body postures.These results should be considered in age management programs when scheduling future employee assignments to workplaces, especially for production systems where manual handling tasks are dominant.

Catastrophic Health Expenditure and Impoverishment Effects of Out-of-pocket Expenses: A Comparative Study of Tannery and Non-tannery Workers of Kanpur, India

PubMed Central

Kashyap, Gyan C.; Singh, Shri K.; Sharma, Santosh K.

2018-01-01

Purpose: Treatment-seeking behaviors and economic burden because of health expenditure are widely discussed issues in India, and more so in recent times. The aim of this study is to identify health problems of tannery workers and their treatment-seeking behavior and their health expenditure. Data and Methods: The primary data used in this article were collected through a cross-sectional household survey of 284 male tannery workers in the Jajmau area of Kanpur city in the state of Uttar Pradesh, during January–June 2015. Results: Findings of the study revealed that around 36% of the tannery workers and 42% of non-tannery workers received treatment as outpatients in government/municipal hospital in the first spell of treatment. The secondary source of treatment was pharmacy/drug stores for 30% of the tannery workers and 24% of the non-tannery workers, an indication that a substantial proportion takes treatment without consulting a qualified medical practitioner; it also highlights that almost one-third of the tannery and non-tannery workers visited private health facility despite poor economic condition. It is evident that a substantial proportion of tannery and non-tannery workers are visiting private/non-governmental organization/trust hospital despite their poor financial situation. Conclusion: There is an urgent need to reinstate people's faith in public health facilities by developing professionalism, integrity, and accountability among different levels of health functionaries and frontline workers with the support of credible, transparent, and responsible regulatory environment. PMID:29743781

76 FR 179 - GMPT Warren Transmission, GM Powertrain Division, a Subsidiary of General Motors Company...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

... Knight Facilities Management, Warren, MI; Amended Certification Regarding Eligibility To Apply for Worker... Knight Facilities Management were employed on-site at the Warren, Michigan location of the subject firm... Knight Facilities Management working on-site at the Warren, Michigan location of GMPT Warren Transmission...

10 CFR 850.27 - Hygiene facilities and practices.

Code of Federal Regulations, 2012 CFR

2012-01-01

... or their personal clothing. (b) Change rooms or areas. The responsible employer must provide clean change rooms or areas for beryllium workers who work in regulated areas. (1) Separate facilities free of... change rooms or areas and shower facilities required under paragraphs (b) and (c) of this section; and (3...

10 CFR 850.27 - Hygiene facilities and practices.

Code of Federal Regulations, 2014 CFR

2014-01-01

... or their personal clothing. (b) Change rooms or areas. The responsible employer must provide clean change rooms or areas for beryllium workers who work in regulated areas. (1) Separate facilities free of... change rooms or areas and shower facilities required under paragraphs (b) and (c) of this section; and (3...

10 CFR 850.27 - Hygiene facilities and practices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... or their personal clothing. (b) Change rooms or areas. The responsible employer must provide clean change rooms or areas for beryllium workers who work in regulated areas. (1) Separate facilities free of... change rooms or areas and shower facilities required under paragraphs (b) and (c) of this section; and (3...

10 CFR 850.27 - Hygiene facilities and practices.

Code of Federal Regulations, 2013 CFR

2013-01-01

... or their personal clothing. (b) Change rooms or areas. The responsible employer must provide clean change rooms or areas for beryllium workers who work in regulated areas. (1) Separate facilities free of... change rooms or areas and shower facilities required under paragraphs (b) and (c) of this section; and (3...

Management of Childhood Illness at Health Facilities in Benin: Problems and Their Causes

PubMed Central

Rowe, Alexander K.; Onikpo, Faustin; Lama, Marcel; Cokou, Francois; Deming, Michael S.

2001-01-01

Objectives. To prepare for the implementation of Integrated Management of Childhood Illness (IMCI) in Benin, we studied the management of ill children younger than 5 years at outpatient health facilities. Methods. We observed a representative sample of consultations; after each consultation, we interviewed caregivers and reexamined children. Health workers' performance was evaluated against IMCI guidelines. To identify determinants of performance, statistical modeling was performed and 6 focus groups with health workers were conducted to solicit their opinions. Results. Altogether, 584 children were enrolled and 101 health workers were observed; 130 health workers participated in focus group discussions. Many serious deficiencies were found: incomplete assessment of children's signs and symptoms, incorrect diagnosis and treatment of potentially life-threatening illnesses, inappropriate prescription of dangerous sedatives, missed opportunities to vaccinate, and failure to refer severely ill children for hospitalization. Quantitative and qualitative analyses showed various health facility–, health worker–, caregiver-, and child-related factors as possible determinants of health worker performance. Conclusions. Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level. PMID:11574325

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal.

PubMed

Citrin, David; Thapa, Poshan; Nirola, Isha; Pandey, Sachit; Kunwar, Lal Bahadur; Tenpa, Jasmine; Acharya, Bibhav; Rayamazi, Hari; Thapa, Aradhana; Maru, Sheela; Raut, Anant; Poudel, Sanjaya; Timilsina, Diwash; Dhungana, Santosh Kumar; Adhikari, Mukesh; Khanal, Mukti Nath; Pratap Kc, Naresh; Acharya, Bhim; Karki, Khem Bahadur; Singh, Dipendra Raman; Bangura, Alex Harsha; Wacksman, Jeremy; Storisteanu, Daniel; Halliday, Scott; Schwarz, Ryan; Schwarz, Dan; Choudhury, Nandini; Kumar, Anirudh; Wu, Wan-Ju; Kalaunee, S P; Chaudhari, Pushpa; Maru, Duncan

2018-06-04

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems. Copyright © 2018 Elsevier Inc. All rights reserved.

Epidemiologic Study of One Million American Workers and Military Veterans Exposed to Ionizing Radiation

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

Boice, John D.

2015-02-27

A pilot study was completed demonstrating the feasibility of conducting an epidemiologic study assessing cancer and other disease mortality among nearly one million US veterans and workers exposed to ionizing radiation, a population 10 times larger than atomic bomb survivor study with high statistical power to evaluate low dose rate effects. Among the groups enumerated and/or studied were: (1) 194,000 Department of Energy Uranium Workers; (2) 6,700 Rocketdyne Radiation Workers; (3) 7,000 Mound Radiation Workers; (4) 156,000 DOE Plutonium Workers; (5) 212,000 Nuclear Power Plant Workers; (6) 130,000 Industrial Radiography Workers; (7) 1.7 million Medical Workers and (8) 135,000 Atomicmore » Veterans.« less

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.

Health workers perceptions and attitude about Ghana's preparedness towards preventing, containing, and managing Ebola Virus Disease.

PubMed

Adongo, Philip Baba; Tabong, Philip Teg-Nefaah; Asampong, Emmanuel; Ansong, Joana; Robalo, Magda; Adanu, Richard M

2017-04-12

Ebola virus is highly infectious and the disease can be very fatal. The World Health Organization has declared the 2014-2015 Ebola Virus Disease outbreak a Public Health Emergency of International Concern. In response to this, preparations were made in various health facilities and entry points across Ghana. This study explored health workers perceptions, and attitude about Ghana's preparedness towards preventing and containing Ebola Virus Disease. We conducted a qualitative study in five (5) of the ten (10) regions in Ghana. Five focus group discussions (N = 44) were conducted among nurses; one in each region. In addition, ten (10) health workers (2 in each region) who are members of regional Ebola Virus Disease task force were recruited and interviewed. In the Greater Accra, Volta and Western regions that have ports, six (6) port health officials: two in each of these regions were also interviewed. The interviews were recorded digitally and transcribed verbatim. Thematic content analysis was used to analyze the transcripts with the aid of NVivo 10 software. The results of this study showed that Ghanaian health workers perceived the screening at various ports as important and ongoing but felt that the screenings at in-land ports were being undermined by the use of unapproved routes. Training of health workers was also being carried out in all the regions, however, there was a general perception among 33 out of 44 nurses that majority of health workers have not received training on Ebola Virus Disease prevention and management. Logistical challenges were also reported as some health facilities did not have adequate Personal Protective Equipment. In facilities where equipment was available, they were stored in places which are not easily accessible to health workers at all times of the day. Human resource preparation was also perceived to be a challenge as health workers (38/44 of nurses) generally expressed fear and unwillingness to work in Ebola treatment centres in the event of an outbreak in Ghana. Our study concludes that preparatory work for Ebola Virus Disease prevention and containment in Ghana is perceived as inadequate by health workers. Ghana needs to strengthen preparation in the area of training of health workers, provision and accessibility of Personal Protective Equipment and incentives for health workers to better position her to contain and manage any Ebola Virus Disease outbreak.

Health systems readiness and management of febrile outpatients under low malaria transmission in Vanuatu.

PubMed

Zurovac, Dejan; Guintran, Jean-Olivier; Donald, Wesley; Naket, Esau; Malinga, Josephine; Taleo, George

2015-12-02

Vanuatu, an archipelago country in Western Pacific harbouring low Plasmodium falciparum and Plasmodium vivax malaria transmission, has been implementing a malaria case management policy, recommending parasitological testing of patients with fever and anti-malarial treatment for test-positive only patients. A health facility survey to evaluate the health systems readiness to implement the policy and the quality of outpatient management for patients with fever was undertaken. A cross-sectional, cluster sample survey, using a range of quality-of-care methods, included all health centres and hospitals in Vanuatu. The main outcome measures were coverage of health facilities and health workers with commodities and support interventions, adherence to test and treatment recommendations, and factors influencing malaria testing. The survey was undertaken in 2014 during the low malaria season and included 41 health facilities, 67 health workers and 226 outpatient consultations for patients with fever. All facilities had capacity for parasitological diagnosis, 95.1 % stocked artemether-lumefantrine and 63.6 % primaquine. The coverage of health workers with support interventions ranged from 50 to 70 %. Health workers' knowledge was high only regarding treatment policy for uncomplicated P. falciparum malaria (83.4 %). History taking and clinical examination practices were sub-optimal. Some 35.0 % (95 % CI 23.4-48.6) of patients with fever were tested for malaria, of which all results were negative and only one patient received anti-malarial treatment. Testing was significantly higher for patients age 5 years and older (OR = 2.33; 95 % CI 1.48-5.02), seen by less qualified health workers (OR = 2.73; 95 % CI 1.48-5.02), health workers who received malaria case management training (OR = 2.39; 95 % CI 1.28-4.47) and patients with increased temperature (OR = 2.56; 95 % CI 1.17-5.57), main complaint of fever (OR = 5.82; 95 % CI 1.26-26.87) and without runny nose (OR = 3.75; 95 % CI 1.36-10.34). Antibiotic use was very high (77.4 %) with sub-optimal dispensing and counselling practices. Health facility and health worker readiness to implement policy is higher for falciparum than vivax malaria. Clinical and malaria testing practices are sub-optimal, however adherence to test negative results is nearly universal. Use of antibiotics is irrational. Quantitative and qualitative improvements of ongoing interventions are needed to re-inforce clinical practices in this area characterized by difficult access, human resource shortages but aspiring towards malaria elimination.

Updated mortality analysis of radiation workers at Rocketdyne (Atomics International), 1948-2008

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

Boice, John; Cohen, Sarah; Mumma, Michael

Updated analyses of mortality data are presented on 5,801 radiation workers, including 2,232 monitored for radionuclide intakes, and 41,169 non-radiation workers employed 1948-1999 at Rocketdyne (Atomics International). The worker population is unique in that lifetime occupational doses from all places of employment were sought and incorporated into the analyses. Further, radiation doses from intakes of 14 different radionuclides were calculated for 16 organs or tissues using biokinetic models of the International Commission on Radiation Protection (ICRP). The mean dose from external radiation was 13.5 mSv (maximum 1 Sv), and the mean lung dose from external and internal radiation combined wasmore » 19.0 mSv (maximum 3.6 Sv). An additional nine years of follow-up, from December 31,1999 through 2008, increased the person-years of observation by 21.7% to 196,674 (mean 33.9 years) and the number of cancer deaths by 50% to 684. Analyses included comparisons with the general population and the computation of standardized mortality ratios (SMRs), and internal comparisons using proportional hazards models. All cancers taken together (SMR 0.88; 95% CI 0.81-0.95), lung cancer (SMR 0.87; 95% CI 0.76-1.00) and leukemia other than chronic lymphocytic leukemia (CLL) (SMR 1.04; 95% 0.67-1.53) were not significantly elevated. Cox regression analyses revealed no significant dose-response trends for any cancer. For all cancers excluding leukemia, the relative risk (RR) at 100 mSv was estimated as 0.98 (95% CI 0.82-1.17) and for all leukemia other than CLL it was 1.06 (95% CI 0.50-2.23). Uranium was the primary radionuclide contributing to internal exposures, but significant increases in lung and kidney disease were not seen. The extended follow-up re-enforces the findings in the previous study in failing to observe a detectable increase in cancer deaths associated with radiation, but strong conclusions still cannot be drawn because of small numbers and relatively low career doses. Larger combined studies of early workers in the United States following similar methodologies are warranted to refine and clarify radiation risks following protracted exposures.« less

Confinement of Radioactive Materials at Defense Nuclear Facilities

DTIC Science & Technology

2004-10-01

The design of defense nuclear facilities includes systems whose reliable operation is vital to the protection of the public, workers, and the...final safety-class barrier to the release of hazardous materials with potentially serious public consequences. The Defense Nuclear Facilities Safety...the public at certain defense nuclear facilities . This change has resulted in downgrading of the functional safety classification of confinement

Radiation exposure related to the shipment of fertilisers to and from commercial ports: the case study of the seaport of Ravenna (Italy).

PubMed

Righi, Serena; Lucialli, Patrizia; Pollini, Elisa

2014-03-01

This paper presents the results of a study of radiological impacts related to the shipment of fertilisers to and from the commercial port of Ravenna (NE Italy). In particular, the effective doses to the port workers and members of the population surrounding the port area have been estimated. The study has included different types of measurement and assessment. First, the natural radioactivity of different fertilisers moving through the port has been determined: (40)K, (226)Ra, (210)Pb, (228)Ra and (228)Th concentrations have been analysed using γ-ray spectrometry, while (238)U and (232)Th concentrations have been determined by ICP-MS. At the same time, a dose rate meter and electret ion chambers were used to measure the external irradiation and the radon concentrations, respectively. Then, air pollutant dispersion models have been applied in order to assess particulate matter concentration in the port site and the surrounding residential areas, and consequently the inhalation doses. Finally, the annual effective doses to workers and local residents have been estimated. The effective doses to workers and the population have been estimated to be 0.9 mSv yr(-1) and 0.07 μSv yr(-1), respectively.

Spatial accessibility to physical activity facilities and to food outlets and overweight in French youth.

PubMed

Casey, R; Chaix, B; Weber, C; Schweitzer, B; Charreire, H; Salze, P; Badariotti, D; Banos, A; Oppert, J-M; Simon, C

2012-07-01

Some characteristics of the built environment have been associated with obesity in youth. Our aim was to determine whether individual and environmental socio-economic characteristics modulate the relation between youth overweight and spatial accessibility to physical activity (PA) facilities and to food outlets. Cross-sectional study. 3293 students, aged 12 ± 0.6 years, randomly selected from eastern France middle schools. Using geographical information systems (GIS), spatial accessibility to PA facilities (urban and nature) was assessed using the distance to PA facilities at the municipality level; spatial accessibility to food outlets (general food outlets, bakeries and fast-food outlets) was calculated at individual level using the student home address and the food outlets addresses. Relations of weight status with spatial accessibility to PA facilities and to food outlets were analysed using mixed logistic models, testing potential direct and interaction effects of individual and environmental socio-economic characteristics. Individual socio-economic status modulated the relation between spatial accessibility to PA facilities and to general food outlets and overweight. The likelihood of being overweight was higher when spatial accessibility to urban PA facilities and to general food outlets was low, but in children of blue-collar-workers only. The odds ratio (OR) (95% confidence interval) for being overweight of blue-collar-workers children compared with non-blue-collar-workers children was 1.76 (1.25-2.49) when spatial accessibility to urban PA facilities was low. This OR was 1.86 (1.20-2.86) when spatial accessibility to general food outlets was low. There was no significant relationship of overweight with either nature PA facilities or other food outlets (bakeries and fast-food outlets). These results indicate that disparities in spatial accessibility to PA facilities and to general food outlets may amplify the risk of overweight in socio-economically disadvantaged youth. These data should be relevant for influencing health policies and urban planning at both a national and local level.

A quantitative method for optimized placement of continuous air monitors.

PubMed

Whicker, Jeffrey J; Rodgers, John C; Moxley, John S

2003-11-01

Alarming continuous air monitors (CAMs) are a critical component for worker protection in facilities that handle large amounts of hazardous materials. In nuclear facilities, continuous air monitors alarm when levels of airborne radioactive materials exceed alarm thresholds, thus prompting workers to exit the room to reduce inhalation exposures. To maintain a high level of worker protection, continuous air monitors are required to detect radioactive aerosol clouds quickly and with good sensitivity. This requires that there are sufficient numbers of continuous air monitors in a room and that they are well positioned. Yet there are no published methodologies to quantitatively determine the optimal number and placement of continuous air monitors in a room. The goal of this study was to develop and test an approach to quantitatively determine optimal number and placement of continuous air monitors in a room. The method we have developed uses tracer aerosol releases (to simulate accidental releases) and the measurement of the temporal and spatial aspects of the dispersion of the tracer aerosol through the room. The aerosol dispersion data is then analyzed to optimize continuous air monitor utilization based on simulated worker exposure. This method was tested in a room within a Department of Energy operated plutonium facility at the Savannah River Site in South Carolina, U.S. Results from this study show that the value of quantitative airflow and aerosol dispersion studies is significant and that worker protection can be significantly improved while balancing the costs associated with CAM programs.

75 FR 11916 - Chrysler Group LLC, Formerly Known as Chrysler LLC, Conner Avenue Assembly Plant, Including On...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

..., CDI, Syncreon and Caravan Knight Facilities Management LLC; Detriot, MI; Amended Certification... workers from Aerotek, CDI, Syncreon and Caravan Knight Facilities Management LLC, Detroit, Michigan, who...

Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training

PubMed Central

2010-01-01

Background Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior and attitudes are too resource-intensive for widespread use. This study tests the feasibility and effectiveness of a less expensive alternative - an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic. Methods A "dose-finding" study compared pre-post changes in three different durations of training. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training, pandemic-related self-efficacy, coping style and interpersonal problems. Results 158 hospital workers took the course and were randomly assigned to the short (7 sessions, median cumulative duration 111 minutes), medium (12 sessions, 158 minutes) or long (17 sessions, 223 minutes) version. Using an intention-to-treat analysis, the course was associated with significant improvements in confidence in support and training, pandemic self-efficacy and interpersonal problems. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. There was a trend towards higher drop-out rates with longer duration of training. Conclusions Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. Comparing three "doses" of the course suggested that the medium course was optimal. PMID:20307302

[Association between urinary polycyclic aromatic hydrocarbon metabolites and elevated serum uric acid levels in coke oven workers].

PubMed

Deng, Siyun; Deng, Qifei; Hu, Die; Li, Jun; Zhu, Xiaoyan; Guo, Huan; Wu, Tangchun

2014-06-01

To analyze the relationship between metabolites of polycyclic aromatic hydrocarbons (PAHs) and serum uric acid levels in coke oven workers and to provide new clues to the pathogenic mechanism of PAHs. A total of 1302 coke oven workers were divided into four groups, namely control group and low-, intermediate-, and high-dose exposure groups. The concentrations of ambient PAHs at each workplace were determined by high-performance liquid chromatography. The detailed information on the occupational history and health of workers was collected by questionnaire survey and physical examination, and so were their blood and urine samples. Serum uric acid and creatinine levels were measured using a Hitachi 7020 automatic biochemical analyzer. Ten urinary PAH metabolites were detected by gas chromatography-mass spectrometry. Serum uric acid levels were the highest in the high-dose exposure group, followed by the intermediate- and low-dose exposure groups, and were the lowest in the control group. There were significant correlations between serum uric acid levels and the quartiles of 1-hydroxynaphthalene and 1-hydroxyphenanthrene (P < 0.05). After adjustment for PAH metabolite-related relationship, only urinary 1-hydroxyphenanthrene was significantly correlated with serum uric acid levels (P = 0.001). After adjustment for confounding factors and using the 1st quartile of 1-hydroxyphenanthrene as a reference, the odds ratio for hyperuricemia in subjects with the 2nd, 3rd, and 4th quartiles of 1-hydroxyphenanthrene were 1.55, 1.57, and 2.35, respectively. Urinary 1-hydroxyphenanthrene is associated with a dose-response increase in serum uric acid levels in coke oven workers, and exposure to phenanthrene in PAHs may be a risk factor for hyperuricemia.

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.

Missing in action: teacher and health worker absence in developing countries.

PubMed

Chaudhury, Nazmul; Hammer, Jeffrey; Kremer, Michael; Muralidharan, Karthik; Rogers, F Halsey

2006-01-01

In this paper, we report results from surveys in which enumerators make unannounced visits to primary schools and health clinics in Bangladesh, Ecuador, India, Indonesia, Peru and Uganda and recorded whether they found teachers and health workers in the facilities.

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.

Effect of an Education Presentation On the Knowledge and Awareness of Urinary Tract Infection among Non-Licensed and Licensed Health Care Workers in Long-Term Care Facilities.

PubMed

Freeman-Jobson, Jennifer H; Rogers, Jamie L; Ward-Smith, Peggy

2016-01-01

This article presents the findings of a pre-test, post-test quality improvement project that describes the change in knowledge from prior to and following an evidence-based education presentation. The presentation addressed the clinical symptoms, diagnostic processes, interventions, and responsibilities of licensed and unlicensed health care workers employed in long-term care facilities related to prevention and detection of non-catheter-related urinary tract infections. Results indicate that the education presentation improved knowledge in specific.

KSC-06pd0515

NASA Image and Video Library

2006-03-15

KENNEDY SPACE CENTER, FLA. - At NASA Kennedy Space Center's Shuttle Landing Facility, emergency personnel lower an "injured astronaut" on a stretcher down the stairs of the orbiter mockup. Volunteers and emergency rescue workers are participating in a simulated emergency landing of a shuttle crew. Known as a Mode VI exercise, the operation uses volunteer workers from the Center to pose as astronauts. The purpose of the simulation is to exercise emergency preparedness personnel, equipment and facilities in rescuing astronauts from a downed orbiter and providing immediate medical attention. Photo credit: NASA/Jim Grossmann

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers (in protective clothing) brief STS-117 Mission Specialist James Reilly (center) and STS-115 Mission Specialist Joseph Tanner (right) about the Japanese Experiment Module (JEM). Equipment familiarization is a routine part of astronaut training and launch preparations.

NASA Image and Video Library

2003-10-21

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers (in protective clothing) brief STS-117 Mission Specialist James Reilly (center) and STS-115 Mission Specialist Joseph Tanner (right) about the Japanese Experiment Module (JEM). Equipment familiarization is a routine part of astronaut training and launch preparations.

Awareness and Attitude of Healthcare Workers to Cosmetic Surgery in Osogbo, Nigeria

PubMed Central

Adedeji, Opeyemi Adeniyi; Oseni, Ganiyu Oladiran; Olaitan, Peter Babatunde

2014-01-01

This study aimed at understanding the level of awareness and elucidates the attitude and disposition of healthcare workers to cosmetic surgery in Osogbo, Nigeria. A questionnaire-based survey was done at LAUTECH Teaching Hospital, Osogbo, in 2012. Questionnaires were administered to 213 workers and students in the hospital. These were then analysed using SPSS version 16.0 with frequencies, means, and so forth. Respondents were 33 doctors, 32 nurses, 79 medical students, 60 nursing students, 4 administrative staff, 1 pharmacist, and 4 ward maids. There is fair awareness about cosmetic surgery generally with 94.5% and its availability in Nigeria with 67.0%. A fewer proportion of the respondents (44.5%) were aware of the facility for cosmetic surgery in their locality. A large percentage (86.5%) favorably considers facilities outside Nigeria when making choice of facility to have cosmetic surgery done. 85.5% considered the information about cosmetic surgery reliable while 19.0% objected going for cosmetic surgery of their choice even if done free. Only 34.0% consider cosmetic surgery socially acceptable. Although the awareness of health workers about cosmetic surgery is high, their disposition to it is low. There is a need to increase the awareness in order to increase cosmetic surgery practice in Nigeria. PMID:25379562

SUDOQU, a new dose-assessment methodology for radiological surface contamination.

PubMed

van Dillen, Teun; van Dijk, Arjan

2018-06-12

A new methodology has been developed for the assessment of the annual effective dose resulting from removable and fixed radiological surface contamination. It is entitled SUDOQU (SUrface DOse QUantification) and it can for instance be used to derive criteria for surface contamination related to the import of non-food consumer goods, containers and conveyances, e.g., limiting values and operational screening levels. SUDOQU imposes mass (activity)-balance equations based on radioactive decay, removal and deposition processes in indoor and outdoor environments. This leads to time-dependent contamination levels that may be of particular importance in exposure scenarios dealing with one or a few contaminated items only (usually public exposure scenarios, therefore referred to as the 'consumer' model). Exposure scenarios with a continuous flow of freshly contaminated goods also fall within the scope of the methodology (typically occupational exposure scenarios, thus referred to as the 'worker model'). In this paper we describe SUDOQU, its applications, and its current limitations. First, we delineate the contamination issue, present the assumptions and explain the concepts. We describe the relevant removal, transfer, and deposition processes, and derive equations for the time evolution of the radiological surface-, air- and skin-contamination levels. These are then input for the subsequent evaluation of the annual effective dose with possible contributions from external gamma radiation, inhalation, secondary ingestion (indirect, from hand to mouth), skin contamination, direct ingestion and skin-contact exposure. The limiting effective surface dose is introduced for issues involving the conservatism of dose calculations. SUDOQU can be used by radiation-protection scientists/experts and policy makers in the field of e.g. emergency preparedness, trade and transport, exemption and clearance, waste management, and nuclear facilities. Several practical examples are worked out demonstrating the potential applications of the methodology. . Creative Commons Attribution license.

Work-related symptoms and dose-response relationships for personal exposures and pulmonary function among woodworkers.

PubMed

Mandryk, J; Alwis, K U; Hocking, A D

1999-05-01

Four sawmills, a wood chipping mill, and five joineries in New South Wales, Australia, were studied for the effects of personal exposure to wood dust, endotoxins. (1-->3)-beta-D-glucans, Gram-negative bacteria, and fungi on lung function among woodworkers. Personal inhalable and respirable dust sampling was carried out. The lung function tests of workers were conducted before and after a workshift. The mean percentage cross-shift decrease in lung function was markedly high for woodworkers compared with the controls. Dose-response relationships among personal exposures and percentage cross-shift decrease in lung function and percentage predicted lung function were more pronounced among joinery workers compared with sawmill and chip mill workers. Woodworkers had markedly high prevalence of regular cough, phlegm, and chronic bronchitis compared with controls. Significant associations were found between percentage cross-shift decrease in FVC and regular phlegm and blocked nose among sawmill and chip mill workers. Both joinery workers and sawmill and chip mill workers showed significant relationships between percentage predicted lung function (FVC, FEV1, FEV1/FVC, FEF25-75%) and respiratory symptoms. Wood dust and biohazards associated with wood dust are potential health hazards and should be controlled.

[Relationship between shift work and overweight/obesity in male steel workers].

PubMed

Xiao, M Y; Wang, Z Y; Fan, H M; Che, C L; Lu, Y; Cong, L X; Gao, X J; Liu, Y J; Yuan, J X; Li, X M; Hu, B; Chen, Y P

2016-11-10

Objective: To investigate the relationship between shift work and overweight/obesity in male steel workers. Methods: A questionnaire survey was conducted among the male steel workers selected during health examination in Tangshan Steel Company from March 2015 to March 2016. The relationship between shift work and overweight/obesity in the male steel workers were analyzed by using logistic regression model and restricted cubic splinemodel. Results: A total of 7 262 male steel workers were surveyed, the overall prevalence of overweight/obesitywas 64.5% (4 686/7 262), the overweight rate was 34.3% and the obesity rate was 30.2%, respectively. After adjusting for age, educational level and average family income level per month by multivariable logistic regression analysis, shift work was associated with overweight/obesity and obesity in the male steel workers. The OR was 1.19(95% CI : 1.05-1.35) and 1.15(95% CI : 1.00-1.32). Restricted cubic spline model analysis showed that the relationship between shift work years and overweight/obesity in the male steel workers was a nonlinear dose response one (nonlinear test χ 2 =7.43, P <0.05). Restricted cubic spline model analysis showed that the relationship between shift work years and obesity in the male steel workers was a nonlinear dose response one (nonlinear test χ 2 =10.48, P <0.05). Conclusion: Shift work was associated with overweight and obesity in the male steel workers, and shift work years and overweight/obesity had a nonlinear relationship.

KSC-04pd1717

NASA Image and Video Library

2004-09-01

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, a worker wraps equipment in plastic in preparation for the expected impact of Hurricane Frances on Saturday. The various modules in the SSPF, such as the Japanese Experiment Module, U.S. Node 2 and Multi-Purpose Logistics Modules, are being covered as well. KSC workers also have powered down the Space Shuttle orbiters, closed their payload bay doors and stowed the landing gear. They are also taking precautions against flooding by moving spacecraft hardware off the ground and sandbagging facilities. The SSPF can withstand sustained winds of 110 mph and wind gusts up to 132 mph. The Orbiter Processing Facility is constructed of concrete and steel and was designed to withstand winds of 105 mph. The Vehicle Assembly Building is constructed of concrete and steel and was designed to withstand winds of 125 mph. Other payload and flight hardware support facilities can endure winds of 110 mph. Launch pads and the Payload Hazardous Servicing Facility can withstand 125-mph winds.

Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

PubMed

Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

2017-06-19

In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage intervention, especially for ADDO dispensers and health facility staff who previously had no formal communication pathway. The study participants perceptions of success included improved knowledge of case management and relationships among the three levels of care, more timely access to care, increased numbers of patients/customers, more meetings between community health workers and health facility staff, and a decrease in child and maternal mortality. Reported challenges included stock-outs of medicines at the health facility, participating ADDO dispensers who left to work in other regions, documentation of referrals, and lack of treatment available at health facilities on the weekend. The primary issue that threatens the sustainability of the intervention is that local council health management team members, who are responsible for facilitating the linkage, had not made any supervision visits and were therefore unaware of how the program was running. The study highlights the benefits of approaches that link different levels of care providers to improve access to maternal and child health care. To strengthen this collaboration further, health campaign platforms should include retail drug dispensers as a type of community health care provider. To increase linkage sustainability, the council health management team needs to develop feasible supervision plans.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries.

PubMed

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-03-27

To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Cross-sectional observational health facility assessment. Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives. 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/.

Potential third-party radiation exposure from outpatients treated with {sup 131}I for hyperthyroidism

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

Matheoud, Roberta; Reschini, Eugenio; Canzi, Cristina

2004-12-01

Thirty-three hyperthyroid patients treated with radioiodine (mean administered activity 414 MBq, range 163-555) were studied to determine if pretreatment dosimetry could be used to give radiation protection advice that could assure compliance with the effective dose constraints suggested by the European Commission. Effective doses to travelers, co-workers, and sleeping partners were estimated by integrating the effective dose rate-versus-time curve obtained by fitting the dose rates measured several times after radioiodine administration to a biexponential function. The mean estimated effective doses to travelers, co-workers, and sleeping partners were 0.11 mSv (0.05-0.24), 0.24 mSv (0.07-0.52), and 1.8 mSv (0.6-4.1), respectively. The bestmore » correlation was found between effective dose (D) in mSv and maximum activity (AU{sub max}) in MBq taken up in the thyroid: D{sub traveler}=0.0005*(AU{sub max})+0.04 (r=0.88,p<0.01); D{sub co-worker}=0.0013*(AU{sub max})+0.03(r=0.89,p<0.01); D{sub sleepingpartners}=0.0105*(AU{sub max})+0.16 (r=0.93,p<0.01). Private/public transports are always allowed. For the co-workers the effective dose constraint of 0.3 mSv is met without restrictions and with 3 days off work if AU{sub max} is lower or higher than 185 MBq, respectively. For the sleeping partners the effective dose constraint of 3 mSv is met without restriction and with 4 nights separate sleeping arrangements if AU{sub max} is lower or higher than 185 MBq, respectively. The potential for contamination by the patients was determined from perspiration samples taken from the patient's hands, forehead, and neck and in saliva at 4, 24, and 48 h after radioiodine treatment. The mean highest {sup 131}I activity levels for hands, forehead, neck, and saliva were 4.1 Bq/cm{sup 2}, 1.9 Bq/cm{sup 2}, 0.9 Bq/cm{sup 2}, and 796 kBq/g, respectively. The results indicate that there is minimal risk of contamination from these patients.« less

Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria.

PubMed

Campbell, P C; Ebuehi, O M

2011-01-01

Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one' efforts. Several factors affect job satisfaction. To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. A cross sectional comparative study recruited qualified health workers selected by multi stage sampling technique from rural and urban health facilities in four local government areas (LGAs) of Ogun State in Southwestern Nigeria. Data were collected and analysed using Epi info V 3.5.1 RESULTS: The response rates were 88(88%) and 91(91%) respectively in the rural and urban areas. While urban workers derived satisfaction from availability of career development opportunities, materials and equipment, in their current job, rural workers derived satisfaction from community recognition of their work and improved staff relationship. Major de-motivating factors common to both groups were lack of supportive supervision, client-provider relationship and lack of in-service training. However more rural 74(84.1%) than urban 62(68.1%) health workers would prefer to continue working in their present health facilities (p=0.04). There was a statistically significant difference between the two groups in job satisfaction with respect to tools availability and career development opportunities (p<0.05). There is dissimilarity in factors influencing job satisfaction between rural and urban healthcare workers. There is need for human resource policy to be responsive to the diverse needs of health workers particularly at the primary level.

Perceptions, attitudes and challenges about obesity and adopting a healthy lifestyle among health workers in Pietermaritzburg, KwaZulu-Natal province.

PubMed

Simfukwe, Patrick; Van Wyk, Brian; Swart, Charl

2017-06-22

The prevalence of obesity is reported to be high and increasing among health workers, in both high-income and low-income countries, which in turn is a common risk factor for all non-communicable diseases. This is alarming, as health workers not only serve the community's health needs but should also serve as role models for a healthy lifestyle. It is therefore important that obesity among health workers is addressed and prevented. The aim of the study was to explore perceptions and attitudes about obesity among health workers in three selected hospitals in Pietermaritzburg, and to identify the barriers to adopting a healthy lifestyle. An explorative and descriptive qualitative study design was used, utilising in-depth interviews for data collection. A total of 18 health workers from the three selected hospitals in the metropolitan were individually interviewed. Thematic analysis was done, using a priori themes that were derived from the Health Belief Model. All health workers were aware of the negative consequences of being overweight or obese. However, only a few of the participants chose to adopt a healthy lifestyle. Barriers to adopting a healthy lifestyle included institutional as well as attitudinal factors. Public healthcare facilities need to invest in their work force by giving health workers access to physical exercise facilities and affordable healthy food within the hospital. Health organisations should introduce health behaviour change programmes to combat negative established cultural norms among health staff.

Risk analysis for worker exposure to benzene

NASA Astrophysics Data System (ADS)

Hallenbeck, William H.; Flowers, Roxanne E.

1992-05-01

Cancer risk factors (characterized by route, dose, dose rate per kilogram, fraction of lifetime exposed, species, and sex) were derived for workers exposed to benzene via inhalation or ingestion. Exposure at the current Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) and at leaking underground storage tank (LUST) sites were evaluated. At the current PEL of 1 ppm, the theoretical lifetime excess risk of cancer from benzene inhalation is ten per 1000. The theoretical lifetime excess risk for worker inhalation exposure at LUST sites ranged from 10 to 40 per 1000. These results indicate that personal protection should be required. The theoretical lifetime excess risk due to soil ingestion is five to seven orders of magnitude less than the inhalation risks.

Dose response effect of cement dust on respiratory muscles competence in cement mill workers.

PubMed

Meo, Sultan A; Azeem, Muhammad A; Qureshi, Aijaz A; Ghori, G Moinudin; Al-Drees, Abdul Majeed; Feisal Subhan, Mirza Muhammad

2006-12-01

Electromyography (EMG) of respiratory muscles is a reliable method of assessing the ventilatory muscle function, but still its use has not been fully utilized to determine the occupational and environmental hazards on respiratory muscles. Therefore, EMG of intercostal muscles was performed to determine the dose response effect of cement dust on respiratory muscles competence. Matched cross-sectional study of EMG in 50 non-smoking cement mill workers with an age range of 20 - 60 years, who worked without the benefit of cement dust control ventilation or respiratory protective devices. EMG was performed by using surface electrodes and chart recorder. Significant reduction was observed in number of peaks (p < 0.0005), maximum peak amplitude (p < 0.0005), peak-to-peak amplitude (p < 0.0005) and duration of response (p < 0.0005) in cement mill workers compared to their matched control. Cement dust impairs the intercostal muscle competence and stratification of results shows a dose-effect of years of exposure in cement mill.

20 CFR 655.1116 - Element VI-What notification must facilities provide to registered nurses?

Code of Federal Regulations, 2010 CFR

2010-04-01

... provide to registered nurses? 655.1116 Section 655.1116 Employees' Benefits EMPLOYMENT AND TRAINING... Requirements Must a Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1116 Element VI—What notification must facilities provide to registered nurses? (a) The sixth attestation element...

20 CFR 655.1116 - Element VI-What notification must facilities provide to registered nurses?

Code of Federal Regulations, 2011 CFR

2011-04-01

... provide to registered nurses? 655.1116 Section 655.1116 Employees' Benefits EMPLOYMENT AND TRAINING... Requirements Must a Facility Meet to Employ H-1C Nonimmigrant Workers as Registered Nurses? § 655.1116 Element VI—What notification must facilities provide to registered nurses? (a) The sixth attestation element...

75 FR 11916 - Chrysler Transportation LLC, a Subsidiary of Chrysler LLC, Including On-Site Leased Workers from...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

... Chrysler manufacturing facilities, a substantial portion of which are shipped to an affiliated plant where... Caravan Knight Facilities Management LLC were employed on-site at the Detroit, Michigan location of... Knight Facilities Management, LLC, working on-site at the Detroit, Michigan location of Chrysler...

Beryllium disease among construction trade workers at Department of Energy nuclear sites.

PubMed

Welch, Laura S; Ringen, Knut; Dement, John; Bingham, Eula; Quinn, Patricia; Shorter, Janet; Fisher, Miles

2013-10-01

A medical surveillance program was developed to identify current and former construction workers at significant risk for beryllium related disease from work at the DOE nuclear weapons facilities, and to improve surveillance among beryllium exposed workers. Medical examinations included a medical history and a beryllium blood lymphocyte proliferation test (BeLPT). Stratified and multivariate logistic regression analyses were used to explore the risk of disease by age, race, trade, and reported work in buildings where beryllium was used. After adjusting for covariates, the risk of BeS was significantly higher among boilermakers, roofers, and sheet metal workers, as suggested in the stratified analyses. Workers identified as sensitized to beryllium were interviewed to determine whether they had been subsequently diagnosed with chronic beryllium disease. Between 1998 and December 31, 2010 13,810 workers received a BeLPT through the BTMed program; 189 (1.4%) were sensitized to beryllium, and 28 reported that they had had a compensation claim accepted for CBD. These data on former construction workers gives us additional information about the predictive value of the blood BeLPT test for detection of CBD in populations with lower total lifetime exposures and more remote exposures than that experienced by current workers in beryllium machining operations. Through this surveillance program we have identified routes of exposures to beryllium and worked with DOE site personnel to identity and mitigate those exposures which still exist, as well as helping to focus attention on the risk for beryllium exposure among current demolition workers at these facilities. Copyright © 2013 Wiley Periodicals, Inc.

Do Dutch workers seek and find information on occupational safety and health?

PubMed

Rhebergen, Martijn D F; Lenderink, Annet F; van Dijk, Frank J H; Hulshof, Carel T J

2012-03-01

Currently, little is known about workers' occupational safety and health (OSH) information-seeking behavior. We assessed whether Dutch workers have (OSH) questions, what motivates them to seek information or advice to solve these questions, and whether workers actually find the information they are looking for. A random sample of 888 workers from a large business panel were sent an online questionnaire. In total, 535 workers, likely parallel to the Dutch working population, returned the questionnaire (response rate 60%). In the last year, 380 of the 535 respondents (71%) had at least one OSH question. In total, 159 of the 380 respondents (42%) with an OSH question actively searched for information or advice. In a logistic regression analysis, three factors were identified to influence workers' information seeking: cognitions about personal benefits or costs of solving the question (OR = 2.8, 95% CI: 1.8-4.5), emotions that accompany the question (OR = 1.8, 95% CI: 1.1-3.0), and encouragement by the social environment (OR = 1.8, 95% CI: 1.0-3.0). In total, 50% of the respondents seeking information indicated they could not find (all) the information they sought. The barrier most often mentioned (47%) was the poor applicability of the information. Although most workers have OSH questions, only 40% seek information or advice to answer their questions. Moreover, many OSH questions remain unanswered by common information facilities. This study provides input on how to develop campaigns and new facilities that may induce workers to seek information and that offer more applicable information. Copyright © 2011 Wiley Periodicals, Inc.

77 FR 34950 - Decision To Evaluate a Petition To Designate a Class of Employees From the Clarksville Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

...: Clarksville Facility. Location: Clarksville, Tennessee. Job Titles and/or Job Duties: Workers potentially..., Division of Compensation Analysis and Support, National Institute for Occupational Safety and Health, 4676...

76 FR 61746 - Western Digital Technologies, Inc.: Hard Drive Development Engineering Group Irvine (Formerly at...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-05

... worker group at the Lake Forest, California facility. The investigation revealed that the business model... Forest, California facility, the subject firm asserted that the firm's business model calls for the...

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.

20 CFR 655.1101 - What are the responsibilities of the government agencies and the facilities that participate in...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Workers as Registered Nurses? § 655.1101 What are the responsibilities of the government agencies and the.... (b) Facility's attestation responsibilities. Each facility seeking one or more H-1C nurse(s) must, as... admission or for the adjustment or extension of status of H-1C nurses. The facility must attach a copy of...

Evaluation of subjective thermal strain in different kitchen working environments using subjective judgment scales.

PubMed

Haruyama, Yasuo; Muto, Takashi; Matsuzuki, Hiroe; Ito, Akiyoshi; Tomita, Shigeru; Muto, Shigeki; Haratani, Takashi; Seo, Akihiko; Ayabe, Makoto; Katamoto, Shizuo

2010-01-01

To elucidate the subjective thermal strain of workers in kitchen working environments, we performed a cross-sectional study involving 991 workers in 126 kitchen facilities in Japan, using a self-reporting questionnaire survey and subjective judgment scales (SJS). The ambient temperature, mean radiant temperature (MRT), and wet-bulb globe temperature (WBGT) index were measured in 10 kitchen facilities of the 126 kitchens. The association of SJS with the types of kitchen was estimated by multiple logistic regression models. Of the 991 kitchen workers, 809 (81%) responded to the questionnaire survey. Compared with the electric kitchens, the proportion of workers who perceived the room temperature as hot to very hot was significantly higher, and the ambient temperature, MRT, and WBGT were significantly higher in the gas kitchens. Compared with the electric kitchens, workers in gas kitchens had a more than fivefold (males) and tenfold (females) higher SJS adjusted for confounding factors (male odds ratio (OR), 5.13; 95% confidence interval (CI), 1.65-15.9; and female OR, 10.9; 95%CI, 3.89-30.5). Although SJS was affected by some confounding factors, our results suggest that workers in gas kitchens might be exposed to a higher heat strains than those in electric kitchens.

Characterization of the radiation environment for a large-area interim spent-nuclear-fuel storage facility

NASA Astrophysics Data System (ADS)

Fortkamp, Jonathan C.

Current needs in the nuclear industry and movements in the political arena indicate that authorization may soon be given for development of a federal interim storage facility for spent nuclear fuel. The initial stages of the design work have already begun within the Department of Energy and are being reviewed by the Nuclear Regulatory Commission. This dissertation addresses the radiation environment around an interim spent nuclear fuel storage facility. Specifically the dissertation characterizes the radiation dose rates around the facility based on a design basis source term, evaluates the changes in dose due to varying cask spacing configurations, and uses these results to define some applicable health physics principles for the storage facility. Results indicate that dose rates from the facility are due primarily from photons from the spent fuel and Co-60 activation in the fuel assemblies. In the modeled cask system, skyshine was a significant contribution to dose rates at distances from the cask array, but this contribution can be reduced with an alternate cask venting system. With the application of appropriate health physics principles, occupation doses can be easily maintained far below regulatory limits and maintained ALARA.

Observations of infection prevention and control practices in primary health care, Kenya.

PubMed

Bedoya, Guadalupe; Dolinger, Amy; Rogo, Khama; Mwaura, Njeri; Wafula, Francis; Coarasa, Jorge; Goicoechea, Ana; Das, Jishnu

2017-07-01

To assess compliance with infection prevention and control practices in primary health care in Kenya. We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care worker's and facility's characteristics. Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility's characteristics (e.g. public or private, or level of specialization) and the health-care worker's knowledge of, and training in, infection prevention and control practices. The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.

Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.

PubMed

Emerson, C; Lipke, V; Kapata, N; Mwananyambe, N; Mwinga, A; Garekwe, M; Lanje, S; Moshe, Y; Pals, S L; Nakashima, A K; Miller, B

2016-07-01

Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.

Evaluation of Kidney Stones with Reduced-Radiation Dose CT: Progress from 2011-2012 to 2015-2016-Not There Yet.

PubMed

Weisenthal, Karrin; Karthik, Priyadarshini; Shaw, Melissa; Sengupta, Debapriya; Bhargavan-Chatfield, Mythreyi; Burleson, Judy; Mustafa, Adel; Kalra, Mannudeep; Moore, Christopher

2018-02-01

Purpose To determine if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011-2012, to determine variability in radiation exposure according to facility for this indication, and to establish a current average radiation dose for CT evaluation for kidney stones by querying a national dose registry. Materials and Methods This cross-sectional study was exempt from institutional review board approval. Data were obtained from the American College of Radiology dose registry for CT examinations submitted from July 2015 to June 2016. Study descriptors consistent with single-phase unenhanced CT for evaluation of kidney stones and associated RadLex® Playbook identifiers (RPIDs) were retrospectively identified. Facilities actively submitting data on kidney stone-specific CT examinations were included. Dose metrics including volumetric CT dose index, dose-length product, and size-specific dose estimate, when available, were reported, and a random effects model was run to account for clustering of CT examinations at facilities. A z-ratio was calculated to test for a significant difference between the proportion of reduced-radiation dose CT examinations (defined as those with a dose-length product of 200 mGy · cm or less) performed in 2015-2016 and the proportion performed in 2011-2012. Results Three hundred four study descriptors for kidney stone CT corresponding to data from 328 facilities that submitted 105 334 kidney stone CT examinations were identified. Reduced-dose CT examinations accounted for 8040 of 105 334 (7.6%) CT examinations, a 5.6% increase from the 1010 of 49 903 (2%) examinations in 2011-2012 (P < .001). Mean overall dose-length product was 689 mGy · cm (95% confidence interval: 667, 712), decreased from the mean of 746 mGy · cm observed in 2011-2012. Median facility dose-length product varied up to sevenfold, from less than 200 mGy · cm to greater than 1600 mGy · cm. Conclusion Use of reduced-radiation dose CT for evaluation of kidney stones has increased since 2011-2012, but remains low; variability of radiation dose according to facility continues to be wide. National mean CT radiation exposure for evaluation of renal colic during 2015-2016 decreased relative to 2011-2012 values, but remained well above what is reasonably achievable. © RSNA, 2017.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring.

PubMed

Okereke, Ekechi; Tukur, Jamilu; Aminu, Amina; Butera, Jean; Mohammed, Bello; Tanko, Mustapha; Yisa, Ibrahim; Obonyo, Benson; Egboh, Mike

2015-02-15

An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria. Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed. The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services. Stakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

203: THE RELATIONSHIP BETWEEN LEADERSHIP STYLES AND HEALTH WORKER MOTIVATION, TEAMWORK AND JOB SATISFACTION IN HEALTH FACILITIES IN UGANDA

PubMed Central

Musinguzi, Conrad; Rutebemberwa, Elizeus; Namale, Leticia; Dahal, Aruna

2017-01-01

Background and aims Some studies have shown that poor leadership is associated with lack of effective teamwork and a demotivated workforce leading to poor service delivery. There is scanty data in Uganda on how leadership styles relate to service delivery. This study was done to identify the leadership style in health facilities in Uganda and their relationship with health workers' motivation, job satisfaction and teamwork. Methods A cross-sectional study was conducted in eastern, Rwenzori and west Nile regions of Uganda in November 2015 using self-administered questionnaires distributed and picked the same day from 564 health workers in 270 health facilities. These questionnaires collected information on the health workers' perception of leadership styles of their facility in-charges, their level of motivation and job satisfaction; and the level of team work. Factor analysis was used to identify and confirm latent variables for constructs on leadership styles, motivation, job satisfaction and team work. Relationships were assessed using Pearson correlation. Results A total of 368/564 (64.3%) health workers indicated that transformational leadership was frequent or fairly often, while for transactional leadership it was 304/564 (54.4%) and laissez faire, it was 64/564 (11.4%). There was high correlation between transformational leadership with job satisfaction (r=0.31) and team work (r=0.47) and less correlation with motivation (r=0.18). Transactional leadership was highly correlated with teamwork (r=0.45) but low correlation with motivation (r=0.20) and job satisfaction (r=0.25). Laissez was negatively correlated with motivation at (r=−0.0002), job satisfaction (r=−0.21) and team work (r=−0.19). Conclusion Health workers who perceived their leaders to display transformational leadership had a strong likelihood of being satisfied with their jobs and working in teams. However, those who perceived their in-charges as having a laissez faire leadership style were not motivated, not satisfied with their jobs and did not have team work.

Estimation of annual occupational effective doses from external ionizing radiation at medical institutions in Kenya

NASA Astrophysics Data System (ADS)

Korir, Geoffrey; Wambani, Jeska; Korir, Ian

2011-04-01

This study details the distribution and trends of doses due to occupational radiation exposure among radiation workers from participating medical institutions in Kenya, where monthly dose measurements were collected for a period of one year ranging from January to December in 2007. A total of 367 medical radiation workers were monitored using thermoluminescent dosemeters. They included radiologists (27%), oncologists (2%), dentists (4%), Physicists (5%), technologists (45%), nurses (4%), film processor technicians (3%), auxiliary staff (4%), and radiology office staff (5%). The average annual effective dose of all categories of staff was found to range from 1.19 to 2.52 mSv. This study formed the initiation stage of wider, comprehensive and more frequent monitoring of occupational radiation exposures and long-term investigations into its accumulation patterns in our country.

[An investigation of ionizing radiation dose in a manufacturing enterprise of ion-absorbing type rare earth ore].

PubMed

Zhang, W F; Tang, S H; Tan, Q; Liu, Y M

2016-08-20

Objective: To investigate radioactive source term dose monitoring and estimation results in a manufacturing enterprise of ion-absorbing type rare earth ore and the possible ionizing radiation dose received by its workers. Methods: Ionizing radiation monitoring data of the posts in the control area and supervised area of workplace were collected, and the annual average effective dose directly estimated or estimated using formulas was evaluated and analyzed. Results: In the control area and supervised area of the workplace for this rare earth ore, α surface contamination activity had a maximum value of 0.35 Bq/cm 2 and a minimum value of 0.01 Bq/cm 2 ; β radioactive surface contamination activity had a maximum value of 18.8 Bq/cm 2 and a minimum value of 0.22 Bq/cm 2 . In 14 monitoring points in the workplace, the maximum value of the annual average effective dose of occupational exposure was 1.641 mSv/a, which did not exceed the authorized limit for workers (5 mSv/a) , but exceeded the authorized limit for general personnel (0.25 mSv/a) . The radionuclide specific activity of ionic mixed rare earth oxides was determined to be 0.9. Conclusion: The annual average effective dose of occupational exposure in this enterprise does not exceed the authorized limit for workers, but it exceeds the authorized limit for general personnel. We should pay attention to the focus of the radiation process, especially for public works radiation.

Health-hazard evaluation report HETA 90-223-2211, Thomson Consumer Electronics, Marion, Indiana

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

Lenhart, S.W.; Driscoll, R.

1992-05-01

In response to a request from the Corporate Medical Consultant to Thomson Consumer Electronics (SIC-3673), Marion, Indiana, a study was undertaken of an illness outbreak in workers at the facility. There were about 1900 workers at the facility, which produced television picture tubes. Production occurred over three shifts, 6 days a week. Charcoal tube sampling indicated the presence of acetone (67641) n-amyl-acetate (628637), n-butyl-acetate (123864), isoamyl-acetate (123922), toluene (108883), 1,1,1-trichloroethane (71556), and trichloroethylene (79016). No contaminants were detected in the bag samples of air collected from the in/house compressed air system. One or more symptoms were reported by 593 (82%)more » of the workers. Those most commonly reported included headache (68%), sore throat (53%), fatigue (51%), eye irritation (50%), itchy skin (47%), irritated nose (45%), dizziness (45%), unusual taste in mouth (45%), unusual smell (41%) and cough. The authors conclude that symptoms were consistent with stress related health complaints in occupational settings. Concentrations of chemicals measured in the facility would not be expected to produce the effects seen in the outbreak. The authors recommend that trichloroethylene degreasing units be replaced with equipment which uses a less toxic degreasing agent. The facility should hire a full time industrial hygienist.« less

42 CFR 82.2 - What are the basics of dose reconstruction?

Code of Federal Regulations, 2012 CFR

2012-10-01

... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES METHODS FOR CONDUCTING DOSE RECONSTRUCTION UNDER THE... this exposure environment. Then methods are applied to translate exposure to radiation into quantified... workers. A hierarchy of methods is used in a dose reconstruction, depending on the nature of the exposure...

42 CFR 82.2 - What are the basics of dose reconstruction?

Code of Federal Regulations, 2013 CFR

2013-10-01

... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES METHODS FOR CONDUCTING DOSE RECONSTRUCTION UNDER THE... this exposure environment. Then methods are applied to translate exposure to radiation into quantified... workers. A hierarchy of methods is used in a dose reconstruction, depending on the nature of the exposure...

Occupational doses and ALARA - recent developments in Sweden

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

Godas, T.; Viktorsson, C.

1995-03-01

Sweden has traditionally experienced very slow doses to workers in the nuclear industry. However, this trend has since last year been broken mainly due to significant maintenance and repair work. This paper will describe occupational dose trends in Sweden and discuss actions that are being implemented to control this new situation.

Study of the association between exposure to transuranic radionuclides and cancer death

NASA Astrophysics Data System (ADS)

Fallahian, Naz Afarin

An exploratory epidemiological study has been conducted on 319 deceased nuclear workers, who had recorded intakes and histories of employment for at least one year during the time period from 1943 to 1995, at different facilities including the United States Department of Energy (DOE) sites, and thorium and uranium mining and milling plants. These workers voluntarily agreed to donate their organs or whole body to the United States Transuranium and Uranium Registries (USTUR) for scientific research purposes. The majority of this population was involved in documented radiological incidents during their careers. Many were exposed to transuranic radionuclides primarily via inhalation or puncture wounds. The purpose of this study was to find the level of dose that was received by the USTUR registrants following accidents and subsequent to mitigating actions, and to investigate whether or not there is any association between exposure to these transuranic radionuclides and cancer deaths. The external and internal dose assessments were performed using occupational radiation exposure histories and postmortem concentrations of transuranic radionuclides in critical organs, respectively. Statistical data analyses were performed to identify whether or not the USTUR registrants can be categorized as a 'low-dose' population and to investigate the potential correlation between exposure to transuranic radionuclides and causes of death within this population due to cancers of the lungs and liver as well as cancers of all sites, while controlling for the effects of other confounders. Based on the statistical tests performed, the USTUR registrants can be categorized as a low-dose population in terms of their occupational external exposures. However, when considering their total effective dose equivalents from both external penetrating radiation and internal exposure to transuranic radionuclides, they can not be categorized as a low-dose population with a 95% confidence level (alpha = 0.05). No association was found between exposure to transuranic radionuclides and causes of death due to cancer development (alpha = 0.05). However, statistically significant associations were found between the cause of death due to any type of cancer and exposure to benzene or toluene (odds ratio = 5.71; 95% CI: 1.04 to 31.34), as well as smoking habits (odds ratio = 5.41; 95% CI: 1.42 to 20.67), and rate of cigarette smoking (odds ratio = 2.70; 95% CI: 1.37 to 5.30). Lung cancer deaths were found to be related to exposure to chlorinated solvents (odds ratio = 10.85; 95% CI: 1.02 to 115.16), and the duration of exposure to these materials (odds ratio = 1.12; 95% CI: 1.01 to 1.24).

A prospective cohort study of exposure-response relationship for vibration-induced white finger.

PubMed

Bovenzi, M

2010-01-01

To investigate prospectively the relation between vibration-induced white finger (VWF) and measures of cumulative (lifetime) exposure to hand-transmitted vibration (HTV). Two hundred and forty-nine HTV workers and 138 control men of the same companies participated in a 3-year follow-up study. The diagnosis of VWF (Raynaud's phenomenon in the controls) was based on the medical history, the administration of colour charts and the results of a cold test. Tool vibration magnitudes were expressed as root-mean-square (r.m.s.) acceleration, frequency-weighted according to international standard ISO 5349-1 and also unweighted over the frequency range 6.3-1250 Hz. From the vibration magnitudes and exposure durations, alternative measures of cumulative vibration dose were calculated for each HTV worker, according to the expression: dose = Sigmaa(i)(m)t(i), where a(i) is the acceleration magnitude on tool i, t(i) is the lifetime exposure duration (hours) for tool i, and m = 0, 1, 2 or 4. The incidence of VWF varied from 5 to 6% in the HTV workers versus 0 to 1.5% for Raynaud's phenomenon in the controls. After adjusting for potential confounders, measures of cumulative vibration dose derived from total operating hours and high powers of unweighted acceleration (ie, , with m>1) gave better predictions of the occurrence of VWF than dose measures calculated from frequency-weighted acceleration (ie, ). These findings were observed in the entire sample of HTV workers, in those with no VWF at the initial investigation, and in those with normal cold test results at baseline. This prospective cohort study suggests that measures of cumulative vibration doses constructed from unweighted r.m.s. acceleration perform better for the prediction of VWF than dose measures calculated according to the recommendations of current standards. These findings should contribute to the improvement of the ISO frequency weighting for evaluating the severity of hand-transmitted vibration.

In-home HIV testing and nevirapine dosing by traditional birth attendants in rural Zambia: a feasibility study.

PubMed

Brennan, Alana T; Thea, Donald M; Semrau, Katherine; Goggin, Caitlin; Scott, Nancy; Pilingana, Portipher; Botha, Belinda; Mazimba, Arthur; Hamomba, Leoda; Seidenberg, Phil

2014-01-01

Access to lifesaving prevention of mother-to-child transmission (PMTCT) services is problematic in rural Zambia. The simplest intervention used in Zambia has been 2-dose nevirapine (NVP) administration in the peripartum period, a regimen of 1 NVP tablet to the mother at the onset of labor and 1 dose in the form of syrup to the newborn within 4 to 72 hours after birth. This 2-dose regimen has been shown to reduce MTCT by nearly 50%. We set out to demonstrate that in-home HIV testing and NVP dosing by traditional birth attendants (TBAs) is feasible and acceptable by women in rural Zambia. This was a pilot program using TBAs to perform rapid saliva-based HIV testing and administer single-dose NVP in tablet form to the mother at the onset of labor and syrup to the infant after birth. A total of 280 pregnant women were consented and enrolled into the program, of whom 124 (44.3%) gave birth at home with the assistance of a trained TBA. Of those, 16 (12.9%) were known to be HIV positive, and 101 of the remaining 108 (93.5%) accepted a rapid HIV test. All these women tested HIV negative. In the subset of 16 mothers who were HIV positive, 13 (81.3%) took single-dose NVP administered by a TBA between 1 and 24 hours prior to birth and 100% of exposed newborns (16 of 16) received NVP syrup within 72 hours after birth, 80% of whom were dosed in the first 24 hours of life. With the substantial shortage of human resources in public health care throughout sub-Saharan Africa, it is extremely valuable to utilize lay health care workers to help extended services beyond the level of the facility. Given the high uptake of PMTCT services we believe that TBAs with proper training and support can successfully provide country-approved PMTCT. © 2013 by the American College of Nurse-Midwives.

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda

PubMed Central

2013-01-01

Background Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately. PMID:23915376

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda.

PubMed

Buregyeya, Esther; Nuwaha, Fred; Verver, Suzanne; Criel, Bart; Colebunders, Robert; Wanyenze, Rhoda; Kalyango, Joan N; Katamba, Achilles; Mitchell, Ellen Mh

2013-08-01

Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks--governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.

[Uranium exposure and cancer risk: a review of epidemiological studies].

PubMed

Tirmarche, M; Baysson, H; Telle-Lamberton, M

2004-02-01

At the end of 2000, certain diseases including leukemia were reported among soldiers who participated in the Balkan and in the Gulf wars. Depleted uranium used during these conflicts was considered as a possible cause. Its radiotoxicity is close to that of natural uranium. This paper reviews the epidemiological knowledge of uranium, the means of exposure and the associated risk of cancer. The only available epidemiological data concerns nuclear workers exposed to uranium. A review of the international literature is proposed by distinguishing between uranium miners and other workers of the nuclear industry. French studies are described in details. In ionizing radiation epidemiology, contamination by uranium is often cited as a risk factor, but the dose-effect relationship is rarely studied. Retrospective assessment of individual exposure is generally insufficient. Moreover, it is difficult to distinguish between uranium radiotoxicity, its chemical toxicity and the radiotoxicity of its progeny. A causal relation between lung cancer and radon exposure, a gas derived from the decay of uranium, has been demonstrated in epidemiological studies of miners. Among other nuclear workers exposed to uranium, there is a mortality deficit from all causes (healthy worker effect). No cancer site appears systematically in excess compared to the national population; very few studies describe a dose-response relationship. Only studies with a precise reconstruction of doses and sufficient numbers of workers will allow a better assessment of risks associated with uranium exposure at levels encountered in industry or during conflicts using depleted uranium weapons.

Working in a decentralized system: a threat to health workers' respect and survival in Uganda.

PubMed

Kyaddondo, David; Whyte, Susan Reynolds

2003-01-01

This article contributes to the sparse empirical material on the position of health workers within health sector reform. Using qualitative data gathered in 1999, it shows how staff at rural health units in Tororo and Busia Districts experienced the reforms during the first 5 years of decentralization in Uganda. The analysis builds on a framework proposed by Franco et al. to examine the relation between health sector reform and health worker motivation. However, it diverges from their objective description of the factors determining motivation, giving more emphasis to the subjective perspective of the health workers. The categorical distinction between organizational and cultural/community factors was less relevant for them as actors. Two themes cross-cut their lives inside and outside the health facilities: professional identity, which entailed recognition by both the organization and members of the community; and 'survival strategies', which were necessitated by the desire to maintain a status and lifestyle befitting a professional. Reform weakened workers' positions as professionals and hindered facility-based 'survival strategies' that helped them get by on poor salaries. With an overall fall in remuneration, they were more motivated than ever to establish supplementary sources of income outside the formal government health care system.

Applying mathematical modeling to create job rotation schedules for minimizing occupational noise exposure.

PubMed

Tharmmaphornphilas, Wipawee; Green, Benjamin; Carnahan, Brian J; Norman, Bryan A

2003-01-01

This research developed worker schedules by using administrative controls and a computer programming model to reduce the likelihood of worker hearing loss. By rotating the workers through different jobs during the day it was possible to reduce their exposure to hazardous noise levels. Computer simulations were made based on data collected in a real setting. Worker schedules currently used at the site are compared with proposed worker schedules from the computer simulations. For the worker assignment plans found by the computer model, the authors calculate a significant decrease in time-weighted average (TWA) sound level exposure. The maximum daily dose that any worker is exposed to is reduced by 58.8%, and the maximum TWA value for the workers is reduced by 3.8 dB from the current schedule.

Oak Ridge Reservation Environmental Protection Rad Neshaps Radionuclide Inventory Web Database and Rad Neshaps Source and Dose Database

DOE PAGES

Scofield, Patricia A.; Smith, Linda Lenell; Johnson, David N.

2017-07-01

The U.S. Environmental Protection Agency promulgated national emission standards for emissions of radionuclides other than radon from US Department of Energy facilities in Chapter 40 of the Code of Federal Regulations (CFR) 61, Subpart H. This regulatory standard limits the annual effective dose that any member of the public can receive from Department of Energy facilities to 0.1 mSv. As defined in the preamble of the final rule, all of the facilities on the Oak Ridge Reservation, i.e., the Y–12 National Security Complex, Oak Ridge National Laboratory, East Tennessee Technology Park, and any other U.S. Department of Energy operations onmore » Oak Ridge Reservation, combined, must meet the annual dose limit of 0.1 mSv. At Oak Ridge National Laboratory, there are monitored sources and numerous unmonitored sources. To maintain radiological source and inventory information for these unmonitored sources, e.g., laboratory hoods, equipment exhausts, and room exhausts not currently venting to monitored stacks on the Oak Ridge National Laboratory campus, the Environmental Protection Rad NESHAPs Inventory Web Database was developed. This database is updated annually and is used to compile emissions data for the annual Radionuclide National Emission Standards for Hazardous Air Pollutants (Rad NESHAPs) report required by 40 CFR 61.94. It also provides supporting documentation for facility compliance audits. In addition, a Rad NESHAPs source and dose database was developed to import the source and dose summary data from Clean Air Act Assessment Package—1988 computer model files. As a result, this database provides Oak Ridge Reservation and facility-specific source inventory; doses associated with each source and facility; and total doses for the Oak Ridge Reservation dose.« less

Oak Ridge Reservation Environmental Protection Rad Neshaps Radionuclide Inventory Web Database and Rad Neshaps Source and Dose Database.

PubMed

Scofield, Patricia A; Smith, Linda L; Johnson, David N

2017-07-01

The U.S. Environmental Protection Agency promulgated national emission standards for emissions of radionuclides other than radon from US Department of Energy facilities in Chapter 40 of the Code of Federal Regulations (CFR) 61, Subpart H. This regulatory standard limits the annual effective dose that any member of the public can receive from Department of Energy facilities to 0.1 mSv. As defined in the preamble of the final rule, all of the facilities on the Oak Ridge Reservation, i.e., the Y-12 National Security Complex, Oak Ridge National Laboratory, East Tennessee Technology Park, and any other U.S. Department of Energy operations on Oak Ridge Reservation, combined, must meet the annual dose limit of 0.1 mSv. At Oak Ridge National Laboratory, there are monitored sources and numerous unmonitored sources. To maintain radiological source and inventory information for these unmonitored sources, e.g., laboratory hoods, equipment exhausts, and room exhausts not currently venting to monitored stacks on the Oak Ridge National Laboratory campus, the Environmental Protection Rad NESHAPs Inventory Web Database was developed. This database is updated annually and is used to compile emissions data for the annual Radionuclide National Emission Standards for Hazardous Air Pollutants (Rad NESHAPs) report required by 40 CFR 61.94. It also provides supporting documentation for facility compliance audits. In addition, a Rad NESHAPs source and dose database was developed to import the source and dose summary data from Clean Air Act Assessment Package-1988 computer model files. This database provides Oak Ridge Reservation and facility-specific source inventory; doses associated with each source and facility; and total doses for the Oak Ridge Reservation dose.

Oak Ridge Reservation Environmental Protection Rad Neshaps Radionuclide Inventory Web Database and Rad Neshaps Source and Dose Database

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

Scofield, Patricia A.; Smith, Linda Lenell; Johnson, David N.

The U.S. Environmental Protection Agency promulgated national emission standards for emissions of radionuclides other than radon from US Department of Energy facilities in Chapter 40 of the Code of Federal Regulations (CFR) 61, Subpart H. This regulatory standard limits the annual effective dose that any member of the public can receive from Department of Energy facilities to 0.1 mSv. As defined in the preamble of the final rule, all of the facilities on the Oak Ridge Reservation, i.e., the Y–12 National Security Complex, Oak Ridge National Laboratory, East Tennessee Technology Park, and any other U.S. Department of Energy operations onmore » Oak Ridge Reservation, combined, must meet the annual dose limit of 0.1 mSv. At Oak Ridge National Laboratory, there are monitored sources and numerous unmonitored sources. To maintain radiological source and inventory information for these unmonitored sources, e.g., laboratory hoods, equipment exhausts, and room exhausts not currently venting to monitored stacks on the Oak Ridge National Laboratory campus, the Environmental Protection Rad NESHAPs Inventory Web Database was developed. This database is updated annually and is used to compile emissions data for the annual Radionuclide National Emission Standards for Hazardous Air Pollutants (Rad NESHAPs) report required by 40 CFR 61.94. It also provides supporting documentation for facility compliance audits. In addition, a Rad NESHAPs source and dose database was developed to import the source and dose summary data from Clean Air Act Assessment Package—1988 computer model files. As a result, this database provides Oak Ridge Reservation and facility-specific source inventory; doses associated with each source and facility; and total doses for the Oak Ridge Reservation dose.« less

42 CFR 82.13 - What sources of information may be used for dose reconstructions?

Code of Federal Regulations, 2010 CFR

2010-10-01

... OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES METHODS FOR CONDUCTING DOSE RECONSTRUCTION UNDER... from health research on DOE worker populations; (c) Interviews and records provided by claimants; (d...

Pros and cons of using paid feeding assistants in nursing homes.

PubMed

Remsburg, Robin E

2004-01-01

Recently the Centers for Medicare and Medicaid Services (CMS), citing increasing resident acuity, staffing shortages, and high turnover rates that make it difficult for nursing homes to provide adequate feeding assistance to residents who need minimal help at mealtimes, began allowing nursing facilities to use single-task workers to provide assistance during mealtimes. This article describes the use of single-task workers to provide feeding assistance to nutritionally at-risk residents during a 6-month clinical study designed to evaluate the effectiveness and feasibility of implementing a buffet-dining program in an academic long-term care facility.

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility insert the liquid oxygen feedline for the 17-inch disconnect in the orbiter Discovery. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

NASA Image and Video Library

2003-11-11

KENNEDY SPACE CENTER, FLA. - Workers in the Orbiter Processing Facility insert the liquid oxygen feedline for the 17-inch disconnect in the orbiter Discovery. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers install the liquid oxygen feedline for the 17-inch disconnect on orbiter Discovery. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

NASA Image and Video Library

2003-11-11

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers install the liquid oxygen feedline for the 17-inch disconnect on orbiter Discovery. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers raise the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

NASA Image and Video Library

2003-11-11

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers raise the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers lift the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

NASA Image and Video Library

2003-11-11

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers lift the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers move the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

NASA Image and Video Library

2003-11-11

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, workers move the liquid oxygen feedline for the 17-inch disconnect toward orbiter Discovery for installation. The 17-inch liquid oxygen and liquid hydrogen disconnects provide the propellant feed interface from the external tank to the orbiter main propulsion system and the three Shuttle main engines.

[The dose response decrease of lung function associated with the urinary polycyclic aromatic hydrocarbons metabolites in coke oven workers].

PubMed

Hu, Die; Deng, Qi-fei; Huang, Su-li; He, Yun-feng; Guo, Huan; Wu, Tang-chun

2012-12-01

To analyze the relationship between metabolites of polycyclic aromatic hydrocarbons (PAHs) and lung function in coke oven workers, and to provide scientific basis for further exploring the potential mechanism and developing the preventing strategies of the workers' early lung damage. We measured carbon monoxide, sulfur dioxide, benzene soluble matter, particulate matters, and PAHs at different workplaces of a coke oven plant. Detailed information on demography and occupational health condition of 912 workers were collected. We divided these workers into control group and coke oven group according to their workplaces and the different concentrations of COEs in the environment. We detected 10 urinary PAH metabolites and lung function using gas chromatography-mass spectrometry and spirometric tests, respectively. FEV(1.0) (91.12 ± 13.31) and FEV(1.0)/FVC (108.61 ± 20.37) of the coke oven group is significantly lower than the control group (94.16 ± 15.57, 113.45 ± 19.70). In the coke oven group, the hydroxyphenanthrene and 1-hydroxypyrene are negatively correlated with FEV(1.0)/FVC (β = -0.136, β = -0.100), Ptrend < 0.05 for all. The dose response decrease of lung function is associated with the urinary PAH metabolites in coke oven workers. Indicated that the long exposure to PAHs may cause the early lung damage in coke oven workers, phenanthrene and pyrene may be the main factors.

75 FR 34170 - Chrysler Group LLC, Formally Known as Chrysler LLC, Kenosha Engine Plant, Including On-Site...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... automobile engines. The company reports that workers leased from Caravan Knight Facilities Management, LLC..., Formally Known as Chrysler LLC, Kenosha Engine Plant, Including On-Site Leased Workers From Caravan Knight..., Kenosha Engine Plant, Kenosha, Wisconsin. The notice was published in [[Page 34171

Self-Directed Workplace Literacy Distance Learning for Developmental Disabilities Workers. Final Report.

ERIC Educational Resources Information Center

Denny, Verna Haskins

The Self-Directed Workplace Literacy Distance Learning Project demonstrated a model workplace literacy program that helped direct care workers in state-operated developmental disabilities facilities improve their literacy skills for a changing workplace. During the project, 268 New York State Office of Mental Retardation and Developmental…

Food Service Worker.

ERIC Educational Resources Information Center

Barker, Ellen; And Others

This curriculum guide provides instructional materials designed to prepare students for entry-level jobs such as dietetic aide or food service worker in a health care facility. It serves as the basic core of the occupationally sequenced Dietetic Support Personnel Training Program. Five sections and 13 instructional units are included. Each unit of…

KSC-04PD-0554

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. Under a workers watchful eyes in the Orbiter Processing Facility, Center Director Jim Kennedy (right) takes a turn on a screw on Endeavour. Kennedy is taking an opportunity to learn first-hand what workers are doing to enable Return to Flight. Endeavour is in an Orbiter Major Modification period.

Implementing a Reentry Framework at a Correctional Facility: Challenges to the Culture

ERIC Educational Resources Information Center

Rudes, Danielle S.; Lerch, Jennifer; Taxman, Faye S.

2011-01-01

Implementation research is emerging in the field of corrections, but few studies have examined the complexities associated with implementing change among frontline workers embedded in specific organizational cultures. Using a mixed methods approach, the authors examine the challenges faced by correctional workers in a work release correctional…

KSC-04PD-0551

NASA Technical Reports Server (NTRS)

2004-01-01

KENNEDY SPACE CENTER, FLA. Under a workers watchful eyes in the Orbiter Processing Facility, Center Director Jim Kennedy (right) takes a turn on a screw on Endeavour. Kennedy is taking an opportunity to learn first-hand what workers are doing to enable Return to Flight. Endeavour is in an Orbiter Major Modification period.

OSHA to inspect hospitals, medical clinics for use of safer needles. Occupational Safety and Health Administration.

PubMed

1999-11-26

The Occupational Safety and Health Administration (OSHA) has notified compliance officers of its intention to start imposing sanctions against health care facilities that do not use safe-needle devices. OSHA also said that facilities need to conduct yearly audits of their bloodborne pathogen programs, and must integrate new technologies wherever possible to protect their employees from exposure. Facilities affected include hospitals, home health service organizations, employment agencies, independent health care professionals, and independent contractors. About 800,000 hospital workers are accidentally punctured by needles each year. HIV is present in about 2 percent of those cases, but only a small number of workers actually contract the virus. The directive is available on the OSHA web site, and contact information is provided.

Lung, liver and bone cancer mortality after plutonium exposure in beagle dogs and nuclear workers.

PubMed

Wilson, Dulaney A; Mohr, Lawrence C; Frey, G Donald; Lackland, Daniel; Hoel, David G

2010-01-01

The Mayak Production Association (MPA) worker registry has shown evidence of plutonium-induced health effects. Workers were potentially exposed to plutonium nitrate [(239)Pu(NO(3))(4)] and plutonium dioxide ((239)PuO(2)). Studies of plutonium-induced health effects in animal models can complement human studies by providing more specific data than is possible in human observational studies. Lung, liver, and bone cancer mortality rate ratios in the MPA worker cohort were compared to those seen in beagle dogs, and models of the excess relative risk of lung, liver, and bone cancer mortality from the MPA worker cohort were applied to data from life-span studies of beagle dogs. The lung cancer mortality rate ratios in beagle dogs are similar to those seen in the MPA worker cohort. At cumulative doses less than 3 Gy, the liver cancer mortality rate ratios in the MPA worker cohort are statistically similar to those in beagle dogs. Bone cancer mortality only occurred in MPA workers with doses over 10 Gy. In dogs given (239)Pu, the adjusted excess relative risk of lung cancer mortality per Gy was 1.32 (95% CI 0.56-3.22). The liver cancer mortality adjusted excess relative risk per Gy was 55.3 (95% CI 23.0-133.1). The adjusted excess relative risk of bone cancer mortality per Gy(2) was 1,482 (95% CI 566.0-5686). Models of lung cancer mortality based on MPA worker data with additional covariates adequately described the beagle dog data, while the liver and bone cancer models were less successful.

77 FR 34950 - Decision To Evaluate a Petition To Designate a Class of Employees From the Medina Facility in San...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

...: Medina Facility. Location: San Antonio, Texas. Job Titles and/or Job Duties: Workers potentially exposed... Compensation Analysis and Support, National Institute for Occupational Safety and Health, 4676 Columbia Parkway...

42 CFR 3.20 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., health care quality, or health care outcomes; and (A) Which are assembled or developed by a provider for... (includes a group practice), long term care facility, behavior health residential treatment facility..., psychologist, certified social worker, registered dietitian or nutrition professional, physical or occupational...

42 CFR 3.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., health care quality, or health care outcomes; and (A) Which are assembled or developed by a provider for... (includes a group practice), long term care facility, behavior health residential treatment facility..., psychologist, certified social worker, registered dietitian or nutrition professional, physical or occupational...

42 CFR 3.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., health care quality, or health care outcomes; and (A) Which are assembled or developed by a provider for... (includes a group practice), long term care facility, behavior health residential treatment facility..., psychologist, certified social worker, registered dietitian or nutrition professional, physical or occupational...

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

Hard beta and gamma emissions of 124I. Impact on occupational dose in PET/CT.

PubMed

Kemerink, G J; Franssen, R; Visser, M G W; Urbach, C J A; Halders, S G E A; Frantzen, M J; Brans, B; Teule, G J J; Mottaghy, F M

2011-01-01

The hard beta and gamma radiation of 124I can cause high doses to PET/CT workers. In this study we tried to quantify this occupational exposure and to optimize radioprotection. Thin MCP-Ns thermoluminescent dosimeters suitable for measuring beta and gamma radiation were used for extremity dosimetry, active personal dosimeters for whole-body dosimetry. Extremity doses were determined during dispensing of 124I and oral administration of the activity to the patient, the body dose during all phases of the PET/CT procedure. In addition, dose rates of vials and syringes as used in clinical practice were measured. The procedure for dispensing 124I was optimized using newly developed shielding. Skin dose rates up to 100 mSv/min were measured when in contact with the manufacturer's vial containing 370 MBq of 124I. For an unshielded 5 ml syringe the positron skin dose was about seven times the gamma dose. Before optimization of the preparation of 124I, using an already reasonably safe technique, the highest mean skin dose caused by handling 370 MBq was 1.9 mSv (max. 4.4 mSv). After optimization the skin dose was below 0.2 mSv. The highly energetic positrons emitted by 124I can cause high skin doses if radioprotection is poor. Under optimized conditions occupational doses are acceptable. Education of workers is of paramount importance.

Analyses of Radiation and Mesothelioma in the US Transuranium and Uranium Registries

PubMed Central

Fulcher, Keri; Nagarajan, Sumitha; McCord, Stacey; Fallahian, Naz Afarin; Hoffman, Heather J.; Haver, Cary; Tolmachev, Sergei

2013-01-01

Objectives. We examined the relationship between radiation and excess deaths from mesothelioma among deceased nuclear workers who were part of the US Transuranium and Uranium Registries. Methods. We performed univariate analysis with SAS Version 9.1 software. We conducted proportionate mortality ratio (PMR) and proportionate cancer mortality ratio (PCMR) analyses using the National Institute for Occupational Safety and Health Life Table Analysis System with the referent group being all deaths in the United States. Results. We found a PMR of 62.40 (P < .05) and a PCMR of 46.92 (P < .05) for mesothelioma. PMRs for the 4 cumulative external radiation dose quartiles were 61.83, 57.43, 74.46, and 83.31. PCMRs were 36.16, 47.07, 51.35, and 67.73. The PMR and PCMR for trachea, bronchus, and lung cancer were not significantly elevated. Conclusions. The relationship between cumulative external radiation dose and the PMR and PCMR for mesothelioma suggests that external radiation at nuclear facilities is associated with an increased risk of mesothelioma. The lack of a significantly elevated PMR and PCMR for trachea, bronchus, and lung cancer suggests that asbestos did not confound this relationship. PMID:23409888

Epidemiologic Study of One Million U.S. Radiation Workers and Veterans

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

Boice, John D.

The single most important question in radiation epidemiology is determining the level of health risks associated with radiation exposures that occur gradually over time. The study of one million early U.S. radiation workers and veterans has been designed to provide information on risk following chronic exposures by focusing on occupational groups with differing radiation exposure patterns, including intakes of radionuclides. The cost-efficient study builds on the investments made and foundations laid by investigators and government agencies over the past 30-40 years, which have established early worker cohorts that can now provide answers to questions on the lifetime human health risksmore » associated with low-level radiation exposures. Within the overall goal of the epidemiologic study of one million U.S. radiation workers and veterans, this project had a total of nine specific aims which included studies of six populations for multiple endpoints including cancer overall mortality, leukemia and non-cancer mortality. The six populations included: Mound, Ohio, workers exposed to polonium, tritium and plutonium; nuclear power plant workers within the Landauer dosimetry and Nuclear Regulatory Commission data files; industrial radiographers; Mallinckrodt uranium workers; uranium workers who linked with the US Renal Data System; and nuclear weapons test participants. Over 400,000 workers and atomic veterans are included in these populations, with vital status being determined and analyses of all causes of death undertaken. A critical, integral component of the studies has been comprehensive evaluations of dosimetry involving, in many cases, complex dose reconstructions, and assessments of uncertainties. The work has also involved development of state-of-the art statistical approaches and modeling. All nine aims were accomplished successfully, resulting in publication of two NCRP documents, 13 literature papers, numerous Boice Reports in Health Physics News and many presentations of the work at scientific meetings. Furthermore, recommendations have been developed for an approach to integrate epidemiologic observations with radiation biology for risk assessment and biological models of radiation effect. The results of this project, as well as ongoing epidemiology studies of US radiation workers and veterans, are providing much-needed insights into complex issues regarding cancer and non-cancer health risks from low dose irradiation, how to apply a "dose and dose rate effectiveness factor" to scale the risks from the A-bomb survivor data to current occupational and environmental circumstances, and how to evaluate risk following intakes of radioactive substances. In addition to application to radiation workers, the results of the studies can provide guidance as society debates the role of nuclear energy and deals with nuclear waste, threats of terrorist attacks with nuclear/radiological devices, the remarkable increase in medical exposures to CT scans and nuclear imaging, and to NASA as radiation protection for astronauts on long-duration mission beyond low-Earth orbit is planned.« less

Expression of Cyclin d1 protein and CCND1 та PNKP genes in peripheral blood mononuclear cells in clean up worker of Chornobyl accident with different state of immune system.

PubMed

Bazyka, D A; Kubashko, A V; Ilyenko, I M; Belyaev, O A; Pleskach, O J

2015-12-01

to investigate the Cyclin D1+ cells levels changes, associated CCND1 and PNKP genes in peripheral blood mononuclear cells in clean up workers of Chornobyl accident with different state of immune system in depends on the dose irradiation. Relative level of Cyclin D1+cells in peripheral blood mononuclears of 39 clean up workers, men, irradiated in dose range (0,01-2,00) Gy have been analyzed. Immunological status of examinee' subjects was determined by CD3/19, CD4/8, CD3/HLA DR, СD3/16/56 testing using flow cytometry method and Ig A,M,G testing by immunoenzymatic assay in blood. CCND1 та PNKP gene expression, which associated with Cyclin D1 metabolism, was conducted using PCR real time method. The obtained results were compared in relation to data from 18 healthy men, who had no contact with ionizing radiation over then nature background. Аnalyzed data of the nuclear controller of cell cycle - Cyclin D1 protein expression changes and related CCND1 та PNKP genes in peripheral blood mononuclear cells in clean up workers Chornobyl accident with different status of immune system in remote period after exposure is represented. It is shown, that in examinees' subjects exposed in dose > 0,1 Gy percentage of Суclin D1+ cells is elevated against normal range and correlates with dose of radiation (rs = 0,417, p = 0,048). Normal range deflation of relative amount of Cyclin D1+cells connects with changes in cellular and humoral immunity. Decline of relative amount of Cyclin D1+ cells below the control level following CD3+ lymphocytes decrease and CD3 16+56+ elevation in clean up workers exposed in dose < 0,35 Gy. Increase of relative amount of Cyclin D1+ cells above the control range associates with CD3+ fall together with tendency of CD3+16+56+ lymphocytes fall that attends the IgG elevation in examinees' subjects with dose > 0,35 Gy. Percentage of Cyclin D1+ cells correlates with CD3 16+56+ (rs = 0,872, p = 0,049), CD8+ and IgG (rs = 0,683, p = 0,042; rs = 0,809, p = 0,014), CD4+ (rs = 0,602, p = 0,029), CD19+ and IgM (rs = 0,604, p = 0,017; rs = 0,538, p = 0,038) under condition of increased level CD4+, CD19+, Іreg. and IgG accordantly. Reviled decrease the CCND1 and PNKP gene expression in clean up workers exposed in dose > 0,1 Gy following appearance of correlation between (relative quantification) RQ PNKP and irradiation dose (rs = 0,638, p = 0,035) and also with RQ PNKP and percentage of Cyclin D1+ cells (rs = 0,792, p = 0,034).Concusions. Reveled changes in expression of Cyclin D1+ cells and regulation of related genes may point on possi ble radiation associated firm molecular disturbances occurred during elimination of consequences of Chornobyl accident, that could be a potential basis for cell and humoral communicative links breach in immune system result ing in elevation of stochastic effects like oncopathology in clean up workers of Chornobyl accident in remote peri od after exposure. D. A. Bazyka, A. V. Kubashko, I. M. Ilyenko, O. A. Belyaev, O. J. Pleskach.

Risks for heart disease and lung cancer from passive smoking by workers in the catering industry.

PubMed

Hedley, Anthony J; McGhee, Sarah M; Repace, James L; Wong, Lai-Chin; Yu, Marcus Y S; Wong, Tze-Wai; Lam, Tai-Hing

2006-04-01

Workers in the catering industry are at greater risk of exposure to secondhand smoke (SHS) when smoke-free workplace policies are not in force. We determined the exposure of catering workers to SHS in Hong Kong and their risk of death from heart disease and lung cancer. Nonsmoking catering workers were provided with screening at their workplaces and at a central clinic. Participants reported workplace, home, and leisure time exposure to SHS. Urinary cotinine was estimated by enzyme immunoassay. Catering facilities were classified into three types: nonsmoking, partially restricted smoking (with nonsmoking areas), and unrestricted smoking. Mean urinary cotinine levels ranged from 3.3 ng/ml in a control group of 16 university staff through 6.4 ng/ml (nonsmoking), 6.1 ng/ml (partially restricted), and 15.9 ng/ml (unrestricted smoking) in 104 workers who had no exposures outside of work. Workers in nonsmoking facilities had exposures to other smoking staff. We modeled workers' mortality risks using average cotinine levels, estimates of workplace respirable particulates, risk data for cancer and heart disease from cohort studies, and national (US) and regional (Hong Kong) mortality for heart disease and lung cancer. We estimated that deaths in the Hong Kong catering workforce of 200,000 occur at the rate of 150 per year for a 40-year working-lifetime exposure to SHS. When compared with the current outdoor air quality standards for particulates in Hong Kong, 30% of workers exceeded the 24-h and 98% exceeded the annual air quality objectives due to workplace SHS exposures.

Quality of Malaria Case Management in Malawi: Results from a Nationally Representative Health Facility Survey

PubMed Central

Steinhardt, Laura C.; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-01-01

Background Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. Methods In April–May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. Results At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Conclusions Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved. PMID:24586497