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Sample records for criticality accident patient

  1. Criticality accident:

    International Nuclear Information System (INIS)

    Canavese, Susana I.

    2000-01-01

    A criticality accident occurred at 10:35 on September 30, 1999. It occurred in a precipitation tank in a Conversion Test Building at the JCO Tokai Works site in Tokaimura (Tokai Village) in the Ibaraki Prefecture of Japan. STA provisionally rated this accident a 4 on the seven-level, logarithmic International Nuclear Event Scale (INES). The September 30, 1999 criticality accident at the JCO Tokai Works Site in Tokaimura, Japan in described in preliminary, technical detail. Information is based on preliminary presentations to technical groups by Japanese scientists and spokespersons, translations by technical and non-technical persons of technical web postings by various nuclear authorities, and English-language non-technical reports from various news media and nuclear-interest groups. (author)

  2. Criticality accident in Argentina

    International Nuclear Information System (INIS)

    Oliveira, A.R. de.

    1984-01-01

    A recent criticality type accident, ocurred in Argetina, is commented. Considerations about the nature of the facility where this accident took place, its genesis, type of operation carried out on the day of the event, and the medical aspects involved are done. (Author) [pt

  3. Criticality accident alarm system

    International Nuclear Information System (INIS)

    Malenfant, R.E.

    1991-01-01

    The American National Standard ANSI/ANS-8.3-1986, Criticality Accident Alarm System provides guidance for the establishment and maintenance of an alarm system to initiate personnel evacuation in the event of inadvertent criticality. In addition to identifying the physical features of the components of the system, the characteristics of accidents of concern are carefully delineated. Unfortunately, this ANSI Standard has led to considerable confusion in interpretation, and there is evidence that the ''minimum accident of concern'' may not be appropriate. Furthermore, although intended as a guide, the provisions of the standard are being rigorously applied, sometimes with interpretations that are not consistent. Although the standard is clear in the use of absorbed dose in free air of 20 rad, at least one installation has interpreted the requirement to apply to dose in soft tissue. The standard is also clear in specifying the response to both neutrons and gamma rays. An assembly of uranyl fluoride enriched to 5% 235 U was operated to simulate a potential accident. The dose, delivered in a free run excursion 2 m from the surface of the vessel, was greater than 500 rad, without ever exceeding a rate of 20 rad/min, which is the set point for activating an alarm that meets the standard. The presence of an alarm system would not have prevented any of the five major accidents in chemical operations nor is it absolutely certain that the alarms were solely responsible for reducing personnel exposures following the accident. Nevertheless, criticality alarm systems are now the subject of great effort and expense. 13 refs

  4. JCO criticality accident termination operation

    International Nuclear Information System (INIS)

    Kanamori, Masashi

    2001-12-01

    On September 30 at around 10:35 AM, criticality accident occurred at the JCO's conversion building in Tokai-mura. Since criticality accident had not been anticipated, neither devices for termination of criticality accident nor neutron detectors were available. Immediately after the information of the accident, our emergency staff (Japan Nuclear Cycle development institute staff) went to JCO site, to measure the intensity of neutrons and gammas. There were four main tasks, first one was to measure the radiation intensity, second one was to terminate the criticality accident, third one is to alert the residents surrounding the JCO site, fourth one is to evacuate the employees in the site. These tasks were successfully performed until October 1. This paper describes about how these operations were performed by the relevant staffs. (author)

  5. First Responders and Criticality Accidents

    Energy Technology Data Exchange (ETDEWEB)

    Valerie L. Putman; Douglas M. Minnema

    2005-11-01

    Nuclear criticality accident descriptions typically include, but do not focus on, information useful to first responders. We studied these accidents, noting characteristics to help (1) first responders prepare for such an event and (2) emergency drill planners develop appropriate simulations for training. We also provide recommendations to help people prepare for such events in the future.

  6. JCO criticality accident termination operation

    OpenAIRE

    金盛 正至

    2010-01-01

    In 2001, we summarized the circumstances surrounding termination of the JCO criticality accident based on testimony in the Mito District Court on December 17, 2001. JCO was the company for uranium fuels production in Japan. That document was assembled based on actual testimony in the belief that a description of the work involved in termination of the accident would be useful in some way for preventing nuclear disasters in the future. This year is the tenth year of the JCO criticality acciden...

  7. Prevention of criticality accidents

    International Nuclear Information System (INIS)

    Canavese, S.I.

    1982-01-01

    These notes used in the postgraduate course on Radiological Protection and Nuclear Safety discuss macro-and microscopic nuclear constants for fissile materials systems. Critical systems: their definition; criteria to analyze the critical state; determination of the critical size; analysis of practical problems about prevention of criticality. Safety of isolated units and of sets of units. Application of standards. Conception of facilities from the criticality control view point. (author) [es

  8. A review of criticality accidents

    International Nuclear Information System (INIS)

    Stratton, W.R.; Smith, D.R.

    1989-03-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Forty-one accidental power transients are reviewed. In each case where available, enough detail is given to help visualize the physical situation, the cause or causes of the accident, the history and characteristics of the transient, the energy release, and the consequences, if any, to personnel and property. Excursions associated with large power reactors are not included in this study, except that some information on the major accident at the Chernobyl reactor in April 1986 is provided in the Appendix. 67 refs., 21 figs., 2 tabs

  9. JCO criticality accident termination operation

    International Nuclear Information System (INIS)

    Kanamori, Masashi

    2010-07-01

    In 2001, we summarized the circumstances surrounding termination of the JCO criticality accident based on testimony in the Mito District Court on December 17, 2001. JCO was the company for uranium fuels production in Japan. That document was assembled based on actual testimony in the belief that a description of the work involved in termination of the accident would be useful in some way for preventing nuclear disasters in the future. The description focuses on the witness' own behavior, and what he saw and heard, and thus is written from the perspective of action by one individual. This was done simply because it was easier for the witness to write down his memories as he remembers them. Description of the activities of other organizations and people is provided only as necessary, to ensure that consistency in the descriptive approach is not lost. The essentials of this report were rewritten as a third-person objective description in the summary of the report by the Atomic Energy Society of Japan (AESJ). Since then, comments have been received from sources such as former members of the Nuclear Safety Commission (Dr. Kenji Sumita and Dr. Akira Kanagawa), concerned parties from the former Science and Technology Agency, and reports from the JCO Criticality Accident Investigation Committee of the AESJ, and thus this report was rewritten to correct incorrect information, and add material where that was felt to be necessary. This year is the tenth year of the JCO criticality accident. To mark this occasion we have decided to translate the record of what occurred at the accident site into English so that more people can draw lessons from this accident. This report is an English version of JAEA-Technology 2009-073. (author)

  10. Criticality accident in uranium fuel processing plant. Emergency medical care and dose estimation for the severely overexposed patients

    Energy Technology Data Exchange (ETDEWEB)

    Akashi, Makoto; Ishigure, Nobuhito [National Inst. of Radiological Sciences, Chiba (Japan)

    2000-08-01

    A criticality accident occurred in JCO, a plant for nuclear fuel production in 1999 and three workers were exposed to extremely high-level radiation (neutron and {gamma}-ray). This report describes outlines of the clinical courses and the medical cares for the patients of this accident and the emergent medical system for radiation accident in Japan. One (A) of the three workers of JCO had vomiting and diarrhea within several minutes after the accident and another one (B) had also vomiting within one hour after. Based on these evidences, the exposure dose of A and B were estimated to be more than 8 and 4 GyEq, respectively. Generally, acute radiation syndrome (ARS) is assigned into three phases; prodromal phase, critical or manifestation phase and recovery phase or death. In the prodromal phase, anorexia, nausea, vomiting and diarrhea often develop, whereas the second phase is asymptotic. In the third phase, various syndromes including infection, hemorrhage, dehydration shock and neurotic syndromes are apt to occur. It is known that radiation exposure at 1 Gy or more might induce such acute radiation syndromes. Based on the clinical findings of Chernobyl accident, it has been thought that exposure at 0.5 Gy or more causes a lowering of lymphocyte level and a decrease in immunological activities within 48 hours. Lymphocyte count is available as an indicator for the evaluation of exposure dose in early phase, but not in later phase The three workers of JCO underwent chemical analysis of blood components, chromosomal analysis and analysis of blood {sup 24}Na immediately after the arrival at National Institute of Radiological Sciences via National Mito Hospital specified as the third and the second facility for the emergency medical care system in Japan, respectively. (M.N.)

  11. The detection of criticality accidents

    International Nuclear Information System (INIS)

    Prigent, R.; Renard, C.

    It is necessary to shield the personnel from the radiological consequences of a criticality accident. In the past ten years the study programmes have highlighted fresh data which have led to new thinking on the detection philosophy and as a consequence the design of detection equipment. Concurrently, new recommendations have been drawn up by the Safety Criticality Committee. The new detection equipment was developed by the CEA on the basis of the CRAC and SILENE experiments. Its industrialization was entrusted to the Intertechnique Company and the first network installed dates back to 1976. An examination is made of the problem of accident detection, dealing in turn with detection, the characteristics of the equipment and the installation rules. To clarify the various points discussed, a parallel has been drawn between the equipment existing up to 1975 and the new generation developed since then [fr

  12. Recommendations about criticality accident dosimetry

    International Nuclear Information System (INIS)

    1975-07-01

    The aims of criticality accident dosimetry and the characteristics peculiar to a critical burst being defined, the requirements to be fulfilled by a dosimetric system applied to this type of measurements are presented. The devices chosen by the C.E.A. Radiation Survey Divisions, simple and cheap, are described along with the main processes to be carried out in order to evaluate doses after an accident. The apparatus necessary for detector counting and the directions for use are presented in detail, allowing standardization of measurements. A set of linear formula enables to obtain, from these measurements, all required informations about neutron fluences and spectra, along with the suitable components of the dose at the irradiated people locations [fr

  13. Criticality accident of nuclear fuel facility. Think back on JCO criticality accident

    International Nuclear Information System (INIS)

    Naito, Keiji

    2003-09-01

    This book is written in order to understand the fundamental knowledge of criticality safety or criticality accident of nuclear fuel facility by the citizens. It consists of four chapters such as critical conditions and criticality accident of nuclear facility, risk of criticality accident, prevention of criticality accident and a measure at an occurrence of criticality accident. A definition of criticality, control of critical conditions, an aspect of accident, a rate of incident, damage, three sufferers, safety control method of criticality, engineering and administrative control, safety design of criticality, investigation of failure of safety control of JCO criticality accident, safety culture are explained. JCO criticality accident was caused with intention of disregarding regulation. It is important that we recognize the correct risk of criticality accident of nuclear fuel facility and prevent disasters. On the basis of them, we should establish safety culture. (S.Y.)

  14. Character and consequence of nuclear criticality accident

    International Nuclear Information System (INIS)

    Liu Xinhua; Liu Hua; Wu Deqiang; Li Bing

    2001-01-01

    The author describes some concepts, the process and magnitude of energy release and the destruction of the nuclear criticality accident and also describes the radiation consequence of criticality accidents from three aspects: prompt radiation, contamination in working place and release of fission products to the environment. It shows that the effects of radioactivity release from criticality accidents in the nuclear fuel processing plants on the environment and the public is minor, the main danger is from the external exposure of prompt rays. The paper make as have a correct understanding of the nuclear criticality accident and it would be helpful to take appropriate emergency response to potential criticality accident

  15. Cytogenetical dose estimation for 3 severely exposed patients in the JCO criticality accident in Tokai-mura

    International Nuclear Information System (INIS)

    Hayata, Isamu; Kanda, Reiko; Minamihisamatsu, Masako; Furukawa, Akira; Sasaki, Masao S.

    2001-01-01

    A dose estimation by chromosome analysis was performed on the 3 severely exposed patients in the Tokai-mura criticality accident. Drastically reduced lymphocyte counts suggested that the whole-body dose of radiation which they had been exposed to was unprecedentedly high. Because the number of lymphocytes in the white blood cells in two patients was very low, we could not culture and harvest cells by the conventional method. To collect the number of lymphocytes necessary for chromosome preparation, we processed blood samples by a modified method, called the high-yield chromosome preparation method. With this technique, we could culture and harvest cells, and then make air-dried chromosome slides. We applied a new dose-estimation method involving an artificially induced prematurely condensed ring chromosome, the PCC-ring method, to estimate an unusually high dose with a short time. The estimated doses by the PCC-ring method were in fairly good accordance with those by the conventional dicentric and ring chromosome (Dic + R) method. The biologically estimated dose was comparable with that estimated by a physical method. As far as we know, the estimated dose of the most severely exposed patient in the present study is the highest recorded among that chromosome analyses have been able to estimate in humans. (author)

  16. Workplace Accidents and Self-Organized Criticality

    OpenAIRE

    Mauro, John C.; Diehl, Brett; Marcellin, Richard F.; Vaughn, Daniel J.

    2018-01-01

    The occurrence of workplace accidents is described within the context of self-organized criticality, a theory from statistical physics that governs a wide range of phenomena across physics, biology, geosciences, economics, and the social sciences. Workplace accident data from the U.S. Bureau of Labor Statistics reveal a power-law relationship between the number of accidents and their severity as measured by the number of days lost from work. This power-law scaling is indicative of workplace a...

  17. Four years after the JCO criticality accident

    International Nuclear Information System (INIS)

    Sumita, Kenji

    2003-01-01

    It has been about four years since the first criticality accident in Japan. The JCO accident site was not so far from this auditorium. I have been asked to give a short review of important results from the various technical investigations on the accident that have been performed during the past four years. I will also give a short introduction to the changes that have been made in the nuclear safety regulation systems of the Japanese Government. (author)

  18. Dosimetric management during a criticality accident

    International Nuclear Information System (INIS)

    Lebaron-Jacobs, L.; Fottorino, R.; Racine, Y.; Miele, A.; Barbry, F.; Briot, F.; Distinguin, S.; Le Goff, J.P.; Berard, P.; Boisson, P.; Cavadore, D.; Lecoix, G.; Persico, M.H.; Rongier, E.; Challeton-De Vathaire, C.; Medioni, R.; Voisin, P.; Exmelin, L.; Flury-Herard, A.; Gaillard-Lecanu, E.; Lemaire, G.; Gonin, M.; Riasse, C.

    2008-01-01

    A working group from health occupational and clinical biochemistry services on French sites has issued essential data sheets on the guidelines to follow in managing the victims of a criticality accident. Since the priority of the medical management after a criticality accident is to assess the dose and the distribution of dose, some dosimetric investigations have been selected in order to provide a prompt response and to anticipate the final dose reconstruction. Comparison exercises between clinical biochemistry laboratories on French sites were carried out to confirm that each laboratory maintained the required operational methods for hair treatment and the appropriate equipment for 32 P activity in hair and 24 Na activity in blood measurements, and to demonstrate its ability to rapidly provide neutron dose estimates after a criticality accident. As a result, a relation has been assessed to estimate the dose and the distribution of dose according to the neutron spectrum following a criticality accident. (authors)

  19. Lessons learned from early criticality accidents

    International Nuclear Information System (INIS)

    Malenfant, R.E.

    1996-01-01

    Four accidents involving the approach to criticality occurred during the period July, 1945, through May, 1996. These have been described in the format of the OPERATING EXPERIENCE WEEKLY SUMMARY which is distributed by the Office of Nuclear and Facility Safety. Although the lessons learned have been incorporated in standards, codes, and formal procedures during the last fifty years, this is their first presentation in this format. It is particularly appropriate that they be presented in the forum of the Nuclear Criticality Technology Safety Project Workshop closest to the fiftieth anniversary of the last of the four accidents, and that which was most instrumental in demonstrating the need to incorporate lessons learned

  20. A Review of Criticality Accidents 2000 Revision

    Energy Technology Data Exchange (ETDEWEB)

    Thomas P. McLaughlin; Shean P. Monahan; Norman L. Pruvost; Vladimir V. Frolov; Boris G. Ryazanov; Victor I. Sviridov

    2000-05-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report.

  1. A Review of Criticality Accidents 2000 Revision

    International Nuclear Information System (INIS)

    McLaughlin, Thomas P.; Monahan, Shean P.; Pruvost, Norman L.; Frolov, Vladimir V.; Ryazanov, Boris G.; Sviridov, Victor I.

    2000-01-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report

  2. Plant safety review from mass criticality accident

    International Nuclear Information System (INIS)

    Susanto, B.G.

    2000-01-01

    The review has been done to understand the resent status of the plant in facing postulated mass criticality accident. From the design concept of the plant all the components in the system including functional groups have been designed based on favorable mass/geometry safety principle. The criticality safety for each component is guaranteed because all the dimensions relevant to criticality of the components are smaller than dimensions of 'favorable mass/geometry'. The procedures covering all aspects affecting quality including the safety related are developed and adhered to at all times. Staff are indoctrinated periodically in short training session to warn the important of the safety in process of production. The plant is fully equipped with 6 (six) criticality detectors in strategic places to alert employees whenever the postulated mass criticality accident occur. In the event of Nuclear Emergency Preparedness, PT BATAN TEKNOLOGI has also proposed the organization structure how promptly to report the crisis to Nuclear Energy Control Board (BAPETEN) Indonesia. (author)

  3. Criticality accident dosimetry with ESR spectroscopy.

    Science.gov (United States)

    d'Errico, F; Fattibene, P; Onori, S; Pantaloni, M

    1996-01-01

    The suitability of the ESR alanine and sugar detectors for criticality accident dosimetry was experimentally investigated during an intercomparison of dosimetry techniques. Tests were performed irradiating detectors both free-in-air and on-phantom during controlled critcality excursions at the SILENE reactor in Valduc, France. Several grays of absorbed dose were imparted in neutron gamma-ray fields of various relative intensities and spectral distributions. Analysed results confirmed the potential of these systems which can immediately provide an acute dose assessment with an average underestimate of 30%in the various fields. This performance allows for the screening of severely exposed individuals and meets the IAEA recommendations on the early estimate of accident absorbed doses.

  4. A neutron dosemeter for nuclear criticality accidents.

    Science.gov (United States)

    d'Errico, F; Curzio, G; Ciolini, R; Del Gratta, A; Nath, R

    2004-01-01

    A neutron dosemeter which offers instant read-out has been developed for nuclear criticality accidents. The system is based on gels containing emulsions of superheated dichlorodifluoromethane droplets, which vaporise into bubbles upon neutron irradiation. The expansion of these bubbles displaces an equivalent volume of gel into a graduated pipette, providing an immediate measure of the dose. Instant read-out is achieved using an array of transmissive optical sensors which consist of coupled LED emitters and phototransistor receivers. When the gel displaced in the pipette crosses the sensing region of the photomicrosensors, it generates a signal collected on a computer through a dedicated acquisition board. The performance of the device was tested during the 2002 International Accident Dosimetry Intercomparison in Valduc, France. The dosemeter was able to follow the initial dose gradient of a simulated accident, providing accurate values of neutron kerma; however, the emulsion was rapidly depleted of all its drops. A model of the depletion effects was developed and it indicates that an adequate dynamic range of the dose response can be achieved by using emulsions of smaller droplets.

  5. A neutron dosemeter for nuclear criticality accidents

    International Nuclear Information System (INIS)

    D'Errico, F.; Curzio, G.; Ciolini, R.; Del Gratta, A.; Nath, R.

    2004-01-01

    A neutron dosemeter which offers instant read-out has been developed for nuclear criticality accidents. The system is based on gels containing emulsions of superheated dichlorodifluoromethane droplets, which vaporise into bubbles upon neutron irradiation. The expansion of these bubbles displaces an equivalent volume of gel into a graduated pipette, providing an immediate measure of the dose. Instant read-out is achieved using an array of transmissive optical sensors which consist of coupled LED emitters and phototransistor receivers. When the gel displaced in the pipette crosses the sensing region of the photo microsensors, it generates a signal collected on a computer through a dedicated acquisition board. The performance of the device was tested during the 2002 International Accident Dosimetry Intercomparison in Valduc (France)). The dosemeter was able to follow the initial dose gradient of a simulated accident, providing accurate values of neutron kerma; however, the emulsion was rapidly depleted of all its drops. A model of the depletion effects was developed and it indicates that an adequate dynamic range of the dose response can be achieved by using emulsions of smaller droplets. (authors)

  6. Process criticality accident likelihoods, consequences and emergency planning

    International Nuclear Information System (INIS)

    McLaughlin, T.P.

    1992-01-01

    Evaluation of criticality accident risks in the processing of significant quantities of fissile materials is both complex and subjective, largely due to the lack of accident statistics. Thus, complying with national and international standards and regulations which require an evaluation of the net benefit of a criticality accident alarm system, is also subjective. A review of guidance found in the literature on potential accident magnitudes is presented for different material forms and arrangements. Reasoned arguments are also presented concerning accident prevention and accident likelihoods for these material forms and arrangements. (Author)

  7. Brief note and evaluation of acute-radiation syndrome and treatment of a Tokai-mura criticality accident patient

    Energy Technology Data Exchange (ETDEWEB)

    Ishii, Takeshi; Futami, Satoru; Nishida, Masamichi; Suzuki, Toru; Sakamoto, Tetsuya; Suzuki, Norio; Maekawa, Kazuhiko [Tokyo Univ. (Japan). Graduate School of Medicine

    2001-09-01

    Patient A who was exposed to a critical dose of radiation developed skin lesions throughout the body surface, gastrointestinal disorder with massive diarrhea and prominent bleeding, which caused severe loss in body fluids. Gastrointestinal bleeding due to the deteriorated intestinal mucosa was considered to be one of the major causes of death, although infection did not develop, possibly because of SDD and aseptic intensive care, until terminal stages. Patient A ultimately developed respiratory and renal failure in addition to skin exudate and gastrointestinal bleeding, and died of multiple organ failure on the 83rd day after exposure. The extreme unevenness of the dose distribution and the neutron versus {gamma}-ray component made the clinical manifestation very complicated. Initially, the mean absorbed dose was calculated as 16-20 GyEq for Patient A, mainly based on neutron-activated {sup 24}Na in the blood. However, a very recent calculation showed that the absorbed skin dose was highest at the upper-right abdomen reaching 61.8 Gy (27.0 as neutron plus 34.8 Gy as {gamma}-ray). The dorsal side was calculated to have received one eighth of the value of the abdominal side, and much smaller neutron component. His absorbed-dose distribution throughout the body was very inhomogeneous because of the closeness of the standing point to the mixing tank. Despite prolonged survival because of intensive care with massive fluids and blood transfusion, peripheral blood stem-cell transplantation, cultured skin-cell grafts, and the administration of cytokines for marrow, the patient was not saved. Restoration of the bone marrow function, prevention of skin fibrosis, radiation lung damage, and repair of gastrointestinal mucosa, and final recovery of the patient were elusive. Abundant personnel and resources were also a prerequisite to allow for the comprehensive and collective intensive care. A further understanding of the effects of high-dose radiation as well as the basic and

  8. Criticality accident studies and methodology implemented at the CEA

    International Nuclear Information System (INIS)

    Barbry, Francis; Fouillaud, Patrick; Reverdy, Ludovic; Mijuin, Dominique

    2003-01-01

    Based on the studies and results of experimental programs performed since 1967 in the CRAC, then SILENE facilities, the CEA has devised a methodology for criticality accident studies. This methodology integrates all the main focuses of its approach, from criticality accident phenomenology to emergency planning and response, and thus includes aspects such as criticality alarm detector triggering, airborne releases, and irradiation risk assessment. (author)

  9. Improved dose estimates for nuclear criticality accidents

    International Nuclear Information System (INIS)

    Wilkinson, A.D.; Basoglu, B.; Bentley, C.L.; Dunn, M.E.; Plaster, M.J.; Dodds, H.L.; Yamamoto, T.

    1995-01-01

    Slide rules are improved for estimating doses and dose rates resulting from nuclear criticality accidents. The original slide rules were created for highly enriched uranium solutions and metals using hand calculations along with the decades old Way-Wigner radioactive decay relationship and the inverse square law. This work uses state-of-the-art methods and better data to improve the original slide rules and also to extend the slide rule concept to three additional systems; i.e., highly enriched (93.2 wt%) uranium damp (H/ 235 U = 10) powder (U 3 O 8 ) and low-enriched (5 wt%) uranium mixtures (UO 2 F 2 ) with a H/ 235 U ratio of 200 and 500. Although the improved slide rules differ only slightly from the original slide rules, the improved slide rules and also the new slide rules can be used with greater confidence since they are based on more rigorous methods and better nuclear data

  10. Chemical dosimetry system for criticality accidents.

    Science.gov (United States)

    Miljanić, Saveta; Ilijas, Boris

    2004-01-01

    Ruder Bosković Institute (RBI) criticality dosimetry system consists of a chemical dosimetry system for measuring the total (neutron + gamma) dose, and a thermoluminescent (TL) dosimetry system for a separate determination of the gamma ray component. The use of the chemical dosemeter solution chlorobenzene-ethanol-trimethylpentane (CET) is based on the radiolytic formation of hydrochloric acid, which protonates a pH indicator, thymolsulphonphthalein. The high molar absorptivity of its red form at 552 nm is responsible for a high sensitivity of the system: doses in the range 0.2-15 Gy can be measured. The dosemeter has been designed as a glass ampoule filled with the CET solution and inserted into a pen-shaped plastic holder. For dose determinations, a newly constructed optoelectronic reader has been used. The RBI team took part in the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002, with the CET dosimetry system. For gamma ray dose determination TLD-700 TL detectors were used. The results obtained with CET dosemeter show very good agreement with the reference values.

  11. A critical assessment of energy accident studies

    International Nuclear Information System (INIS)

    Felder, Frank A.

    2009-01-01

    A comparison of two studies conducted ten years apart on energy accidents provides important insights into methodological issues and policy implications. Recommendations for further improvements in energy accident studies are developed including accounting for differences between average and incremental accident damages, testing for appropriate levels of aggregation of accidents, making references and databases publicly available, more precisely defining and reporting different types of economic damages, accounting for involuntary and voluntary risks, reporting normalized damages, raising broader public policy and planning implications and updating existing accident databases.

  12. A critical assessment of energy accident studies

    Energy Technology Data Exchange (ETDEWEB)

    Felder, Frank A. [Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, 33 Livingston Avenue, New Brunswick, NJ 08901 (United States)

    2009-12-15

    A comparison of two studies conducted ten years apart on energy accidents provides important insights into methodological issues and policy implications. Recommendations for further improvements in energy accident studies are developed including accounting for differences between average and incremental accident damages, testing for appropriate levels of aggregation of accidents, making references and databases publicly available, more precisely defining and reporting different types of economic damages, accounting for involuntary and voluntary risks, reporting normalized damages, raising broader public policy and planning implications and updating existing accident databases. (author)

  13. Patient treatment in radiation accidents

    International Nuclear Information System (INIS)

    Tanum, G.; Bruland, Oe.S.; Hjelle, D.; Reitan, J.B.

    1999-01-01

    Accidental human injury due to ionizing radiation is rare. Industrial accidents are comparatively the most common. Life saving procedures should always have priority to any concern about radiation injury or contamination. The personal risks for emergency medial personnel is negligible when simple measures are taken. Repeated clinical examinations and blood lymphocyte counts should be performed on all patients with suspected radiation injury to allow a diagnosis. The radiation syndrome develops within days or weeks depending on total radiation dose, dose rate and dose distribution. Damage to the bone marrow and gut are the most important. Local radiation injuries to the hands are common in industrial accidents. The Norwegian Radiation Protection Authority should always be called when a potential ionizing radiation accident takes place within Norway

  14. Process criticality accident likelihoods, consequences, and emergency planning

    Energy Technology Data Exchange (ETDEWEB)

    McLaughlin, T.P.

    1991-01-01

    Evaluation of criticality accident risks in the processing of significant quantities of fissile materials is both complex and subjective, largely due to the lack of accident statistics. Thus, complying with standards such as ISO 7753 which mandates that the need for an alarm system be evaluated, is also subjective. A review of guidance found in the literature on potential accident magnitudes is presented for different material forms and arrangements. Reasoned arguments are also presented concerning accident prevention and accident likelihoods for these material forms and arrangements. 13 refs., 1 fig., 1 tab.

  15. Review of the CRAC and SILENE Criticality Accident Studies

    International Nuclear Information System (INIS)

    Barbry, F.; Fouillaud, P.; Grivot, P.; Reverdy, L.

    2009-01-01

    In 1967, the Commissariat et l'Energie Atomique (French Atomic Energy Agency) performed its first research on criticality accidents for the purpose of limiting their impact on people, the environment, and nuclear facilities themselves. A criticality accident is accompanied by intense neutron and gamma emissions and release of radioactive fission products-gases and aerosols-gene rating risk of irradiation and contamination. This work has supplemented earlier work in criticality safety, which concentrated on critical mass measurements and computations. Understanding of the consequences of criticality accidents was limited. Emergency planning was hampered by lack of data. Information became available from pulsed reactor experiments, but the experiments were restricted to the established reactor configurations. The objectives of research performed at the Valduc criticality laboratory, mainly on aqueous fissile media, using the CRAC and SILENE facilities, by multidisciplinary teams of physicists, dosimetry specialists, and radio-biologists, were to model criticality accident physics, estimate irradiation risks and radioactive releases, detect excursions, and organize emergency response. The results of the Valduc experiments have contributed toward improved understanding of criticality accident phenomenology and better evaluation of the risks associated with such accidents. (authors)

  16. Review of the CRAC and SILENE Criticality Accident Studies

    Energy Technology Data Exchange (ETDEWEB)

    Barbry, F.; Fouillaud, P.; Grivot, P.; Reverdy, L. [CEA Valduc, Serv Rech Neutron and Critcite, 21 - Is-sur-Tille (France)

    2009-02-15

    In 1967, the Commissariat et l'Energie Atomique (French Atomic Energy Agency) performed its first research on criticality accidents for the purpose of limiting their impact on people, the environment, and nuclear facilities themselves. A criticality accident is accompanied by intense neutron and gamma emissions and release of radioactive fission products-gases and aerosols-gene rating risk of irradiation and contamination. This work has supplemented earlier work in criticality safety, which concentrated on critical mass measurements and computations. Understanding of the consequences of criticality accidents was limited. Emergency planning was hampered by lack of data. Information became available from pulsed reactor experiments, but the experiments were restricted to the established reactor configurations. The objectives of research performed at the Valduc criticality laboratory, mainly on aqueous fissile media, using the CRAC and SILENE facilities, by multidisciplinary teams of physicists, dosimetry specialists, and radio-biologists, were to model criticality accident physics, estimate irradiation risks and radioactive releases, detect excursions, and organize emergency response. The results of the Valduc experiments have contributed toward improved understanding of criticality accident phenomenology and better evaluation of the risks associated with such accidents. (authors)

  17. Applicability of simplified methods to evaluate consequences of criticality accident using past accident data

    International Nuclear Information System (INIS)

    Nakajima, Ken

    2003-01-01

    Applicability of four simplified methods to evaluate the consequences of criticality accident was investigated. Fissions in the initial burst and total fissions were evaluated using the simplified methods and those results were compared with the past accident data. The simplified methods give the number of fissions in the initial burst as a function of solution volume; however the accident data did not show such tendency. This would be caused by the lack of accident data for the initial burst with high accuracy. For total fissions, simplified almost reproduced the upper envelope of the accidents. However several accidents, which were beyond the applicable conditions, resulted in the larger total fissions than the evaluations. In particular, the Tokai-mura accident in 1999 gave in the largest total specific fissions, because the activation of cooling system brought the relatively high power for a long time. (author)

  18. Bayesian methods for chromosome dosimetry following a criticality accident

    International Nuclear Information System (INIS)

    Brame, R.S.; Groer, P.G.

    2003-01-01

    Radiation doses received during a criticality accident will be from a combination of fission spectrum neutrons and gamma rays. It is desirable to estimate the total dose, as well as the neutron and gamma doses. Present methods for dose estimation with chromosome aberrations after a criticality accident use point estimates of the neutron to gamma dose ratio obtained from personnel dosemeters and/or accident reconstruction calculations. In this paper a Bayesian approach to dose estimation with chromosome aberrations is developed that allows the uncertainty of the dose ratio to be considered. Posterior probability densities for the total and the neutron and gamma doses were derived. (author)

  19. Detection of criticality accidents. The Intertechnique EDAC II system

    International Nuclear Information System (INIS)

    Prigent, R.

    1991-01-01

    The chief aim of the new generation of EDAC II criticality accidents detection system is to reduce the risks associated to the handling of fissile material by providing a swift and safe warning of the development of any criticality accident. To this function already devolving on the EDAC system of the previous generation, the EDAC II adds the possibility of storing in memory the characteristics of the accident, providing a daily follow-up of the striking events in the system through the print-out of a log book and providing assistance to the operators during the periodical tests. (Author)

  20. Process criticality accident likelihoods, magnitudes and emergency planning. A focus on solution accidents

    International Nuclear Information System (INIS)

    McLaughlin, Thomas P.

    2003-01-01

    This paper presents analyses and applications of data from reactor and critical experiment research on the dynamics of nuclear excursions in solution media. Available criticality accident information is also discussed and shown to provide strong evidence of the overwhelming likelihood of accidents in liquid media over other forms and to support the measured data. These analyses are shown to provide valuable insights into key parameters important to understanding solution excursion dynamics in general and in evaluating practical upper bounds on criticality accident magnitudes. This understanding and these upper bounds are directly applicable to the evaluation of the consequences of postulated criticality accidents. These bounds are also essential in order to comply with national and international consensus standards and regulatory requirements for emergency planning. (author)

  1. Neutron personal dosimetry in criticality accidents

    International Nuclear Information System (INIS)

    Fonseca, E.S. da; Mauricio, C.L.P.

    1996-01-01

    In the present work an innovating method is proposed to estimate the absorbed dose received by individuals irradiated with neutrons in an accident, even in the case that the victim is not using any kind of neutron dosemeter. The method combines direct measurements of 24 Na and 32 P activated in the human body. The calculation method was developed using data taken from previously published papers and experimental measurements. Other irradiations results in different neutron spectra prove the validity of the method here proposed. Using a whole body counter to measure 24 Na activity, it is possible to evaluate neutron absorbed doses in the order of 140 μ Gy of very soft (thermal) spectra. For fast neutron fields, the lower limit for neutron dose detection increases, but the present method continues to be very useful in accidents, with higher neutron doses. (author)

  2. Cognitive systems engineering analysis of the JCO criticality accident

    International Nuclear Information System (INIS)

    Tanabe, Fumiya; Yamaguchi, Yukichi

    2000-01-01

    The JCO Criticality Accident is analyzed with a framework based on cognitive systems engineering. With the framework, analysis is conducted integrally both from the system viewpoint and actors viewpoint. The occupational chemical risk was important as safety constraint for the actors as well as the nuclear risk, which is due to criticality accident, to the public and to actors. The inappropriate actor's mental model of the work system played a critical role and several factors (e.g. poor training and education, lack of information on criticality safety control in the procedures and instructions, and lack of warning signs at workplace) contributed to form and shape the mental model. Based on the analysis, several countermeasures, such as warning signs, information system for supporting actors and improved training and education, are derived to prevent such an accident. (author)

  3. Development of the criticality accident analysis code, AGNES

    International Nuclear Information System (INIS)

    Nakajima, Ken

    1989-01-01

    In the design works for the facilities which handle nuclear fuel, the evaluation of criticality accidents cannot be avoided even if their possibility is as small as negligible. In particular in the system using solution fuel like uranyl nitrate, solution has the property easily becoming dangerous form, and all the past criticality accidents occurred in the case of solution, therefore, the evaluation of criticality accidents becomes the most important item of safety analysis. When a criticality accident occurred in a solution fuel system, due to the generation and movement of radiolysis gas voids, the oscillation of power output and pressure pulses are observed. In order to evaluate the effect of criticality accidents, these output oscillation and pressure pulses must be calculated accurately. For this purpose, the development of the dynamic characteristic code AGNES (Accidentally Generated Nuclear Excursion Simulation code) was carried out. The AGNES is the reactor dynamic characteristic code having two independent void models. Modified energy model and pressure model, and as the benchmark calculation of the AGNES code, the results of the experimental analysis on the CRAC experiment are reported. (K.I.)

  4. Program for rapid dose assessment in criticality accident, RADAPAS

    International Nuclear Information System (INIS)

    Takahashi, Fumiaki

    2006-09-01

    In a criticality accident, a person near fissile material can receive extremely high dose which can cause acute health effect. For such a case, medical treatment should be carried out for the exposed person, according to severity of the exposure. Then, radiation dose should be rapidly assessed soon after an outbreak of an accident. Dose assessment based upon the quantity of induced 24 Na in human body through neutron exposure is expected as one of useful dosimetry techniques in a criticality accident. A dose assessment program, called RADAPAS (RApid Dose Assessment Program from Activated Sodium in Criticality Accidents), was therefore developed to assess rapidly radiation dose to exposed persons from activity of induced 24 Na. RADAPAS consists of two parts; one is a database part and the other is a part for execution of dose calculation. The database contains data compendiums of energy spectra and dose conversion coefficients from specific activity of 24 Na induced in human body, which had been derived in a previous analysis using Monte Carlo calculation code. Information for criticality configuration or characteristics of radiation in the accident field is to be interactively given with interface displays in the dose calculation. RADAPAS can rapidly derive radiation dose to the exposed person from the given information and measured 24 Na specific activity by using the conversion coefficient in database. This report describes data for dose conversions and dose calculation in RADAPAS and explains how to use the program. (author)

  5. Prevention of criticality accidents in a fuel cycle plant

    International Nuclear Information System (INIS)

    Gatti, A.M.; Canavese, S.I.; Capadona, N.M.

    1990-01-01

    This work reports the basic considerations on criticality accidents applied to an uranium dioxide fuel cycle production plant. The different fabrication stages are briefly described, with the identification of the neutronically isolated areas. Once the areas have been defined, an evaluation is made, setting up the control parameters to be used in each of them and their variation ranges; normal operation limitations based on experimental data or validating calculations, applied specifically to 5% enriched uranium, are established. Afterwards, defined parameters deviations are analyzed due to incidental conditions in order to prevent criticality accidents under normal conditions and maintenance operations. (Author) [es

  6. PNNL Results from 2010 CALIBAN Criticality Accident Dosimeter Intercomparison Exercise

    International Nuclear Information System (INIS)

    Hill, Robin L.; Conrady, Matthew M.

    2011-01-01

    This document reports the results of the Hanford personnel nuclear accident dosimeter (PNAD) and fixed nuclear accident dosimeter (FNAD) during a criticality accident dosimeter intercomparison exercise at the CEA Valduc Center on September 20-23, 2010. Pacific Northwest National Laboratory (PNNL) participated in a criticality accident dosimeter intercomparison exercise at the Commissariat a Energie Atomique (CEA) Valduc Center near Dijon, France on September 20-23, 2010. The intercomparison exercise was funded by the U.S. Department of Energy, Nuclear Criticality Safety Program, with Lawrence Livermore National Laboratory as the lead Laboratory. PNNL was one of six invited DOE Laboratory participants. The other participating Laboratories were: Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory (LANL), Savannah River Site (SRS), the Y-12 National Security Complex at Oak Ridge, and Sandia National Laboratory (SNL). The goals of PNNL's participation in the intercomparison exercise were to test and validate the procedures and algorithm currently used for the Hanford personnel nuclear accident dosimeters (PNADs) on the metallic reactor, CALIBAN, to test exposures to PNADs from the side and from behind a phantom, and to test PNADs that were taken from a historical batch of Hanford PNADs that had varying degrees of degradation of the bare indium foil. Similar testing of the PNADs was done on the Valduc SILENE test reactor in 2009 (Hill and Conrady, 2010). The CALIBAN results are reported here.

  7. A second simulated criticality accident dosimetry experiment

    CERN Document Server

    Adams, N

    1973-01-01

    This experiment was undertaken to facilitate training in criticality dose assessment by UKAEA and BNFL establishments with potential criticality hazards. Personal dosemeters, coins, samples of hair, etc. supplied by the seven participating establishments were attached to a man-phantom filled with a solution of sodium nitrate (simulating 'body-sodium'), and exposed to a burst of radiation from the AWRE pulsed reactor VIPER. The neutron and photon doses were each several hundred rads. Participants made two sets of dose assessments. The first, made solely from the evidence of their routine dosemeters the activation of body-sodium and standard monitoring data, simulated the initial dose assessment that would be made before the circumstances of a real incident were established. The second was made when the position and orientation of the phantom relative to the reactor and the shielding (20 cm of copper) between the reactor core and the phantom were disclosed. Neutron and photon dose assessments for comparison wit...

  8. Criticality accident studies and research performed in the Valduc criticality laboratory, France

    International Nuclear Information System (INIS)

    Barbry, F.; Fouillaud, P.

    2001-01-01

    In 1967, the IPSN (Institut de Protection et de Surete Nucleaire - Nuclear Protection and Safety Institute) started studies and research in France on criticality accidents, with the objective of improving knowledge and modelling of accidents in order to limit consequences to the public, the environment and installations. The criticality accident is accompanied by an intense emission of neutronic and gamma radiation and releases of radioactive products in the form of gas and aerosols, generating irradiation and contamination risks. The main objectives of the studies carried out, particularly using the CRAC installation and the SILENE reactor at Valduc (France), were to model the physics of criticality accidents, to estimate the risks of irradiation and radioactive releases, to elaborate an accident detection system and to provide information for intervention plans. This document summarizes the state of knowledge in the various fields mentioned above. The results of experiments carried out in the Valduc criticality laboratory are used internationally as reference data for the qualification of calculation codes and the assessment of the consequences of a criticality accident. The SILENE installation, that reproduces the various conditions encountered during a criticality accident, is also a unique international research tool for studies and training on those matters. (author)

  9. NIRS report of the criticality accident in a uranium conversion test plant in Tokai-mura

    International Nuclear Information System (INIS)

    2001-01-01

    This report is a detailed account of the roles that National Institute of Radiological Sciences (NIRS) played at the criticality accident in the title, which occurred at around 10:35, on Sep. 30, 1999 and resulted in death of two workers after all, and is published to discharge NIRS responsibilities in regards to the accident. The accident caused many residents concern on their health and rumors had both social and economic consequences. The report involves chapters of detailed outline of the accident; demand for acceptance of the victims and communications until the identification of the criticality'' accident; the acceptance and initial treatment; the exposure dose estimation (based on acute symptoms, on physics, on chromosomal analyses and on neutron-activated dental metals, and detailed analyses for dose distribution); decision made for therapeutic strategies; cooperation with the Network Council for Radiation Emergency and with other medical facilities; the urgent import of medicine; treatment and processes (patients, nursing system and radiation injuries); radiation protection in medical facilities; response to nearby residents of the Plant; international response; press release; Uranium Processing Plant Criticality Accident Investigation Committee and the Health Management Committee organized by the Nuclear Safety Commission; handling of information; and radiation emergency medical preparedness at the NIRS (future issues and prospect). The report is hopefully useful in preventing the occurrence of future accidents. (N.I.)

  10. Comparison of the dose evaluation methods for criticality accident

    International Nuclear Information System (INIS)

    Shimizu, Yoshio; Oka, Tsutomu

    2004-01-01

    The improvement of the dose evaluation method for criticality accidents is important to rationalize design of the nuclear fuel cycle facilities. The source spectrums of neutron and gamma ray of a criticality accident depend on the condition of the source, its materials, moderation, density and so on. The comparison of the dose evaluation methods for a criticality accident is made. Some methods, which are combination of criticality calculation and shielding calculation, are proposed. Prompt neutron and gamma ray doses from nuclear criticality of some uranium systems have been evaluated as the Nuclear Criticality Slide Rule. The uranium metal source (unmoderated system) and the uranyl nitrate solution source (moderated system) in the rule are evaluated by some calculation methods, which are combinations of code and cross section library, as follows: (a) SAS1X (ENDF/B-IV), (b) MCNP4C (ENDF/B-VI)-ANISN (DLC23E or JSD120), (c) MCNP4C-MCNP4C (ENDF/B-VI). They have consisted of criticality calculation and shielding calculation. These calculation methods are compared about the tissue absorbed dose and the spectrums at 2 m from the source. (author)

  11. Recalibration of indium foil for personnel screening in criticality accidents.

    Science.gov (United States)

    Takada, C; Tsujimura, N; Mikami, S

    2011-03-01

    At the Nuclear Fuel Cycle Engineering Laboratories of the Japan Atomic Energy Agency (JAEA), small pieces of indium foil incorporated into personal dosemeters have been used for personnel screening in criticality accidents. Irradiation tests of the badges were performed using the SILENE reactor to verify the calibration of the indium activation that had been made in the 1980s and to recalibrate them for simulated criticalities that would be the most likely to occur in the solution process line. In addition, Monte Carlo calculations of the indium activation using the badge model were also made to complement the spectral dependence. The results lead to a screening level of 15 kcpm being determined that corresponds to a total dose of 0.25 Gy, which is also applicable in posterior-anterior exposure. The recalibration based on the latest study will provide a sounder basis for the screening procedure in the event of a criticality accident.

  12. Modeling of criticality accidents and their environmental consequences

    International Nuclear Information System (INIS)

    Thomas, W.; Gmal, B.

    1987-01-01

    In the Federal Republic of Germany, potential radiological consequences of accidental nuclear criticality have to be evaluated in the licensing procedure for fuel cycle facilities. A prerequisite to this evaluation is to establish conceivable accident scenarios. First, possibilities for a criticality exceeding the generally applied double contingency principle of safety are identified by screening the equipment and operation of the facility. Identification of undetected accumulations of fissile material or incorrect transfer of fissile solution to unfavorable geometry normally are most important. Second, relevant and credible scenarios causing the most severe consequences are derived from these possibilities. For the identified relevant scenarios, time-dependent fission rates and reasonable numbers for peak power and total fissions must be determined. Experience from real accidents and experiments (KEWB, SPERT, CRAC, SILENE) has been evaluated using empirical formulas. To model the time-dependent behavior of criticality excursions in fissile solutions, a computer program FELIX has been developed

  13. ANS-8.23: Criticality accident emergency planning and response

    International Nuclear Information System (INIS)

    Pruvost, N.L.

    1991-01-01

    A study group has been formed under the auspices of ANS-8 to examine the need for a standard on nuclear criticality accident emergency planning and response. This standard would be ANS-8.23. ANSI/ANS-8.19-1984, Administrative Practices for Nuclear Criticality Safety, provides some guidance on the subject in Section 10 titled -- Planned Response to Nuclear Criticality Accidents. However, the study group has formed a consensus that Section 10 is inadequate in that technical guidance in addition to administrative guidance is needed. The group believes that a new standard which specifically addresses emergency planning and response to a perceived criticality accident is needed. Plans for underway to request the study group be designated a writing group to create a draft of such a new standard. The proposed standard will divide responsibility between management and technical staff. Generally, management will be charged with providing the necessary elements of emergency planning such as a criticality detection and alarm system, training, safe evacuation routes and assembly areas, a system for timely accountability of personnel, and an effective emergency response organization. The technical staff, on the other hand, will be made responsible for establishing specific items such as safe and clearly posted evacuation evacuation routes and dose criteria for personnel assembly areas. The key to the question of responsibilities is that management must provide the resources for the technical staff to establish the elements of an emergency response effort

  14. Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

    Science.gov (United States)

    Dasgupta, Sugata; Singh, Shipti Shradha; Chaudhuri, Arunima; Bhattacharya, Dipasri; Choudhury, Sourav Das

    2016-01-01

    Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs. PMID:27076709

  15. Simple estimate of fission rate during JCO criticality accident

    Energy Technology Data Exchange (ETDEWEB)

    Oyamatsu, Kazuhiro [Faculty of Studies on Contemporary Society, Aichi Shukutoku Univ., Nagakute, Aichi (Japan)

    2000-03-01

    The fission rate during JCO criticality accident is estimated from fission-product (FP) radioactivities in a uranium solution sample taken from the preparation basin 20 days after the accident. The FP radioactivity data are taken from a report by JAERI released in the Accident Investigation Committee. The total fission number is found quite dependent on the FP radioactivities and estimated to be about 4x10{sup 16} per liter, or 2x10{sup 18} per 16 kgU (assuming uranium concentration 278.9 g/liter). On the contrary, the time dependence of the fission rate is rather insensitive to the FP radioactivities. Hence, it is difficult to determine the fission number in the initial burst from the radioactivity data. (author)

  16. Simple estimate of fission rate during JCO criticality accident

    International Nuclear Information System (INIS)

    Oyamatsu, Kazuhiro

    2000-01-01

    The fission rate during JCO criticality accident is estimated from fission-product (FP) radioactivities in a uranium solution sample taken from the preparation basin 20 days after the accident. The FP radioactivity data are taken from a report by JAERI released in the Accident Investigation Committee. The total fission number is found quite dependent on the FP radioactivities and estimated to be about 4x10 16 per liter, or 2x10 18 per 16 kgU (assuming uranium concentration 278.9 g/liter). On the contrary, the time dependence of the fission rate is rather insensitive to the FP radioactivities. Hence, it is difficult to determine the fission number in the initial burst from the radioactivity data. (author)

  17. CARNAC, Neutron Flux and Neutron Spectra in Criticality Accident

    International Nuclear Information System (INIS)

    Bessis, J.

    1976-01-01

    Nature of physical problem solved: Calculation of flux and neutron spectra in the case of a criticality accident. The method is unsophisticated but fast. The program is divided into two parts: (1) The code CRITIC is based on the Fermi age equation and evaluates the neutron number per fission emitted from a moderate critical system and its energy spectrum. (2) The code NARCISSE uses concrete current albedo, evaluates the product of neutron reflection on walls of the source containment and calculates the resulting flux at any point, and its energy distribution into 21 groups. The results obtained seem satisfactory, if compared with a Monte Carlo program

  18. JCO criticality accident as POST-LOCA: Poor structure induced loss of organizational control accident

    International Nuclear Information System (INIS)

    Furuhama, Yutaka

    2000-01-01

    Some problems in operation and business management of JCO (Japan Nuclear Fuel Conversion Co.) have been studied as background factors of the criticality accident. Open information about business conditions of JCO suggests that the cause of the accident is not so simple as to be attributed only to economic pressure, but includes immanent problems in JCO. We investigate the problems from five viewpoints, organization of safety management, system of operation management, activities for business improvement, risk awareness, and restructuring of business, and discuss the effects and causality of background factors as well as remedies for them. (author)

  19. Measurement of the Portsmouth Gaseous Diffusion Plant criticality accident alarm

    International Nuclear Information System (INIS)

    Tayloe, R.W. Jr.; D'Aquila, D.M.; McGinnis, R.B.

    1991-01-01

    The nuclear criticality accident radiation alarm system installed at the Portsmouth Gaseous Diffusion Plant was tested extensively at critical facilities located at the Los Alamos National Laboratory. The ability of the neutron scintillator radiation detection units to respond to a minimum accident of concern as defined in Standard ANSI/ANS-83.-1986 was demonstrated. Detector placement and the established trip point are based on shielding calculations performed by the Oak Ridge National Laboratory and criticality specialists at the Portsmouth plant. Based on these experiments and calculations, a detector trip point of 5 mrad/h in air is used. Any credible criticality accident is expected to produce neutron radiation fields >5 mrad/h in air at one or more radiation alarm locations. Each radiation alarm location has a cluster of three detectors that employs a two-out-of-three alarm logic. Earlier work focused on testing the alarm logic latching circuitry. This work was directed toward measurements involving the actual audible alarm signal delivered

  20. Development of INCTAC code for analyzing criticality accident phenomena

    International Nuclear Information System (INIS)

    Mitake, Susumu; Hayashi, Yamato; Sakurai, Shungo

    2003-01-01

    Aiming at understanding nuclear transients and thermal- and hydraulic-phenomena of the criticality accident, a code named INCTAC has been newly developed at the Institute of Nuclear Safety. The code is applicable to the analysis of criticality accident transients of aqueous homogenous fuel solution system. Neutronic transient model is composed of equations for the kinetics and for the spatial distributions, which are deduced from the time dependent multi-group transport equations with the quasi steady state assumption. Thermal-hydraulic transient model is composed of a complete set of the mass, momentum and energy equations together with the two-phase flow assumptions. Validation tests of INCTAC were made using the data obtained at TRACY, a transient experiment criticality facility of JAERI. The calculated results with INCTAC showed a very good agreement with the experiment data, except a slight discrepancy of the time when the peak of reactor power was attained. But, the discrepancy was resolved with the use of an adequate model for movement and transfer of the void in the fuel solution mostly generated by radiolysis. With a simulation model for the transport of radioactive materials through ventilation systems to the environment, INCTAC will be used as an overall safety evaluation code of the criticality accident. (author)

  1. Triage and medical management of criticality accident victims

    International Nuclear Information System (INIS)

    Lebaron-Jacobs, L.; Flury-Herard, A.; Cavadore, D.

    2002-01-01

    The criticality accident is the result of an uncontrolled chain fission reaction initiated when the quantities of nuclear materials (uranium or plutonium)present accidentally exceed a given limit called the c ritical mass . As soon as the critical state is exceeded, the chain reaction increases exponentially. The result is a fast increase in the number of fission events which occur within the fissile medium. This phenomenon results in a release of energy mainly in the form of heat, accompanied by the intense emission of neutron and gamma radiation and the release of fission gases (Barby, 1983)

  2. Locations of criticality alarms and nuclear accident dosimeters at Hanford

    International Nuclear Information System (INIS)

    1992-08-01

    Hanford facilities that contain fissionable materials capable of achieving critical mass are monitored with nuclear accident dosimeters (NADS) in compliance with the requirements of DOE Order 5480.11, Chapter XI, Section 4.c. (DOE 1988). The US Department of Energy (DOE) Richland Field Office (RL) has assigned the responsibility for maintaining and evaluating the Hanford NAD system to the Instrumentation and External Dosimetry (I ampersand ED) Section of Pacific Northwest Laboratory's (PNL's) Health Physics Department. This manual provides a description of the Hanford NAD, criteria and instructions for proper NAD placement, and the locations of these dosimeters onsite

  3. A Review of Accident Modelling Approaches for Complex Critical Sociotechnical Systems

    National Research Council Canada - National Science Library

    Qureshi, Zahid H

    2008-01-01

    .... This report provides a review of key traditional accident modelling approaches and their limitations, and describes new system-theoretic approaches to the modelling and analysis of accidents in safety-critical systems...

  4. Measurement of the Portsmouth Gaseous Diffusion Plant criticality accident alarm

    International Nuclear Information System (INIS)

    Tayloe, R.W. Jr.; McGinnis, B.

    1990-01-01

    Measurements of the Portsmouth Gaseous Diffusion Plant's nuclear criticality accident radiation alarm signal response time, sound wave frequency, and sound volume levels were made to demonstrate compliance with ANSI/ANS-8.3-1986. A steady-state alarm signal is produced within one-half second of obtaining a two-out-of-three detector trip. The fundamental alarm sound wave frequency is 440 hertz. The sound volume levels are greater than 10 decibels above background and ranged from 100 to 125 A-weighted decibels. The requirements of the standard were met; however the recommended maximum sound volume level of 115 dBA was exceeded. Emergency procedures require immediate evacuation upon initiation of a facility's radiation alarm. Comparison with standards for allowable time of exposure at different noise levels indicate that the elevated noise level at this location does not represent an occupational injury hazard. 8 refs., 5 figs

  5. Updated tool for nuclear criticality accident emergency response

    International Nuclear Information System (INIS)

    Broadhead, B.L.; Hopper, C.M.

    1995-01-01

    Some 20 yr ago a hand-held slide rule was developed at the Oak Ridge Y-12 Plant to aid in the response to several postulated nuclear criticality accidents. These assumed accidents involved highly enriched uranium in either a bare metal or a uranyl nitrate system. The slide rule consisted of a sliding scale based on the total fission yield and four corresponding dose indicators: (1) a prompt radiation dose relationship as a function of distance; (2) a delayed fission product gamma dose rate relationship as a function of time and distance; (3) the total dose relationship with time and distance; and (4) the I-min integrated dose relationship with time and distance. The original slide rule was generated assuming very simplistic numerical procedures such as the inverse-square relationship of dose with distance and the Way-Wigner relationship to express the time dependence of the dose. The simple prescriptions were tied to actual dose measurements from similar systems to yield a meaningful, yet simple approach to emergency planning and response needs. This paper describes the application of an advanced procedure to the updating of the original slide rule for five critical systems. These five systems include (a) an unreflected sphere of 93.2 wt% enriched uranium metal, (b) an unreflected sphere of 93.2 wt% enriched uranyl nitrate solution with a H/ 235 U ratio of 500, (c) an unreflected sphere of damp 93.2 wt% enriched uranium oxide with a H/ 235 U ratio of 10, (d) an unreflected sphere of 4.95 wt% enriched uranyl fluoride solution having a H/ 235 U ratio of 410, and (e) an unreflected sphere of damp 5 wt% enriched uranium dioxide having a H/ 235 U ratio of 200

  6. Update of the Nuclear Criticality Slide Rule for the Emergency Response to a Nuclear Criticality Accident

    Science.gov (United States)

    Duluc, Matthieu; Bardelay, Aurélie; Celik, Cihangir; Heinrichs, Dave; Hopper, Calvin; Jones, Richard; Kim, Soon; Miller, Thomas; Troisne, Marc; Wilson, Chris

    2017-09-01

    AWE (UK), IRSN (France), LLNL (USA) and ORNL (USA) began a long term collaboration effort in 2015 to update the nuclear criticality Slide Rule for the emergency response to a nuclear criticality accident. This document, published almost 20 years ago, gives order of magnitude estimates of key parameters, such as number of fissions and doses (neutron and gamma), useful for emergency response teams and public authorities. This paper will present, firstly the motivation and the long term objectives for this update, then the overview of the initial configurations for updated calculations and preliminary results obtained with modern 3D codes.

  7. Update of the Nuclear Criticality Slide Rule for the Emergency Response to a Nuclear Criticality Accident

    Directory of Open Access Journals (Sweden)

    Duluc Matthieu

    2017-01-01

    Full Text Available AWE (UK, IRSN (France, LLNL (USA and ORNL (USA began a long term collaboration effort in 2015 to update the nuclear criticality Slide Rule for the emergency response to a nuclear criticality accident. This document, published almost 20 years ago, gives order of magnitude estimates of key parameters, such as number of fissions and doses (neutron and gamma, useful for emergency response teams and public authorities. This paper will present, firstly the motivation and the long term objectives for this update, then the overview of the initial configurations for updated calculations and preliminary results obtained with modern 3D codes.

  8. Biological dosimetry following exposure to neutrons in a criticality accident

    Energy Technology Data Exchange (ETDEWEB)

    Lindholm, C. (Radiation and Nuclear Safety Authority, STUK (Finland)); Wojcik, A. (Stockholm Univ. (SU), Stockholm (Sweden)); Jaworska, A. (Norwegian Radiation Protection Authority (NRPA) (Norway))

    2011-01-15

    The aim of the BIONCA project was to implement cytogenetic techniques for biodosimetry purposes in the Nordic countries. The previous NKS-funded biodosimetry activities (BIODOS and BIOPEX) concentrated on experiments using gamma-irradiation and on developing the PCC ring assay for biodosimetry. Experiments conducted during the present BIONCA project has broadened the biodosimetry capacity of the Nordic countries to include dose estimation of exposure to neutrons for both PCC ring and dicentric chromosome techniques. In 2009, experiments were conducted for establishing both PCC ring and dicentric dose calibration curves. Neutron irradiation of human whole blood obtained from two volunteers was conducted in the Netherlands at the Petten reactor. Cell cultures and analysis of whole blood exposed to eight doses between 0 and 10 Gy were performed for both techniques. For the dicentric assay, excellent uniformity in dose calibration for data from both SU and STUK was observed. For PCC rings, the SU and STUK curves were not equally congruent, probably due to the less uniform scoring criteria. However, both curves displayed strong linearity throughout the dose range. In 2010, an exercise was conducted to simulate a criticality accident and to test the validity of the established dose calibration curves. For accident simulation, 16 blood samples were irradiated in Norway at the Kjeller reactor and analysed for dose estimation with both assays. The results showed that, despite a different com-position of the radiation beams in Petten and Kjeller, good dose estimates were obtained. The activity has provided good experience on collaboration required in radiation emergency situations where the biodosimetry capacity and resources of one laboratory may be inadequate. In this respect, the project has strengthened the informal network between the Nordic countries: STUK, the Finnish Radiation and Nuclear Safety Authority, NRPA, the Norwegian Radiation Protection Authority and SU

  9. Review and compilation of criticality accidents in nuclear fuel processing facilities outside of Japan

    International Nuclear Information System (INIS)

    Watanabe, Norio; Tamaki, Hitoshi

    2000-04-01

    On September 30, 1999, a criticality accident occurred at the Tokai-mura uranium processing plant operated by JCO Co., Ltd., which resulted in the first nuclear accident involving a fatality, in Japan, and forced the residents in the vicinity of the site to be evacuated and be sheltered indoors. There have now been 21 criticality accidents reported in nuclear fuel processing facilities in foreign countries: seven in the United States, one in the United Kingdom and thirteen in Russia. Most of them occurred during the period from mid-1950's to mid-1960's, but one criticality accident tool place in Russian in 1997. This report reviews and compiles the published information on these accidents, including the latest information, focusing on the event sequence, the consequence of accident, and the cause of accident. The observations from the reviews are summarized as follows: Twenty of the 21 accidents occurred with the fissile material in a liquid. Twenty of the 21 accidents occurred in vessels/tanks with unfavorable geometry but one occurred in the vessel with favorable geometry. There were seven fatalities that were involved in five accidents. Three accidents involved a re-criticality condition caused by inadequate operator actions and two of them led to the death of the operators. One accident reached a re-criticality condition several hours after the first excursion was terminated by injecting borated water into the affected vessel. This accident implies the possibility that the borated water injection might not be effective to the criticality termination due to solubility of boric acid. Mechanisms of the criticality termination vary as follows: ejection or splashing of the solution at the time of power excursion, boiling or evaporation, addition of neutron poisons, or manual draining of solutions. (author)

  10. Review and compilation of criticality accidents in nuclear fuel processing facilities outside of Japan

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Norio [Planning and Analysis Division, Nuclear Safety Research Center, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan); Tamaki, Hitoshi [Department of Safety Research Technical Support, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan)

    2000-04-01

    On September 30, 1999, a criticality accident occurred at the Tokai-mura uranium processing plant operated by JCO Co., Ltd., which resulted in the first nuclear accident involving a fatality, in Japan, and forced the residents in the vicinity of the site to be evacuated and be sheltered indoors. There have now been 21 criticality accidents reported in nuclear fuel processing facilities in foreign countries: seven in the United States, one in the United Kingdom and thirteen in Russia. Most of them occurred during the period from mid-1950's to mid-1960's, but one criticality accident tool place in Russian in 1997. This report reviews and compiles the published information on these accidents, including the latest information, focusing on the event sequence, the consequence of accident, and the cause of accident. The observations from the reviews are summarized as follows: Twenty of the 21 accidents occurred with the fissile material in a liquid. Twenty of the 21 accidents occurred in vessels/tanks with unfavorable geometry but one occurred in the vessel with favorable geometry. There were seven fatalities that were involved in five accidents. Three accidents involved a re-criticality condition caused by inadequate operator actions and two of them led to the death of the operators. One accident reached a re-criticality condition several hours after the first excursion was terminated by injecting borated water into the affected vessel. This accident implies the possibility that the borated water injection might not be effective to the criticality termination due to solubility of boric acid. Mechanisms of the criticality termination vary as follows: ejection or splashing of the solution at the time of power excursion, boiling or evaporation, addition of neutron poisons, or manual draining of solutions. (author)

  11. A criticism of ANSI/ANS-8.3-1986: Criticality accident alarm system

    International Nuclear Information System (INIS)

    Malenfant, R.E.

    1991-01-01

    The American National Standard on criticality accident alarm systems has given rise to confusion in interpretation and implementation of the requirements. In addition, some of the standards have recently been incorporated into US Department of Energy (DOE) orders, and others have been paraphrased in the DOE orders. Some of the DOE orders referencing these standards are being incorporated into law by means of the Code of Federal Regulations. As such, the intent of the authors of the standards to recommend a code of good practice is now being codified into law with attendant civil and criminal penalties for failure to comply. It is suggested that ANSI/ANS-8.3-1986, Critically Accident Alarm System, be carefully reviewed to alleviate the confusion that has been experienced in practice, to clarify the minimum accident of concern, to further define the dose (or dose rate) criteria for activation, and to stress the fact that a prime consideration in any safety system is the overall reduction of risk

  12. Fuel solution criticality accident studies with the SILENE reactor: phenomenology, consequences and simulated intervention

    International Nuclear Information System (INIS)

    Barbry, F.

    1984-01-01

    After defining the content and the objectives of criticality accident studies, the SILENE reactor, a means of studying fuel solution criticality accidents, is presented. Information obtained from the CRAC and SILENE experimental programs are then presented; they concern power excursion phenomenology, radiological consequences, and finally guide-lines for current and future programs

  13. TL detectors for gamma ray dose measurements in criticality accidents

    International Nuclear Information System (INIS)

    Miljanic, S.; Zorko, B.; Gregori, B.; Knezevic, Z.

    2007-01-01

    Determination of gamma ray dose in mixed neutron + gamma ray fields is still a demanding task. Dosemeters used for gamma ray dosimetry are usually in some extent sensitive to neutrons and their response variations depend on neutron energy i.e., on neutron spectra. Besides, it is necessary to take into account the energy dependence of dosemeter responses to gamma rays. In this work, several types of thermoluminescent detectors (TLD) placed in different holders used for gamma ray dose determination in the mixed fields were examined. Dosemeters were from three different institutions: Ruder Boskovic Inst. (RBI), Croatia, Jozef Stefan Inst. (JSI), Slovenia and Autoridad Regulatoria Nuclear (ARN), Argentina. All dosemeters were irradiated during the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002. Three accidental scenarios were reproduced and in each irradiation the dosemeters were exposed placed on the front of phantom and 'free in air'. Following types of TLDs were used: 7 LiF (TLD-700), CaF 2 :Mn and Al2 O3 :Mg,Y - all from RBI; CaF 2 :Mn from JSI and 7 LiF (TLD-700) from ARN. Reported doses were compared with the reference values as well as with the values obtained from the results of all participants. The results show satisfactory agreement with other dosimetry systems used in the Intercomparison. The influence of different types of holders and applied corrections of dosemeters' readings are discussed. (authors)

  14. TL detectors for gamma ray dose measurements in criticality accidents.

    Science.gov (United States)

    Miljanić, Saveta; Zorko, Benjamin; Gregori, Beatriz; Knezević, Zeljka

    2007-01-01

    Determination of gamma ray dose in mixed neutron+gamma ray fields is still a demanding task. Dosemeters used for gamma ray dosimetry are usually in some extent sensitive to neutrons and their response variations depend on neutron energy i.e., on neutron spectra. Besides, it is necessary to take into account the energy dependence of dosemeter responses to gamma rays. In this work, several types of thermoluminescent detectors (TLD) placed in different holders used for gamma ray dose determination in the mixed fields were examined. Dosemeters were from three different institutions: Ruder Bosković Institute (RBI), Croatia, JoZef Stefan Institute (JSI), Slovenia and Autoridad Regulatoria Nuclear (ARN), Argentina. All dosemeters were irradiated during the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002. Three accidental scenarios were reproduced and in each irradiation the dosemeters were exposed placed on the front of phantom and 'free in air'. Following types of TLDs were used: 7LiF (TLD-700), CaF2:Mn and Al2O3:Mg,Y-all from RBI; CaF2:Mn from JSI and 7LiF (TLD-700) from ARN. Reported doses were compared with the reference values as well as with the values obtained from the results of all participants. The results show satisfactory agreement with other dosimetry systems used in the Intercomparison. The influence of different types of holders and applied corrections of dosemeters' readings are discussed.

  15. Analysis and evaluation of the nuclear criticality accident in JCO CO. LTD in Japan

    International Nuclear Information System (INIS)

    Liu Hua; Liu Xinhua; Li Bing

    2001-01-01

    The author describes JCO criticality accident situation including the background, process chronology and emergency countermeasures taken of the accident and its radiation consequence. The analysis about the direct and root causes of the accident and some conclusions are also showed. The direct cause of the accident is the use of geometrically unsafe process equipment and personnel violation. However, the root cause is lack of efficient technical management. Therefore, it is necessary to emphasize the criticality safety in nuclear fuel cycle installations and enhance safety culture of regulatory and operational personnel

  16. The criticality accident in Tokaimura and medical aspects of radiation emergency

    International Nuclear Information System (INIS)

    Chen Xiaohua; Mao Bingzhi

    2003-01-01

    A criticality accident occurred on September 30, 1999 at the uranium processing plant in Tokaimura Japan, which is the most severe accident since Chernobyl catastrophe. 213 people were exposed to radiation, among them 2 workers were exposed to 16-23 Gy and 6-10 Gy individually, one worker was 2 Gy, 2 people was 10 mSv and 208 person was 0-5 mSv. Author was invited to attend an international symposium on 'The Criticality Accident in Tokaimura Medical Aspects of Radiation Emergency' in Chiba Japan on December 2000. An overview of the accident, dose estimation and neutron relative biological effects are discussed in this article

  17. An analysis on human factor issues in criticality accident at a uranium processing plant. Investigation on human behavior contributing to the criticality accident. Interim report

    International Nuclear Information System (INIS)

    Sasou, Kuonihide; Goda, Hideki; Hirotsu, Yuko

    1999-01-01

    At 10:30 am, September 30th, 1999, a criticality accident occurred in a conversion building of a uranium processing plant in Tokai, Ibaraki prefecture. 69 people including 3 workers who then worked at the building, 3 fire fighters who dispatched to rescue them were exposed to the radiation. People with a 350 m-radius of the site were recommended to evacuate themselves from the region to a temporarily prepared evacuation center. And about one hundred thousand people within a 10 km-radius were also advised to stay inside of their home. Nuclear Safety Commission's Accident Investigation Committee is investigating causes of this accident and have been revealing that deviation from government-authorized processing method and negligence of its illegal procedure had contributed to the accident. The influence of this accident is expanding not only to the plant operating company, local people but also to Japanese nuclear power policy, the whole nuclear industry in Japan. Especially pervasion of 'Safety Culture' is strongly being required. This report analyses latent factors of some human behavior directly contributing to the criticality accident. It also mentions that 4 critical points on the poor climate for safety in the work place, the inadequate safety management, the unsuitable equipment and the production-biased company's policy are the latent factors of this accident. It also finds that the poor climate and the production-biased policy are the most important factors. It can be said that some people directly or indirectly having caused the accident are the victims of them. (author)

  18. Bibliography for nuclear criticality accident experience, alarm systems, and emergency management

    International Nuclear Information System (INIS)

    Putman, V.L.

    1995-09-01

    The characteristics, detection, and emergency management of nuclear criticality accidents outside reactors has been an important component of criticality safety for as long as the need for this specialized safety discipline has been recognized. The general interest and importance of such topics receives special emphasis because of the potentially lethal, albeit highly localized, effects of criticality accidents and because of heightened public and regulatory concerns for any undesirable event in nuclear and radiological fields. This bibliography lists references which are potentially applicable to or interesting for criticality alarm, detection, and warning systems; criticality accident emergency management; and their associated programs. The lists are annotated to assist bibliography users in identifying applicable: industry and regulatory guidance and requirements, with historical development information and comments; criticality accident characteristics, consequences, experiences, and responses; hazard-, risk-, or safety-analysis criteria; CAS design and qualification criteria; CAS calibration, maintenance, repair, and testing criteria; experiences of CAS designers and maintainers; criticality accident emergency management (planning, preparedness, response, and recovery) requirements and guidance; criticality accident emergency management experience, plans, and techniques; methods and tools for analysis; and additional bibliographies

  19. Prevention of the causes and consequences of a criticality accident - measures adopted in France

    International Nuclear Information System (INIS)

    Fruchard, Y.; Lavie, J.M.

    1966-01-01

    The question of safety in regard to criticality accident risks has two aspects: prevention of the cause and limitation of the consequences. These two aspects are closely connected. The effort devoted to prevention of the causes depends on the seriousness of the possible human psychologic and economic consequences of the accident. The criticality accidents which have occurred in the nuclear industry, though few in number, do reveal the imperfect nature of the techniques adopted to prevent the causes, and also constitute the only available realistic basis for evaluating the consequences and developing measures to limit them. The authors give a analysis of the known causes and consequences of past criticality accidents and on this basis make a number of comments concerning: the validity of traditional safety criteria, the probability of accidents for different types of operations, characteristic accidents which can serve as models, and the extent of possible radiological consequences. The measures adopted in France to limit the consequences of a possible criticality accident under the headings: location, design and lay-out of the installations, accident detection, and dosimetry for the exposed personnel, are briefly described after a short account of the criteria used in deciding on them. (author) [fr

  20. Cerebrovascular accidents in patients with a ventricular assist device.

    Science.gov (United States)

    Tsukui, Hiroyuki; Abla, Adib; Teuteberg, Jeffrey J; McNamara, Dennis M; Mathier, Michael A; Cadaret, Linda M; Kormos, Robert L

    2007-07-01

    A cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident. Prospectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients. Thirty-one patients (25%) had 48 cerebrovascular accidents. The mean ventricular assist device support period was 228 and 89 days in patients with and without cerebrovascular accidents, respectively (P cerebrovascular accidents occurred within 4 months after implantation. Actuarial freedom from cerebrovascular accident at 6 months was 75%, 64%, 63%, and 33% with the HeartMate device (Thoratec Corp, Pleasanton, Calif), Thoratec biventricular ventricular assist device (Thoratec Corp), Thoratec left ventricular assist device (Thoratec), and Novacor device (WorldHeart, Oakland, Calif), respectively. Twenty cerebrovascular accidents (42%) occurred in patients with infections. The mean white blood cell count at the cerebrovascular accident was greater than the normal range in patients with infection (12,900/mm3) and without infection (9500/mm3). The mean maximum amplitude of the thrombelastogram in the presence of infection (63.6 mm) was higher than that in the absence of infection (60.7 mm) (P = .0309). The risk of cerebrovascular accident increases with a longer ventricular assist device support period. Infection may activate platelet function and predispose the patient to a cerebrovascular accident. An elevation of the white blood cell count may also exacerbate the risk of cerebrovascular accident even in patients without infection. Selection of device type, prevention of infection, and meticulous control of anticoagulation are key to preventing cerebrovascular accident.

  1. An analysis on human factor issues in criticality accident at a uranium processing plant

    International Nuclear Information System (INIS)

    Sasou, Kunihide; Goda, Hidenori; Hirotsu, Yuko

    2000-01-01

    This report analyses latent factors of a human behavior directly contributing to the criticality accident. It is pouring some 16 kg-U with an enrichment of 18.8% into the precipitation tank. It is the fact that the direct cause of this accident is the workers' unsafe act. However, the authors find lots of latent factors relating to the production-biased company's policy, the poor climate for safety in the work place, the inadequate safety management and the unsuitable equipment. This accident was caused by many organizational factors. This paper also discusses lessons learned from this accident. (author)

  2. Installation places of criticality accident detectors in the plutonium conversion development facility

    International Nuclear Information System (INIS)

    Sanada, Yukihisa; Tsujimura, Norio; Shimizu, Yoshio; Izaki, Kenji; Furuta, Sadaaki

    2008-01-01

    At the Plutonium Conversion Development Facility (PCDF) in the Nuclear Fuel Cycle Engineering Laboratories, the co-conversion technologies to purify the mixed plutonium and uranium nitrate solution discharged from a reprocessing plant have been developed. The probability of a criticality accident in PCDF is extremely low. However, the criticality accident alarm system (CAAS) has been in place since 1982 to reduce the radiation dose to workers in case of such a rare criticality accident. The CAAS contains criticality accident detector units (CADs), one unit consisting of three plastic scintillation detectors, and using the 2 out of 3 voting system for the purpose of high reliability. Currently, eight CADs are installed in PCDF evaluating the dose using a simple equation allowing for a safety margin. The purpose of this study is to show the determination procedures for the adequate relocation of the CADs which adequately ensures safety in PCDF. (author)

  3. Multiple parameter biodosimetry of exposed workers from the JCO criticality accident in Tokai-mura

    Energy Technology Data Exchange (ETDEWEB)

    Blakely, William F. [Armed Forces Radiobiology Research Institute, Bethesda, MD (United States)

    2002-03-01

    molecular biomarkers for neutron exposures in order to overcome this limitation. Lymphocyte counts were used to estimate radiation doses for the same three severely exposed patients. Haematological responses are an early response biomarker for radiation dose assessment. Goans and colleagues earlier reported lymphocyte depletion kinetic models for dose estimates based on human radiation accident registry data for whole-body acute gamma exposures and more recently for criticality accidents. Their data indicate a neutron RBE for lymphocyte depletion kinetics close to unity. Measurement of lymphocyte depletion kinetics is useful for initial dose estimation for radiation accidents. This biodosimetric approach alone, however, does not gauge the greater effectiveness of neutron radiation in criticality accidents involving mixed neutron and gamma radiation. Sodium-24 counts, with both blood and whole-body (Worker C) counts based on neutron activation of stable {sup 23}Na, were also used to obtain early estimates of absorbed doses for the Tokai-mura victims. The measurement of {sup 32}P in blood and urine samples is a potentially useful alternative for estimation of severe neutron radiation exposures because, during interaction with biological materials, fast neutrons convert {sup 32}S to {sup 32}P and thermal neutrons convert {sup 31}P to {sup 32}P. Nishimura and colleagues report, in the accompanying article in this issue, blood and urine {sup 32}P values obtained from the three severely exposed patients in the JCO criticality accident. These data, combined with dose estimates derived from other approaches, can contribute to the establishment of an in vivo human calibration curve for neutron dose assessment based on urine {sup 32}P kinetics measurements. The current state of the art for dose assessment following radiation accidents involves use of multiple parameter biological dosimetry. Several of the radiation bioassays (i.e., chromosome aberrations, lymphocyte counts, prodromal

  4. Nuclear criticality safety: general. 3. Tokaimura Criticality Accident: Point Model Stochastic Neutronic Interpretation

    International Nuclear Information System (INIS)

    Mechitoua, Boukhmes

    2001-01-01

    This paper shows what can be the stochastic neutronic contribution for the interpretation of criticality accidents. Stochastic neutronic comprehensive texts may be found in refs.1 through 4. We limit our study to the use of initiation probability, which is an important stochastic neutronic tally. Initiation probability P may be defined as the probability for one neutron to initiate an infinite neutron fission chain. The complement probability of P is the extinction probability Q. The probability that the neutron fission chain produced by one neutron will quench is equal to the multiplication of the probability of production of i neutrons g i by the probability of extinction of these i neutrons. We can estimate P by a Newton or by a dichotomic method. We suppose that P S (t) is the probability that an infinite neutron fission chain has been initiated before time t by a neutron produced by the source S(t). P S (t + dt) is the sum of two probabilities: 1. the probability that an infinite neutron fission chain has been initiated before time t by a neutron produced by the source S(t): P S (t); 2. The second probability is a multiplication of two probabilities: the probability that there was no initiation before t that is 1-P S (t), and the probability that a neutron emitted by the source with the probability S dt initiates an infinite neutron fission chain with the probability P(t). This last relation gives the link between P and the source density. The aim of this paper is to show how one can apply the foregoing derivations. We have simplified the Tokaimura criticality accident for this application. We have mono-energetic neutrons with infinite and homogeneous media; we have two reactions: capture and fission. In this section, we show how one can estimate the initiation probability with a source density as a function of time. This estimation makes use of three steps: 1. Reactivity insertion: Estimation of the multiplication coefficient as a function of time K(t). This

  5. Safety demonstration analyses on criticality for severe accident during overland transport of fresh nuclear fuel

    International Nuclear Information System (INIS)

    Takahashi, Satoshi; Okuno, Hiroshi; Yamada, Kenji; Watanabe, Kouji; Nomura, Yasushi; Miyoshi, Yoshinori

    2005-01-01

    Criticality safety analysis was performed for transport packages of uranium dioxide powder or of fresh PWR fuel involved in a severe accident during overland transportation, and as a result, sub-criticality was confirmed against impact accident conditions such as loaded by a drop from high position to a concrete or asphalt surface, and fire accident conditions such as caused by collisions with an oil tank trailer carrying lots of inflammable material in open air, or with a commonly used two-ton-truck inside an unventilated tunnel. (author)

  6. The classification of cases related to Tokai-mura criticality accident. Mental care after radiation exposure

    International Nuclear Information System (INIS)

    Minoshita, Seiko; Satoh, Shinji

    2012-01-01

    Cases classified into each pattern, which the authors have met so far after the criticality accident JCO was introduced. Case is introduced, based on multiple cases actually met in medical institutions, has been created as a model case. When the cases that were considered related to the criticality accident in Tokai-mura was summarized, the cases could be classified by the time consultation. Therefore the cases were discussed along the time, also discussed about the time. From the first year to the second year, the most cases seen were the cases with high anxiety. Then, there were many cases which symptoms were worsened by the impact received through the residents meeting. Among the patients who received counseling from half a year to three years after the incident, the onset of mental illness, and the aggravation of the mental disease increased, too. After two or three years of the incident, there were a lot of consultation with women who were pregnant or had infants then. Four years later, men gradually came to have consultation at hospitals. In addition, the consultation of alcohol from problems of a family member has increased. In the first year, there were many patients that a symptom turned worse since they were shocked by the booing of the residents meeting. On the other hand, the patients that a symptom turned worse because of the prolonged issue increased four years later. Four or five years, after the incident the cases of because of bankruptcy or dismissal, life been deteriorated economically were increased, and some cases were led to the discrete of family in a chain reaction. Approximately 10 years later, due to the increase of the aging population, the amount of patient who were frightened because they got cancer increased since they lost the people around them as a result of cancer. (author)

  7. Critical analysis of accident scenario and consequences modelling applied to light-water reactor power plants for accident categories beyond the design basis accident (DBA)

    International Nuclear Information System (INIS)

    Brofferio, C.; Cagnetti, P.; Ferrara, V.; Manilia, E.; Pietrangeli, G.; Sennis, C.

    1985-01-01

    A critical analysis and sensitivity study of the modelling of accident scenarios and environmental consequences are presented, for light-water reactor accident categories beyond the standard design-basis-accident category. The first chapter, on ''source term'' deals with the release of fission products from a damaged core inventory and their migration within the primary circuit and the reactor containment. Particular attention is given to the influence of engineering safeguards intervention and of the chemical forms of the released fission products. The second chapter deals with their release to the atmosphere, transport and wet or dry deposition, outlining relevant partial effects and confronting short-duration or prolonged releases. The third chapter presents a variability analysis, for environmental contamination levels, for two extreme hypothetical scenarios, evidencing the importance of plume rise. A numerical plume rise model is outlined

  8. Development of likelihood estimation method for criticality accidents of mixed oxide fuel fabrication facilities

    International Nuclear Information System (INIS)

    Tamaki, Hitoshi; Yoshida, Kazuo; Kimoto, Tatsuya; Hamaguchi, Yoshikane

    2010-01-01

    A criticality accident in a MOX fuel fabrication facility may occur depending on several parameters, such as mass inventory and plutonium enrichment. MOX handling units in the facility are designed and operated based on the double contingency principle to prevent criticality accidents. Control failures of at least two parameters are needed for the occurrence of criticality accident. To evaluate the probability of such control failures, the criticality conditions of each parameter for a specific handling unit are necessary for accident scenario analysis to be clarified quantitatively with a criticality analysis computer code. In addition to this issue, a computer-based control system for mass inventory is planned to be installed into MOX handling equipment in a commercial MOX fuel fabrication plant. The reliability analysis is another important issue in evaluating the likelihood of control failure caused by software malfunction. A likelihood estimation method for criticality accident has been developed with these issues been taken into consideration. In this paper, an example of analysis with the proposed method and the applicability of the method are also shown through a trial application to a model MOX fabrication facility. (author)

  9. Replacement of the criticality accident alarm system in the Tokai reprocessing plant

    International Nuclear Information System (INIS)

    Sanada, Yukihisa; Momose, Takumaro; Suzuki, Kei; Kawai, Keiichi

    2008-01-01

    A Criticality Accident Alarm System (CAAS) was installed as part of criticality safety management for use in reducing the radiation workers could be exposed to in the rare case of a criticality accident. The initial CAAS version was installed the Tokai Reprocessing Plant (TRP) in the 1980s. It includes units that can detect gamma-rays or neutron-rays released in criticality accidents (CADs), one of which consists of three plastic scintillation gamma detectors and three solid state neutron detectors with fissile material, and in being highly reliable utilizes the 2 out of 3 voting system. The purpose of this study is to give the design principles and procedures for determining the adequate relocation of the CADs within the TRP. The optimal places for the CADs to be relocated to were determined using a conservative evaluation method. Firstly, equipment needing to be monitored for criticality accidents was selected with consideration given to the risk of excessive exposure to workers. Secondly, the detection threshold of a minimum accident was set to be an increase in power of 10 15 fissions/s occurring within a rise-time of between 0.5 ms and 1 s. The sum of neutron and gamma doses of a minimum accident (10 15 fissions) was 0.3 Gy at an unshielded distance of 1 m. Finally, doses at where the CADs were installed were evaluated using parameters calculated with MCNP and ANISN. As a result, the alarm trip level of both the gamma detector and the neutron detector being set at 2.0 mGy/h enabled minimum criticality accidents to be conservatively detected. These results were then applied to the new CAD positions. (author)

  10. Dependency in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Rumei Yang

    2016-03-01

    Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.

  11. Initial medical management of criticality accident victim; Conduite a tenir aux victimes d'un accident de criticite

    Energy Technology Data Exchange (ETDEWEB)

    Miele, A; Bebaron-Jacobs, L

    2005-07-01

    The extremely severe criticality accidents known to this day, and the subsequent deaths recorded (Sarov 1997 and Tokai Mura 1999), demonstrate the need for sustained surveillance and constant adapted training for the teams in charge of irradiated and/or contaminated victims. The aim of this work group, composed of occupational health services and associated medical biology laboratories, is to present, in leaflet format, the essential data on the documentation and the conduct to be held when facing the victims of a criticality accident. The studies of this work group confirm the difficulties involved in managing this type of accident, both from the dosimetric evaluation point of view and from the therapeutic management point of view. That is why several research themes and perspectives are developed. During the different phases of victim triage, the recommendations given on these leaflets describe the operational conducts to be held. This work will have to be updated according to the evolution in knowledge and means: short and long term effects of exposure to neutrons, multi-competence hospital cooperation, expertise networks related to dosimetric reconstitution. (authors)

  12. Initial medical management of criticality accident victim; Conduite a tenir aux victimes d'un accident de criticite

    Energy Technology Data Exchange (ETDEWEB)

    Miele, A.; Bebaron-Jacobs, L

    2005-07-01

    The extremely severe criticality accidents known to this day, and the subsequent deaths recorded (Sarov 1997 and Tokai Mura 1999), demonstrate the need for sustained surveillance and constant adapted training for the teams in charge of irradiated and/or contaminated victims. The aim of this work group, composed of occupational health services and associated medical biology laboratories, is to present, in leaflet format, the essential data on the documentation and the conduct to be held when facing the victims of a criticality accident. The studies of this work group confirm the difficulties involved in managing this type of accident, both from the dosimetric evaluation point of view and from the therapeutic management point of view. That is why several research themes and perspectives are developed. During the different phases of victim triage, the recommendations given on these leaflets describe the operational conducts to be held. This work will have to be updated according to the evolution in knowledge and means: short and long term effects of exposure to neutrons, multi-competence hospital cooperation, expertise networks related to dosimetric reconstitution. (authors)

  13. The report of the criticality accident in a uranium conversion test plant in Tokai-mura

    International Nuclear Information System (INIS)

    Murata, Hajime; Akashi, Makoto

    2002-03-01

    The criticality accident in the title occurred at around 10:35, on Sep. 30, 1999, cost the lives of two workers and caused many residents concern on their health. Moreover, rumors had both social and economic consequences. This report is a detailed account of the roles that many individuals and groups in the National Institute of Radiological Sciences (NIRS) performed in a range of the areas, and is published to discharge NIRS responsibilities in regards to the accident. The report involves chapters of detailed outline of the accident; acceptance of the victims and communications until the identification of the ''criticality'' accident; initial treatment; dose estimation (medical, hematological, physical and biological ones and that by dental metals activated by the neutron); decision making for therapeutic strategies; cooperation with the Network Council for Radiation Emergency Medicine and other medical facilities; emergency importation of medical supplies; treatment and progress (nursing system and radiation injuries); protection from radiation in medical facilities; response to nearby residents of the Plant; international response; press release; Uranium Processing Plant Criticality Accident Investigation Committee and the Health Management Committee organized by the Nuclear Safety Commission; handling of information; and radiation emergency medical preparedness at the NIRS (future issues and prospect). The report is hoped to be useful in preventing the occurrence of future accidents. (K.H.)

  14. State of reaction on news media for JCO criticality accident on abroad

    International Nuclear Information System (INIS)

    Itoh, Takeshi

    1999-01-01

    The criticality accident, which occurred in JCO Tokai on September 30th 1999, was the first accident accompanied with serious radiation exposure to persons at Japanese nuclear facilities. As an evacuation order for local residents was issued, it caused uneasiness to the public. It also gave great impact to the foreign countries. In this report we have investigated the reactions in such countries, as U.S., France, Germany and U.K. by means of news media like TV, newspapers and magazines. Finding are as follows: They were all surprised to know the cause of the accident, which was by improper procedure of JCO workers. Because they couldn't imagine that such an accident might happen in such a high-tech country as Japan. The Japanese regulator was criticized for their insufficient criticality facility surveillance. There arose some questions for Japanese nuclear reliabilities. Because of the delayed announcement of the accident by Japanese public sector, anti-nuclear groups, like Greenpeace, NCI, etc., have a chance to carry on their campaign. The information from Japanese public sector was not enough to satisfy the foreign news media. We concluded that it is also necessary to develop effective information dissemination to overseas in case of a nuclear accident. (author)

  15. Compendium on neutron spectra in criticality accident dosimetry

    International Nuclear Information System (INIS)

    Ing, H.

    1978-01-01

    Graphical and tabulated neutron spectra are presented: from selected critical assemblies; from critical solutions; of fission neutrons through shielding; of H 2 O-moderated fission neutrons through shielding; of D 2 O-moderated fission neutrons through shielding; of fission neutrons reflected from various materials; from the D(T, 4 He)n reaction (''14 MeV'' neutrons) through shielding and of ''14 MeV'' neutrons reflected from various materials

  16. Application of Whole Body Counter to Neutron Dose Assessment in Criticality Accidents

    Energy Technology Data Exchange (ETDEWEB)

    Kurihara, O.; Tsujimura, N.; Takasaki, K.; Momose, T.; Maruo, Y. [Japan Nuclear Cycle Development Institute, Tokai (Japan)

    2001-09-15

    Neutron dose assessment in criticality accidents using Whole Body Counter (WBC) was proved to be an effective method as rapid neutron dose estimation at the JCO criticality accident in Tokai-mura. The 1.36MeV gamma-ray of {sup 24}Na in a body can be detected easily by a germanium detector. The Minimum Detectable Activity (MDA) of {sup 24}Na is approximately 50Bq for 10minute measurement by the germanium-type whole body counter at JNC Tokai Works. Neutron energy spectra at the typical shielding conditions in criticality accidents were calculated and the conversion factor, whole body activity-to-organ mass weighted neutron absorbed dose, corresponding to each condition were determined. The conversion factor for uncollied fission spectrum is 7.7 [(Bq{sup 24}Na/g{sup 23}Na)/mGy].

  17. Instructions on the nuclear critical accident and how to correspond to future

    International Nuclear Information System (INIS)

    Kimura, Itsuro

    2000-01-01

    The nuclear accident occurred at Tokai Works of the JCO Co., Ltd. is a simple but disallowable one formed by neglecting possibility of nuclear fission chain reaction, one of three dangers specific to nuclear power facilities and by feeding middle concentrated uranium solution with more than critical mass into a precipitation tank. As a man consumed most of his life to nuclear power, it is to occur a critical accident forming about 50 previous examples in the world and about 10 victims at Tokai-mura the most earnestly promoting its experiment and analysis and to generate new victims, what was thought to be the most regrettable in this accident. How the previous experiences and results in Tokai-mura could be transmitted to the JCO Co., Ltd. ? This was a large alarm-bell for persons engaging to R and D on nuclear power. As this accident was much deplorable and apological for the common public, it must be carried out to thoroughly analyze its causes, to establish its future responses, and to promote its essential countermeasures. As it is important to open informations on its contents, it is hopeful not to over-exaggerate and over-differentiate the accident, to calmly and scientifically analyze the risk as well as in the other accidents, and to construct actually effective countermeasures. (G.K.)

  18. Organizational factors and reoccurrence protection on the JCO nuclear critical accident

    International Nuclear Information System (INIS)

    Takano, Kenichi

    2000-01-01

    A nuclear critical accident formed at a nuclear fuel conversion factory in Tokai-mura on September, 1999 became gradually clear not to be a simple human error formed at a level of workmen but to be an organizational error or accident relating to various organizational factors. As a nuclear power facility adopts a depth protection system fundamentally, a large accident with serious danger would not form only by a single trouble and a human error and unless some factors overlaps. By reviewing recent serious accidents and troubles, all of them seem to have a keyword of 'organizational factor'. In the JCO accident, there are some organizational factors such as a climate deviating from a manual, insufficient and loose check against change of procedure, reduction of operators from a reason of profit priority, attitude on priority of working efficiency, and so forth, which are partially common to the Chernobyl accident. Recently, accidents and troubles impossible to make them a cause of simple human error by a person but to have to say an organizational error, have increased. This trend seems to depend upon not only complication and scale-up of technology system but also graduate change of social and management systems operating them. Therefore, it seems to be necessary to introduce a concept of depth protection (multiple protection) in order to keep its reliability and safety when complicating and scaling-up of system. (G.K.)

  19. Questionnaire survey report about the criticality accident at a nuclear fuel processing facility

    International Nuclear Information System (INIS)

    2000-01-01

    The Radiation Protection Section of the Japanese Society of Radiological Technology conducted a questionnaire survey on the criticality accident at the nuclear fuel processing facility in Tokai village on September 30, 1999 in order to identify factors related to the accident and consider countermeasures to deal with such accidents. The questionnaire was distributed to 347 members (122 facilities) of the Japanese Society of Radiological Technology who were working or living in Ibaraki Prefecture, and replies were obtained from 104 members (75 facilities). Questions to elicit the opinions of individuals were as following: method of obtaining information about the accident, knowledge about radiation, opinions about the accident, and requests directed to the Society. Questions regarding facilities concerned the following: communication after the accident, requests for dispatch to the accident site, and possession of radiometry devices. In regard to acquisition of information, 91 of the 104 members (87.5%) answered 'television or radios' followed by newspapers. Forty-five of 101 members were questioned about radiation exposure and radiation effects by the public. There were many opinions that accurate news should be provided rapidly, by the mass media. Many members (75%) felt that they lacked knowledge about radiation, reconfirming the importance of education and instruction concerning radiation. Dispatch was requested of 36 of the 75 facilities (48%), and 44 of 83 facilities (53%) owned radiometry instruments. (K.H.)

  20. Critical examination of emergency plans for nuclear accidents

    International Nuclear Information System (INIS)

    Catsaros, Nicolas.

    1986-08-01

    An analysis of emergency plans of various countries for nuclear installations on- and off-site emergency preparedness is presented. The analysis is focused on the off-site organization and countermeasures to protect public health and safety. A critical examination of the different approaches is performed and recommendations for effectiveness improvement and optimization are formulated. (author)

  1. Evaluation of coverage of enriched UF6 cylinder storage lots by existing criticality accident alarms

    International Nuclear Information System (INIS)

    Lee, B.L. Jr.; Dobelbower, M.C.; Woollard, J.E.; Sutherland, P.J.; Tayloe, R.W. Jr.

    1995-03-01

    The Portsmouth Gaseous Diffusion Plant (PORTS) is leased from the US Department of Energy (DOE) by the United States Enrichment Corporation (USEC), a government corporation formed in 1993. PORTS is in transition from regulation by DOE to regulation by the Nuclear Regulatory Commission (NRC). One regulation is 10 CFR Part 76.89, which requires that criticality alarm systems be provided for the site. PORTS originally installed criticality accident alarm systems in all building for which nuclear criticality accidents were credible. Currently, however, alarm systems are not installed in the enriched uranium hexafluoride (UF 6 ) cylinder storage lots. This report analyzes and documents the extent to which enriched UF 6 cylinder storage lots at PORTS are covered by criticality detectors and alarms currently installed in adjacent buildings. Monte Carlo calculations are performed on simplified models of the cylinder storage lots and adjacent buildings. The storage lots modelled are X-745B, X-745C, X745D, X-745E, and X-745F. The criticality detectors modelled are located in building X-343, the building X-344A/X-342A complex, and portions of building X-330 (see Figures 1 and 2). These criticality detectors are those located closest to the cylinder storage lots. Results of this analysis indicate that the existing criticality detectors currently installed at PORTS are largely ineffective in detecting neutron radiation from criticality accidents in most of the cylinder storage lots at PORTS, except sometimes along portions of their peripheries

  2. Air Transportation of Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    E. P. Rodionov

    2008-01-01

    Full Text Available During the Napoleonic wars, balloon evacuation of the wounded was the first to be made in the history when Paris was being defended. In the USA, casualty helicopters are being used in 20% of cases on evacuating the victims from the accident scene and in 80% during interhospital transportation. Russia also shows an ambiguous approach to employing air medical service — from the wide use of air transportation in the country’s regions that are difficult of access to its almost complete refusal in the regions with the well-developed transportation system. Long-distance transportation of critically ill patients by chartered or commercial planes is the reality of our time. In each region, continuing specialized teams of qualified medical workers who have a good knowledge of altitude pathophysiology and handle the obligatorily certified equipment should be created on the basis of large-scale medical centers.

  3. Crisis, criticism, change: Regulatory reform in the wake of nuclear accidents

    International Nuclear Information System (INIS)

    Sexton, Kimberly A.; )

    2015-01-01

    Accidents are a forcing function for change in the nuclear industry. While these events can shed light on needed technical safety reforms, they can also shine a light on needed regulatory system reforms. The TEPCO Fukushima Daiichi nuclear power plant (NPP) accident in Japan is the most recent example of this phenomenon, but it is not the only one. In the wake of the three major accidents that have occurred in the nuclear power industry - Three Mile Island (TMI) in the United States; Chernobyl in Ukraine, in the former Soviet Union; and the Fukushima Daiichi NPP accident in Japan - a commission or committee of experts issued a report (or reports) with harsh criticism of the countries' regulatory system. And each of these accidents prompted changes in the respective regulatory systems. In looking at these responses, however, one must ask if this crisis, criticism, change approach is working and whether regulatory bodies around the world should instead undertake their own systematic reviews, un-prompted by crisis, to better ensure safety. This article will attempt to analyse the issue of regulatory reform in the wake of nuclear accidents by first providing a background in nuclear regulatory systems, looking to international and national legal frameworks. Next, the article will detail a cross-section of current regulatory systems around the world. Following that, the article will analyse the before and after of the regulatory systems in the United States, the Soviet Union and Japan in relation to the TMI, Chernobyl and Fukushima accidents. Finally, taking all this together, the article will address some of the international and national efforts to define exactly what makes a good regulator and provide conclusions on regulatory reform in the wake of nuclear accidents. (author)

  4. The critically ill injured patient.

    Science.gov (United States)

    Cereda, Maurizio; Weiss, Yoram G; Deutschman, Clifford S

    2007-03-01

    Patients admitted to the ICU after severe trauma require frequent procedures in the operating room, particularly in cases where a damage control strategy is used. The ventilatory management of these patients in the operating room can be particularly challenging. These patients often have severely impaired respiratory mechanics because of acute lung injury and abdominal compartment syndrome. Consequently, the pressure and flow generation capabilities of standard anesthesia ventilators may be inadequate to support ventilation and gas exchange. This article presents the problems that may be encountered in patients who have severe abdominal and lung injuries, and the current management concepts used in caring for these patients in the critical care setting, to provide guidelines for the anesthetist faced with these patients in the operating room.

  5. Calculation code used in criticality analyses for the accident of JCO precipitation tank

    International Nuclear Information System (INIS)

    Miyoshi, Yoshinori

    2000-01-01

    In order to evaluate nuclear features on criticality accident formed at the nuclear fuel processing facility in Tokai Works of the JCO, Ltd. (JCO), in Tokai-mura, Ibaraki prefecture, dynamic analyses to calculate output change after occurring the accident as well as criticality analyses to calculate reactivity added to precipitation tank, were carried out according to scenario on accident formation. For the criticality analyses, a continuous energy Monte Carlo code MCNP was used to carry out calculation of reactivity fed into the precipitation tank as correctly as possible. And, SRAC code system was used for calculation on temperature and void reactivity coefficients, effective delayed neutron ratio beta eff , and instantaneous neutron generation time required for parameters controlling transition features at criticality accident. In addition, for the dynamic analyses, because of necessity of considering on volume expansion of solution fuels used as exothermic body and radiation decomposition gas forming into solution, output behavior, numbers of nuclear fission, and so forth at initial burst portion were calculated by using TRACE and quasi-regular code, at a center of AGNES-2 promoting on its development in JAERI. Here were reported on outlines and an analysis example on calculation code using for the nuclear features evaluation. (G.K.)

  6. The relationship of JNC and JCO in the uranium processing plant criticality accident

    International Nuclear Information System (INIS)

    Kanamori, Masashi; Yanagibashi, Katsumi; Okamoto, Naritoshi

    2002-12-01

    On September 30th 1999, the criticality accident occurred at JCO's uranium conversion building in Tokai. The accident occurred during reconversion from U 3 O 8 to uranium nitrate solution (UNH) with uranium enriched 18.8% and about 60 kgU. JCO contacted with JNC to supply UNH that is fuel material for the experimental fast breeder reactor 'JOYO'. JNC has contracted with JCO that had started nuclear fuel material processing business following a definite policy of Japanese government and developed SUMITOMO ADU PROCESS'. JNC made the first contract with JCO in 1985 and has made a contact every year. There had never been a problem in their products. JNC inspected products based on contract. JNC discharge our duty as customer inspecting products based on contract. As for safety control, JCO had taken licensing safety review and had been permitted to be 'a processing facility'. Therefore JNC understood that JCO produced following this license. 'The Uranium Processing Plant Criticality Accident Investigation' showed that JCO had been taking a different method from the permit and violating the license. However JNC had never been explained about that and JCO's operation procedures had never described about that. Therefore the Criticality Accident couldn't be avoided. This report describes the relationship of JNC and JCO in the uranium reconversion contract for JOYO, atomic development policy of Japanese government, process to the order and the contents of contract. (author)

  7. Energy and angular responses of the criticality accident detector using a plastic scintillator

    International Nuclear Information System (INIS)

    Tsujimura, Norio; Yoshida, Tadayoshi

    2006-01-01

    The Japan Atomic Energy Agency (JAEA), Nuclear Fuel Cycle Engineering Laboratories, operates a spent fuel reprocessing plant and MOX (Plutonium-Uranium Mixed Oxide) fuel fabrication plants. Criticality accident detectors have been installed in these facilities. The detector, the Toshiba RD120, is composed of a plastic scintillator coupled to a photomultiplier tube, and an operational amplifier. The alarm triggering point is set to 1.0-3.6 mGy·h -1 in photon dose rate to detect the minimum accident of concern. However, a plastic scintillator is principally sensitive not only to primary photons but also to neutrons by secondary photons and heavy charged particles produced in the detector itself. The authors calculated energy and angular responses of the RD120 criticality accident detector to photons and neutrons using Monte Carlo computer codes. The response to primary photons was evaluated with the MCNP-4B and EGS4 calculations, and photon and X-ray irradiation experiments. The response to neutrons that produce secondary photons and heavy charged particles from neutron interactions was computed using the MCNP-4B and SCINFUL, respectively. As a result, reliable response functions were obtained. These results will be a great help in reassessing the coverage area and in determining the appropriate triggering dose rate level in criticality accidents. (author)

  8. Radiological dose assessment for bounding accident scenarios at the Critical Experiment Facility, TA-18, Los Alamos National Laboratory

    International Nuclear Information System (INIS)

    1991-09-01

    A computer modeling code, CRIT8, was written to allow prediction of the radiological doses to workers and members of the public resulting from these postulated maximum-effect accidents. The code accounts for the relationships of the initial parent radionuclide inventory at the time of the accident to the growth of radioactive daughter products, and considers the atmospheric conditions at time of release. The code then calculates a dose at chosen receptor locations for the sum of radionuclides produced as a result of the accident. Both criticality and non-criticality accidents are examined

  9. Review of design criteria for Criticality Accident Alarm System (CAAS) used in Fuel Reprocessing Facility

    International Nuclear Information System (INIS)

    Chandrasekaran, S.; Basu, Pew; Sivasubramaniyan, K.; Venkatraman, B.

    2016-01-01

    Though fuel cycle facilities handling fissile materials are designed with careful criticality safety analysis, the criticality accident cannot be ruled out completely. Criticality Accident Alarm System (CAAS) is being installed as part of criticality safety management in fuel cycle facilities. CAAS system being used in India, is ECIL make, ionization chamber based gamma detector, which houses three identical detectors and works on 2/3 logic. As per ISO 7753 and ANSI/ANS-8.3, the CAAS must be designed to be capable of detecting any minimum accident occurs which could be of concern. Based on this, alarm limit used in CAAS is: 4 R/h (fast transient excursion) and 3 mR in 0.5 sec (slow excursion). In case of reprocessing facilities wherein process tanks located in heavy shielding, identification of CAAS installation locations require detailed radiation transport calculations. A study has been taken to estimate the gamma dose rate from thick concrete hot cells in order to determine the locations of CAAS to meet the present design criteria of alarm limit

  10. Evaluation of the 17 June 1997 Criticality Accident at Arzamas-16

    International Nuclear Information System (INIS)

    Morris Klein

    1999-01-01

    On June 17, 1997, a critically accident occurred at Arzamas-16, which resulted in the death (within three days) of A. N. Zakharov, a Russian scientist with 20 years' experience conducting multiassembly experiments. In this case, the multiplying assembly was a fast metal system consisting of a 235 U (90% enriched) core and a copper reflector. According to the Russian press, ''Zakharov misjudged the degree of criticality of the breeding system and committed several gross violations of regulations.'' As we see it, there were three major causes of this accident. First, the experiment was flawed by Zakharov's misreading of the appropriate size of the assembly, which he took from a notebook that described the old experiment he was attempting to repeat. Second, he disregarded the appropriate procedures and safety regulations. Third, these two mistakes were compounded by an improperly set audible alarm system and Zakharov's unsafe use of the table. We also discuss our reconstruction of the accident based on information given by the Russians to US scientists and information culled from Russian newspaper and magazine articles. We also describe our thoughts on the behavior of the assembly following the accident and the radiation dose level Zakharov may have received. These levels match values we have lately obtained from translations of Russian news articles. This accident clearly points out the penalty for weak administrative control of work with multiplying systems. Criticality experimentation requires formality of operation. The experimenter, his peers, and a trained safety person need to document that they understand the experiment and how it will be conducted. Knowing that the experiment was successfully run several decades ago does not justify bypassing a safety evaluation

  11. ANSI/ANS-8.23-1997: nuclear criticality accident emergency planning and response

    International Nuclear Information System (INIS)

    Baker, J.S.

    2004-01-01

    American National Standard ANSUANS-8.23 was developed to expand upon the basic emergency response guidance given in American National Standard, 'Administrative Practices for Nuclear Criticality Safety' ANSI/ANS-8.19-1996 (Ref. 1). This standard provides guidance for minimizing risks to personnel during emergency response to a nuclear criticality accident outside reactors. This standard is intended to apply to those facilities for which a criticality accident alarm system, as specified in American National Standard, 'Criticality Accident Alarm System', ANSI/ANS-8.3-1997 (Ref. 2) is in use. The Working Group was established in 1990, with Norman L. Pruvost as chairman. The Working Group had up to twenty-three members representing a broad range of the nuclear industry, and has included members from Canada, Japan and the United Kingdom. The initial edition of ANSI/ANS-8.23 was approved by the American National Standards Institute on December 30, 1997. It provides guidance for the following topics: (1) Management and technical staff responsibilities; (2) Evaluation of a potential criticality accident; (3) Emergency plan provisions; (4) Evacuation; (5) Re-entry, rescue and stabilization; and (6) Classroom training, exercises and evacuation drills. This guidance is not for generic emergency planning issues, but is specific to nuclear criticality accidents. For example, it assumes that an Emergency Plan is already established at facilities that implement the standard. During the development of the initial edition of ANSI/ANS-8.23, each Working Group member evaluated potential use of the standard at a facility with which the member was familiar. This revealed areas where a facility could have difficulty complying with the standard. These reviews helped identify and eliminate many potential problems and ambiguities with the guidance. The Working Group has received very limited feedback from the user community since the first edition of the standard was published. Suggestions

  12. The Tokai-mura JCO criticality accident and the activities of the accident countermeasure support team of Electric Power Companies, Japan

    International Nuclear Information System (INIS)

    Ogawa, Junko

    2000-01-01

    A criticality accident occurred at the JCO Tokai-mura nuclear fuel processing plant on September 30, 1999. This accident brought the damages which were unrivaled in the history of atomic energy development in Japan, seriously influencing the citizen life to such an extent as requesting for 320,000 inhabitants within 10 kilometers radius to stay indoors for as long as 18 hours. However, it could be said that though three workers suffered fatal injuries, no substantial hazards were made upon the regional inhabitants due to little release of radioactive substances. This video recorded the activities of the Accident Countermeasure Support Team of the Electric Power Companies immediately after the accident occurred, showing the chronological overview of the particulars of the accident. (author)

  13. SICK SINUS SYNDROME IN PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENTS

    Directory of Open Access Journals (Sweden)

    E. K. Kazakova

    2015-01-01

    Full Text Available The article presents a clinical case of 2 patients with heart arrhythmias of the sick sinus syndrome type, who were implanted electriccardiac pacemakers in the acute period of cerebrovascular accidents. There were no cardiac complaints in the clinical manifestation, however, a comprehensive assessment confirmed the diagnosis of sick sinus syndrome.

  14. Cerebrovascular accidents in adult patients with congenital heart disease

    NARCIS (Netherlands)

    Hoffmann, A.; Chockalingam, P.; Balint, O.H.; Dadashev, A.; Dimopoulos, K.; Engel, R.; Schmid, M.; Schwerzmann, M.; Gatzoulis, M.A.; Mulder, B.J.M.; Oechslin, E.

    2010-01-01

    Objective To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with congenital heart disease (CHD). Methods and results In a retrospective analysis of aggregated European and Canadian databases a total population of 23 153 patients with

  15. Cerebrovascular accidents in adult patients with congenital heart disease

    NARCIS (Netherlands)

    Hoffmann, A.; Chockalingam, P.; Balint, O. H.; Dadashev, A.; Dimopoulos, K.; Engel, R.; Schmid, M.; Schwerzmann, M.; Gatzoulis, M. A.; Mulder, B.; Oechslin, E.

    2010-01-01

    To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with congenital heart disease (CHD). In a retrospective analysis of aggregated European and Canadian databases a total population of 23 153 patients with CHD was followed up to the

  16. Management of older patients presenting after a fall - an accident ...

    African Journals Online (AJOL)

    Background. It is common for older patients to present to accident and emergency (AE) departments after a fall. Management should include assessment and treatment of the injuries and assessment and correction of underlying risk factors in order to prevent recurrent falls. Objectives. To determine management of older ...

  17. Workplace accidents, absenteeism and productivity in patients with sleep apnea.

    Science.gov (United States)

    Jurado-Gámez, Bernabé; Guglielmi, Ottavia; Gude, Francisco; Buela-Casal, Gualberto

    2015-05-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity. One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results. Patients with OSAHS had more sick leave lasting longer than 30days (16.6% vs. 7%, P=.049) and lower productivity (63.80% vs. 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity. OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  18. Development of criticality accident detector measuring neutrons and gamma-rays

    International Nuclear Information System (INIS)

    Tsujimura, Norio; Yoshida, Tadayoshi; Ishii, Masato

    2005-01-01

    The authors developed a new criticality accident detector measuring neutrons and gamma-rays. The detector is a cylindrical plastic scintillator coupled to a current-mode operated photomultiplier, and is covered by an inner cadmium shell, acting as a neutron to gamma-ray converter, and a 5cm thick outer polyethylene moderator in order to respond to the same threshold triggering dose regardless of whether it was exposed to neutrons, gamma-rays or a mixture of the two radiations. (author)

  19. Criticality accident in uranium fuel processing plant. Questionnaires from Research Committee of Nuclear Safety

    International Nuclear Information System (INIS)

    Kataoka, Isao; Sekimoto, Hiroshi

    2000-01-01

    The Research Committee of Nuclear Safety carried out a research on criticality accident at the JCO plant according to statement of president of the Japan Atomic Energy Society on October 8, 1999, of which results are planned to be summarized by the constitutions shown as follows, for a report on the 'Questionnaires of criticality accident in the Uranium Fuel Processing Plant of the JCO, Inc.': general criticality safety, fuel cycle and the JCO, Inc.; elucidation on progress and fact of accident; cause analysis and problem picking-up; proposals on improvement; and duty of the Society. Among them, on last two items, because of a conclusion to be required for members of the Society at discussions of the Committee, some questionnaires were send to more than 1800 of them on April 5, 2000 with name of chairman of the Committee. As results of the questionnaires contained proposals and opinions on a great numbers of fields, some key-words like words were found on a shape of repeating in most questionnaires. As they were thought to be very important nuclei in these two items, they were further largely classified to use for summarizing proposals and opinions on the questionnaires. This questionnaire had a big characteristic on the duty of the Society in comparison with those in the other organizations. (G.K.)

  20. Activities of JAERI's health physics department for the criticality accident of JCO

    International Nuclear Information System (INIS)

    Yamamoto, Katsumune; Kitano, Kyoshiro; Murakami, Hiroyuki; Yamaguchi, Takenori; Tsunoda, Masahiko

    2000-01-01

    This report describes early health physics activities from September 30 to October 1 taken by the authors' department after the JCO accident. They firstly knew the accident at around 12:20 (about 2 hr after the criticality). The activities involved the planning of schedule for ending the criticality; calculation of scheduled dose for the work to end it; dose measurement around JCO site; loaning out of devices for measuring neutron and of personal dose-meter; collection and radioactivity measurement of dust and soil, and of drinking water; and examination for contamination of people around the site, of their houses inside and of school gardens and equipments. The dose was scheduled to be firstly 20 mSv and then changed to 50 mSv due to the actual measurement at the accident site. The working time was to be 3 min at the site. The work was on either the dose or time. Radiation monitoring outside the JCO site revealed the presence of Na-24 and Cs-138: neutron dose was 10 times as high as γ-ray dose. The time course of dose rate change was found to be in parallel with the progress of works to end the criticality. (K.H.)

  1. Criticality accidents in solution (CRAC and SILENE programmes) and complementary studies of accidents; radiation dosimetry in human organism during the CRAC programme

    International Nuclear Information System (INIS)

    Barbry, M.; Dousset, M.

    C.R.A.C. (CRiticality occurring ACcidentally) programme is intended to study experimentally the development of a criticality accident as it could occur when handling solutions of fissile material as well as the radiological consequences of such an accident. The fissile matter solutions have been chosen (a) for practical considerations of use and (b) because the probability of an accident occurring seems greater with this type of environment, as the known accidents have shown. The programme is twofold: study of accident physics: form of the evolution (peak, plateau, oscillations, boil up of solutions) the most probable maximum power, minimal power, flux and radiation spectra emitted, freed energy, associated effects, radiolysis, constraints, etc., study of radiological consequences: area dosimetry, individual dosimetry, radiobiological studies, etc. Additional criticality Accident experiments have been and continue to be made on the SILENE reactor in the following principal domains: determination of the emission rate of gaseous fission products and aerosols, area dosimetry and health dosimetry in the presence of shields around the core to vary the neutron and gamma components of the radiation field. Improvement in the knowledge of certain particular aspects of the power excursion, radiolysis gas and pressure wave, experiments of the ''boiling'' type [fr

  2. Source term analysis for a criticality accident in metal production line glove boxes

    International Nuclear Information System (INIS)

    Nguyen, D.H.

    1991-06-01

    A recent development in criticality accident analysis is the deterministic calculations of the transport of fission products and actinides through the barriers of the physical facility. The knowledge of the redistribution of the materials inside the facility will help determine the reentry and clean-up procedures. The amount of radioactive materials released to the environment is the source term for dispersion calculations. We have used an integrated computer model to determine the release of fission products to the environment from a hypothetical criticality event in a glove box of the metal production line (MPL) at the Lawrence Livermore National Laboratory (LLNL)

  3. A cost effective approach for criticality accident analysis of a DOE SNF storage facility

    International Nuclear Information System (INIS)

    Garrett, R.L.; Couture, G.F.; Gough, S.T.

    1997-01-01

    This paper presents the methodologies used to derive criticality accident analyses for a spent nuclear fuel receipt, storage, handling, and shipping facility. Two criticality events are considered: process-induced and Natural Phenomena Hazards (NPH)-induced. The criticality analyses required the development of: (1) the frequency at which each sceanario occurred, (2) the estimated number of fissions for each scenario, and (3) the consequences associated with each criticality scenario. A fault tree analysis was performed to quantify the frequency of criticality due to process-induced events. For the frequency analysis of NPH-induced criticality, a probabilistic approach was employed. To estimate the consequences of a criticality event, the resulting fission yield was determined using a probabilistic approach. For estimating the source term, a 95% amount of overall conservatism was targeted. This methodology applied to the facility criticality scenarios indicated that: (1) the 95th percentile yield levels from the historical yield distributions are approximately 5 x 10 17 fissions and 5 x 10 18 fissions for internal event and NPH-induced criticality event, respectively; and (2) using probabilistic Latin Hypercube Sampling, the downwind 95th percentile dose to a receptor at the US DOE reservation boundary is 2.2 mrem. This estimate is compared to the bounding dose of 1.4 rem. 4 refs., 1 fig

  4. Estimation of dose distribution and neutron spectra in JCO critical accident by shielding calculations

    International Nuclear Information System (INIS)

    Sakamoto, Yukio

    2001-01-01

    The information about neutrons at the surrounding of JCO site in the critical accident is limited to survey results by neutron Rem counter in the period of accident and activation data very near the test facility measured after the shut down of accident. This caused the big uncertainty in the dose estimation by detailed shielding calculation codes. On the other hand, environmental activity data measured by radiochemical researchers included the information about fast neutrons inside of JCO site and thermal neutrons up to 1 km from test facility. It is important to grasp the actual circumstance and examine the executed evaluation of the critical accident as scientifically as possible. Therefore, it is meaningful for different field researchers to corporate and exchange the information. In the Technical Divisions of Radiation Science and Technology in Atomic Energy Society of Japan, the information about neutron spectra are released from their home page and three groups of JAERI/CRC, Sumitomo Atomic Energy Industry and Nuclear Power Engineering Corp. (NUPEC)/Mitsubishi Research Institute Inc. (MRI), tried the shielding calculation by Monte Carlo Code MCNP-4B. The procedures and main results of shielding calculations were reviewed in this report. The main difference of shielding calculation by three groups was density and water content of autoclaved light-weight concrete (ALC) as the wall and ceiling. From the result by NUPEC/MRI, it was estimated that the water content in ALC was from 0.05 g/cm 3 to 0.10 g/cm 3 . The behavior of dose equivalent attenuation obtained by shielding calculation was very similar with the measured data from 250 m to 1,700 m obtained by survey meter, TLD and monitoring post. For more exact dose estimation, more detail examination of density and water content of ALC will be needed. (author)

  5. A microcomputer-based model for identifying urban and suburban roadways with critical large truck accident rates

    International Nuclear Information System (INIS)

    Brogan, J.D.; Cashwell, J.W.

    1992-01-01

    This paper presents an overview of techniques for merging highway accident record and roadway inventory files and employing the combined data set to identify spots or sections on highway facilities in urban and suburban areas with unusually high large truck accident rates. A statistical technique, the rate/quality control method, is used to calculate a critical rate for each location of interest. This critical rate may then be compared to the location's actual accident rate to identify locations for further study. Model enhancements and modifications are described to enable the technique to be employed in the evaluation of routing alternatives for the transport of radioactive material

  6. Accident precursors, near misses, and warning signs: Critical review and formal definitions within the framework of Discrete Event Systems

    International Nuclear Information System (INIS)

    Saleh, Joseph H.; Saltmarsh, Elizabeth A.; Favarò, Francesca M.; Brevault, Loïc

    2013-01-01

    An important consideration in safety analysis and accident prevention is the identification of and response to accident precursors. These off-nominal events are opportunities to recognize potential accident pathogens, identify overlooked accident sequences, and make technical and organizational decisions to address them before further escalation can occur. When handled properly, the identification of precursors provides an opportunity to interrupt an accident sequence from unfolding; when ignored or missed, precursors may only provide tragic proof after the fact that an accident was preventable. In this work, we first provide a critical review of the concept of precursor, and we highlight important features that ought to be distinguished whenever accident precursors are discussed. We address for example the notion of ex-ante and ex-post precursors, identified for postulated and instantiated (occurred) accident sequences respectively, and we discuss the feature of transferability of precursors. We then develop a formal (mathematical) definition of accident precursors as truncated accident sequences within the modeling framework of Discrete Event Systems. Additionally, we examine the related notions of “accident pathogens” as static or lurking adverse conditions that can contribute to or aggravate an accident, as well as “near misses”, “warning signs” and the novel concept of “accident pathway”. While these terms are within the same linguistic neighborhood as “accident precursors”, we argue that there are subtle but important differences between them and recommend that they not be used interchangeably for the sake of accuracy and clarity of communication within the risk and safety community. We also propose venues for developing quantitative importance measures for accident precursors, similar to component importance measures in reliability engineering. Our objective is to establish a common understanding and clear delineation of these terms, and

  7. Residents call for greater openness, accountability and involvement: Lessons learned from the JCO criticality accident

    International Nuclear Information System (INIS)

    Taniguchi, Taketoshi; Tsuchiya, Tomoko; Kosugi, Motoko

    2000-01-01

    This paper discusses the JCO (Japan Nuclear Fuel Conversion Co.) criticality accident from social viewpoints based on the detailed examination of the survey data and experience of participation into Tokai village office's surveys. We focus the mechanisms of amplifying anxieties of the local residents and clarify the key factors affected in the social amplification process. And we discuss the importance of communicating and deliberating among the lay people, public officials and professionals about health, safety and environmental risks associated with nuclear energy, referring to the public opinions about what kinds of information and actions are needed. (J.P.N.)

  8. Environment radiological monitoring by JNC related to the JCO criticality accident

    International Nuclear Information System (INIS)

    Watanabe, Hitoshi

    2001-01-01

    Concerning the criticality accident at JCO Co., Ltd. (JCO) which occurred at 10:35 on 30th Sep. 1999, Japan Nuclear Cycle Development Institute (JNC) established ''JNC's task force'' at 12:35 on the same data in conjunction with Head Office and Tokai Works. JNC's task force had collaborated on environmental radiological monitoring with the government of Japan and the local governments. This report compiles the results of the environmental monitoring performed by JNC's task force based on the request from the government of Japan and the local governments. (author)

  9. Physiotherapy in critically ill patients

    Directory of Open Access Journals (Sweden)

    N. Ambrosino

    2011-11-01

    Full Text Available Prolonged stay in Intensive Care Unit (ICU can cause muscle weakness, physical deconditioning, recurrent symptoms, mood alterations and poor quality of life.Physiotherapy is probably the only treatment likely to increase in the short- and long-term care of the patients admitted to these units. Recovery of physical and respiratory functions, coming off mechanical ventilation, prevention of the effects of bed-rest and improvement in the health status are the clinical objectives of a physiotherapy program in medical and surgical areas. To manage these patients, integrated programs dealing with both whole-body physical therapy and pulmonary care are needed.There is still limited scientific evidence to support such a comprehensive approach to all critically ill patients; therefore we need randomised studies with solid clinical short- and long-term outcome measures. Resumo: Uma estadia prolongada na Unidade de Cuidados Intensivos (UCI pode causar fraqueza muscular, descondicionamento físico, sintomas recorrentes, alterações de humor e má qualidade de vida.A fisioterapia é, provavelmente, o único tratamento com potencial para aumentar nos cuidados a curto e longo prazo aos pacientes internados nestas unidades. A recuperação das funções físicas e respiratórias, retirar a ventilação mecânica, prevenção de efeitos do repouso na cama e melhoria do estado de saúde são objectivos clínicos de um programa de fisioterapia nas áreas médicas e cirúrgicas. Para tratar estes pacientes, são necessários programas integrados que englobem tanto a fisioterapia global como os cuidados respiratórios necessários.A evidência científica para apoiar esta abordagem abrangente para todos os doentes críticos é ainda limitada; portanto, são necessários estudos aleatorizados com medidas de resultados a curto e longo prazo. Keywords: Rehabilitation, Mechanical ventilation, Physiotherapy, Weaning, Palavras-chave: Reabilitação, Ventilação mec

  10. Study of a criticality accident involving fuel rods and water outside a power reactor

    International Nuclear Information System (INIS)

    Beloeil, L.

    2000-01-01

    It is possible to imagine highly unlikely but numerous accidental situations where fuel rods come into contact with water under conditions close to atmospheric values. This work is devoted to modelling and simulation of first instants of the power excursion that may result from such configurations. We show that void effect is a preponderant feedback for most severe accidents. The formation of a vapour film around the rods is put forward and confirmed with the help of experimental transients using electrical heating. We propose then a vapour/liquid flow model able to reproduce void fraction evolution. The vapour film is treated as a compressible medium. Conservation balance equations are solved on a moving mesh with a two-dimensional scheme and boundary conditions taking notice of interfacial phenomena and axial escape possibility. Movements of the liquid phase are modelled through a non-stationary integral equation and a dissipative term suited to the particular geometry of this flow. The penetration of energy into the liquid is also calculated. Thus, the coupling of aerodynamic and hydrodynamic modules gives results in excellent agreement with experiments. Next, neutronic phenomena into the fuel pellet, their feedback effects and the distribution of power through the rod are numerically translated. For each developed module, validation tests are provided. Then, it is possible to simulate the first seconds of the whole criticality accident. Even if this calculation tool is only a way of study as a first approach, performed simulations are proving coherent with reported data on recorded accidents. (author)

  11. Psychological evaluation of the patients contaminated in the Goiania radiological accident in Brazil

    International Nuclear Information System (INIS)

    1989-08-01

    The psychological evaluation of 68 patients contaminated in the Goiania accident as well as of the personnel (about 27) working at the organizations responsible for the assistance given to the victims of the accident is presented

  12. Local governments' roles of the compensation for damage by the Tokai JCO criticality accident

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, Tomoyuki [Central Research Inst. of Electric Power Industry, Tokyo (Japan). Socio-Economic Research Center

    2003-03-01

    The Tokai JCO criticality accident on September 30, 1999 was the first case to which The Law on Compensation for Nuclear Damage was applied. Although the Law on Compensation for Nuclear Damage formulates the outline of the institutional framework for nuclear third party liability together with operator's insurance scheme, details of actual compensation procedure are not specified. By this reason, the compensation procedure in the Tokai accident had been executed without a concrete legal specification and a precedent. In spite of this situation, the compensation procedure with the accident led to an unexpectedly successful result. We observe the several reasons why the compensation procedure was implemented successfully despite the lack of concrete legal specification and a precedent. One of the reasons is that the local governments, Tokai Village and Ibaraki Prefecture, immediately took the leadership in implementing a temporary regime of compensation procedure without wasting time for waiting national government's directives. Upon practicing this compensation procedure, the local governments implemented the following steps. (1) Initial estimation of the amount and scope of damage. (2) Providing the criteria and heads of damage subject to compensation. (3) Unitary compensation procedure at the local levels. (4) Distribution of emergency payments for the victims. (5) Facilitating compensatory negotiation between the victims and JCO as arbitrator. However, some concerns are also pointed out about the fact that the local government directed the whole procedure without sufficient adjustment with the national government for compensation policy. Among all, in the compensation led by the local governments, it was difficult to guarantee fairness of compensation because victims who are influential on the local government such as industrial associations would have unfairly strong negotiation power in the compensatory negotiation, while the operator being

  13. Local governments' roles of the compensation for damage by the Tokai JCO criticality accident

    International Nuclear Information System (INIS)

    Tanabe, Tomoyuki

    2003-01-01

    The Tokai JCO criticality accident on September 30, 1999 was the first case to which The Law on Compensation for Nuclear Damage was applied. Although the Law on Compensation for Nuclear Damage formulates the outline of the institutional framework for nuclear third party liability together with operator's insurance scheme, details of actual compensation procedure are not specified. By this reason, the compensation procedure in the Tokai accident had been executed without a concrete legal specification and a precedent. In spite of this situation, the compensation procedure with the accident led to an unexpectedly successful result. We observe the several reasons why the compensation procedure was implemented successfully despite the lack of concrete legal specification and a precedent. One of the reasons is that the local governments, Tokai Village and Ibaraki Prefecture, immediately took the leadership in implementing a temporary regime of compensation procedure without wasting time for waiting national government's directives. Upon practicing this compensation procedure, the local governments implemented the following steps. (1) Initial estimation of the amount and scope of damage. (2) Providing the criteria and heads of damage subject to compensation. (3) Unitary compensation procedure at the local levels. (4) Distribution of emergency payments for the victims. (5) Facilitating compensatory negotiation between the victims and JCO as arbitrator. However, some concerns are also pointed out about the fact that the local government directed the whole procedure without sufficient adjustment with the national government for compensation policy. Among all, in the compensation led by the local governments, it was difficult to guarantee fairness of compensation because victims who are influential on the local government such as industrial associations would have unfairly strong negotiation power in the compensatory negotiation, while the operator being responsible for the

  14. 2010 Criticality Accident Alarm System Benchmark Experiments At The CEA Valduc SILENE Facility

    International Nuclear Information System (INIS)

    Miller, Thomas Martin; Dunn, Michael E.; Wagner, John C.; McMahan, Kimberly L.; Authier, Nicolas; Jacquet, Xavier; Rousseau, Guillaume; Wolff, Herve; Piot, Jerome; Savanier, Laurence; Baclet, Nathalie; Lee, Yi-kang; Masse, Veronique; Trama, Jean-Christophe; Gagnier, Emmanuel; Naury, Sylvie; Lenain, Richard; Hunter, Richard; Kim, Soon; Dulik, George Michael; Reynolds, Kevin H.

    2011-01-01

    Several experiments were performed at the CEA Valduc SILENE reactor facility, which are intended to be published as evaluated benchmark experiments in the ICSBEP Handbook. These evaluated benchmarks will be useful for the verification and validation of radiation transport codes and evaluated nuclear data, particularly those that are used in the analysis of CAASs. During these experiments SILENE was operated in pulsed mode in order to be representative of a criticality accident, which is rare among shielding benchmarks. Measurements of the neutron flux were made with neutron activation foils and measurements of photon doses were made with TLDs. Also unique to these experiments was the presence of several detectors used in actual CAASs, which allowed for the observation of their behavior during an actual critical pulse. This paper presents the preliminary measurement data currently available from these experiments. Also presented are comparisons of preliminary computational results with Scale and TRIPOLI-4 to the preliminary measurement data.

  15. Medical follow up of ten patients victims of the radiological accident occurred in Goiania, Goias State, Brazil 1988/1992

    International Nuclear Information System (INIS)

    Curado, M.P.; Morais, M.S.A.; Silva, J.F.; Assis, P.R.; Oliveira, A.R.; Santos, E.A.

    1992-01-01

    The author makes an update of the medical aspects of ten victims of the radiological accident occurred in Goiania in September 1987. These patients received specialized treatment during the critical phase at Marcilio Dias Naval Hospital in Rio de Janeiro. Actually these patients are under medical follow-up at Leide das Neves Ferreira Foundation since march 1988. The clinical, haematological and laboratorial results are presented and discussed. The importance of a close medical follow-up direct victims of a radiological accident is stressed. (author)

  16. Oral hygiene care in critically ill patients

    African Journals Online (AJOL)

    2007-11-19

    Nov 19, 2007 ... conditions, treatment interventions, equipment, and the patient's inability to attend to his or her ... practices for a critically ill patient include assessment of the oral cavity, brushing the teeth, moisturising the lips and mouth and ...

  17. Criticality accident in uranium fuel processing plant. Cause analysis and teachings from a viewpoint of a human factor

    International Nuclear Information System (INIS)

    Furuta, Kazuo

    2000-01-01

    On the JCO criticality accident occurred on September 30, 1999, from relatively earlier time since its occurrence it was elucidated that it was formed not by accident and error operation of apparatus and instruments but by unsafe actions of operators beyond regular manual as its direct cause, and that an organizational factor on business managers and safety administration unable to control such unsafe actions of operators at its background. Then, it was judged to be essential to carry out an accident research from a viewpoint of the human factor (HF) for elucidation on essence of the accident, to establish a 'special workshop on the JCO accident research' to investigate elucidation of the accident cause and countermeasure of reoccurrence at a standpoint of HF. As a result, the essential cause of this accident was summarized that safety information such as ideals, information, teachings and so forth necessary for safety management were failed to share among different organizations. As a teaching of this accident, nuclear energy participants must recognize that safety culture is not finished only in specific organization and range but produced by protecting weathering of danger consciousness and effort of mutually exciting and learning by sharing a safety information beyond different organization, range and time. (G.K.)

  18. [Observation of critically ill patients

    DEFF Research Database (Denmark)

    Fuhrmann, L.; Hesselfeldt, R.; Lippert, A.

    2009-01-01

    . MATERIAL AND METHODS: Prospective observational study at Herlev Hospital, Copenhagen, Denmark. Study personnel measured vital signs on all patients present on five wards during the evening and night and interviewed nursing staff about patients with abnormal vital signs. Subsequently, patient records were...

  19. Study of source term evaluation from fuel solution under simulated nuclear criticality accident in TRACY

    International Nuclear Information System (INIS)

    Abe, Hitoshi; Tashiro, Shinsuke; Nagai, Hitoshi; Koike, Tadao; Okagawa, Seigo; Murata, Mikio

    1999-01-01

    In a accident at the dissolver in a reprocessing plant, various fission products and radiolysis gases will be produced in the fuel solution and volatile radioactive nuclides and radiolysis gases and nitrogen oxide will be released into vent-gas spontaneously. Moreover other on-volatile nuclide will be releases as radioactive aerosol (mist) with bursting bubbles at surface of the solution. Therefore quantitative estimation of release and transport behavior of the radioactive material from solution as source term is very important. TRACY is a transient criticality experimental facility for studying the transient criticality characteristics of low enriched uranium. In this paper, experiment methods and results about the release behavior of the hydrogen, radioactive aerosol and iodine species from the fuel solutions are reported. As the results of the experiments, release patterns of H 2 , 140 Ba and 131 I could be grasped. Concentrations of H 2 in the vent-gas and 140 Ba in the gas phase in the core tank attained to the peak just after the transient criticality and decreased exponentially with time. On the other hand, concentrations of 131 I in the gas phase of the tank began to increase with a time lag of several minutes from the transient criticality and attained approximately constant values. (J.P.N.)

  20. A micro-gap, air-filled ionisation chamber as a detector for criticality accident dosimetry

    International Nuclear Information System (INIS)

    Murawski, I.; Zielczynski, M.; Gryzinski, M.A.; Golnik, N.

    2014-01-01

    A micro-gap air-filled ionisation chamber was designed for criticality dosimetry. The special feature of the chamber is its very small gap between electrodes of only 0.3 mm. This prevents ion recombination at high dose rates and minimises the influence of gas on secondary particles spectrum. The electrodes are made of polypropylene because of higher content of hydrogen in this material, when compared with soft tissue. The difference between neutron and gamma sensitivity in such chamber becomes practically negligible. The chamber's envelope contains two specially connected capacitors, one for polarising the electrodes and the other for collecting the ionisation charge. Air-filled ionisation chamber with very small gap is a simple dosemeter, which fulfills the most desired properties of criticality accident dosemeters. Short ion collection time is achieved by combination of small gap and relatively high polarising voltage. For the same reason, parasitic recombination of ions in the chamber is negligibly small even at high dose rates. The difference between neutron and gamma sensitivity is small for tissue-equivalent chamber and is expected to become practically negligible when the chamber electrodes are made of polypropylene. Additional capacitor provides a broad measuring range from ∼0.1 Gy up to ∼25 Gy; however, leakage of electrical charge from polarising capacitor has to be observed and taken into account. Periodical re-charging of the device is necessary. Obviously, final test of the device in conditions simulating criticality accident is needed and will be performed as soon as available. (authors)

  1. Participation of IRD/CNEN-Br in International Intercomparison of Criticality Accident Dosimetry Systems at Silene reactor, France

    International Nuclear Information System (INIS)

    Mauricio, Claudia Lucia P.; Fonseca, Evaldo S. da

    1996-01-01

    IRD has participated in an International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE reactor, France on June 1993. The dosemeters were irradiated on phantoms and free in air, in bare and lead shield reactor pulses, simulating different irradiation fields that can be found in criticality accidents. Comparing with the reference measurements, the calculated mean neutron kerma found by IRD was only 2% greater for lead shield and 14% greater for bare reactor. For gamma absorbed dose, the differences were, respectively + 22% and -9% for the dosemeters free in air and -19% and -9% for dosemeters on phantoms. IRD results are closer to the real values than the mean values measured by the participants. IRD results show a good performance if its simple criticality accident system. (author)

  2. Results of Questionnaire for the member of JHPS concerning the criticality accident at Tokai

    International Nuclear Information System (INIS)

    2000-01-01

    During the investigation of the criticality accident at Tokai occurring on Sep. 30, 1999, the project team in Japan Health Physics Society (JHPS) carried out a questionnaire for the member on the accident and this paper summarized its results. The effective answer was obtained in 36% of members. Major questions (and frequent answers) were: media of information obtained (internet 33%, TV and radio 22%, and newspaper 19%); concerning actions done by Japanese and local governments, the recommendation on Sep. 30 at 15:00 of evacuation for people living in the area within the radius of 350 m (necessary 92%), timing of its release on Oct. 2 at 18:30 (appropriate 41% and too late 36%) and its information to the people (more information needed 60%) and the recommendation on Sep. 30 at 22:30 of in-door refuge within 10 km radius (unnecessary 43% and necessary 41%), timing of its release on Oct. 1 at 16:40 (too late 49%) and its information to the people (more information needed 63%); and safety declaration for food etc. on Oct. 2 at 18:30 (necessary 92%). Based on above results and free description on the questionnaire, JHPS considered the necessity of described systems of JHPS for emergency.(K.H.)

  3. Early clinical consequences of victims in JCO criticality accident in Tokaimura

    International Nuclear Information System (INIS)

    Suzuki, Gen

    2000-01-01

    The JCO criticality accident occurred at 10:35 on September 30, 1999 when two workers (O and S) poured the solution of uranyl nitrate into the precipitation tank and one (Y) worked at desk in the neighboring room. O's symptoms were unconsciousness, rigidity and emesis, and S's, numbness. The three were moved to Mito National Hospital by an ambulance car at 12:07 and then to the Hospital of National Institute of Radiological Sciences by the helicopter and car at 15:25, where contamination of their cloths by Na-24, suggesting the exposure to neutron, was found. O exhibited emesis within 10 min after the accident and diarrhea, unconsciousness and severe pyrexia within 1 hr, suggesting he had undergone the lethal exposure of >8 Gy. S showed emesis, light unconsciousness and numbness within 1 hr, suggesting >6 Gy and Y did not show even emesis, less dose exposure than the two. They underwent firstly the drip of sodium hydrogen carbonate (due to possible internal exposure of uranium), oxygen inhalation and then corticoid injection as well as the drip of antibiotics. At that day, they had the special therapy with pentoxyphylline and L-glutamine+elementary diet. Later, in the Hospital of Tokyo University, O and S had the heamopoietic stem cell transplantation. At present, O passed away, S is still in hospital and Y is discharged. (K.H.)

  4. Oxygen supplementation for critically ill patients

    DEFF Research Database (Denmark)

    Barbateskovic, M; Schjørring, O L; Jakobsen, J C

    2018-01-01

    . The objective of this systematic review is to critically assess the evidence of randomised clinical trials on the effects of higher versus lower inspiratory oxygen fractions or targets of arterial oxygenation in critically ill adult patients. METHODS: We will search for randomised clinical trials in major......BACKGROUND: In critically ill patients, hypoxaemia is a common clinical manifestation of inadequate gas exchange in the lungs. Supplemental oxygen is therefore given to all critically ill patients. This can result in hyperoxaemia, and some observational studies have identified harms with hyperoxia...... in international guidelines despite lack of robust evidence of its effectiveness. To our knowledge, no systematic review of randomised clinical trials has investigated the effects of oxygen supplementation in critically ill patients. This systematic review will provide reliable evidence to better inform future...

  5. Quick evaluation of the neutron dose following a criticality accident by measurement of sodium 24 activity

    International Nuclear Information System (INIS)

    Tabardel, R.; Ricourt, A.; Parmentier, N.

    1984-07-01

    In order to quickly sort out the irradiated individuals following a criticality accident, the neutron dose can be evaluated quickly by measuring the sodium-24 activity induced in the human body. The report supplies the information necessary for this evaluation from the response of various detectors of current use in radiation protection. The first part describes the method of evaluation of sodium-24 activity (A) given by the reading (M) of each instrument. The second part describes the method of kerma evaluation from the measured sodium-24 activity. The third part is an experimental application of the method of kerma evaluation from the sodium-24 activity measured in a phantom irradiated in the SILENE reactor flux. The results given by radiation protection instruments are in good agreement with the calculated values for a front exposure and demonstrate the usefulness of measuring the induced sodium-24 activity by radiation protection instruments of current use [fr

  6. Improved set of criticality accident detectors used in the intercomparison experiment in Valduc

    International Nuclear Information System (INIS)

    Jozefowicz, K.; Golnik, N.

    1996-01-01

    An improved set of critically accident detectors has been elaborated for the needs of the Inst. of Atomic Energy in Swierk. The sets, which consist of fission track detectors, wide-base silicon diodes and RPL glasses, were tested in the international intercomparison experiment in Valduc, France. Comparison of our results with the reference measurements showed a good agreement (within 25%) for both the neutron and gamma measurements. Additionally, the diode response to neutron kerma was investigated more extensively in the dose range between 2 and 10 Gy, where the dependence of the diode signal versus neutron kerma was not well known. A possibility of the multiple use of the diodes has been proved. (author)

  7. Evaluation of dose equivalent rate distribution in JCO critical accident by radiation transport calculation

    CERN Document Server

    Sakamoto, Y

    2002-01-01

    In the prevention of nuclear disaster, there needs the information on the dose equivalent rate distribution inside and outside the site, and energy spectra. The three dimensional radiation transport calculation code is a useful tool for the site specific detailed analysis with the consideration of facility structures. It is important in the prediction of individual doses in the future countermeasure that the reliability of the evaluation methods of dose equivalent rate distribution and energy spectra by using of Monte Carlo radiation transport calculation code, and the factors which influence the dose equivalent rate distribution outside the site are confirmed. The reliability of radiation transport calculation code and the influence factors of dose equivalent rate distribution were examined through the analyses of critical accident at JCO's uranium processing plant occurred on September 30, 1999. The radiation transport calculations including the burn-up calculations were done by using of the structural info...

  8. SARTEMP2 - A computer program to calculate power and temperatures in a transport flask during a criticality accident

    International Nuclear Information System (INIS)

    Shaw, P.M.

    1983-04-01

    The computer code SARTEMP2, an extended version of the original SARTEMP program, which calculates the power and temperatures in a transport flask during a hypothetical criticality accident is described. The accident arises, it is assumed, during the refilling of the flask with water, bringing the system to delayed critical. As the water level continues to rise, reactivity is added causing the power to rise, and thus temperatures in the fuel, clad and water to increase. The point kinetics equations are coupled to the one-dimensional heat conduction equation. The model used, the method of solution of the equations and the input data required are given. (author)

  9. Invasive and noninvasive hemodynamic monitoring of patients with cerebrovascular accidents.

    Science.gov (United States)

    Velmahos, G C; Wo, C C; Demetriades, D; Bishop, M H; Shoemaker, W C

    1998-01-01

    Seventeen patients with hemodynamic instability from acute cerebrovascular accidents were evaluated shortly after arrival at the emergency department of a university-run county hospital with both invasive Swan-Ganz pulmonary artery catheter placement and a new, noninvasive, thoracic electrical bioimpedance device. Values were recorded and temporal patterns of survivors and nonsurvivors were described. Cardiac indices obtained simultaneously by the 2 techniques were compared. Of the 17 patients, 11 (65%) died. Survivors had higher values than nonsurvivors for mean arterial pressure, cardiac index, and oxygen saturation, delivery, and consumption at comparable times. Cardiac index values, as measured by invasive and noninvasive methods, were correlated. We concluded that hemodynamic monitoring in an acute care setting may recognize temporal circulatory patterns associated with outcome. Noninvasive electrical bioimpedance technology offers a new method for early hemodynamic evaluation. Further research in this area is warranted. PMID:9682626

  10. Theoretical Derivation of Simplified Evaluation Models for the First Peak of a Criticality Accident in Nuclear Fuel Solution

    International Nuclear Information System (INIS)

    Nomura, Yasushi

    2000-01-01

    In a reprocessing facility where nuclear fuel solutions are processed, one could observe a series of power peaks, with the highest peak right after a criticality accident. The criticality alarm system (CAS) is designed to detect the first power peak and warn workers near the reacting material by sounding alarms immediately. Consequently, exposure of the workers would be minimized by an immediate and effective evacuation. Therefore, in the design and installation of a CAS, it is necessary to estimate the magnitude of the first power peak and to set up the threshold point where the CAS initiates the alarm. Furthermore, it is necessary to estimate the level of potential exposure of workers in the case of accidents so as to decide the appropriateness of installing a CAS for a given compartment.A simplified evaluation model to estimate the minimum scale of the first power peak during a criticality accident is derived by theoretical considerations only for use in the design of a CAS to set up the threshold point triggering the alarm signal. Another simplified evaluation model is derived in the same way to estimate the maximum scale of the first power peak for use in judging the appropriateness for installing a CAS. Both models are shown to have adequate margin in predicting the minimum and maximum scale of criticality accidents by comparing their results with French CRiticality occurring ACcidentally (CRAC) experimental data

  11. Criticality accident in uranium fuel processing plant. The estimation of the total number of fissions with related reactor physics parameters

    International Nuclear Information System (INIS)

    Nishina, Kojiro; Oyamatsu, Kazuhiro; Kondo, Shunsuke; Sekimoto, Hiroshi; Ishitani, Kazuki; Yamane, Yoshihiro; Miyoshi, Yoshinori

    2000-01-01

    This accident occurred when workers were pouring a uranium solution into a precipitation tank with handy operation against the established procedure and both the cylindrical diameter and the total mass exceeded the limited values. As a result, nuclear fission chain reactor in the solution reached not only a 'criticality' state continuing it independently but also an instantly forming criticality state exceed the criticality and increasing further nuclear fission number. The place occurring the accident at this time was not reactor but a place having not to form 'criticality' called by a processing process of uranium fuel. In such place, as because of relating to mechanism of chain reaction, it is required naturally for knowledge on the reactor physics, it is also necessary to understand chemical reaction in chemical process, and functions of tanks, valves and pumps mounted at the processes. For this purpose, some information on uranium concentration ratio, atomic density of nuclides largely affecting to chain reaction such as uranium, hydrogen, and so forth in the solution, shape, inner structure and size of container for the solution, and its temperature and total volume, were necessary for determining criticality volume of the accident uranium solution by using nuclear physics procedures. Here were described on estimation of energy emission in the JCO accident, estimation from analytical results on neutron and solution, calculation of various nuclear physics property estimation on the JCO precipitation tank at JAERI. (G.K.)

  12. PNNL Measurement Results for the 2016 Criticality Accident Dosimetry Exercise at the Nevada National Security Stite (IER-148)

    Energy Technology Data Exchange (ETDEWEB)

    Rathbone, Bruce A.; Morley, Shannon M.; Stephens, John A.

    2017-05-01

    The Pacific Northwest National Laboratory (PNNL) participated in a criticality accident dosimetry intercomparison exercise held at the Nevada National Security Site (NNSS) May 24-27, 2016. The exercise was administered by Lawrence Livermore National Laboratory (LLNL) and consisted of three exposures performed using the Godiva-IV critical assembly housed in the Device Assembly Facility (DAF) located on the NNSS site. The exercise allowed participants to test the ability of their nuclear accident dosimeters to meet the performance criteria in ANSI/HPS N13.3-2013, Dosimetry for Criticality Accidents and to obtain new measurement data for use in revising dose calculation methods and quick sort screening methods where appropriate. PNNL participated with new prototype Personal Nuclear Accident Dosimeter (PNAD) and Fixed Nuclear Accident Dosimeter (FNAD) designs as well as the existing historical PNAD design. The new prototype designs incorporate optically stimulated luminescence (OSL) dosimeters in place of thermoluminescence dosimeters (TLDs), among other design changes, while retaining the same set of activation foils historically used. The default dose calculation methodology established decades ago for use with activation foils in PNNL PNADs and FNADs was used to calculate neutron dose results for both the existing and prototype dosimeters tested in the exercise. The results indicate that the effective cross sections and/or dose conversion factors used historically need to be updated to accurately measure the operational quantities recommended for nuclear accident dosimetry in ANSI/HPS N13.3-2013 and to ensure PNAD and FNAD performance meets the ANSI/HPS N13.3-2013 performance criteria. The operational quantities recommended for nuclear accident dosimetry are personal absorbed dose, Dp(10), and ambient absorbed dose, D*(10).

  13. [Medicines reconciliation in critically ill patients].

    Science.gov (United States)

    Lopez-Martin, C; Aquerreta, I; Faus, V; Idoate, A

    2014-01-01

    Medicines reconciliation plays a key role in patient safety. However, there is limited data available on how this process affects critically ill patients. In this study, we evaluate a program of reconciliation in critically ill patients conducted by the Intensive Care Unit's (ICU) pharmacist. Prospective study about reconciliation medication errors observed in 50 patients. All ICU patients, excluding patients without regular treatment. Reconciliation process was carried out in the first 24h after ICU admission. Discrepancies were clarified with the doctor in charge of the patient. We analyzed the incidence of reconciliation errors, their characteristics and gravity, the interventions made by the pharmacist and their acceptance by physicians. A total of 48% of patients showed at least one reconciliation error. Omission of drugs accounted for 74% of the reconciliation errors, mainly involving antihypertensive drugs (33%). An amount of 58% of reconciliation errors detected corresponded to severity category D. Pharmacist made interventions in the 98% of patients with discrepancies. A total of 81% of interventions were accepted. The incidence and characteristics of reconciliation errors in ICU are similar to those published in non-critically ill patients, and they affect drugs with high clinical significance. Our data support the importance of the stablishment of medication reconciliation proceedings in critically ill patients. The ICU's pharmacist could carry out this procedure adequately. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  14. The ENEA criticality accident dosimetry system: a contribution to the 2002 international intercomparison at the SILENE reactor.

    Science.gov (United States)

    Gualdrini, G; Bedogni, R; Fantuzzi, E; Mariotti, F

    2004-01-01

    The present paper summarises the activity carried out at the ENEA Radiation Protection Institute for updating the methodologies employed for the evaluation of the neutron and photon dose to the exposed workers in case of a criticality accident, in the framework of the 'International Intercomparison of Criticality Accident Dosimetry Systems' (Silène reactor, IRSN-CEA-Valduc June 2002). The evaluation of the neutron spectra and the neutron dosimetric quantities relies on activation detectors and on unfolding algorithms. Thermoluminescent detectors are employed for the gamma dose measurement. The work is aimed at accurately characterising the measurement system and, at the same time, testing the algorithms. Useful spectral information were included, based on Monte Carlo simulations, to take into account the potential accident scenarios of practical interest. All along this exercise intercomparison a particular attention was devoted to the 'traceability' of all the experimental and computational parameters and therefore, aimed at an easy treatment by the user.

  15. Cerebrovascular accidents in adult patients with congenital heart disease.

    Science.gov (United States)

    Hoffmann, A; Chockalingam, P; Balint, O H; Dadashev, A; Dimopoulos, K; Engel, R; Schmid, M; Schwerzmann, M; Gatzoulis, M A; Mulder, B; Oechslin, E

    2010-08-01

    To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with congenital heart disease (CHD). In a retrospective analysis of aggregated European and Canadian databases a total population of 23 153 patients with CHD was followed up to the age of 16-91 years (mean 36.4 years). Among them, 458 patients (2.0%) had one or more CVA, with an estimated event rate of 0.05% per patient-year. Permanent neurological sequelae were noted in 116 patients (25.3%). The prevalence of CVA in selected diagnostic categories was as follows: open atrial septal defect 93/2351 (4.0%); closed atrial or ventricular septal defect 57/4035 (1.4%); corrected tetralogy of Fallot 52/2196 (2.4%); Eisenmenger physiology 24/467 (5.1%); other cyanotic 50/215 (23.3%); mechanical prostheses (29/882 (3.3%). Associated conditions in patients with CVA were absence of sinus rhythm (25%), transvenous pacemakers (7%), endocarditis (2%), cardiac surgery (11%) and catheter intervention (2%), but with the exception of absent sinus rhythm these were not significantly more prevalent in patients with CVA. CVA are a major contributor to morbidity in this young population despite absence of classical cardiovascular risk factors. Although the prevalence of CVA in patients with CHD appears low, it is 10-100 times higher than expected in control populations of comparable age. Residua occur in a strong minority of patients. The subjects at highest risk are those patients with CHD with cyanotic lesions, in whom the prevalence is over 10-fold above the average.

  16. The effect of kineziotape on ankle joint in patients with cerebrovascular accident - objectivisation by a footscan

    OpenAIRE

    Veličková, Barbora

    2013-01-01

    BACHELOR THESIS ABSTRACT Name and surname: Barbora Veličková Supervisor: Bc. Tereza Chalupská Opponent: Title: The effect of kineziotape on ankle joint in patients with cerebrovascular accident - objectivisation by a footscan Key words: kineziotaping, ankle joint, cerebrovascular accident, Footscan® Abstract: This bachelor thesis is focused on on the effect of kineziotape on ankle joint in patients with cerebrovascular accident. The bachelor thesis consists of theoretical and practical part. ...

  17. Nutritional requirements of the critically ill patient.

    Science.gov (United States)

    Chan, Daniel L

    2004-02-01

    The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.

  18. Energy Requirements in Critically Ill Patients

    Science.gov (United States)

    2018-01-01

    During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.

  19. Energy Requirements in Critically Ill Patients.

    Science.gov (United States)

    Ndahimana, Didace; Kim, Eun-Kyung

    2018-04-01

    During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.

  20. Family presence preference when patients are receiving resuscitation in an accident and emergency department.

    Science.gov (United States)

    Hung, Maria S Y; Pang, Samantha M C

    2011-01-01

    This paper is a report of a study to illuminate the experience of family members whose relatives survived the resuscitation in an accident and emergency department, and their preferences with regard to being present. Family presence during resuscitation can offer benefits to both patient and family members, and large healthcare organizations support and recommend offering the option for their presence. However, many staff believe that this is too distressing or traumatic for families and that they would interfere with the resuscitation process. An interpretive phenomenological approach was used to collect data in 2007-2008 with 18 family members of patients who survived life-sustaining interventions in an accident and emergency department in Hong Kong. Audio-recorded interviews were transcribed verbatim for thematic analysis and verified with the participants in second interviews. None of the family members was present in resuscitation room during the life-sustaining interventions, and five entered the room after the patients' condition was stable. The majority indicated a strong preference to be present if given the option. Three interrelated themes emerged: (i) emotional connectedness, (ii) knowing the patient, and (iii) perceived (in)appropriateness, with 10 subthemes representing affective, rational and contextual determinants of family presence preferences. The interplay of these determinants and how they contributed to strong or weak preference for family presence was analysed. Variations among the contributing determinants to each family member's preference to be present were revealed. Appropriate nursing interventions, policy and guidelines should be developed to meet individualized needs during such critical and life-threatening moments in accident and emergency departments. © 2010 Blackwell Publishing Ltd.

  1. The incretin effect in critically ill patients

    DEFF Research Database (Denmark)

    Nielsen, Signe Tellerup; Janum, Susanne; Krogh-Madsen, Rikke

    2015-01-01

    INTRODUCTION: Patients admitted to the intensive care unit often develop hyperglycaemia, but the underlying mechanisms have not been fully described. The incretin effect is reduced in patients with type 2 diabetes. Type 2 diabetes and critical illness have phenotypical similarities, such as hyper...

  2. Melatonin Secretion Pattern in Critically Ill Patients

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Holst, René; Jennum, Poul

    2017-01-01

    effect of remifentanil on melatonin secretion. We found that the risk of atypical sleep compared to normal sleep was significantly lower (p REM) sleep was only observed during the nonsedation period. We found preserved diurnal pattern of melatonin...... secretion in these patients. Remifentanil did not affect melatonin secretion but was associated with lower risk of atypical sleep pattern. REM sleep was only registered during the period of nonsedation.......Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin...

  3. Glucose metabolism in critically ill patients

    DEFF Research Database (Denmark)

    Nielsen, Signe Tellerup; Krogh-Madsen, Rikke; Møller, Kirsten

    2015-01-01

    glucose (BG). This is taken advantage of in the treatment of patients with T2DM, for whom GLP-1 analogs have been introduced during the recent years. Infusion of GLP-1 also lowers the BG level in critically ill patients without causing severe hypoglycemia. The T2DM and critical illness share similar......, stimulates insulin secretion and inhibits glucagon release both in healthy individuals and in patients with type 2 diabetes (T2DM). Compared to insulin, GLP-1 appears to be associated with a lower risk of severe hypoglycemia, probably because the magnitude of its insulinotropic action is dependent on blood...

  4. Pharmacokinetics of linezolid in critically ill patients.

    Science.gov (United States)

    Sazdanovic, Predrag; Jankovic, Slobodan M; Kostic, Marina; Dimitrijevic, Aleksandra; Stefanovic, Srdjan

    2016-06-01

    Linezolid is an oxazolidinone antibiotic active against Gram-positive bacteria, and is most commonly used to treat life-threatening infections in critically ill patients. The pharmacokinetics of linezolid are profoundly altered in critically ill patients, partly due to decreased function of vital organs, and partly because life-sustaining drugs and devices may change the extent of its excretion. This article is summarizes key changes in the pharmacokinetics of linezolid in critically ill patients. The changes summarized are clinically relevant and may serve as rationale for dosing recommendations in this particular population. While absorption and penetration of linezolid to tissues are not significantly changed in critically ill patients, protein binding of linezolid is decreased, volume of distribution increased, and metabolism may be inhibited leading to non-linear kinetics of elimination; these changes are responsible for high inter-individual variability of linezolid plasma concentrations, which requires therapeutic plasma monitoring and choice of continuous venous infusion as the administration method. Acute renal or liver failure decrease clearance of linezolid, but renal replacement therapy is capable of restoring clearance back to normal, obviating the need for dosage adjustment. More population pharmacokinetic studies are necessary which will identify and quantify the influence of various factors on clearance and plasma concentrations of linezolid in critically ill patients.

  5. [From fishing trip to the critical care unit : Successful resuscitation after a near drowning accident].

    Science.gov (United States)

    Kippnich, M; Keller, D; Jokinen, J; Kilgenstein, C; Muellenbach, R M; Markus, C; Roewer, N; Kranke, P

    2014-11-01

    In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia. After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits. Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.

  6. Simulation of hypothetical criticality accidents involving homogeneous damp low-enriched UO2 powder systems

    International Nuclear Information System (INIS)

    Basoglu, B.; Brewer, R.W.; Haught, C.F.; Hollenbach, D.F.; Wilkinson, A.D.; Dodds, H.L.; Pasqua, P.F.

    1994-01-01

    This paper describes the development of a computer model for predicting the excursion characteristics of a postulated, hypothetical, critically accident involving a homogeneous mixture of low-enriched UO 2 powder and water contained in a cylindrical blender. The model uses point neutronics coupled with simple lumped-parameter thermal-hydraulic feedback. The temperature of the system is calculated using a simple time-dependent energy balance where two extreme conditions for the thermal behavior of the system are considered, which bound the real life situation. Using these extremes, three different models are developed. To evaluate the models, the authors compared the results with the results of the POWDER code, which was developed by the Commissariat a l'Energie Atomique/United Kingdom Atomic Energy Authority (CEA/UKAEA) for damp powder systems. The agreement in these comparisons is satisfactory. Results of the excursion studies in this work show that approximately 10 19 fissions occur as a result of accidental water ingress into powder blenders containing 5,000 kg of low-enriched (5%) UO 2 powder

  7. Criticality accident dosimetry systems: an international intercomparison at the SILENE reactor in 2002.

    Science.gov (United States)

    Médioni, R; Asselineau, B; Verrey, B; Trompier, F; Itié, C; Texier, C; Muller, H; Pelcot, G; Clairand, I; Jacquet, X; Pochat, J L

    2004-01-01

    In criticality accident dosimetry and more generally for high dose measurements, special techniques are used to measure separately the gamma ray and neutron components of the dose. To improve these techniques and to check their dosimetry systems (physical and/or biological), a total of 60 laboratories from 29 countries (America, Europe, Asia) participated in an international intercomparaison, which took place in France from 9 to 21 June 2002, at the SILENE reactor in Valduc and at a pure gamma source in Fontenay-aux-Roses. This intercomparison was jointly organised by the IRSN and the CEA with the help of the NEA/OCDE and was partly supported by the European Communities. This paper describes the aim of this intercomparison, the techniques used by the participants and the two radiation sources and their characteristics. The experimental arrangements of the dosemeters for the irradiations in free air or on phantoms are given. Then the dosimetric quantities measured and reported by the participants are summarised, analysed and compared with the reference values. The present paper concerns only the physical dosimetry and essentially experiments performed on the SILENE facility. The results obtained with the biological dosimetry are published in two other papers of this issue.

  8. Criticality safety assessment of a TRIGA reactor spent-fuel pool under accident conditions

    International Nuclear Information System (INIS)

    Glumac, B.; Ravnik, M.; Logar, M.

    1997-01-01

    Additional criticality safety analysis of a pool-type storage for TRIGA spent fuel at the Jozef Stefan Institute in Ljubljana, Slovenia, is presented. Previous results have shown that subcriticality is not guaranteed for some postulated accidents (earthquake with subsequent fuel rack disintegration resulting in contact fuel pitch) under the assumption that the fuel rack is loaded with fresh 12 wt% standard fuel. To mitigate this deficiency, a study was done on replacing a certain number of fuel elements in the rack with cadmium-loaded absorber rods. The Monte Carlo computer code MCNP4A with an ENDF/B-V library and detailed three-dimensional geometrical model of the spent-fuel rack was used for this purpose. First, a minimum critical number of fuel elements was determined for contact pitch, and two possible geometries of rack disintegration were considered. Next, it was shown that subcriticality can be ensured when pitch is decreased from a rack design pitch of 8 cm to contact, if a certain number of fuel elements (8 to 20 out of 70) are replaced by absorber rods, which are uniformly mixed into the lattice. To account for the possibility that random mixing of fuel elements and absorber rods can occur during rack disintegration and result in a supercritical configuration, a probabilistic study was made to sample the probability density functions for random absorber rod lattice loadings. Results of the calculations show that reasonably low probabilities for supercriticality can be achieved (down to 10 -6 per severe earthquake, which would result in rack disintegration and subsequent maximum possible pitch decrease) even in the case where fresh 12 wt% standard TRIGA fuel would be stored in the spent-fuel pool

  9. Cerebrovascular accidents in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    S V Kakorin

    2013-03-01

    Full Text Available Cerebrovascular accident (CA is a nowadays widely spread, highly incapacitating and often lethal event that poses a prominent clini- cal problem. Cardiovascular disease (CVD and type 2 diabetes mellitus (T2DM – an “epidemic” of the century, – are known to be its primary risk factors. Hyperglycemia promotes CA risks by induction of protein glycosylation, elevation of blood plasma atherogenic potential, activation of coagulation system with higher risk for thrombosis and disturbance of microcirculation on tissue and organ lev- els. Influence of hyperglycemia on severity and extent of neurologic damage is still under evaluation. Development of macroangiopathy is thought to be associated with media calcification, distal polyneuropathy and renal disorders, all of which are cardiovascular risk factors. Application of so-called metabolic drugs resulted in certain disillusionment, as these agents failed to prove their efficacy during clinical trials. Incidence of pulmonary edema in patients with ischemic CA and T2DM is important as it dictates the necessity for use of loop diuretics. Incidence and severity of heart failure and its correlation with degree of glycemic disorders, incidence of pulmonary em- bolism, as well as tactics of management and prognosis in patients with ischemic CA and T2DM, remains a relevant research problem.

  10. The JCO criticality accident at Tokai-mura, Japan: an overview of the sampling campaign and preliminary results

    International Nuclear Information System (INIS)

    Komura, K.; Yamamoto, M.; Muroyama, T.; Murata, Y.; Nakanishi, T.; Hoshi, M.; Takada, J.; Ishikawa, M.; Takeoka, S.; Kitagawa, K.; Suga, S.; Endo, S.; Tosaki, N.; Mitsugashira, T.; Hara, M.; Hashimoto, T.; Takano, M.; Yanagawa, Y.; Tsuboi, T.; Ichimasa, M.; Ichimasa, Y.; Imura, H.; Sasajima, E.; Seki, R.; Saito, Y.; Kondo, M.; Kojima, S.; Muramatsu, Y.; Yoshida, S.; Shibata, S.; Yonehara, H.; Watanabe, Y.; Kimura, S.; Shiraishi, K.; Ban-nai, T.; Sahoo, S.K.; Igarashi, Y.; Aoyama, M.; Hirose, K.; Uehiro, T.; Doi, T.; Tanaka, A.; Matsuzawa, T.

    2000-01-01

    A criticality accident occurred on September 30, 1999 at the uranium conversion facility of the JCO Company Ltd. in Tokai-mura, Japan. A collaborating scientific investigation team was organized in two groups, the first to carry out research on the environmental impact (the environmental research group) and the second to assess the radiation effects on residents (the biological research group). This report concerns only the activities of the environmental research group. Four investigative teams were sent on different dates to the accident site and its vicinity to collect samples. About 400 samples were collected and subjected to analysis. An outline of the sampling campaign is presented here along with a brief chronology of the accident and the preliminary key results obtained by the independent research group are summarised in this Special Issue of the Journal of Environmental Radioactivity

  11. Design parameters and testing techniques for criticality accident detection systems used in various nuclear establishments - a review

    International Nuclear Information System (INIS)

    Janardhanan, S.; Krishnamony, S.; Krishnamurthi, T.N.; Gopalan, C.S.

    1981-01-01

    Accidental criticality excursion is a potential hazard in operations involving fissile material. In this review paper, design criteria for criticality detection systems, associated requirements for reliable functioning of the instrument and recent advances in the field are discussed. Systems based on integrated dose and rate of change of dose rate concepts are explained. A criticality accident simulator using a pneumatically driven 60 Co source for testing the detector is described. The paper also discusses the relative advantages of gamma and neutron sensing devices. (author)

  12. Design parameters and testing techniques for criticality accident detection systems used in various nuclear establishments - a review

    Energy Technology Data Exchange (ETDEWEB)

    Janardhanan, S.; Krishnamony, S.; Krishnamurthi, T.N.; Gopalan, C.S. (Bhabha Atomic Research Centre, Bombay (India). Health Physics Div.)

    Accidental criticality excursion is a potential hazard in operations involving fissile material. In this review paper, design criteria for criticality detection systems, associated requirements for reliable functioning of the instrument and recent advances in the field are discussed. Systems based on integrated dose and rate of change of dose rate concepts are explained. A criticality accident simulator using a pneumatically driven /sup 60/Co source for testing the detector is described. The paper also discusses the relative advantages of gamma and neutron sensing devices.

  13. Critical thinking in patient centered care.

    Science.gov (United States)

    Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L

    2014-06-01

    Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. NARCISS critical stand experiments for studying the nuclear safety in accident water immersion of highly enriched uranium dioxide fuel elements

    International Nuclear Information System (INIS)

    Ponomarev-Stepnoj, N.N.; Glushkov, E.S.; Bubelev, V.G.

    2005-01-01

    A brief description of the Topaz-2 SNPS designed under scientific supervision of RRC KI in Russia, and of the NARCISS critical facility, is given. At the NARCISS critical facility, neutronic peculiarities and nuclear safety issues of the Topaz-2 system reactor were studied experimentally. This work is devoted to a detailed description of experiments on investigation of criticality safety in accident water immersion og highly enriched uranium dioxide fuel elements, performed at the NARCISS facility. The experiments were carried out at water-moderated critical assemblies with varying height, number, and spacing of fuel elements. The results obtained in the critical experiments, computational models of the investigated critical configurations, and comparison of the computational and experimental results are given [ru

  15. The incidence of cerebrovascular accidents in patients with pituitary adenoma

    International Nuclear Information System (INIS)

    Brada, M.; Burchell, L.; Ashley, S.; Traish, D.

    1999-01-01

    Background and Purpose: Patients with pituitary adenomas are effectively treated with a combination of surgery, radiotherapy, and medical therapy. Nevertheless, long-term studies suggest increased mortality that is independent of tumor control, with cerebrovascular accidents (CVA) as the major contributing cause. The purpose of this study was to define the frequency of CVAs in a cohort of patients with pituitary adenoma and identify potential predisposing factors. Patients and Methods: A cohort of 331 United Kingdom (UK) residents with pituitary adenoma treated at the Royal Marsden Hospital (RMH) between 1962 and 1986 was studied. The frequency of CVA was assessed from RMH and referring hospital records and clinicians, by postal questionnaire of referring hospitals and general practitioners, and by examination of all death certificates. The data were analyzed by actuarial methods, and risk factors were assessed by multivariate analysis. The data were compared to the incidence of CVA in the general population using a published UK population cohort. Results: Sixty-four of 331 patients developed CVA after primary treatment of pituitary adenoma. The actuarial incidence of CVA was 4% (95% CI: 2-7%) at 5 years, 11% (95% CI: 8-14%) at 10 years, and 21% (95% CI: 16-28%) at 20 years measured from the date of radiotherapy. The relative risk of CVA compared to the general population in the UK was 4.1. Age was an independent predictive factor for CVA. However, the relative risk in comparison to the general population was independent of age. The relative risk of developing CVA was higher in women compared to men, in patients undergoing debulking surgery compared to less radical procedures, and in patients diagnosed and treated in the 1980s compared to previous decades. The dose of radiotherapy was an additional independent prognostic factor on multivariate analysis. Conclusion: Patients with pituitary adenoma treated with surgery and radiotherapy have a significantly increased

  16. Prevention of the causes and consequences of a criticality accident - measures adopted in France; Prevention des causes et des consequences d'un accident de criticite - solutions adoptees en France

    Energy Technology Data Exchange (ETDEWEB)

    Fruchard, Y.; Lavie, J.M

    1966-07-01

    The question of safety in regard to criticality accident risks has two aspects: prevention of the cause and limitation of the consequences. These two aspects are closely connected. The effort devoted to prevention of the causes depends on the seriousness of the possible human psychologic and economic consequences of the accident. The criticality accidents which have occurred in the nuclear industry, though few in number, do reveal the imperfect nature of the techniques adopted to prevent the causes, and also constitute the only available realistic basis for evaluating the consequences and developing measures to limit them. The authors give a analysis of the known causes and consequences of past criticality accidents and on this basis make a number of comments concerning: the validity of traditional safety criteria, the probability of accidents for different types of operations, characteristic accidents which can serve as models, and the extent of possible radiological consequences. The measures adopted in France to limit the consequences of a possible criticality accident under the headings: location, design and lay-out of the installations, accident detection, and dosimetry for the exposed personnel, are briefly described after a short account of the criteria used in deciding on them. (author) [French] La surete relative aux risques d'accidents de criticite presente deux aspects: la prevention des causes et les parades aux consequences. Ces deux aspects sont tres lies. L'effort consenti a la prevention des causes decoule de l'importance des consequences humaines economiques et psychologiques possibles d'un eventuel accident. Les accidents de criticite survenus dans l'industrie nucleaire, malgre leur rarete, d'une part devoilent les imperfections des techniques de prevention des causes, d'autre part constituent la seule base realiste disponible d'evaluation des consequences et de mise au point des parades a ces consequences

  17. Prevention of the causes and consequences of a criticality accident - measures adopted in France; Prevention des causes et des consequences d'un accident de criticite - solutions adoptees en France

    Energy Technology Data Exchange (ETDEWEB)

    Fruchard, Y; Lavie, J M

    1966-07-01

    The question of safety in regard to criticality accident risks has two aspects: prevention of the cause and limitation of the consequences. These two aspects are closely connected. The effort devoted to prevention of the causes depends on the seriousness of the possible human psychologic and economic consequences of the accident. The criticality accidents which have occurred in the nuclear industry, though few in number, do reveal the imperfect nature of the techniques adopted to prevent the causes, and also constitute the only available realistic basis for evaluating the consequences and developing measures to limit them. The authors give a analysis of the known causes and consequences of past criticality accidents and on this basis make a number of comments concerning: the validity of traditional safety criteria, the probability of accidents for different types of operations, characteristic accidents which can serve as models, and the extent of possible radiological consequences. The measures adopted in France to limit the consequences of a possible criticality accident under the headings: location, design and lay-out of the installations, accident detection, and dosimetry for the exposed personnel, are briefly described after a short account of the criteria used in deciding on them. (author) [French] La surete relative aux risques d'accidents de criticite presente deux aspects: la prevention des causes et les parades aux consequences. Ces deux aspects sont tres lies. L'effort consenti a la prevention des causes decoule de l'importance des consequences humaines economiques et psychologiques possibles d'un eventuel accident. Les accidents de criticite survenus dans l'industrie nucleaire, malgre leur rarete, d'une part devoilent les imperfections des techniques de prevention des causes, d'autre part constituent la seule base realiste disponible d'evaluation des consequences et de mise au point des parades a ces consequences. Les auteurs presentent une analyse des

  18. Motor vehicle accidents: How should cirrhotic patients be managed?

    Institute of Scientific and Technical Information of China (English)

    Takumi Kawaguchi; Eitaro Taniguchi; Michio Sata

    2012-01-01

    Motor vehicle accidents (MVAs) are serious social issues worldwide and driver illness is an important cause of MVAs.Minimal hepatic encephalopathy (MHE) is a complex cognitive dysfunction with attention deficit,which frequently occurs in cirrhotic patients independent of severity of liver disease.Although MHE is known as a risk factor for MVAs,the impact of diagnosis and treatment of MHE on MVA-related societal costs is largely unknown.Recently,Bajaj et al demonstrated valuable findings that the diagnosis of MHE by rapid screening using the inhibitory control test (ICT),and subsequent treatment with lactulose could substantially reduce the societal costs by preventing MVAs,Besides the ICT and lactulose,there are various diagnostic tools and therapeutic strategies for MHE.In this commentary,we discussed a current issue of diagnostic tools for MHE,including neuropsychological tests.We also discussed the advantages of the other therapeutic strategies for MHE,such as intake of a regular breakfast and coffee,and supplementation with zinc and branched chain amino acids,on the MVA-related societal costs.

  19. Testing of LWR fuel rods to support criticality safety analysis of transport accident conditions

    Energy Technology Data Exchange (ETDEWEB)

    Purcell, P.C. [BNFL International Transport, Spent Fuel Services (United Kingdom); Dallongeville, M. [COGEMA Logistics (AREVA Group) (France)

    2004-07-01

    For the transport of low enriched materials, criticality safety may be demonstrated by applying pessimistic modelling assumptions that bound any realistic case. Where Light Water Reactor (LWR) fuel is being transported, enrichment levels are usually too high to permit this approach and more realistic data is needed. This requires a method by which the response of LWR fuel under impact accident conditions can be approximated or bounded. In 2000, BNFL and COGEMA LOGISTICS jointly commenced the Fuel Integrity Project (FIP) whose objective was to develop such methods. COGEMA LOGISTICS were well advanced with a method for determining the impact response of unirradiated fuel, but required further test data before acceptance by the Transport Regulators. The joint project team extensively discussed the required inputs to the FIP, from which it was agreed that BNFL would organise new tests on both unirradiated and irradiated fuel samples and COGEMA LOGISTICS would take major responsibility for evaluating the test results. Tests on unirradiated fuel rod samples involved both dynamic and quasi-static loading on fuel samples. PWR fuel rods loaded with uranium pellets were dropped vertically from 9m onto a rigid target and this was repeated on BWR fuel rods, similar tests on empty fuel rods were also conducted. Quasi-static tests were conducted on 530 mm long PWR and BWR fuel specimens under axial loading. Tests on irradiated fuel samples were conducted on high burn-up fuel rods of both PWR and BWR types. These were believed original to the FIP project and involved applying bending loads to simply supported pressurised rod specimens. In one test the fuel rod was heated to nearly 500oC during loading, all specimens were subject to axial impact before testing. Considerable experience of fuel rod testing and new data was gained from this test programme.

  20. TL detectors for gamma-ray dose measurements in critically accidents

    International Nuclear Information System (INIS)

    Miljanic, S.; Knezevic, Z.; Zorko, B.; Gregori, B.

    2005-01-01

    Full text: Determination of gamma-ray dose in mixed neutron + gamma-ray fields is still a challenging task. Dosemeters used for gamma-ray dosimetry are usually in some extent sensitive to neutrons and their response variations depend on neutron energy i.e. on neutron spectra. Besides, it is necessary to take into account the energy dependence of dosimeter responses to gamma-rays. To reduce all these influences, design of dosemeter holders is of special importance. In this work, several types of thermoluminescent detectors (TLD) placed in different holders used for gamma-ray dose determination in mixed fields were examined. Dosemeters were from three different institutions: Ruder Boscovic Institute (RBI), Croatia, Jozef Stefan Institute (JSI), Slovenia and Autoridad Regulatoria Nuclear (ARN), Argentina. All dosemeters were irradiated during the International Intercomparison of Criticality Accident Dosimetry Systems at the SILENE Reactor, Valduc, June 2002. At that exercise three accidental scenarios were reproduced: bare reactor, free evolution; lead shielded reactor, steady state; and lead shielded reactor, free evolution. In each irradiation dosemeters were exposed placed on the front of phantom and 'free-in-air'. Also, dosemeters were irradiated in a pure gamma ray field of 60 Co source. Following types of TLDs were used: 7 LiF (TLD-700), CaF 2 :Mn and AI 2 O 3 :Mg,Y - all from RBI; CaF 2 :Mn from JSI and 7 LiF (TLD-700) from ARN. Reported doses were compared with the reference values as well as with the mean participants' values. The results show satisfactory agreement with other dosimetry systems used in the Intercomparison. The influence of different types of holders and applied corrections of dosemeters' readings are discussed. (author)

  1. Critical heat flux for APR1400 lower head vessel during a severe accident

    International Nuclear Information System (INIS)

    Noh, Sang W.; Suh, Kune Y.

    2013-01-01

    Highlights: ► Studied boiling on downward-facing hemispherical vessel with asymmetric thermal insulator. ► Scaled the APR1400 lower head linearly down by 1/10 including ICI tubes and shear keys. ► Performed thermal analysis using ANSYS V11.0 to determine the internal temperature and heat flux. ► Performed tests to obtain the CHF with saturated demineralized water at atmospheric pressure. ► Measured CHF accounting for 3D random flow effect expected in the APR1400 application. -- Abstract: Corium Ablation Stopper Apparatus (CASA) has a downward-facing hemispherical vessel and geometrically asymmetric thermal insulator of the Advanced Power Reactor 1400 MWe (APR1400) scaled linearly down by 1/10, as well as sixty-one in-core instrumentation (ICI) tubes and four shear keys. The heated vessel plays a pivotal role in CASA depending on the configuration of the oxide pool and metal layer to bring about the focusing effect expected of a molten pool in the lower head during a severe accident. The heated vessel was designed through a trial-and-error method and thermal analysis. Thermal analysis was performed using ANSYS V11.0 to investigate the effect of the internal temperature and heat flux on the integral hemispherical copper vessel. The CASA tests were carried out to obtain the critical heat flux (CHF) with saturated and demineralized water at the atmospheric pressure (0.1 MPa). The CHF in the metal layer through the hemispherical channel was found to be lower than that in the ULPU-2400 configuration V data through the streamlined thermal insulator. The experimental CHF was measured and obtained through the CASA hemispherical heated surface accounting for the three-dimensional random flow effect expected in the APR1400 application

  2. Testing of LWR fuel rods to support criticality safety analysis of transport accident conditions

    International Nuclear Information System (INIS)

    Purcell, P.C.; Dallongeville, M.

    2004-01-01

    For the transport of low enriched materials, criticality safety may be demonstrated by applying pessimistic modelling assumptions that bound any realistic case. Where Light Water Reactor (LWR) fuel is being transported, enrichment levels are usually too high to permit this approach and more realistic data is needed. This requires a method by which the response of LWR fuel under impact accident conditions can be approximated or bounded. In 2000, BNFL and COGEMA LOGISTICS jointly commenced the Fuel Integrity Project (FIP) whose objective was to develop such methods. COGEMA LOGISTICS were well advanced with a method for determining the impact response of unirradiated fuel, but required further test data before acceptance by the Transport Regulators. The joint project team extensively discussed the required inputs to the FIP, from which it was agreed that BNFL would organise new tests on both unirradiated and irradiated fuel samples and COGEMA LOGISTICS would take major responsibility for evaluating the test results. Tests on unirradiated fuel rod samples involved both dynamic and quasi-static loading on fuel samples. PWR fuel rods loaded with uranium pellets were dropped vertically from 9m onto a rigid target and this was repeated on BWR fuel rods, similar tests on empty fuel rods were also conducted. Quasi-static tests were conducted on 530 mm long PWR and BWR fuel specimens under axial loading. Tests on irradiated fuel samples were conducted on high burn-up fuel rods of both PWR and BWR types. These were believed original to the FIP project and involved applying bending loads to simply supported pressurised rod specimens. In one test the fuel rod was heated to nearly 500oC during loading, all specimens were subject to axial impact before testing. Considerable experience of fuel rod testing and new data was gained from this test programme

  3. Effects of the criticality accident at Tokai-mura on the public's attitude to nuclear power generation

    Energy Technology Data Exchange (ETDEWEB)

    Kitada, Atsuko [Institute of Social Research, Institute of Nuclear Safety System Inc., Mihama, Fukui (Japan); Hayashi, Chikio [The Institute of Statistical Mathematics, Tokyo (Japan)

    2000-09-01

    The objective of our study was to clarify the effects on the public's attitude of nuclear power and the criticality accident that occurred at the JCO plant in Tokai-mura, Ibaraki Prefecture. For this purpose, we conducted an awareness survey in the Kansai and Kanto areas two months after the accident. Analysis was made on the basis of the comparison of the survey results with the data that the Institute of Nuclear Safety System had accumulated through continuous awareness surveys on nuclear power generation (regular surveys) since 1993. The public's reactions were twofold. On one hand, there were emotional reactions about accidents in nuclear facilities and a reduction in the sense of security. On the other hand, there were reactions concerning the image of nuclear power plant workers and demand on electricity utilities for enhanced employee education and training. The latter reactions correspond to the problems pointed out after the JCO accident. Regarding the utilization of nuclear power generation, the opinion that 'the utilization of nuclear power generation is unavoidable' accounts for 60% of those surveyed. With the opinion that 'nuclear power generation should be utilized' added, 70% of those surveyed take an affirmative attitude to nuclear power utilization. This situation has remained about the same since 1998, the year before the JCO accident. Using the quantification method III to analyze a number of questionnaires about nuclear power generation such as the anxiety about it, we determined overall attitude indexes regarding nuclear power to perform a time sequence comparison. The comparison shows that the attitude after the JCO accident tended to be more negative than in 1998. However, no significant difference in the overall indexes is seen between 1993 and 1998. Judging the comparison results on the basis of the time span starting in 1993 allows us to conclude that the JCO accident has not greatly contributed to worsening

  4. Effects of the criticality accident at Tokai-mura on the public's attitude to nuclear power generation

    International Nuclear Information System (INIS)

    Kitada, Atsuko; Hayashi, Chikio

    2000-01-01

    The objective of our study was to clarify the effects on the public's attitude of nuclear power and the criticality accident that occurred at the JCO plant in Tokai-mura, Ibaraki Prefecture. For this purpose, we conducted an awareness survey in the Kansai and Kanto areas two months after the accident. Analysis was made on the basis of the comparison of the survey results with the data that the Institute of Nuclear Safety System had accumulated through continuous awareness surveys on nuclear power generation (regular surveys) since 1993. The public's reactions were twofold. On one hand, there were emotional reactions about accidents in nuclear facilities and a reduction in the sense of security. On the other hand, there were reactions concerning the image of nuclear power plant workers and demand on electricity utilities for enhanced employee education and training. The latter reactions correspond to the problems pointed out after the JCO accident. Regarding the utilization of nuclear power generation, the opinion that 'the utilization of nuclear power generation is unavoidable' accounts for 60% of those surveyed. With the opinion that 'nuclear power generation should be utilized' added, 70% of those surveyed take an affirmative attitude to nuclear power utilization. This situation has remained about the same since 1998, the year before the JCO accident. Using the quantification method III to analyze a number of questionnaires about nuclear power generation such as the anxiety about it, we determined overall attitude indexes regarding nuclear power to perform a time sequence comparison. The comparison shows that the attitude after the JCO accident tended to be more negative than in 1998. However, no significant difference in the overall indexes is seen between 1993 and 1998. Judging the comparison results on the basis of the time span starting in 1993 allows us to conclude that the JCO accident has not greatly contributed to worsening the attitude towards nuclear

  5. A critical review of Jan Beyea's report: A study of some of the consequences of hypothetical reactor accidents at Barsebaeck

    International Nuclear Information System (INIS)

    Gjoerup, H.L.; Hedemann Jensen, P.; Jensen, N.O.; Pejtersen, V.; Lundtang Petersen, E.; Petersen, T.; Thykier-Nielsen, S.; Heikel Vinther, F.

    1978-04-01

    This report contains a critical review of Jan Beyea's report: A study of some of the consequences of hypothetical reactor accidents at Barsebaeck (Princeton University, January 1978). Unreasonable assumptions concerning dry deposition, plume rise, meteorological considerations, dose-response relationship and probability distributions were found in the report. It is found that the conclusions of the Beyea report are the result of a mathematical exercise rather than the results of a realistic risk evaluation for Barsebaeck. (author)

  6. Framatome-ANP France UO2 fuel fabrication. Criticality safety analysis in the light of the JCO accident

    International Nuclear Information System (INIS)

    Doucet, M.; Zheng, S.; Mouton, J.; Porte, R.

    2003-01-01

    In France the 1999' Tokai Mura criticality accident in Japan had a big impact on the nuclear fuel manufacturing facility community. Moreover this accident led to a large public discussion about all the nuclear facilities. The French Safety Authorities made strong requirements to the industrials to revisit completely their safety analysis files mainly those concerning nuclear fuels treatments. The FRAMATOME-ANP production of its French low enriched (5 w/o) UO2 fuel fabrication plant (FBFC/Romans) exceeds 1000 metric tons a year. Special attention was given to the emergency evacuation plan that should be followed in case of a criticality accident. If a criticality accident happens, site internal and external radioprotection requirements need to have an emergency evacuation plan showing the different routes where the absorbed doses will be as low as possible for people. The French Safety Authorities require also an update of the old based neutron source term accounting for state of the art methodology. UO2 blenders units contain a large amount of dry powder strictly controlled by moderation; a hypothetical water leakage inside one of these apparatus is simulated by increasing the water content of the powder. The resulted reactivity insertion is performed by several static calculations. The French IRSN/CEA CRISTAL codes are used to perform these static calculations. The kinetic criticality code POWDER simulates the power excursion versus time and determines the consequent total energy source term. MNCP4B performs the source term propagation (including neutrons and gamma) used to determine the isodose curves needed to define the emergency evacuation plant. This paper deals with the approach FRAMATOME-ANP has taken to assess Safety Authorities demands using the more up to date calculation tools and methodology. (author)

  7. Critical analysis of radiologist-patient interaction.

    Science.gov (United States)

    Morris, K J; Tarico, V S; Smith, W L; Altmaier, E M; Franken, E A

    1987-05-01

    A critical incident interview technique was used to identify features of radiologist-patient interactions considered effective and ineffective by patients. During structured interviews with 35 radiology patients and five patients' parents, three general categories of physician behavior were described: attention to patient comfort, explanation of procedure and results, and interpersonal sensitivity. The findings indicated that patients are sensitive to physicians' interpersonal styles and that they want physicians to explain procedures and results in an understandable manner and to monitor their well-being during procedures. The sample size of the study is small; thus further confirmation is needed. However, the implications for training residents and practicing radiologists in these behaviors are important in the current competitive medical milieu.

  8. Ethics research in critically ill patients.

    Science.gov (United States)

    Estella, A

    2018-05-01

    Research in critical care patients is an ethical obligation. The ethical conflicts of intensive care research arise from patient vulnerability, since during ICU admission these individuals sometimes lose all or part of their decision making capacity and autonomy. We therefore must dedicate effort to ensure that neither treatment (sedation or mechanical ventilation) nor the disease itself can affect the right to individual freedom of the participants in research, improving the conditions under which informed consent must be obtained. Fragility, understood as a decrease in the capacity to tolerate adverse effects derived from research must be taken into account in selecting the participants. Research should be relevant, not possible to carry out in non-critical patients, and a priori should offer potential benefits that outweigh the risks that must be known and assumable, based on principles of responsibility. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  9. Rhabdomyolysis in Critically Ill Surgical Patients.

    Science.gov (United States)

    Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana

    2016-07-27

    Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.

  10. Antithrombin III for critically ill patients

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Wetterslev, Jørn; Ravn, Frederikke B

    2016-01-01

    Background: Critical illness is associated with uncontrolled inflammation and vascular damage which can result in multiple organ failure and death. Antithrombin III (AT III) is an anticoagulant with anti-inflammatory properties but the efficacy and any harmful effects of AT III supplementation...... in critically ill patients are unknown. This review was published in 2008 and updated in 2015.  Objectives: To examine: 1. The effect of AT III on mortality in critically ill participants. 2. The benefits and harms of AT III. We investigated complications specific and not specific to the trial intervention......, bleeding events, the effect on sepsis and disseminated intravascular coagulation (DIC) and the length of stay in the intensive care unit (ICU) and in hospital in general.  Search methods: We searched the following databases from inception to 27 August 2015: Cochrane Central Register of Controlled Trials...

  11. Infections in critically ill burn patients.

    Science.gov (United States)

    Hidalgo, F; Mas, D; Rubio, M; Garcia-Hierro, P

    2016-04-01

    Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  12. Development of posture-specific computational phantoms using motion capture technology and application to radiation dose-reconstruction for the 1999 Tokai-Mura nuclear criticality accident

    International Nuclear Information System (INIS)

    Vazquez, Justin A; Caracappa, Peter F; Xu, X George

    2014-01-01

    The majority of existing computational phantoms are designed to represent workers in typical standing anatomical postures with fixed arm and leg positions. However, workers found in accident-related scenarios often assume varied postures. This paper describes the development and application of two phantoms with adjusted postures specified by data acquired from a motion capture system to simulate unique human postures found in a 1999 criticality accident that took place at a JCO facility in Tokai-Mura, Japan. In the course of this accident, two workers were fatally exposed to extremely high levels of radiation. Implementation of the emergent techniques discussed produced more accurate and more detailed dose estimates for the two workers than were reported in previous studies. A total-body dose of 6.43 and 26.38 Gy was estimated for the two workers, who assumed a crouching and a standing posture, respectively. Additionally, organ-specific dose estimates were determined, including a 7.93 Gy dose to the thyroid and 6.11 Gy dose to the stomach for the crouching worker and a 41.71 Gy dose to the liver and a 37.26 Gy dose to the stomach for the standing worker. Implications for the medical prognosis of the workers are discussed, and the results of this study were found to correlate better with the patient outcome than previous estimates, suggesting potential future applications of such methods for improved epidemiological studies involving next-generation computational phantom tools. (paper)

  13. Nosocomial pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    Dandagi Girish

    2010-01-01

    Full Text Available The care of critically ill patients in the intensive care unit (ICU is a primary component of modern medicine. ICUs create potential for recovery in patients who otherwise may not have survived. However, they may suffer from problems associated with of nosocomial infections. Nosocomial infections are those which manifest in patients 48 hours after admission to hospital. Nosocomial infections are directly related to diagnostic, interventional or therapeutic procedures a patient undergoes in hospital, and are also influenced by the bacteriological flora prevailing within a particular unit or hospital. Urinary tract infections are the most frequent nosocomial infection, accounting for more than 40% of all nosocomial infections. Critical care units increasingly use high technology medicine for patient care, hemodynamic monitoring, ventilator support, hemodialysis, parenteral nutrition, and a large battery of powerful drugs, particularly antibiotics to counter infection. It is indeed a paradox that the use of high-tech medicine has brought in its wake the dangerous and all too frequent complication of nosocomial infections

  14. The critically ill obstetric patient - Recent concepts

    Directory of Open Access Journals (Sweden)

    Anjan Trikha

    2010-01-01

    Full Text Available Obstetric patients admitted to an Intensive Care Unit (ICU present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.

  15. Trial evaluation on criticality safety of the fuel assemblies at falling accident as spent fuel transport and storage cask

    International Nuclear Information System (INIS)

    Tadano, Tomoaki

    2016-01-01

    The authors conducted critical safety assessment on the supposed event at the time of a fall accident of cask, and examined the influence on criticality safety. If the spacer of fuel assembly is sound, it is assumed that the pitch of fuel rod interval changes, and if the spacer is broken, it is assumed that the fuel rod is unevenly distributed in the basket. For the critical calculation of fuel assembly basket system, they performed it using a calculation code. For both of the single cell and assembly, calculation results showed an increase in the effective multiplication factor of reactivity of 2-3%. When this reactivity is applied to the criticality analysis result of PWR fuel assembly, the value approaches to the limit 0.95 of the neutron effective multiplication factor keff. However, the keff when new fuel is loaded is sufficiently lower than 0.93. Therefore, it is unlikely that the criticality analysis result approaches to 0.95 at all burnups, and the possibility to become criticality is very low in actual spent fuel transport. When considering the reactivity of this research, it is possible that the design condition for the assumption of novel fuel loading becomes severer. Furthermore, criticality analysis under non-uniform pitch will become necessary, and criticality safety analysis for BWR fuel with heterogeneous enrichment degree and burnup degree will become also necessary. (A.O.)

  16. Hyperglycemia and mortality in critically ill patients

    International Nuclear Information System (INIS)

    Rezvanfar, M.R.; Dalvandy, M.; Emami, A.R.; Rafiee, M.; Eshratee, B.

    2009-01-01

    To analyze the relation between serum glucose concentration and hospital outcome across the critically ill patients. A single-centre, retrospective study was performed at surgical and medical intensive care unit. Admission glucose, mean morning glucose, mean glucose, maximal glucose and time-averaged glucose levels were calculated for each patient. The time-averaged hyperglycemia was defined as the area under the curve above the upper limit of normal, divided by the total length of stay. Of 300 patients with a median stay of 16 days, the mortality rate was 32%. Mean fasting glucose was 121 mg/dl in survivors versus 160 mg/dl in non survivors (P=0.001). Mean admission glucose was 127 mg/dl in survivors versus 142 mg/dl in non survivors (0.03). Median time-averaged hyperglycemia was 4 mg/dl in survivors versus 17.5 mg/dl in non survivors (P < 0.006). The area under the receiver operator characteristic (ROC) curve was 0.59 for time-averaged glucose and 0.73 for mean fasting glucose. Whereas time-averaged hyperglycemia is a useful assessment for glucose control in critically ill patients, it has no priority to admission glucose and mean fasting glucose for outcome prediction. (author)

  17. The epidemiology and cost analysis of patients presented to Emergency Department following traffic accidents.

    Science.gov (United States)

    Akgül Karadana, Gökçe; Metin Aksu, Nalan; Akkaş, Meltem; Akman, Canan; Üzümcügil, Akın; Özmen, M Mahir

    2013-12-09

    Traffic accidents are ranked first as the cause of personal injury throughout the world. The high number of traffic accidents yielding injuries and fatalities makes them of great importance to Emergency Departments. Patients admitted to Hacettepe University Faculty of Medicine Adult Emergency Department due to traffic accidents were investigated epidemiologically. Differences between groups were evaluated by Kruskall-Wallis, Mann-Whitney, and Wilcoxon tests. A value of paccidents were the most common. In 2004 the rate of traffic accidents (15.3%) was higher than the other years, the most common month was May (10.8%), and the most common time period was 6 pm to 12 am (midnight). About half of the patients (51.5%) were admitted in the first 30 minutes. Life-threatening condition was present in 9.6% of the patients. Head trauma was the most common type of trauma, with the rate of 18.3%. Mortality rate was 81.8%. The average length of hospital stay was 403 minutes (6.7 hours) and the average cost per patient was 983 ± 4364 TL. Further studies are needed to compare the cost found in this study with the mean cost for Turkey. However, the most important step to reduce the direct and indirect costs due to traffic accidents is the prevention of these accidents.

  18. Mortality Rates of Traumatic Traffic Accident Patients at the University Hospital

    Directory of Open Access Journals (Sweden)

    Atilla Senih MAYDA

    2014-05-01

    Full Text Available The aim of the study is to estimate hospitalization and mortality rates in patients admitted to the University Hospital due to traffic accidents, and to determine the mean cost of the applicants in the hospital due to traffic accident. In this retrospective study data were obtained from the records of a university research and practice hospital. There were 802 patients admitted to emergency and other outpatient clinics of the University Hospital because of traffic accidents throughout the year 2012. Out of these patients, 166 (20.7% were hospitalized, and the annual mortality rate was 0.87%. The total cost was 322,545.2 euro and 402.2 euro per patient. Road traffic accident detection reports covered only the numbers of fatal injuries and injuries that happened at the scene of accidents. Determination of the number of the dead and wounded with overall mortality rate would be supposed to reveal the magnitude of public health problem caused by traffic accidents.

  19. Determination of gamma-ray exposure rate from short-lived fission products under criticality accident conditions

    International Nuclear Information System (INIS)

    Yanagisawa, Hiroshi; Ohno, Akio; Aizawa, Eijyu

    2002-01-01

    For the assessment of γ-ray doses from short-lived fission products (FPs) under criticality accident conditions, γ-ray exposure rates varying with time were experimentally determined in the Transient Experiment Critical Facility (TRACY). The data were obtained by reactivity insertion in the range of 1.50 to 2.93$. It was clarified from the experiments that the contribution of γ-ray from short-lived FPs to total exposure during the experiments was evaluated to be 15 to 17%. Hence, the contribution cannot be neglected for the assessment of γ-ray doses under criticality accident conditions. Computational analyses also indicated that γ-ray exposure rates from short-lived FPs calculated with the Monte Carlo code, MCNP4B, and photon sources based on the latest FP decay data, the JENDL FP Decay Data File 2000, well agreed with the experimental results. The exposure rates were, however, extremely underestimated when the photon sources were obtained by the ORIGEN2 code. The underestimation is due to lack of energy-dependent photon emission data for major short-lived FP nuclides in the photon database attached to the ORIGEN2 code. It was also confirmed that the underestimation arose in 1,000 or less of time lapse after an initial power burst. (author)

  20. Phenytoin pharmacokinetics in critically ill trauma patients.

    Science.gov (United States)

    Boucher, B A; Rodman, J H; Jaresko, G S; Rasmussen, S N; Watridge, C B; Fabian, T C

    1988-12-01

    Preliminary data have suggested that phenytoin systemic clearance may increase during initial therapy in critically ill patients. The objectives for this study were to model the time-variant phenytoin clearance and evaluate concomitant changes in protein binding and urinary metabolite elimination. Phenytoin was given as an intravenous loading dose of 15 mg/kg followed by an initial maintenance dose of 6 mg/kg/day in 10 adult critically ill trauma patients. Phenytoin bound and unbound plasma concentrations were determined in 10 patients and urinary excretion of the metabolite p-hydroxyphenyl phenylhydantoin (p-HPPH) was measured in seven patients for 7 to 14 days. A Michaelis-Menten one-compartment model incorporating a time-variant maximal velocity (Vmax) was sufficient to describe the data and superior to a conventional time-invariant Michaelis-Menten model. Vmax for the time-variant model was defined as V'max + Vmax delta (1 - e(-kindt)). Vmax infinity is the value for Vmax when t is large. The median values (ranges) for the parameters were Km = 4.8 (2.6 to 20) mg/L, Vmax infinity = 1348 (372 to 4741) mg/day, and kind = 0.0115 (0.0045 to 0.132) hr-1. Phenytoin free fraction increased in a majority of patients during the study period, with a binding ratio inversely related to albumin. Measured urinary p-HPPH data were consistent with the proposed model. A loading and constant maintenance dose of phenytoin frequently yielded a substantial, clinically significant fall in plasma concentrations with a pattern of apparently increasing clearance that may be a consequence of changes in protein binding, induction of metabolism, or the influence of stress on hepatic metabolic capacity.

  1. A study on posttraumatic experience of road traffic accident afflicted maxillofacial trauma patient at tertiary hospital.

    Science.gov (United States)

    Yadav, Santosh Kumar; Shrestha, Suraksha

    2017-01-01

    Patients are usually left in a vulnerable state after an accident. Because of this, they long for a good encounter when they are brought to the hospital. Physical impairment and psychological morbidities are some of the complications that can occur to them. Traditionally, surgeons tend to pay little attention to a patient's emotional and psychological perspective. The aim of this study was to understand the experience of oral and maxillofacial trauma patients due to road traffic accident right from immediate after the accident till the end of definitive treatment. Phenomenological approach of qualitative study was used to explore these patients' experience. Twenty subjects involved in road traffic accidents without any cognitive impairment aged 18 and above were recruited. Purposive sampling was used to include maximal variation sample regarding age, gender, types of injury, and types of treatment received. Semi-structured and open-ended interview approach was used to obtain in-depth information. Seven themes were identified to describe the patients' response to and experience after meeting with a road traffic accident; they are unreal experiences, emotional responses, need to inform and need for information, need for assistance, their perception toward the maxillofacial injury, their experience on treatment and staff-patient interaction. This qualitative study has provided an in-depth understanding of patients experience during maxillofacial trauma and treatment, which otherwise cannot be obtained by the use of surveys and test questions.

  2. WWER-440/V-230 Confinement modernization to upgrade the critical safety function 'Containment integrity' in case of severe accident

    International Nuclear Information System (INIS)

    Sartmadjiev, A.

    1999-01-01

    In this lecture the WWER-440/V-230 confinement modernization to upgrade the critical safety function 'Containment integrity' in case of severe accident is presented. There are discussed: design limitations of the location system; consequence from these design limitations; a few confinement reconstruction concepts of this type of units worldwide; and purpose of the confinement reconstruction - to improve significantly the original design, ensuring (1) localization for all possible primary breaks and (2) limitation of the radiological consequences for the personnel, the population and the environment below the regulatory requirements

  3. Evaluation of Neutron Response of Criticality Accident Alarm System Detector to Quasi-Monoenergetic 24 keV Neutrons

    Science.gov (United States)

    Tsujimura, Norio; Yoshida, Tadayoshi; Yashima, Hiroshi

    The criticality accident alarm system (CAAS), which was recently developed and installed at the Japan Atomic Energy Agency's Tokai Reprocessing Plant, consists of a plastic scintillator combined with a cadmium-lined polyethylene moderator and thereby responds to both neutrons and gamma rays. To evaluate the neutron absorbed dose rate response of the CAAS detector, a 24 keV quasi-monoenergetic neutron irradiation experiment was performed at the B-1 facility of the Kyoto University Research Reactor. The detector's evaluated neutron response was confirmed to agree reasonably well with prior computer-predicted responses.

  4. Evaluation of neutron response of criticality accident alarm system detector to quasi-monoenergetic 24 keV neutrons

    International Nuclear Information System (INIS)

    Tsujimura, Norio; Yoshida, Tadayoshi; Yashima, Hiroshi

    2016-01-01

    The criticality accident alarm system (CAAS), which was recently developed and installed at the Japan Atomic Energy Agency's Tokai Reprocessing Plant, consists of a plastic scintillator combined with a cadmium-lined polyethylene moderator and thereby responds to both neutrons and gamma rays. To evaluate the neutron absorbed dose rate response of the CAAS detector, a 24 keV quasi-monoenergetic neutron irradiation experiment was performed at the B-1 facility of the Kyoto University Research Reactor. The detector's evaluated neutron response was confirmed to agree reasonably well with prior computer-predicted responses. (author)

  5. Long-term follow-up of radiation accident patients in Peru: Review of two cases

    International Nuclear Information System (INIS)

    Barriga, L. E.; Zaharia, M.; Pinillos, L.; Moscol, A.; Heredia, A.; Sarria, G.; Marquina, J.; Barriga, O.; Picon, C.

    2012-01-01

    Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990's: one patient exposed to a radiotherapy 60 Co source in Arequipa, the other patient to a 192 Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients. (authors)

  6. in Critically Ill Patients: Success and Limits

    Directory of Open Access Journals (Sweden)

    Filippo Mariano

    2011-01-01

    Full Text Available Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.

  7. Calculation notes that support accident scenario and consequence determination of a waste tank criticality

    International Nuclear Information System (INIS)

    Marusich, R.M. Westinghouse Hanford

    1996-01-01

    The purpose of this calculation note is to provide the basis for criticality consequences for the Tank Farm Safety Analysis Report (FSAR). Criticality scenario is developed and details and description of the analysis methods are provided

  8. A cohort study of accidents occurring in mentally handicapped patients living in institutions

    Directory of Open Access Journals (Sweden)

    Muriel Alfonso

    2010-05-01

    Full Text Available Abstract Background Mentally handicapped patients who require extensive and generalised care and are resident in mental health institutions have certain characteristics that could mean that they suffer certain types of accidents. The aim of this study was to determine the number and type of accident-related injuries in this population in order to design appropriate preventative strategies. Methods Accident-related injuries in patients resident in six institutions in the north of Spain were recorded prospectively over a period of 21 months. The characteristics of these injuries were recorded in a database linked to another in which patient data were recorded. A logistic regression model employing the generalized estimating equation (GEE methodology was employed due to the repetition of patient accidents. Results There was one death due to foreign body aspiration into the airways. A total of 1,671 injuries were recorded, 0.5% of which were classified as serious, 10% moderate and 89.5% minor. The serious injuries involved fractures (6 and cuts (2, the moderate injuries mainly cuts (57%, bruising (18% and sprains (13%, and the minor injuries bruising (40%, cuts (35% and scratches (20%. Falls were the main cause of these injuries (25.2%. The variables associated with serious accidents were self-harm (OR = 1.18, non-collaborative behaviour (OR = 1.21 and inpatient (OR = 1.37. Conclusions Accidents in mentally handicapped patients occur in different ways compared to those in the general population. The majority of injuries found were minor (an average of 0.8 to 3.4 accidents per year, with falls being the most common cause. Patients with behavioural disorders undergoing treatment with neuroleptic agents were found to be a risk group, therefore this finding should be taken into consideration when establishing care groups.

  9. Lateral positioning for critically ill adult patients.

    Science.gov (United States)

    Hewitt, Nicky; Bucknall, Tracey; Faraone, Nardene M

    2016-05-12

    Critically ill patients require regular body position changes to minimize the adverse effects of bed rest, inactivity and immobilization. However, uncertainty surrounds the effectiveness of lateral positioning for improving pulmonary gas exchange, aiding drainage of tracheobronchial secretions and preventing morbidity. In addition, it is unclear whether the perceived risk levied by respiratory and haemodynamic instability upon turning critically ill patients outweighs the respiratory benefits of side-to-side rotation. Thus, lack of certainty may contribute to variation in positioning practice and equivocal patient outcomes. To evaluate effects of the lateral position compared with other body positions on patient outcomes (mortality, morbidity and clinical adverse events) in critically ill adult patients. (Clinical adverse events include hypoxaemia, hypotension, low oxygen delivery and global indicators of impaired tissue oxygenation.) We examined single use of the lateral position (i.e. on the right or left side) and repeat use of the lateral position (i.e. lateral positioning) within a positioning schedule. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1950 to 23 May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to 23 May 2015), the Allied and Complementary Medicine Database (AMED) (1984 to 23 May 2015), Latin American Caribbean Health Sciences Literature (LILACS) (1901 to 23 May 2015), Web of Science (1945 to 23 May 2015), Index to Theses in Great Britain and Ireland (1950 to 23 May 2015), Trove (2009 to 23 May 2015; previously Australasian Digital Theses Program (1997 to December 2008)) and Proquest Dissertations and Theses (2009 to 23 May 2015; previously Proquest Digital Dissertations (1980 to 23 May 2015)). We handsearched the reference lists of potentially relevant reports and two nursing journals. We included randomized and quasi-randomized trials examining effects of

  10. Clinical use of lactate monitoring in critically ill patients

    NARCIS (Netherlands)

    J. Bakker (Jan); M.W.N. Nijsten (Maarten); T.C. Jansen (Tim)

    2013-01-01

    textabstractIncreased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased

  11. Prevention of the Causes and Consequences of Criticality Accidents: Measures Adopted in France; Prevention des Causes et des Consequences d'un Accident de Criticite: Solutions Adoptees en France

    Energy Technology Data Exchange (ETDEWEB)

    Fruchard, Y.; Lavie, J. -M. [Commissariat a l' Energie Atomique, Paris (France)

    1966-05-15

    It is important to guard against the risk of criticality accidents by seeking to prevent their occurrence through the elimination of their causes and also by taking steps to provide against their consequences. These two aspects are closely linked since the efforts made to elaborate preventive procedures are dictated by the importance of the repercussions which such accidents are liable to have in the human, economic and psychological spheres. The criticality accidents which have occurred in the nuclear industry, though small in number, do reveal the imperfect nature of the techniques adopted to prevent them, and they constitute the only available realistic basis for evaluating their consequences and developing suitable precautionary techniques. The authors give a detailed analysis of the known causes and consequences of past criticality accidents and on this basis make a number of comments in connection with the validity of traditional safety criteria, the probability of accidents for different types of operation, the characteristic accidents capable of serving as models, and the extent of possible radiological consequences. The measures adopted in France to limit the consequences of a possible criticality accident (location, design and lay-out of installations, accident detection dosimetry for exposed personnel) are briefly described after a short account of the criteria used in deciding on them. Finally, the authors discuss the economic implications of adopting particular precautionary measures and of applying them uniformly, taking due account of the question of reliability. (author) [French] II est important de se proteger contre les risques d'accidents de criticite en tentant, d'une part, de prevenir les accidents eux-memes par l'elimination de leurs causes, d'autre part, de parer a leurs consequences. Ces deux aspects sont tres lies: l'effort portant sur la prevention des accidents decoule de l'importance de leurs consequences sur les plans humain, economique

  12. The sensitivity of calculated doses to critical assumptions for the offsite consequences of nuclear power reactor accidents

    International Nuclear Information System (INIS)

    Moeller, M.P.; Scherpelz, R.I.; Desrosiers, A.E.

    1982-01-01

    This work analyzes the sensitivity of calculated doses to critical assumptions for offsite consequences following a PWR-2 accident at a nuclear power reactor. The calculations include three radiation dose pathways: internal dose resulting from inhalation, external doses from exposure to the plume, and external doses from exposure to contaminated ground. The critical parameters are the time period of integration for internal dose commitment and the duration of residence on contaminated ground. The data indicate the calculated offsite whole body dose will vary by as much as 600% depending upon the parameters assumed. When offsite radiation doses determine the size of emergency planning zones, this uncertainty has significant effect upon the resources allocated to emergency preparedness

  13. Measurements of 60Co in spoons activated by neutrons during the JCO criticality accident at Tokai-mura in 1999

    International Nuclear Information System (INIS)

    Gasparro, J.; Hult, M.; Komura, K.; Arnold, D.; Holmes, L.; Johnston, P.N.; Laubenstein, M.; Neumaier, S.; Reyss, J.-L.; Schillebeeckx, P.; Tagziria, H.; Van Britsom, G.; Vasselli, R.

    2004-01-01

    Neutron activated items from the vicinity of the place where the JCO criticality accident occurred have been used to determine the fluence of neutrons around the facility and in nearby residential areas. By using underground laboratories for measuring the activation products, it is possible to extend the study to also cover radionuclides with very low activities from long-lived radionuclides. The present study describes γ-ray spectrometry measurements undertaken in a range of underground laboratories for the purpose of measuring 60 Co more than 2 years after the criticality event. The measurements show that neutron fluence determined from 60 Co activity is in agreement with previous measurements using the short-lived radionuclides 51 Cr and 59 Fe. Limits on contamination of the samples with 60 Co are evaluated and shown to not greatly affect the utility of neutron fluence determinations using 60 Co activation

  14. Measurements of 60Co in spoons activated by neutrons during the JCO criticality accident at Tokai-mura in 1999.

    Science.gov (United States)

    Gasparro, J; Hult, M; Komura, K; Arnold, D; Holmes, L; Johnston, P N; Laubenstein, M; Neumaier, S; Reyss, J-L; Schillebeeckx, P; Tagziria, H; Van Britsom, G; Vasselli, R

    2004-01-01

    Neutron activated items from the vicinity of the place where the JCO criticality accident occurred have been used to determine the fluence of neutrons around the facility and in nearby residential areas. By using underground laboratories for measuring the activation products, it is possible to extend the study to also cover radionuclides with very low activities from long-lived radionuclides. The present study describes gamma-ray spectrometry measurements undertaken in a range of underground laboratories for the purpose of measuring (60)Co more than 2 years after the criticality event. The measurements show that neutron fluence determined from (60)Co activity is in agreement with previous measurements using the short-lived radionuclides (51)Cr and (59)Fe. Limits on contamination of the samples with (60)Co are evaluated and shown to not greatly affect the utility of neutron fluence determinations using (60)Co activation.

  15. Determination of the response function for the Portsmouth Gaseous Diffusion Plant criticality accident alarm system neutron detectors

    International Nuclear Information System (INIS)

    Tayloe, R.W. Jr.; Brown, A.S.; Dobelbower, M.C.; Woollard, J.E.

    1997-03-01

    Neutron-sensitive radiation detectors are used in the Portsmouth Gaseous Diffusion Plant's (PORTS) criticality accident alarm system (CAAS). The CAAS is composed of numerous detectors, electronics, and logic units. It uses a telemetry system to sound building evacuation horns and to provide remote alarm status in a central control facility. The ANSI Standard for a CAAS uses a free-in-air dose rate to define the detection criteria for a minimum accident-of-concern. Previously, the free-in-air absorbed dose rate from neutrons was used for determining the areal coverge of criticality detection within PORTS buildings handling fissile materials. However, the free-in-air dose rate does not accurately reflect the response of the neutron detectors in use at PORTS. Because the cost of placing additional CAAS detectors in areas of questionable coverage (based on a free-in-air absorbed dose rate) is high, the actual response function for the CAAS neutron detectors was determined. This report, which is organized into three major sections, discusses how the actual response function for the PORTS CAAS neutron detectors was determined. The CAAS neutron detectors are described in Section 2. The model of the detector system developed to facilitate calculation of the response function is discussed in Section 3. The results of the calculations, including confirmatory measurements with neutron sources, are given in Section 4

  16. A NPO project for measurement of environmental neutrons in the peninsula Shimokita after the JCO criticality accident

    International Nuclear Information System (INIS)

    Aratani, Michi

    2001-01-01

    The Penin. Shimokita as a Nuclear Peninsula: Past and Present: Since 1967, the Penin. Shimokita is characterized as a Nuclear Peninsula. Then the Shimokita Wharf of Ohminato Port in Mutsu-city was appointed as a home port of the Nuclear Power Ship Mutsu. In 1984 Mutsu Ogawara Region, a southern part of the Penin. around Rokkasho, was paid attention as a target region for reprocessing facilities of burnt nuclear fuels from all the nuclear power stations in this country. At the present stage, uranium enrichment facilities, low-level radioactive waste laying center and high-level vitrified waste storage center are in operation, and the reprocessing facilities are under construction. Burnt fuels are also carried into the site before completion of the facilities mainly for the purpose of cooling in the water pool, because cooling pools of some nuclear power stations are already full of the burnt nuclear fuels. Recently, Mayor of Mutsu has announced that Mutsu City are ready to accept a 'temporary' storage facilities for burnt nuclear fuels. Constructions of two nuclear power stations are in procession. Practice and Results: After the JCO critical accident, members of the Penin. Shimokita Activation Society (SAS) have made voluntarily some chances for learning neutron, which has played a definite role in the accident. Before the time of the accident, they have ever heard nothing about a neutron. So, neutron is entirely a new face radiation for them. Members of NPO EGG (Environmental Guardian of GALA) then obtained information from Urgent Session of the 44th Annual Meeting of Radiochemistry held in Tsukuba by the Japan Society of Nuclear and Radiochemical Sciences, and attended the seminar on the JCO accident held at Institute for Environmental Sciences (IES) in Rokkasho. A title of the seminar was 'Extremely Low Background Gamma Ray Spectroscopy applied to the JCO Accident'. The lecturer was Prof. Komura of LLRL (Low Level Radioactivity Laboratory), Kanazawa University

  17. Remifentanil in critically ill cardiac patients

    Directory of Open Access Journals (Sweden)

    Ruggeri Laura

    2011-01-01

    Full Text Available Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal. In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.

  18. Dose evaluation in criticality accidents using response of panasonic TL personal dosemeters (UD-809/UD-802)

    International Nuclear Information System (INIS)

    Zeyrek, C. T.; Guenduez, H.

    2012-01-01

    This study gives the results of dosimetry measurements carried out in the Silene reactor at Valduc (France) with neutron and photon personal thermoluminescence dosemeters (TLDs) in mixed neutron and gamma radiation fields, in the frame of the international accident dosimetry intercomparison programme in 2002. The intercomparison consisted of a series of three irradiation scenarios. The scenarios took place at the Valduc site (France) by using the Silene experimental reactor. For neutron and photon dosimetry, Panasonic model UD-809 and UD-802 personal TLDs were used together. (authors)

  19. Dose evaluation in criticality accidents using response of Panasonic TL personal dosemeters (UD-809/UD-802).

    Science.gov (United States)

    Zeyrek, C T; Gündüz, H

    2012-09-01

    This study gives the results of dosimetry measurements carried out in the Silène reactor at Valduc (France) with neutron and photon personal thermoluminescence dosemeters (TLDs) in mixed neutron and gamma radiation fields, in the frame of the international accident dosimetry intercomparison programme in 2002. The intercomparison consisted of a series of three irradiation scenarios. The scenarios took place at the Valduc site (France) by using the Silène experimental reactor. For neutron and photon dosimetry, Panasonic model UD-809 and UD-802 personal TLDs were used together.

  20. Ventilator Technologies Sustain Critically Injured Patients

    Science.gov (United States)

    2012-01-01

    Consider this scenario: A soldier has been critically wounded in a sudden firefight in a remote region of Afghanistan. The soldier s comrades attend to him and radio for help, but the soldier needs immediate medical expertise and treatment that is currently miles away. The connection between medical support for soldiers on the battlefield and astronauts in space may not be immediately obvious. But when it comes to providing adequate critical care, NASA and the military have very similar operational challenges, says Shannon Melton of NASA contractor Wyle Integrated Science and Engineering. Melton works within Johnson Space Center s Space Medicine Division, which supports astronaut crew health before, during, and after flight. In space, we have a limited number of care providers, and those providers are not always clinicians with extensive medical training. We have limited room to provide care, limited consumables, and our environment is not like that of a hospital, she says. The Space Medicine Division s Advanced Projects Group works on combining the expertise of both clinicians and engineers to develop new capabilities that address the challenges of medical support in space, including providing care to distant patients. This field, called telemedicine, blends advanced communications practices and technologies with innovative medical devices and techniques to allow caregivers with limited or no medical experience to support a patient s needs. NASA, just by its nature, has been doing remote medicine since the beginning of the Space Program, says Melton, an engineer in the Advanced Projects Group. Since part of NASA s mandate is to transfer the results of its technological innovation for the benefit of the public, the Agency has worked with doctors and private industry to find ways to apply the benefits of space medicine on Earth. In one such case, a NASA partnership has resulted in new technologies that may improve the quality of emergency medicine for wounded

  1. Clinical validation of nursing outcome mobility in patients with cerebrovascular accidents.

    Science.gov (United States)

    Moreira, Rafaella Pessoa; Araujo, Thelma Leite de; Lopes, Marcos Venicios de Oliveira; Cavalcante, Tahissa Frota; Guedes, Nirla Gomes; Chaves, Emília Soares; Portela, Regiane Campos; Holanda, Rose-Eloise

    2016-12-15

    To clinically validate the nursing outcome Mobility in patients with cerebrovascular accidents. Descriptive study, conducted in July 2011, with 38 outpatients, in northeastern Brazil. Data collection took place by evaluating two pairs of specialist nurses, where one pair used the instrument containing the constitutive and operational definitions of the indicators and magnitudes of the Mobility Outcome and the other pair without such definitions. When analyzing the evaluations among nurses, all indicators showed significant differences by the Friedman test (p cerebrovascular accident patient's mobility state.

  2. Continuous oscillation: outcome in critically ill patients.

    Science.gov (United States)

    Traver, G A; Tyler, M L; Hudson, L D; Sherrill, D L; Quan, S F

    1995-09-01

    To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. One hundred and three intensive care patients were randomly assigned to standard turning or turning by an oscillating bed. Data, collected at baseline, daily for 7 days, and then three times weekly until study discharge, included demographics, initial Acute Physiology and Chronic Health Evaluation (APACHE II) score, ventilatory/gas exchange parameters, indicators of pneumonia, nursing measures, and chest roentgenograph. There were no significant differences for LOS, duration of ventilation, nor incidence of pneumonia. Higher survival for subjects on the oscillating bed reached borderline significance (P = .056) for subjects with APACHE II greater than or equal to 20. Longitudinal data were analyzed using the random effects model. No differences in ventilatory or gas exchange parameters were identified. Among subjects who developed pneumonia there was a significantly higher respiratory score (nursing acuity scale) for subjects on the oscillating bed. In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.

  3. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients

    Directory of Open Access Journals (Sweden)

    Roland N. Dickerson

    2016-04-01

    Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.

  4. Analytical evaluation of dose measurement of critical accident at SILENE (Contract research)

    CERN Document Server

    Nakamura, T; Tonoike, K

    2003-01-01

    Institute for Radioprotection and Nuclear Safety (IRSN) and the OECD Nuclear Energy Agency (NEA) jointly organized SILENE Accident Dosimetry Intercomparison Exercise to intercompare the dose measurement systems of participating countries. Each participating country carried out dose measurements in the same irradiation field, and the measurement results were mutually compared. The participated in the exercise to measure the doses of gamma rays and neutron from SILENE by using thermoluminescence dosimeters (TLD's) and an alanine dosimeter. In this examination, the derived evaluation formulae for obtaining a tissue-absorbed dose from measured value (ambient dose equivalent) of TLD for neutron. We reported the tissue-absorbed dose computed using this evaluation formula to OECD/NEA. TLD's for neutron were irradiated in the TRACY facility to verify the evaluation formulae. The results of TLD's were compared with the calculations of MCNP and measurements with alanine dose meter. We found that the ratio of the dose b...

  5. Evaluation of re-criticality potential in Fukushima Dai-ichi reactors following core damage accidents

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-15

    The re-criticality potential of the debris-bed, formed of the degraded core materials, cannot be ruled out during the cooling-down procedure of the Fukushima Dai-ichi NPPs. In this study the re-criticality potential has systematically investigated based on the core disruption phase analysis using a IMPACT-SAMPSON code prepared by The Institute of Applied Energy (IAE). The results obtained for the re-criticality potential, characterized by the eigen-values k-eff dependent on the debris composition formed at the core, RPV bottom, and PCV pedestal, are reflected to the arguments on the re-criticality prevention measures, such as timing and concentration of boron-compounds, during the cooling-down process of the Fukushima Dai-ichi NPPs. (author)

  6. Characteristics of the French system for the detection of criticity accidents

    International Nuclear Information System (INIS)

    Barbry, F.; Prigent, R.

    1983-01-01

    The first versions of these devices were put in operation in the industry during 1976, i.e., more than 10 years after the very first criticity detection and warning systems in France. Today some 350 probes are installed

  7. The efficacy of Bobath neurodevelopmental interventions at home for patients after postcerebrovascular accidents.

    Science.gov (United States)

    Garrett, C G; Bechtel, G A

    1996-06-01

    The traditional approach to rehabilitating patients after cerebrovascular accidents encourages the patient to use only the unaffected side for all activities. This article presents the Bobath approach, which focuses on patients using both sides to regain former capabilities. The rationale and implementation of this method are outlined so that the home care nurse can learn how to use this method, used so commonly by rehabilitative therapists.

  8. Chromosome aberration analysis in persons exposed to low-level radiation from the JCO criticality accident in Tokai-mura

    International Nuclear Information System (INIS)

    Sasaki, Masao S.; Hayata, Isamu; Kamada, Nanao; Kodama, Yoshiaki; Kodama, Seiji

    2001-01-01

    Chromosome aberrations were studied in peripheral blood lymphocytes of 43 persons who were exposed to low-level radiation of mixed neutrons and γ-rays resulting from the JCO criticality accident. When the age-adjusted frequencies of dicentric and ring chromosomes were compared with the dose calibration curve established in vitro for 60 Co γ-rays as a reference radiation, a significant correlation was observed between the chromosomally estimated doses and the documented doses evaluated by physical means. The regression coefficient of the chromosomal doses against the documented doses, 1.47±0.33, indicates that the relative biological effectiveness of fission neutrons at low doses is considerably higher than that currently adopted in the radiation protection standard. (author)

  9. Calibration of the indium foil used for criticality accident dosimetry in the UCC-ND employee identification badge

    International Nuclear Information System (INIS)

    Ryan, M.T.; Butler, H.M.; Gupton, E.D.; Sims, C.S.

    1982-05-01

    The UCC-ND Employee Identification Badge contains an indium foil disc that is intended for use as a dosimetry screening device in the event of a criticality accident. While it is recognized that indium is not a precise mixed neutron-gamma dosimeter, its activation by neutrons provides adequate means for separating potentially exposed persons into three groups. These groups are: (1) personnel exposed below annual dose limits, (2) personnel exposed above annual dose limits but below 25 rem, and (3) personnel exposed above 25 rem. This screening procedure is designed to facilitate dosimeter processing in order to meet regulatory reporting requirements. A quick method of interpreting induced activity measurements is presented and discussed

  10. Design of and experience with the gamma-detecting criticality accident alarm system at ALKEM MOX fuel fabrication plant

    International Nuclear Information System (INIS)

    Kindleben, G.

    1988-01-01

    At ALKEM mixed oxide fuel fabrication plant there are two criticality accident alarm systems in operation and another one is planned for different buildings. They use ionization chambers for gamma-measuring. The measuring channels are self controlled with implemented test sources. The order of limit transgression at the detectors is registrated. The interpretation indicates the room of the radiation source, which is signaled by flash lights. Extensive radiation protection shieldings make detector-placing a complex problem with secondary gamma-radiation to be taken into account. Most of the appearing defects can easily be repaired by exchange of components. Some of them have been eliminated by technical modification. Redundancy prevents total system failure. Some false alarms occurred during the operation time of the alarm systems. The main reason is pulse induction, resulting from lightning strike. Measures to prevent such events have been taken, while further measures are being considered

  11. Increased pain sensitivity in accident-related chronic pain patients with comorbid posttraumatic stress

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Andersen, Tonny Elmose; Harvold, Mathea

    2018-01-01

    , anxiety, pain catastrophizing, and fear of movement) in patients with accident-related chronic spinal pain with (N=44) and without (N=64) comorbid PTSD characteristics. METHODS: Cuff algometry was performed on lower legs to assess pressure pain threshold (cPPT), tolerance (cPTT), temporal summation...

  12. Should we mobilise critically ill patients? A review.

    LENUS (Irish Health Repository)

    O'Connor, Enda D

    2009-12-01

    Neuromuscular weakness, a frequent complication of prolonged bed rest and critical illness, is associated with morbidity and mortality. Mobilisation physiotherapy has widespread application in patients hospitalised with non-critical illness.

  13. Analytical evaluation of dose measurement of critical accident at SILENE (Contract research)

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Takemi; Tonoike, Kotaro; Miyoshi, Yoshinori [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2003-03-01

    Institute for Radioprotection and Nuclear Safety (IRSN) and the OECD Nuclear Energy Agency (NEA) jointly organized SILENE Accident Dosimetry Intercomparison Exercise to intercompare the dose measurement systems of participating countries. Each participating country carried out dose measurements in the same irradiation field, and the measurement results were mutually compared. The authors participated in the exercise to measure the doses of gamma rays and neutron from SILENE by using thermoluminescence dosimeters (TLD's) and an alanine dosimeter. In this examination, the authors derived evaluation formulae for obtaining a tissue-absorbed dose from measured value (ambient dose equivalent) of TLD for neutron. We reported the tissue-absorbed dose computed using this evaluation formula to OECD/NEA. TLD's for neutron were irradiated in the TRACY facility to verify the evaluation formulae. The results of TLD's were compared with the calculations of MCNP and measurements with alanine dose meter. We found that the ratio of the dose by the evaluation formula to the measured value by the alanine dosimeter was 0.94 and the formula agreed within 6%. From examination of this TRACY, we can conclude that the value reported to OECD/NEA has equivalent accuracy. (author)

  14. Pharmacokinetics of trimethoprim-sulfamethoxazole in critically ill and non-critically ill AIDS patients.

    OpenAIRE

    Chin, T W; Vandenbroucke, A; Fong, I W

    1995-01-01

    Current dosage regimens of trimethoprim-sulfamethoxazole used to treat Pneumocystis carinii pneumonia in AIDS patients have been based on data from healthy subjects or patients without AIDS. The clearance and absorption characteristics of the drugs may potentially be different between patients with and without AIDS. This study was conducted to assess the pharmacokinetics of trimethoprim-sulfamethoxazole in critically ill and non-critically ill AIDS patients treated for P. carinii pneumonia. P...

  15. Evaluation of Seizure Attacks in Patients with Cerebrovascular Accident

    Directory of Open Access Journals (Sweden)

    Ebrahim Koochaki

    2013-04-01

    Full Text Available Background: The most common reason for seizure in elderly duration is the stroke. This study was conducted aiming to assess the frequency of seizure attack occurrence in those patients. Materials and Methods: This investigation was carried out through a cross-sectional method for one year on 330 patients admitted to the neurology ward as diagnosed with stroke. The required data was collected through the researcher-made questionnaire from the patients suffering from stoke which was diagnosed based on clinical findings, CT-Scan and MRI as required. Results: Among 330 patient suffering from stroke (162 men and 168 women, 48 cases (14.5% were suffering from seizure. Six percent of the patients had early seizure and another 8.5% had late seizure. Among 162 men suffering from the stroke, 32 ones were without seizures and 30 men were suffering the seizure. A number of 150 women out of total 168 ones suffering from the stroke, had no seizure and 18 others had seizures; frequency of seizure occurrence was more in male samples (p=0.044. In the people under 60 year, there were mostly early types of seizure (45% and in the age range above 60 year, it was mostly late type (89.3%. A 68.5% of the patients suffering from the seizure had experienced ischemic stroke. However, the frequency of seizure occurrence in the patients with hemorrhagic stroke was statistically greater (p=0.003. Conclusion: This examination showed that occurrence of seizure attacks in the people with stroke is 14.5% and it is seen more in the hemorrhagic strokes than ischemic ones. The frontoparietal area is the most common location involved and tonic clonic was the most common seizure in the patients suffering from it who have experienced the stroke

  16. An association between dietary habits and traffic accidents in patients with chronic liver disease: A data-mining analysis.

    Science.gov (United States)

    Kawaguchi, Takumi; Suetsugu, Takuro; Ogata, Shyou; Imanaga, Minami; Ishii, Kumiko; Esaki, Nao; Sugimoto, Masako; Otsuyama, Jyuri; Nagamatsu, Ayu; Taniguchi, Eitaro; Itou, Minoru; Oriishi, Tetsuharu; Iwasaki, Shoko; Miura, Hiroko; Torimura, Takuji

    2016-05-01

    The incidence of traffic accidents in patients with chronic liver disease (CLD) is high in the USA. However, the characteristics of patients, including dietary habits, differ between Japan and the USA. The present study investigated the incidence of traffic accidents in CLD patients and the clinical profiles associated with traffic accidents in Japan using a data-mining analysis. A cross-sectional study was performed and 256 subjects [148 CLD patients (CLD group) and 106 patients with other digestive diseases (disease control group)] were enrolled; 2 patients were excluded. The incidence of traffic accidents was compared between the two groups. Independent factors for traffic accidents were analyzed using logistic regression and decision-tree analyses. The incidence of traffic accidents did not differ between the CLD and disease control groups (8.8 vs. 11.3%). The results of the logistic regression analysis showed that yoghurt consumption was the only independent risk factor for traffic accidents (odds ratio, 0.37; 95% confidence interval, 0.16-0.85; P=0.0197). Similarly, the results of the decision-tree analysis showed that yoghurt consumption was the initial divergence variable. In patients who consumed yoghurt habitually, the incidence of traffic accidents was 6.6%, while that in patients who did not consume yoghurt was 16.0%. CLD was not identified as an independent factor in the logistic regression and decision-tree analyses. In conclusion, the difference in the incidence of traffic accidents in Japan between the CLD and disease control groups was insignificant. Furthermore, yoghurt consumption was an independent negative risk factor for traffic accidents in patients with digestive diseases, including CLD.

  17. An association between dietary habits and traffic accidents in patients with chronic liver disease: A data-mining analysis

    Science.gov (United States)

    KAWAGUCHI, TAKUMI; SUETSUGU, TAKURO; OGATA, SHYOU; IMANAGA, MINAMI; ISHII, KUMIKO; ESAKI, NAO; SUGIMOTO, MASAKO; OTSUYAMA, JYURI; NAGAMATSU, AYU; TANIGUCHI, EITARO; ITOU, MINORU; ORIISHI, TETSUHARU; IWASAKI, SHOKO; MIURA, HIROKO; TORIMURA, TAKUJI

    2016-01-01

    The incidence of traffic accidents in patients with chronic liver disease (CLD) is high in the USA. However, the characteristics of patients, including dietary habits, differ between Japan and the USA. The present study investigated the incidence of traffic accidents in CLD patients and the clinical profiles associated with traffic accidents in Japan using a data-mining analysis. A cross-sectional study was performed and 256 subjects [148 CLD patients (CLD group) and 106 patients with other digestive diseases (disease control group)] were enrolled; 2 patients were excluded. The incidence of traffic accidents was compared between the two groups. Independent factors for traffic accidents were analyzed using logistic regression and decision-tree analyses. The incidence of traffic accidents did not differ between the CLD and disease control groups (8.8 vs. 11.3%). The results of the logistic regression analysis showed that yoghurt consumption was the only independent risk factor for traffic accidents (odds ratio, 0.37; 95% confidence interval, 0.16–0.85; P=0.0197). Similarly, the results of the decision-tree analysis showed that yoghurt consumption was the initial divergence variable. In patients who consumed yoghurt habitually, the incidence of traffic accidents was 6.6%, while that in patients who did not consume yoghurt was 16.0%. CLD was not identified as an independent factor in the logistic regression and decision-tree analyses. In conclusion, the difference in the incidence of traffic accidents in Japan between the CLD and disease control groups was insignificant. Furthermore, yoghurt consumption was an independent negative risk factor for traffic accidents in patients with digestive diseases, including CLD. PMID:27123257

  18. Radiation accidents

    International Nuclear Information System (INIS)

    Poplavskij, K.K.; Smorodintseva, G.I.

    1978-01-01

    On the basis of a critical analysis of the available data on causes and consequences of radiation accidents (RA), a classification of RA by severity (five groups of accidents) according to biomedical consequences and categories of exposed personnel is proposed. A RA is defined and its main characteristics are described. Methods of RA prevention are proposed, as is a plan of specific measures to deal with RA in accordance with the proposed classification

  19. Nuclear accident dosimetry

    International Nuclear Information System (INIS)

    1982-01-01

    The film presents statistical data on criticality accidents. It outlines past IAEA activities on criticality accident dosimetry and the technical documents that resulted from this work. The film furthermore illustrates an international comparison study on nuclear accident dosimetry conducted at the Atomic Energy Research Establishment, Harwell, United Kingdom

  20. Nuclear accident dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1983-12-31

    The film presents statistical data on criticality accidents. It outlines past IAEA activities on criticality accident dosimetry and the technical documents that resulted from this work. The film furthermore illustrates an international comparison study on nuclear accident dosimetry conducted at the Atomic Energy Research Establishment, Harwell, United Kingdom

  1. Potential criticality accident at the General Electric Nuclear Fuel and Component Manufacturing Facility, May 29, 1991

    International Nuclear Information System (INIS)

    1991-08-01

    At the General Electric Nuclear Fuel and Component Manufacturing facility, located near Wilmington, North Carolina, on May 28 and 29, 1991, approximately 150 kilograms of uranium were inadvertently transferred from safe process tanks to an unsafe tank located at the waste treatment facility, thus creating the potential for a localized criticality safety problem. The excess uranium was ultimately safely recovered when the tank contents were centrifuged to remove the uranium-bearing material. Subsequently, the US Nuclear Regulatory Commission dispatched an Incident Investigation Team to determine what happened, to identify probable causes, and to make appropriate findings and conclusions. This report describes the incident, the methodology used by the team in its investigation, and presents the team's findings and conclusions. 48 figs., 8 tabs

  2. INTRACRANIAL STENOSIS IN PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENTS

    Directory of Open Access Journals (Sweden)

    Hossein Zarei

    2010-12-01

    Full Text Available Abstract    INTRODUCTION: This study was conducted to investigate pattern and risk factors associated with the location of atherosclerotic occlusive lesions in cerebral vessels. Previous studies of patients with stroke or transient ischemic attack (TIA suggest that extracranial atherosclerosis is more common in the white race. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD, and magnetic resonance angiography (MRA allow vascular assessment of a more representative proportion of the patients, compared to conventional angiography alone.    METHODS: We evaluated patients with cerebrovascular problems (stroke and/or TIA during a period of 6 months, using duplex ultrasonography, TCD and MRA to detect significant stenosis according to standard criteria.    RESULTS: Stenosis of extracranial and intracranial arteries was detected in 38% and 29% of cases, respectively. MCA was the most frequent involved intracranial artery (11% bilaterally and 5% unilaterally. Intracranial lesions tend to be multiple. There was no significant difference between men and women in terms of frequency and distribution of stenosis. No correlation was found between opium use and stenosis. The women had significantly more poor windows than men (P<0.05. The extracranial stenosis was significantly more frequent than intracranial stenosis (P<0.01.    CONCLUSION: The relations between hypertension and extracranial stenosis, and diabetes and MCA stenosis were statistically significant. TCD seemed to be a better technique for evaluating intracranial lesions in men than in women.      Keywords: Atherosclerosis, Stenosis, Carotid artery, Doppler Sonography.  

  3. An emergent proposal on the Committee of Uranium Processing Factory Criticality Accident Survey of the Nuclear Safety Commission. A meantime report dated on November 5, 1999

    International Nuclear Information System (INIS)

    2000-01-01

    The Nuclear Safety Commission was received a decision on thorough investigations of accident reason on criticality accident at the Tokai-mura uranium processing factory of the JCO Incorporation occurred on September 30, 1999, to establish the Committee of Uranium Processing Factory Criticality Accident Survey to elucidate its reason thoroughly and contribute to set up a sufficient reforming prevention countermeasure. This Committee judged that it was important to propose a countermeasure directly obtainable by grasping some fact relations clarified before now as soon as possible and intended to conduct this meantime report of 'emergent proposal' by arrangement of such fact relations. Here were described on accidental conditions and their effects, response to the accident (on prevention of the accident), its reasons and their relating conditions, and some emergent proposals. In the last items, safety security at accidental site, health countermeasures to residents and others, establishment of safety security for nuclear business workers and others, and reconstruction on safety regulation in national government. (G.K.)

  4. Characteristics of cerebrovascular accidents at time of diagnosis in a series of 98 patients with giant cell arteritis.

    Science.gov (United States)

    Zenone, Thierry; Puget, Marie

    2013-12-01

    The objective of this study was to determine the characteristics of cerebrovascular accidents at time of diagnosis in patients with giant cell arteritis. Retrospective data were collected from 98 patients at a single hospital with giant cell arteritis (according to the American College of Rheumatology classification criteria) diagnosed between October 1999 and January 2012. Cerebrovascular accident was found at initial presentation in 6 patients (6.1 %, 95 % CIs 2.3-12.9). Most of them had other symptoms of giant cell arteritis when the disease began. Signs reflecting the involvement of vertebro-basilar territory were present in 3 cases. No other case of cerebrovascular accident was described during the follow-up of patient; particularly no case of cerebrovascular accident occurred once corticosteroid therapy for the treatment of giant cell arteritis had been initiated. No differences in the epidemiologic, clinical and laboratory features at the time of diagnosis between patients who had cerebrovascular accidents and the rest of the giant cell arteritis patients were observed. Prognosis was good in our survey. However, there was no case of bilateral vertebral artery occlusion, a condition associated with poor prognosis. The present study confirms that cerebrovascular accidents may be the initial manifestation of giant cell arteritis, an argument in favor of a direct effect of the vasculitis in the development of cerebrovascular accidents rather than a complication of the corticosteroid therapy. The diagnosis of giant cell arteritis should always be considered in an elderly patient with stroke and an unexplained elevation of inflammatory biomarkers.

  5. Does gender influence outcomes in critically ill patients?

    OpenAIRE

    Angele, Martin K; Pratschke, Sebastian; Chaudry, Irshad H

    2012-01-01

    Investigators continue to debate whether gender plays any role in patient outcome following injury/critical illness. We submit that age and hormonal milieu at the time of injury, rather than gender, are the critical factors influencing patient outcome under those conditions.

  6. Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.

    Science.gov (United States)

    Nair, Chandra K; Aronow, Wilbert S; Shen, Xuedong; Anand, Kishlay; Holmberg, Mark J; Esterbrooks, Dennis J

    2009-11-01

    The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up. Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.

  7. Radioimmunoassay of serummyelin basic protein and its application to patients with cerebrovascular accident

    International Nuclear Information System (INIS)

    Palfreyman, J.W.; Johnston, R.V.; Ratcliffe, J.G.; Forbes, G.D.; Thomas, D.G.T.

    1979-01-01

    Myelin basic protein-like immunoactivity was measured in the serum of patients after cerebrovascular accident (CVA) using a double antibody radioimmunoassay for myelin basic protein with a detection limit of 3 ng/ml serum. For up to 6 days after ictus, serum myelin basic protein levels in patients with severe CVA and patients who died as a result of CVA were significantly greater than those in control patients, patients with moderate CVA and patients surviving CVA. All patients with serum myelin basic protein levels greater than the range found in control subjects subsequently died. Serial dilutions of positive sera suggested that the immunoactivity differs from authentic myelin basic protein and may represent breakdown products of the protein. Serum from some patients with a previous history of moderate CVA had myelin basic protein binding activity consistent with the presence of antibodies to the protein. (Auth.)

  8. Biological dosimetry after criticality accidents. Intercomparison exercise in the Silene Reactor - France

    International Nuclear Information System (INIS)

    Di Giorgio, Marina; Vallerga, Maria B.; Taja, Maria R.

    2004-01-01

    The Institute of Radiation Protection and Nuclear Safety Institute (IRSN) organized an international biological dosimetry intercomparison, at the SILENE experimental reactor (Valduc, France), simulating different criticality scenarios: bare source 4 Gy, lead shield source 1 and 2 Gy and gamma pure 60 Co source 2 Gy. Fifteen laboratories were involved in this exercise, including the Argentine Biological Dosimetry Laboratory. The purposes of the intercomparison were: 1) To compare the unstable chromosome aberration (UCA) frequency observed by the different laboratories; and 2) To compare the dose estimation for gamma rays and neutrons. The objects of the present work were: I) To compare the mean frequency of UCA observed by the Argentine laboratory with the mean frequency observed by the participant laboratories as a whole. II) To compare the dose estimates performed by the Argentine lab with those estimated by the other laboratories involved in the second stage of the intercomparison. Overall, the mean frequencies of UCA and the correspondent 95% confidence limits obtained by the Argentine lab were consistent with the results obtained by the laboratories as a whole. For the gamma pure scenario, smaller variations were observed among laboratories in terms of dose (CV=18,2%) than in terms of frequency (CV=30,1%). For the mixed field scenarios, only four laboratories, including the Argentine lab, estimated gamma and neutron components of the total dose and just two (Argentine lab and lab 12) were in agreement with the given physical doses. The 1 Gy experiment presented lesser variations both in terms of frequency and dose than the other two scenarios. For the 4 and 2 Gy experiments, variations in neutron dose were more significant than variations in gamma dose, related to the magnitude of the dose. The results suggest that intercomparison exercises jointly with the accreditation of biological dosimetry by cytogenetic service laboratories, in compliance with ISO

  9. Clinical significance of the dynamic changes of serum IGF-1 levels in patients with acute cerebro-vascular accident

    International Nuclear Information System (INIS)

    Chen Yujuan; Liu Xueyuan; Bian Weihong; Du Xinlu; Yang Hongyan

    2006-01-01

    Objective: To investigate the dynamic changes of serum insulin-like growth factor-1 (IGF-1) levels in patients with acute cerebrovascular accident. Methods: Serum IGF-1 levels were determined with RIA in 40 patients with cerebral infarction, 20 patients with lacunar infarcts and 40 patients with cerebral haemorrhage within 3days after onset and on d14 as well as in 30 controls. Results: The serum IGF-1 levels in patients with cerebral vascular accidents were significantly lower than those in controls (P 0.05). Conclusion: Serum levels of IGF-1 dropped markedly during the acute stage after cerebrovascular accident and the magnitude might reflect the severity of the event, IGF-1 might be capable of crossing the blood-brain barrier after cerebrovascular accident and providing some protection against nerve injury, this fact might be of potential clinical applicability. (authors)

  10. Treatment of Chryseobacterium indologenes ventilator-associated pneumonia in a critically ill trauma patient.

    Science.gov (United States)

    Monteen, Megan R; Ponnapula, Supriya; Wood, G Christopher; Croce, Martin A; Swanson, Joseph M; Boucher, Bradley A; Fabian, Timothy C

    2013-12-01

    To report a case of Chryseobacterium indologenes ventilator-associated pneumonia (VAP) in a critically ill trauma patient. This report describes a 66-year-old critically ill trauma patient who developed VAP, which was caused by C indologenes. The patient was injured in a riding lawn mower accident that trapped him underwater in a pond. The patient required surgery for intra-abdominal injuries and was mechanically ventilated in the trauma intensive care unit. On hospital day 5, the patient developed signs and symptoms of VAP. A diagnosis of C indologenes VAP was confirmed based on a quantitative culture from a bronchoscopic bronchoalveolar lavage. The patient's infection was successfully treated with moxifloxacin for 2 days followed by cefepime for 7 days. Formally known as Flavobacterium indologenes, C indologenes is a Gram-negative bacillus normally found in plants, soil, foodstuffs, and fresh and marine water sources. Recently, worldwide reports of C indologenes infections in humans have been increasing, though reports from the United States are still rare. Bacteremia and pneumonia are the most commonly reported infections, and most patients are immunocompromised. The current case differs from most previous reports because this patient was in the United States and did not have any traditional immunocompromised states (eg, transplant, cancer, HIV/AIDS, or corticosteroid use). This case report demonstrates that C indologenes can cause VAP in a trauma ICU patient.

  11. Research on consequence analysis method for probabilistic safety assessment of nuclear fuel facilities (5). Evaluation method and trial evaluation of criticality accident

    International Nuclear Information System (INIS)

    Yamane, Yuichi; Abe, Hitoshi; Nakajima, Ken; Hayashi, Yoshiaki; Arisawa, Jun; Hayami, Satoru

    2010-01-01

    A special committee of 'Research on the analysis methods for accident consequence of nuclear fuel facilities (NFFs)' was organized by the Atomic Energy Society of Japan (AESJ) under the entrustment of Japan Atomic Energy Agency (JAEA). The committee aims to research on the state-of-the-art consequence analysis method for the Probabilistic Safety Assessment (PSA) of NFFs, such as fuel reprocessing and fuel fabrication facilities. The objectives of this research are to obtain information useful for establishing quantitative performance objectives and to demonstrate risk-informed regulation through qualifying issues needed to be resolved for applying PSA to NFFs. The research activities of the committee were mainly focused on the consequence analysis method for postulated accidents with potentially large consequences in NFFs, e.g., events of criticality, spill of molten glass, hydrogen explosion, boiling of radioactive solution and fire (including the rapid decomposition of TBP complexes), resulting in the release of radioactive materials to the environment. The results of the research were summarized in a series of six reports, which consist of a review report and five technical ones. In this report, the evaluation methods of criticality accident, such as simplified methods, one-point reactor kinetics codes and quasi-static method, were investigated and their features were summarized to provide information useful for the safety evaluation of NFFs. In addition, several trial evaluations were performed for a hypothetical scenario of criticality accident using the investigated methods, and their results were compared. The release fraction of volatile fission products in a criticality accident was also investigated. (author)

  12. Patients' opinions on outcomes following critical illness

    DEFF Research Database (Denmark)

    Nedergaard, H K; Haberlandt, T; Reichmann, P D

    2018-01-01

    BACKGROUND: Our aim was to explore which outcomes are most important to patients following ICU-discharge, and to explore whether intensive care unit (ICU)-nurses and anesthesiologists are aware of patients' priorities. METHODS: First, interviews with adult ICU-survivors were conducted until data......, fatigue, and decreased walking distance. The top three for ICU-nurses (54 participants) were: fatigue, difficulties concentrating, sadness/depression, and for anesthesiologists (17 participants): fatigue, difficulties in activities of daily living, and lack of physical strength. CONCLUSION: Patients chose......-ICU discharge) rated the items, as did ICU-nurses and anesthesiologists. RESULTS: A total of 32 patients participated (44% women, medians: age 70.5, time since discharge 179 days, length of stay in ICU 9 days, APACHEII 19.5). The three most important outcomes defined by patients were: lack of physical strength...

  13. Predicting recovery from acute kidney injury in critically ill patients

    DEFF Research Database (Denmark)

    Itenov, Theis S; Berthelsen, Rasmus Ehrenfried; Jensen, Jens-Ulrik

    2018-01-01

    these patients. DESIGN: Observational study with development and validation of a risk prediction model. SETTING: Nine academic ICUs in Denmark. PARTICIPANTS: Development cohort of critically ill patients with AKI at ICU admission from the Procalcitonin and Survival Study cohort (n = 568), validation cohort.......1%. CONCLUSION: We constructed and validated a simple model that can predict the chance of recovery from AKI in critically ill patients....

  14. Patients' Risk of Causing Traffic Violations and Traffic Accidents while Driving.

    Science.gov (United States)

    Šestan, Nevenka; Dodič Fikfak, Metoda; Balantič, Zvone

    2017-09-01

    This study examines whether drivers suffering from epilepsy, chronic alcoholism and/or hazardous drinking, psychoactive substance abuse, other diseases of the nervous system, mental and behavioural disorders, cardiovascular diseases, severe diabetes, and severe eye diseases are at a greater risk of causing traffic accidents and traffic violations than drivers that cause accidents and violations without these diagnoses. A case control study was carried out. The cases were drivers checked by a special medical committee in the period observed suffering from the diseases listed above. Matched controls were taken from the cohort of those that caused accidents and violations during the same period observed. The descriptive statistics were followed by calculation of correlations, t-tests and χ 2 , and the odds ratio. Drivers with referrals for diseases of the nervous system are five times more likely to cause a traffic accident compared to controls (OR=5.18; 95% CI=2.59-10.34); in addition, a high risk is associated with drivers with mental and behavioural disorders (OR=3.64; 95% CI=1.91-6.94), drivers with epilepsy (OR=1.99; 95% CI=1.01-3.92), and drivers addicted to alcohol (OR=1.71; 95% CI=1.01-2.89). Drivers suffering from addiction, a disease of the nervous system, or epilepsy are more likely to cause a traffic accident, which is a contribution to the inconclusive findings of previous studies. The multiple reasons for risks of patients suffering from mental and behavioural disorders need to be further investigated. Copyright© by the National Institute of Public Health, Prague 2017

  15. Criticality accident in uranium fuel processing plant. Efficacy of insurance and third party inspection system. Capability margins of insurance, in view of bitter experience at JCO

    Energy Technology Data Exchange (ETDEWEB)

    Izumi, Taiichiro [Songaihokenryoritsusanteikai (Japan)

    2000-08-01

    Among persons relating to safety engineering, most of them point out merit and demerit of safety theory in Japan since a long term before. Under national policy aiming at growth and expansion due to a policy under leading of government after war, running for about 50 years remained some strains containing a number of contradictions and absurdities in various fields. Here was described mainly on how to be done safety accident protection and inspection on a base of happenings incidentally seen at a chance of the criticality accident. Therefore, here were also established some viewpoints such as transferable risk, limit from insurance feature, genealogy of insurance, under-writing, and risk management, to mention effectiveness of the third party inspection with closed relationship with accident insurance. (G.K.)

  16. Criticality accident in uranium fuel processing plant. Efficacy of insurance and third party inspection system. Capability margins of insurance, in view of bitter experience at JCO

    International Nuclear Information System (INIS)

    Izumi, Taiichiro

    2000-01-01

    Among persons relating to safety engineering, most of them point out merit and demerit of safety theory in Japan since a long term before. Under national policy aiming at growth and expansion due to a policy under leading of government after war, running for about 50 years remained some strains containing a number of contradictions and absurdities in various fields. Here was described mainly on how to be done safety accident protection and inspection on a base of happenings incidentally seen at a chance of the criticality accident. Therefore, here were also established some viewpoints such as transferable risk, limit from insurance feature, genealogy of insurance, under-writing, and risk management, to mention effectiveness of the third party inspection with closed relationship with accident insurance. (G.K.)

  17. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.

    Science.gov (United States)

    LaPietra, Angelo; Santana, Orlando; Mihos, Christos G; DeBeer, Steven; Rosen, Gerald P; Lamas, Gervasio A; Lamelas, Joseph

    2014-07-01

    Minimally invasive valve surgery has been associated with increased cerebrovascular complications. Our objective was to evaluate the incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. We retrospectively reviewed all the minimally invasive valve surgery performed at our institution from January 2009 to June 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed. A total of 1501 consecutive patients were identified. The mean age was 73 ± 13 years, and 808 patients (54%) were male. Of the 1501 patients, 206 (13.7%) had a history of a cerebrovascular accident, and 225 (15%) had undergone previous heart surgery. The procedures performed were 617 isolated aortic valve replacements (41.1%), 658 isolated mitral valve operations (43.8%), 6 tricuspid valve repairs (0.4%), 216 double valve surgery (14.4%), and 4 triple valve surgery (0.3%). Femoral cannulation was used in 1359 patients (90.5%) and central cannulation in 142 (9.5%). In 1392 patients (92.7%), the aorta was clamped, and in 109 (7.3%), the surgery was performed with the heart fibrillating. The median aortic crossclamp and cardiopulmonary bypass times were 86 minutes (interquartile range [IQR], 70-107) minutes and 116 minutes (IQR, 96-143), respectively. The median intensive care unit length of stay was 47 hours (IQR, 29-74), and the median postoperative hospital length of stay was 7 days (IQR, 5-10). A total of 23 cerebrovascular accidents (1.53%) and 38 deaths (2.53%) had occurred at 30 days postoperatively. Minimally invasive valve surgery was associated with an acceptable stroke rate, regardless of the cannulation technique. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  18. Providing care for critically ill surgical patients: challenges and recommendations.

    Science.gov (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

  19. Findings of thyroid ultrasonography in patients with hypothyroidism exposed to ionizing radiation due to Chernobyl accident

    International Nuclear Information System (INIS)

    Grid'ko, O.M.

    1997-01-01

    Comparative analysis of the findings of clinical and ultrasound study of the thyroid gland in 403 participants of the accident clean-up irradiated in the 'iodine' period and 57 patients with hypothyroidism (of them, 46 were exposed to radiation in the 'iodine' period and 11 in 'non-iodine' one) was carried out. The disease dynamics was investigated in 81 patients with acute radiation sickness. The structural changes suggest different ways of hypothyroidism development in the exposed persons and manifest themselves in two main clinical forms of the disease, atrophic and hypertrophic ones

  20. [Fatal hyperpyrexia in an adolescent patient with severe burns after a traffic accident].

    Science.gov (United States)

    Jaehn, T; Sievers, R; Junger, A; Graunke, F; Blings, A; Reichert, B

    2016-07-01

    After a motorcycle accident a 16-year-old patient suffered severe burns to 40.5 % of the total body surface area (TBSA) of which 37 % were deep subdermal burns. After tangential and partly epifascial necrosectomy, Integra® was used as a temporary dermis replacement material for the lower extremities, combined with extensive negative pressure wound therapy (NPWT). In the further course of the treatment the patient developed uncontrollable hyperpyrexia with a fatal outcome. Possible influencing factors, such as the dermis replacement material combined with NPWT over large areas as well as the differential diagnoses propofol infusion syndrome, heatstroke and malignant hyperthermia are discussed.

  1. Initial ventilator settings for critically ill patients

    OpenAIRE

    Kilickaya, Oguz; Gajic, Ognjen

    2013-01-01

    The lung-protective mechanical ventilation strategy has been standard practice for management of acute respiratory distress syndrome (ARDS) for more than a decade. Observational data, small randomized studies and two recent systematic reviews suggest that lung protective ventilation is both safe and potentially beneficial in patients who do not have ARDS at the onset of mechanical ventilation. Principles of lung-protective ventilation include: a) prevention of volutrauma (tidal volume 4 to 8 ...

  2. Determination of beta-ray emitter concentrations in bioassay samples of the victims in JCO criticality accident

    International Nuclear Information System (INIS)

    Yukawa, Masae; Nishimura, Yoshikazu; Watanabe, Yoshito

    2001-01-01

    Concentrations of neutron-induced β-ray emitters in the hair, blood, urine and bone of three workers severely exposed to neutrons in JCO criticality accident were measured with a low background β-ray spectrometer (Pico β) and liquid scintillation counter for the purpose of neutron dose estimation. 32 P is generated by the fast neutron of 2.5 MeV and over in sulfur with (n, p) reaction. Since content of sulfur in hair is high as compared with the other human tissues, we tried to estimate fast neutron fluence to the body surface of the victims using concentrations of 32 P and stable sulfur in their hair. The result shows that two workers, who were exposed to the higher neutron radiation than another worker, received higher doses of irradiation to the frontal side of their trunks than to the heads. For a more detailed mapping of neutron fluence in the body, the measurements of 32 P and 45 Ca induced by (n, γ) reaction in bone were carried out. The results show that one worker (worker A) received a higher dose of neutrons at the frontal right side of the trunk, and that the dose decreased with the distance from the central part of the body. The other (worker B) seems to have gotten a higher dose of irradiation in the face, hands and waist. High amount of 32 P was detected in urine of the workers, and the concentration gradient among three workers showed a similar tendency to the estimated neutron dose from 24 Na in blood. Therefore, radioactivity of 32 P in urine could be used for estimating the neutron exposure dose. Moreover, the activity can be easily determined by scintillation counting, and urine is less invading bioassay sample that can be collected by non-medical stuffs. (author)

  3. The optimal blood glucose level for critically ill adult patients.

    Science.gov (United States)

    Lv, Shaoning; Ross, Paul; Tori, Kathleen

    2017-09-01

    Glycaemic control is recognized as one of the important aspects in managing critically ill patients. Both hyperglycaemia and hypoglycaemia independently increase the risk of patient mortality. Hence, the identification of optimal glycaemic control is of paramount importance in the management of critically ill patients. The aim of this literature review is to examine the current status of glycaemic control in critically ill adult patients. This literature review will focus on randomized controlled trials comparing intensive insulin therapy to conventional insulin therapy, with an objective to identify optimal blood glucose level targets for critically ill adult patients. A literature review was conducted to identify large randomized controlled trials for the optimal targeted blood glucose level for critically ill adult patients published since 2000. A total of eight studies fulfilled the selection criteria of this review. With current human and technology resources, the results of the studies support commencing glycaemic control once the blood glucose level of critically ill patients reaches 10 mmol/L and maintaining this level between 8 mmol/L and 10 mmol/L. This literature review provides a recommendation for targeting the optimal blood glucose level for critically ill patients within moderate blood glucose level target range (8-10 mmol/L). The need for uniformed glucometrics for unbiased reporting and further research for optimal blood glucose target is required, especially in light of new technological advancements in closed-loop insulin delivery and monitoring devices. This literature review has revealed a need to call for consensus in the measurement and reporting of glycaemic control using standardized glucometrics. © 2017 British Association of Critical Care Nurses.

  4. Preload assessment and optimization in critically ill patients.

    Science.gov (United States)

    Voga, Gorazd

    2010-01-01

    Preload assessment and optimization is the basic hemodynamic intervention in critically ill. Beside clinical assessment, non-invasive or invasive assessment by measurement of various pressure or volume hemodynamic variables, are helpful for estimation of preload and fluid responsiveness. The use of dynamic variables is useful in particular subgroup of critically ill patients. In patients with inadequate preload, fluid responsiveness and inadequate flow, treatment with crystalloids or colloids is mandatory. When rapid hemodynamic response is necessary colloids are preferred.

  5. Altered molecular profile in thyroid cancers from patients affected by the Three Mile Island nuclear accident.

    Science.gov (United States)

    Goldenberg, David; Russo, Mariano; Houser, Kenneth; Crist, Henry; Derr, Jonathan B; Walter, Vonn; Warrick, Joshua I; Sheldon, Kathryn E; Broach, James; Bann, Darrin V

    2017-07-01

    In 1979, Three Mile Island (TMI) nuclear power plant experienced a partial meltdown with release of radioactive material. The effects of the accident on thyroid cancer (TC) in the surrounding population remain unclear. Radiation-induced TCs have a lower incidence of single nucleotide oncogenic driver mutations and higher incidence of gene fusions. We used next generation sequencing (NGS) to identify molecular signatures of radiation-induced TC in a cohort of TC patients residing near TMI during the time of the accident. Case series. We identified 44 patients who developed papillary thyroid carcinoma between 1974 and 2014. Patients who developed TC between 1984 and 1996 were at risk for radiation-induced TC, patients who developed TC before 1984 or after 1996 were the control group. We used targeted NGS of paired tumor and normal tissue from each patient to identify single nucleotide oncogenic driver mutations. Oncogenic gene fusions were identified using quantitative reverse transcription polymerase chain reaction. We identified 15 patients in the at-risk group and 29 patients in the control group. BRAF V600E mutations were identified in 53% patients in the at-risk group and 83% patients in the control group. The proportion of patients with BRAF mutations in the at-risk group was significantly lower than predicted by the The Cancer Genome Atlas cohort. Gene fusion or somatic copy number alteration drivers were identified in 33% tumors in the at-risk group and 14% of tumors in the control group. Findings were consistent with observations from other radiation-exposed populations. These data raise the possibility that radiation released from TMI may have altered the molecular profile of TC in the population surrounding TMI. 4 Laryngoscope, 127:S1-S9, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  6. The meaning of social support for the critically ill patient.

    Science.gov (United States)

    Hupcey, J E

    2001-08-01

    Social support has been shown to be important for the critically ill patient. However, what constitutes adequate support for these patients has not been investigated. Thus, the purpose of this qualitative study was to investigate patients' perceptions of their need for and adequacy of the social support received while they were critically ill. Thirty adult patients who were critical during some point of their stay in the intensive care unit (ICU) stay were interviewed, once stable. Interviews were tape-recorded and began with an open-ended question regarding the ICU experience. This was followed by open-ended focused questions regarding social support, such as 'Who were your greatest sources of social support while you were critically ill?' 'What did they do that was supportive or unsupportive?' Data were analyzed according to Miles and Huberman (1994). The categories that emerged were need for social support based on patient perceptions (not number of visitors), quality of support (based on perceptions of positive and negative behaviors of supporters) and lack of support. This study found that quality of support was more important than the actual number of visitors. Patients with few visitors may have felt supported, while those with numerous visitors felt unsupported. Patients who felt unsupported also were more critical of the staff and the care they received. Nurses need to individually assess patients regarding their need for support, and assist family/friends to meet these needs.

  7. Accidents - Chernobyl accident; Accidents - accident de Tchernobyl

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    This file is devoted to the Chernobyl accident. It is divided in four parts. The first part concerns the accident itself and its technical management. The second part is relative to the radiation doses and the different contaminations. The third part reports the sanitary effects, the determinists ones and the stochastic ones. The fourth and last part relates the consequences for the other European countries with the case of France. Through the different parts a point is tackled with the measures taken after the accident by the other countries to manage an accident, the cooperation between the different countries and the groups of research and studies about the reactors safety, and also with the international medical cooperation, specially for the children, everything in relation with the Chernobyl accident. (N.C.)

  8. Medical follow up of ten patients victims of the radiological accident occurred in Goiania, Goias State, Brazil 1988/1992; Acompanhamento clinico de dez pacientes vitimas do acidente radiologico de Goiania - 1988/1992

    Energy Technology Data Exchange (ETDEWEB)

    Curado, M.P.; Morais, M.S.A.; Silva, J.F.; Assis, P.R.; Oliveira, A.R.; Santos, E.A

    1992-12-31

    The author makes an update of the medical aspects of ten victims of the radiological accident occurred in Goiania in September 1987. These patients received specialized treatment during the critical phase at Marcilio Dias Naval Hospital in Rio de Janeiro. Actually these patients are under medical follow-up at Leide das Neves Ferreira Foundation since march 1988. The clinical, haematological and laboratorial results are presented and discussed. The importance of a close medical follow-up direct victims of a radiological accident is stressed. (author) 13 refs., 5 tabs., 2 graphs.

  9. [Identification of emotions in patients with low-grade gliomas versus cerebrovascular accidents].

    Science.gov (United States)

    du Boullay, V; Plaza, M; Capelle, L; Chaby, L

    2013-03-01

    Facial and vocal emotions contribute to sustain efficient social relationships. Brain disease may impair their identification. In the case of slow-growth tumors (Low Grade Gliomas [LGG]) or sudden stroke (cerebrovascular accidents [CVA]), the lesions induce contrasted plasticity and reorganisation processes. We compared the facial, vocal and intermodal identification of six emotions (happiness, fear, angriness, sadness, disgust and neutral) of three groups: patients with LGG before and after tumor resection, patients with CVA and control subjects. In LGG patients, the results revealed less efficient performances after tumor resection and in CVA patients weak performances regarding negative emotions. The intermodal condition (simultaneous visual and vocal association) improved performances in all groups and enabled equivalent performance in CVA subjects compared with control subjects. The intergroup differences may be related to variable brain plasticity as a function of type and rapidity of brain injury. Intermodal processing appears to be a compensatory condition. Copyright © 2012. Published by Elsevier Masson SAS.

  10. Patient autonomy and informed consent in critically lll

    Directory of Open Access Journals (Sweden)

    Todorović Zoran M.

    2017-01-01

    Full Text Available Patient autonomy has been a cornerstone of contemporary clinical ethics since the Nuremberg trial, especially in American school of bioethics. Topic: Patient autonomy has been defined in the Nuremberg Code, and re-defined in the Declaration of Helsinki, Belmont Report and Barcelona Declaration. Founders and followers of the rights-oriented bioethics (for example, Hellegers, Beauchamp and Childers have established and promoted the patient autonomy as the main principle of bio(medical ethics since 1970s. However, there is a lot of controversy surrounding such a principle, especially in vulnerable patients. We aimed at evaluating the real meaning and value of patient autonomy in critical care settings regarding the communication between health workers and their patients and families. Conclusion: Protection of patients autonomy in critically ill is a complex issue. Careful benefit-risk assessment is needed in order to find the most appropriate way of obtaining the informed consent, proxy consent or to omit or delay it.

  11. A rare case of Shewanella putrefaciens bacteremia in a patient of road traffic accident

    Directory of Open Access Journals (Sweden)

    Ritesh Ranjan

    2017-01-01

    Full Text Available Shewanella putrefaciens rarely causes human infection. These are mostly found in environment and food stuffs. Shewanella are often found in mixed culture. It has been implicated in cellulitis, otitis media, and septicemia. It may be found in respiratory tract, urine, feces, and pleural fluid. There is no definite guideline for therapeutic option. In general, these are susceptible to various antimicrobial agents but are often resistant to penicillin and cephalothin. We report a rare case of bacteremia by S. putrefaciens in a patient of head injury with polytrauma after a road traffic accident.

  12. Daptomycin experience in critical care patients: results from a registry.

    Science.gov (United States)

    Brown, Jack E; Fominaya, Cory; Christensen, Keith J; McConnell, Scott A; Lamp, Kenneth C

    2012-04-01

    Vancomycin is often the drug of choice in critically ill patients with gram-positive infections, although circumstances often prevent its use. In these situations, clinicians are frequently left with limited data regarding alternative agents. To describe patients with reported sepsis receiving daptomycin in a critical care unit. This multicenter, noncomparative, noninterventional study identified patients in critical care units, using the Cubicin Outcomes Registry and Experience (CORE) 2005-2009 registry. A descriptive account of patient characteristics, infectious etiology, outcomes at the end of daptomycin therapy, and 30-day mortality is reported. Nonevaluable patients were excluded from the efficacy analysis but included in the safety analysis. We identified 128 patients, 98 (77%) of whom were evaluable for efficacy. Patient characteristics for the efficacy population were 55 (56%) males, 30 (31%) aged 66 years or older, 38 (39%) had creatinine clearance less than 30 mL/min, and 27 (28%) were on dialysis. Common underlying diseases included acute or chronic renal failure 44 (45%), hypertension 40 (41%), and diabetes 27 (28%). Seventy-two (73%) patients were bacteremic. The most common pathogens found were methicillin-resistant Staphylococcus aureus (32%), vancomycin-resistant Enterococcus faecium (21%), and coagulase-negative staphylococci (20%). Prior to daptomycin, antibiotics were used in 84 (86%) patients, most commonly vancomycin (65/84; 77%). The median (range) initial daptomycin dose was 6 mg/kg (3-10) and duration of 10 days (1-58). Overall success rate was 70% (31% cured; 39% improved). Twelve adverse events possibly related to daptomycin were reported in 9 of 128 (7%) patients in the safety population; 4 of these in 4 (3%) patients were serious. The mortality rate within 30 days of completing daptomycin was 42 of 128 (33%) patients. These data provide preliminary results on the use of daptomycin in critically ill patients with complicated conditions

  13. Low but Sufficient Anidulafungin Exposure in Critically Ill Patients

    NARCIS (Netherlands)

    van Wanrooy, Marjolijn J. P.; Rodgers, Michael G. G.; Uges, Donald R. A.; Arends, Jan P.; Zijlstra, Jan G.; Werf, van der Tjip S.; Kosterink, Jos G. W.; Alffenaar, Jan-Willem C.

    The efficacy of anidulafungin is driven by the area under the concentration-time curve (AUC)/MIC ratio. Patients in intensive care may be at risk for underexposure. In critically ill patients with an invasive Candida infection, the anidulafungin exposure and a possible correlation with disease

  14. Effect of hyperbaric oxygen therapy on whole blood cyanide concentrations in carbon monoxide intoxicated patients from fire accidents

    DEFF Research Database (Denmark)

    Lawson-Smith, Pia; Jansen, Erik C; Hilsted, Linda

    2010-01-01

    Hydrogen cyanide (HCN) and carbon monoxide (CO) may be important components of smoke from fire accidents. Accordingly, patients admitted to hospital from fire accidents may have been exposed to both HCN and CO. Cyanide (CN) intoxication results in cytotoxic hypoxia leading to organ dysfunction...... and animal experiments have shown that in rats exposed to CN intoxication, HBO can increase the concentration of CN in whole blood....

  15. Study of a criticality accident involving fuel rods and water outside a power reactor; Etude d'un accident de criticite mettant en presence des crayons combustibles et de l'eau hors reacteur de puissance

    Energy Technology Data Exchange (ETDEWEB)

    Beloeil, L

    2000-05-30

    It is possible to imagine highly unlikely but numerous accidental situations where fuel rods come into contact with water under conditions close to atmospheric values. This work is devoted to modelling and simulation of first instants of the power excursion that may result from such configurations. We show that void effect is a preponderant feedback for most severe accidents. The formation of a vapour film around the rods is put forward and confirmed with the help of experimental transients using electrical heating. We propose then a vapour/liquid flow model able to reproduce void fraction evolution. The vapour film is treated as a compressible medium. Conservation balance equations are solved on a moving mesh with a two-dimensional scheme and boundary conditions taking notice of interfacial phenomena and axial escape possibility. Movements of the liquid phase are modelled through a non-stationary integral equation and a dissipative term suited to the particular geometry of this flow. The penetration of energy into the liquid is also calculated. Thus, the coupling of aerodynamic and hydrodynamic modules gives results in excellent agreement with experiments. Next, neutronic phenomena into the fuel pellet, their feedback effects and the distribution of power through the rod are numerically translated. For each developed module, validation tests are provided. Then, it is possible to simulate the first seconds of the whole criticality accident. Even if this calculation tool is only a way of study as a first approach, performed simulations are proving coherent with reported data on recorded accidents. (author)

  16. The increase of the life quality for patients who had a cerebrovascular accident by using the MBT physiotherapy device

    Directory of Open Access Journals (Sweden)

    Danelciuc Francisc Tadeus

    2017-05-01

    Full Text Available The cerebrovascular accident is a major health issue, with medical and economic consequences upon the society. The cerebrovascular accident determines the sensorial and motor impairment, the speech and postural control impairment. Some patients who had a cerebrovascular accident may have difficulties in the response to the postural perturbations. Some patients who had a cerebrovascular accident may have difficulties in the response to the postural perturbations. The recovery of the postural control and of the balance depends on the quality of the motor action in order to use the ADL and to ensure the social and professional reintegration of the patients. That is why the postural control is essential in the recovery of the patients who had a cerebrovascular accident. The current study aims at the possibilities to regain the postural control for the patients with motor deficit by an individual program of recovery sessions. The current trial aimed at finding the way in which it is possible to influence the quality of life for the patients who had a cerebrovascular accident by using the MBT physiotherapy device. The use of the MBT physiotherapy devices in the recovery programme of the postural control after the cerebrovascular accident involves the need to set up an individualized programme of kinetic therapy. According to the established deficiency, namely the average one and the slight one, the recovery programme would need the introduction of techniques and methods whose effect is to reeducate the postural function. This can be done more easily if the recovery is initiated by using the MBT physiotherapy device that can intervene in the functional recovery which corresponds to each recovery stage.

  17. Is refeeding syndrome relevant for critically ill patients?

    Science.gov (United States)

    Koekkoek, Wilhelmina A C; Van Zanten, Arthur R H

    2018-03-01

    To summarize recent relevant studies regarding refeeding syndrome (RFS) in critically ill patients and provide recommendations for clinical practice. Recent knowledge regarding epidemiology of refeeding syndrome among critically ill patients, how to identify ICU patients at risk, and strategies to reduce the potential negative impact on outcome are discussed. RFS is a potentially fatal acute metabolic derangement that ultimately can result in marked morbidity and even mortality. These metabolic derangements in ICU patients differ from otherwise healthy patients with RFS, as there is lack of anabolism. This is because of external stressors inducing a hypercatabolic response among other reasons also reflected by persistent high glucagon despite initiation of feeding. Lack of a proper uniform definition complicates diagnosis and research of RFS. However, refeeding hypophosphatemia is commonly encountered during critical illness. The correlations between risk factors proposed by international guidelines and the occurrence of RFS in ICU patients remains unclear. Therefore, regular phosphate monitoring is recommended. Based on recent trials among critically ill patients, only treatment with supplementation of electrolytes and vitamins seems not sufficient. In addition, caloric restriction for several days and gradual increase of caloric intake over days is recommendable.

  18. Plasmapheresis and other extracorporeal filtration techniques in critical patients.

    Science.gov (United States)

    Daga Ruiz, D; Fonseca San Miguel, F; González de Molina, F J; Úbeda-Iglesias, A; Navas Pérez, A; Jannone Forés, R

    2017-04-01

    Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  19. Fulminant Invasive Pulmonary Aspergillosis After a Near-Drowning Accident in an Immunocompetent Patient.

    Science.gov (United States)

    Ratermann, Kelley L; Ereshefsky, Benjamin J; Fleishaker, Elise L; Thornton, Alice C; Buch, Ketan P; Martin, Craig A

    2014-09-01

    To report on invasive aspergillosis infection in an immunocompetent adult after a near-drowning event, which allowed this pathogen to easily gain access to the human respiratory system and result in rapid, severe infection. A 51-year-old female developed severe pneumonia after a near-drowning accident. Two days after admission, a bronchial alveolar lavage (BAL) was performed and was positive for Aspergillus fumigatus. After a 30-day hospital course, multiple antifungals, and various routes of administration, the patient expired. Pneumonia is particularly common because of the aspiration of contaminated water. Whereas pneumococci, staphylococci, and Gram-negative bacteria are all common pathogens for this type of infection, fungi such as Aspergillus spp can also be involved and may be life threatening. Typically, these cases are reported in individuals with an immunodeficiency such as from receipt of myelosuppressive chemotherapy, bone marrow transplants, or lung transplants. Despite initiation of an appropriate empirical antifungal regimen, the rapid recovery of A fumigatus from pulmonary alveolar lavage and BAL samples as well as extremely elevated levels of galactomannan and (1→3)-β-D glucan may have indicated an invasive fungal infection (IFI). IFIs are uncommon in immunocompetent adults, but in the event of a near-drowning accident, environmental fungi can gain access to the human respiratory system and result in rapid, severe infection. Based on this case and the others described, it appears that near-drowning patients need an early initial evaluation for IFI. © The Author(s) 2014.

  20. Safety-critical human factors issues derived from analysis of the TEPCO Fukushima Daiichi accident investigation reports

    International Nuclear Information System (INIS)

    Sakuda, Hiroshi; Takeuchi, Michiru

    2013-01-01

    The Fukushima Daiichi nuclear power plant accident on March 11, 2011 had a large impact both in and outside Japan, and is not yet concluded. After Tokyo Electric Power Co.'s (TEPCO's) Fukushima accident, electric power suppliers have taken measures to respond in the event that the same state of emergency occurs - deploying mobile generators, temporary pumps and hoses, and training employees in the use of this equipment. However, it is not only the “hard” problems including the design of equipment, but the “soft” problems such as organization and safety culture that have been highlighted as key contributors in this accident. Although a number of organizations have undertaken factor analysis of the accident and proposed issues to be reviewed and measures to be taken, a systematic overview about electric power suppliers' organization and safety culture has not yet been undertaken. This study is based on three major reports: the report by the national Diet of Japan Fukushima Nuclear Accident Independent Investigation Commission (the Diet report), the report by the Investigation Committee on the Accident at Fukushima Nuclear Power Stations of Tokyo Electric Power Company (Government report), and the report by the non-government committee supported by the Rebuild Japan Initiative Foundation (Non-government report). From these reports, the sections relevant to electric power suppliers' organization and safety culture were extracted. These sections were arranged to correspond with the prerequisites for the ideal organization, and 30 issues to be reviewed by electric power suppliers were extracted using brainstorming methods. It is expected that the identified issues will become a reference for every organization concerned to work on preventive measures hereafter. (author)

  1. Determination of neutron dose from criticality accidents with bioassays for sodium-24 in blood and phosphorus-32 in hair

    International Nuclear Information System (INIS)

    Feng, Y.; Miller, L.F.; Brown, K.S.; Casson, W.H.; Mei, G.T.; Thein, M.

    1993-06-01

    A comprehensive review of accident neutron dosimetry using blood and hair analysis was performed and is summarized in this report. Experiments and calculations were conducted at Oak Ridge National Laboratory (ORNL) and the University of Tennessee (UT) to develop measurement techniques for the activity of 24 Na in blood and 32 P in hair for nuclear accident dosimetry. An operating procedure was established for the measurement of 24 Na in blood using an HPGe detector system. The sensitivity of the measurement for a 20-mL sample is 0.01-0.02 Gy of total neutron dose for hard spectra and below 0.005 Gy for soft spectra based on a 30- to 60-min counting time. The operating procedures for direct counting of hair samples are established using a liquid scintillation detector. Approximately 0.06-0.1 Gy of total neutron dose can be measured from a 1-g hair sample using this procedure. Detailed procedures for chemical dissolution and ashing of hair samples are also developed. A method is proposed to use blood and hair analysis for assessing neutron dose based on a collection of 98 neutron spectra. Ninety-eight blood activity-to-dose conversion factors were calculated. The calculated results for an uncollided fission spectrum compare favorably with previously published data for fission neutrons. This nuclear accident dosimetry system makes it possible to estimate an individual's neutron dose within a few hours after an accident if the accident spectrum can be approximated from one of 98 tabulated neutron spectrum descriptions. If the information on accident and spectrum description is not available, the activity ratio of 32 P in hair and 24 Na in blood can provide information related to the neutron spectrum for dose assessment

  2. Some issues on the Law for the Regulations of Nuclear Source Material, Nuclear Fuel Material and Reactors Amendment after JCO criticality accident

    International Nuclear Information System (INIS)

    Tanabe, Tomoyuki

    2001-01-01

    As the Amendment of the Law for the Regulation of Nuclear Material, Nuclear Fuel Material and Reactors on an opportunity of the JCO criticality accident can be almost evaluated at a viewpoint of upgrading on effectiveness of safety regulation, it is thought to remain a large problem to rely on only enforcement of regulation due to amendment of the Law at future accident. In future, it can be also said to be important subjects to further expand a philosophy on the regulation (material regulation) focussed to hazards of nuclear material itself, not only to secure effectiveness on the multi-complementary safety regulation due to the administrative agency and the Nuclear Safety Commission but also to prepare a mechanism reflexible of a new information to the safety regulation, and to prepare a mechanism to assist adequate business execution and so forth of enterprises. (G.K.)

  3. Sandia National Laboratories results for the 2010 criticality accident dosimetry exercise, at the CALIBAN reactor, CEA Valduc France.

    Energy Technology Data Exchange (ETDEWEB)

    Ward, Dann C.

    2011-09-01

    This document describes the personal nuclear accident dosimeter (PNAD) used by Sandia National Laboratories (SNL) and presents PNAD dosimetry results obtained during the Nuclear Accident Dosimeter Intercomparison Study held 20-23 September, 2010, at CEA Valduc, France. SNL PNADs were exposed in two separate irradiations from the CALIBAN reactor. Biases for reported neutron doses ranged from -15% to +0.4% with an average bias of -7.7%. PNADs were also exposed on the back side of phantoms to assess orientation effects.

  4. Sandia National Laboratories results for the 2010 criticality accident dosimetry exercise, at the CALIBAN reactor, CEA Valduc France

    International Nuclear Information System (INIS)

    Ward, Dann C.

    2011-01-01

    This document describes the personal nuclear accident dosimeter (PNAD) used by Sandia National Laboratories (SNL) and presents PNAD dosimetry results obtained during the Nuclear Accident Dosimeter Intercomparison Study held 20-23 September, 2010, at CEA Valduc, France. SNL PNADs were exposed in two separate irradiations from the CALIBAN reactor. Biases for reported neutron doses ranged from -15% to +0.4% with an average bias of -7.7%. PNADs were also exposed on the back side of phantoms to assess orientation effects.

  5. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn

    2016-01-01

    INTRODUCTION: Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. METHODS: This systematic...... trials were at high risk of bias, and none reported the primary composite outcome SAE. Fourteen trials with 1611 randomised patients reported mortality data at maximum follow-up (RR 0.96; 95% confidence interval 0.76-1.21). Milrinone did not significantly affect other patient-centred outcomes. All...... analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. DISCUSSION: The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks...

  6. Advances in Biomarkers in Critical Ill Polytrauma Patients.

    Science.gov (United States)

    Papurica, Marius; Rogobete, Alexandru F; Sandesc, Dorel; Dumache, Raluca; Cradigati, Carmen A; Sarandan, Mirela; Nartita, Radu; Popovici, Sonia E; Bedreag, Ovidiu H

    2016-01-01

    The complexity of the cases of critically ill polytrauma patients is given by both the primary, as well as the secondary, post-traumatic injuries. The severe injuries of organ systems, the major biochemical and physiological disequilibrium, and the molecular chaos lead to a high rate of morbidity and mortality in this type of patient. The 'gold goal' in the intensive therapy of such patients resides in the continuous evaluation and monitoring of their clinical status. Moreover, optimizing the therapy based on the expression of certain biomarkers with high specificity and sensitivity is extremely important because of the clinical course of the critically ill polytrauma patient. In this paper we wish to summarize the recent studies of biomarkers useful for the intensive care unit (ICU) physician. For this study the available literature on specific databases such as PubMed and Scopus was thoroughly analyzed. Each article was carefully reviewed and useful information for this study extracted. The keywords used to select the relevant articles were "sepsis biomarker", "traumatic brain injury biomarker" "spinal cord injury biomarker", "inflammation biomarker", "microRNAs biomarker", "trauma biomarker", and "critically ill patients". For this study to be carried out 556 original type articles were analyzed, as well as case reports and reviews. For this review, 89 articles with relevant topics for the present paper were selected. The critically ill polytrauma patient, because of the clinical complexity the case presents with, needs a series of evaluations and specific monitoring. Recent studies show a series of either tissue-specific or circulating biomarkers that are useful in the clinical status evaluation of these patients. The biomarkers existing today, with regard to the critically ill polytrauma patient, can bring a significant contribution to increasing the survival rate, by adapting the therapy according to their expressions. Nevertheless, the necessity remains to

  7. Causes of death in critically ill multiple sclerosis patients.

    Science.gov (United States)

    Karamyan, A; Brandtner, H; Grinzinger, S; Chroust, V; Bacher, C; Otto, F; Reisp, M; Hauer, L; Sellner, J

    2017-10-01

    Patients with multiple sclerosis (MS) experience higher mortality rates as compared to the general population. While the risk of intensive care unit (ICU) admission is also reported to be higher, little is known about causes of death CoD in critically ill MS patients. To study the causes of death (CoD) in the series of critically ill patients with MS verified by autopsy. We reviewed hospital electronic charts of MS patients treated at the neurological ICU of a tertiary care hospital between 2000 and 2015. We compared clinical and pathological CoD for those who were autopsied. Overall, 10 patients were identified (seven female; median age at death 65 years, range 27-80), and six of them were autopsied. The median MS duration prior to ICU admission was 27.5 years (range 1-50), and the median EDSS score at the time of ICU admission was 9 (range 5-9.5). The median length of ICU stay was 3 days (range 2-213). All the individuals in our series had experienced respiratory insufficiency during their ICU stay. The autopsy examination of brain tissue did not reveal evidences of MS lesions in one patient. In another patient, Lewy bodies were found on brain immunohistochemistry. Mortality in critically ill MS patients is largely driven by respiratory complications. Sporadic disparities between clinical and pathological findings can be expected. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. In-111 platelets used in evaluation of emboli and thrombi in patients with cerebrovascular accident

    International Nuclear Information System (INIS)

    Kuecuek, N.O.; Aras, G.; Ibis, E.; Soylu, A.; Tascilar, N.; Yuecemen, N.; Mutluer, N.

    2000-01-01

    Studies with In-111 platelets were conducted to evaluate pulmonary embolus, deep vein thrombus and cardiac thrombus. This study aimed to evaluate active thrombi and possible new emboli in patients with cerebrovascular accident (CVA) in the first 24 hours by using autologous In-111 platelets. Twenty-five patients were included in the study. Carotid artery thrombi observed in 10 patients with this technique were confirmed by Doppler ultrasonography. Intracranial thrombi appearing in 3 cases were verified by X-ray computed tomography (CT). Scintigraphy of 8 patients who showed findings suggesting CVA in CT revealed no abnormal accumulation. This was attributed to the possibility that they were small in size, deep in location and/or were also quite aged. Abnormal accumulations observed in the lungs of 3 patients and in the mediastinum and pelvis in one patient were verified by other radiological methods. In-111 platelet study was found to be useful in patients with CVA to evaluate the active thrombi and possible emboli in the early period before clinical symptoms appeared. (author)

  9. Factors associated with prehospital death among traffic accident patients in Osaka City, Japan: A population-based study.

    Science.gov (United States)

    Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Ogura, Hiroshi; Shimazu, Takeshi

    2018-01-02

    Although it is important to assess the factors associated with traffic accident fatalities to decrease them as a matter of public health, such factors have not been fully identified. Using a large-scale data set of ambulance records in Osaka City, Japan, we retrospectively analyzed all traffic accident patients transported to hospitals by emergency medical service personnel from 2013 to 2014. In this study, prehospital death was defined as that occurring at the scene or in the emergency department immediately after hospital arrival. We assessed prehospital factors associated with prehospital death due to traffic accidents by logistic regression models. This study enrolled 28,903 emergency patients involved in traffic accidents, of whom 68 died prehospital. In a multivariate model, elderly patients aged ≥75 years (adjusted odds ratio [AOR] = 4.34; 95% confidence interval [CI], 2.29-8.23), nighttime (AOR = 2.75; 95% CI, 1.65-4.70), and type of injured person compared to bicyclists such as pedestrians (AOR = 9.58; 95% CI, 5.07-17.99), motorcyclists (AOR = 2.75; 95% CI, 1.21-6.24), and car occupants (AOR = 2.98; 95% CI, 1.39-6.40) were significantly associated with prehospital death due to traffic accidents. In addition, the AOR for automobile versus nonautomobile as the collision opponent was 4.76 (95% CI, 2.30-9.88). In this population, the factors associated with prehospital death due to traffic accidents were elderly people, nighttime, and pedestrian as the type of patient. The proportion of prehospital deaths due to traffic accidents was also high when the collision component was an automobile.

  10. Annual incidence and standardized incidence ratio of cerebrovascular accidents in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Mok, C C; Ho, L Y; To, C H

    2009-01-01

    To study the annual incidence and standardized incidence ratio (SIR) of cerebrovascular accident (CVA) in patients with systemic lupus erythematosus (SLE). The annual incidence of CVA from 1999 to 2007 in a longitudinal cohort of SLE patients was calculated each year and compared with that of the regional population within the same study period. Age-specific SIRs and outcome of CVA in SLE patients were also studied. In 2007, there were 490 SLE patients in our cohort. The mean annual incidence of CVA between 1999 and 2007 was 6.45/1000 patients and no obvious trend over time was observed. Of the 20 CVAs in patients with SLE, 18 (90%) were ischaemic stroke whereas two (10%) were haemorrhagic stroke. The mean SIR of all types of CVA in SLE patients was 2.02 [95% confidence interval (CI) 1.30-3.81; p = 0.002]. The SIR of ischaemic stroke decreased with age and the stroke incidence was no longer significantly higher than that of the population in patients aged >or= 60 years. Haemorrhagic stroke occurred mainly in younger SLE patients. The duration of hospitalization and the mortality rate for CVA was non-significantly higher in SLE than in non-SLE patients. The incidence of CVA in SLE remained constant over the 8 years between 1999 and 2007. Younger SLE patients are at substantially increased risk of CVA compared to age-matched population. The duration of hospitalization and the mortality rate for CVA are similar in SLE and non-SLE patients.

  11. Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients.

    Science.gov (United States)

    Farahmand, Farahmand; Choobi Anzali, Babak; Heshmat, Ramin; Ghafouri, Hamed-Basir; Hamedanchi, Sepehr

    2013-05-01

    We aim to assess serum sodium and potassium levels in patients with different types of cerebro-vascular accidents (CVA) in comparison to control group. A comparative cross-sectional study conducted on patients admitted to the emergency department from January to August 2012. Control group consisted of patients admitted to emergency department due to common cold, urinary tract infection, low back pain, cluster, and tension headache or migraine. Serum sodium and potassium levels were measured via standard laboratory methods. There were 77 patients in control group and 78 in CVA group. Forty nine patients from the CVA group had ischemic CVA, 11 had hemorrhagic CVA and 18 suffered a transient ischemic attack (TIA). Serum sodium level in control group was significantly lower than in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Serum potassium level in control group was higher than patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Patients with hemorrhagic CVA showed significantly lower serum potassium level than patients with TIA and ischemic CVA (P < 0.001). Correspondingly, it was observed that serum sodium to potassium ratio was higher in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). In patients with hemorrhagic CVA serum sodium to potassium ratio was higher when compared to patients with TIA and ischemic CVA (P < 0.001). This study shows that higher serum sodium and lower serum potassium level may be associated with higher incidence of CVA. Further studies are paramount to elucidate the role of serum electrolyte levels in vascular events.

  12. [Evaluation and treatment of the critically ill cirrhotic patient].

    Science.gov (United States)

    Fernández, Javier; Aracil, Carles; Solà, Elsa; Soriano, Germán; Cinta Cardona, Maria; Coll, Susanna; Genescà, Joan; Hombrados, Manoli; Morillas, Rosa; Martín-Llahí, Marta; Pardo, Albert; Sánchez, Jordi; Vargas, Victor; Xiol, Xavier; Ginès, Pere

    2016-11-01

    Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions. Copyright © 2015 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  13. Medical management of irradiated patients in a radiation accident in Jining, Shandong province

    International Nuclear Information System (INIS)

    Ai Huisheng; Yu Changlin; Qiao Jianhui; Zhang Shi; Guo Mei; Zhang Xignag; Wang Danhong; Sun Qiyun; Niu Wenkai; Li Guang; Yao Bo; Zhou Zhenshan; Luo Weidong; Liu Sugang; He Yaozhong; Chen Jiankui; Li Xiaobing; Hu Kaixun; Chen Ying; Wu Ke; Yang Guoshan; Liu Ying

    2007-01-01

    Objective: To summarize the experience of diagnosis and treatment from the extremely severe bone marrow form of acute radiation sickness and intestinal form of acute radiation sickness. Methods: A nuclear accident occurred in China on October 21st, 2004. Two individuals were accidentally irradiated by a 60 Co source. The two patients were estimated at more than 20-25 Gy and 9-15 Gy of γ-rays exposures, respectively, and were diagnosed as the intestinal form of acute radiation sickness (patient A) and the extremely severe bone marrow form of acute radiation sickness (patient B), respectively. After urgent preparative regimen based on low- dose fludarabine, antilymphocyte globulin and cyclophosphamide, the two patients received HLA-haploidentical (patient A) or HLA-identical (patient B) peripheral blood stem cell transplantation (PBSCT), respectively. Cyclosporin A combined mycophenolate mofetil regimen was used for the prevention of graft-versus-host disease (GVHD). Bone marrow mesenchymal stem cells from donor were injected to bone marrow of patient A additionally. Results: Both peripheral blood and bone marrow examinations showed hemopoietic recovery after PBSCT. Neither of the two patients showed obvious clinical signs specific to GVHD. Patient A died of septicemia and multi-organ failure on the 33rd day after exposure, while patient B died of multi-organ failure with predominant heart failure on the 75th day after exposure. Conclusions: Chromosome analysis of bone marrow and peripheral blood, and electron spin resonance measurement of tooth enamel play a very important role in diagnosis of the very high dose radiation disease. It is possible and feasible to treat acute radiation sickness using HLA-haploidentical or HLA-identical PBSCT. The death of patients is mainly due to infection and multi-organ failure. (authors)

  14. Cytokines in chronically critically ill patients after activity and rest.

    Science.gov (United States)

    Winkelman, Chris; Higgins, Patricia A; Chen, Yea Jyh Kathy; Levine, Alan D

    2007-04-01

    Inflammation, a common problem for patients in the intensive care unit (ICU), frequently is associated with serious and prolonged critical illnesses. To date, no study has examined whether physical activity influences inflammatory factors in critically ill adults. The objectives of this study were to (a) examine the relationships between type and duration of physical activity and serum levels of interleukin 6 (IL-6), a proinflammatory cytokine; IL-10, an anti-inflammatory cytokine; and their ratio and (b) determine if there are associations between cytokines or their ratio and activity or outcomes. This descriptive feasibility study investigated the approaches to measuring levels of physical activity and its relationship to serum levels of IL-6 and IL-10 and the ratio between them in patients with prolonged mechanical ventilation during periods of activity and rest. Measurements included serum IL-6 and IL-10 levels, direct observation and actigraphy, and prospective chart review. Ten critically ill patients who were mechanically ventilated for an average of 10 days in a large, urban, teaching hospital were enrolled. The average ratio of IL-6 to IL-10 improved after an average of 14.7 min of passive physical activity, typically multiple in-bed turns associated with hygiene. IL-6, IL-10, and their ratio were not associated with patient outcomes of weaning success or length of stay. High levels of IL-6 were associated with mortality. Cytokine balance may be improved by low levels of activity among patients with prolonged critical illness. The pattern of cytokines produced after activity may improve patients' recovery from prolonged critical illness and mechanical ventilation.

  15. Predictors of maternal mortality among critically ill obstetric patients

    African Journals Online (AJOL)

    et al.,15 that absence of prenatal care was a predictor of maternal mortality in critically ill obstetric patients, the booking status in this study was not a predictor of mortality. This could be because the delay in recognition of the need for ICU care and delays in presentation could have removed the otherwise expected beneficial ...

  16. Ventilator-associated pneumonia in critically ill African patients on ...

    African Journals Online (AJOL)

    Background: Stress ulcer prophylaxis is an integral part of the care of the critically ill. Agents that alter gastric pH may predispose these patients to gastric colonisation, with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfate preserve gastric acidity and may be protective. Objective: To determine ...

  17. 807: melatonin secretion pattern in critically ill patients

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Holst, René; Jennum, Poul Jørgen

    2016-01-01

    in over 100 patients from 0% to 54%. The project is ongoing as part of the Society of Critical Care Medicine’s ICU Liberation Collaborative. Conclusions: A multidisciplinary team based initiative to reinforce education, audit and feedback resulted in increased documentation of CAM-ICU screening rates...

  18. Plan for IER-443 Testing of the Y-12 and AWE Criticality Accident Alarm System Detectors at the Godiva IV Burst Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Scorby, J. C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hickman, D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hudson, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Garbett, S. [Atomic Weapons Establishment (AWE), Berkshire (United Kingdom); Auld, G. [Atomic Weapons Establishment (AWE), Berkshire (United Kingdom); Horrne, A. [Atomic Weapons Establishment (AWE), Berkshire (United Kingdom); Beller, T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Goda, J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Haught, C. [Y-12 National Security Complex, Oak Ridge, TN (United States); Woodrow, C. [Y-12 National Security Complex, Oak Ridge, TN (United States); Ward, D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-07-24

    This document provides the scope and details of the “Plan for Testing the Y-12 and AWE Criticality Accident Alarm System Detectors at the Godiva IV Burst Reactor”. Due to the relative simplicity of the testing goals, scope, and methodology, the NCSP Manager approved execution of the test when ready. No preliminary CED-1 or final design CED-2 reports were required or issued. The test will subject Criticality Accident Alarm System (CAAS) detectors supplied by Y- 12 and AWE to very intense and short duration mixed neutron and gamma radiation fields. The goals of the test will be to (1) substantiate functionality, for both existing and newly acquired Y- 12 CAAS detectors, and (2) the ability of the AWE detectors to provide quality temporal dose information after a hypothetical criticality accident. ANSI/ANS-8.3.1997 states that the “system shall be sufficiently robust as to actuate an alarm signal when exposed to the maximum radiation expected”, which has been defined at Y-12, in Documented Safety Analyses (DSAs), to be a dose rate of 10 Rad/s. ANSI/ANS-8.3.1997 further states that “alarm actuation shall occur as a result of a minimum duration transient” which may be assumed to be 1 msec. The pulse widths and dose rates which will be achieved in this test will exceed these requirements. Pulsed radiation fields will be produced by the Godiva IV fast metal burst reactor at the National Criticality Experimental Research Center (NCERC) at the Nevada National Security Site (NNSS). The magnitude of the pulses and the relative distances to the detectors will be varied to afford a wide range of radiation fluence and pulse widths. The magnitude of the neutron and gamma fields will be determined by reactor temperature rise to fluence and dose conversions which have been previously established through extensive measurements performed under IER-147. The requirements for CAAS systems to detect and alarm under a “minimum accident of concern” as well as other

  19. Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

    Science.gov (United States)

    Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

    2014-01-01

    Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

  20. Study of 185 diabetic patients with cerebrovascular accident as confirmed on CT

    International Nuclear Information System (INIS)

    Ito, Yasuo; Yanaga, Tatsurou; Nunoi, Kiyohide.

    1988-01-01

    In 185 diabetic patients with cerebrovascular accident (CVA) from 15 institutions, responsible lesions were confirmed on CT. The ratio of men to women was 2:1. Multiple cerebral infarction was seen in 22%. According to the type and lesions of CVA, CVA was classified as cerebral infarction confined to the perforating branch (Group 1), that confined to the cortical branch (Group II), and cerebral hemorrhage (Group III). The common background factors for initial CVA were a history of hypertension, abnormal ECG findings, abnormality in the fundus of the eyes, and 121-199 mmHg/dl of fasting blood sugar in all groups. Groups I and II were characterized by comprising many patients with diabetic retinopathy, proteinuria, and hyperlipemia. In Group I, the patients tended to be young and managed unfavorably, and to have hypertriglyceremia, while patients in Group II were old and managed favorably and had frequently atrial fibrillation. Many patients in Group III had a history of diabetes mellitus over less than 5 years and were not managed for diabetes mellitus and hypertension. Prognosis was the most favorable in Group I. There was no background factor for prognosis in Group III. (Namekawa, K)

  1. Radiation monitoring using imaging plate technology: A case study of leaves affected by the Chernobyl nuclear power plant and JCO criticality accidents

    Directory of Open Access Journals (Sweden)

    Kimura Shinzo

    2006-01-01

    Full Text Available This paper describes the use of a photostimulable phosphor screen imaging technique to detect radioactive contamination in the leaves of wormwood (Artemisia vulgaris L and fern (Dryopteris filix-max CL. Schoff plants affected by the Chernobyl nuclear power plant accident. The imaging plate technology is well known for many striking performances in two-dimensional radiation detection. Since imaging plate comprises an integrated detection system, it has been extensively applied to surface contamination distribution studies. In this study, plant samples were collected from high- and low-contaminated areas of Ukraine and Belarus, which were affected due to the Chernobyl accident and exposed to imaging technique. Samples from the highly contaminated areas revealed the highest photo-stimulated luminescence on the imaging plate. Moreover, the radio nuclides detected in the leaves by gamma and beta ray spectroscopy were 137Cs and 90Sr, respectively. Additionally, in order to assess contamination, a comparison was also made with leaves of plants affected during the JCO criticality accident in Japan. Based on the results obtained, the importance of imaging plate technology in environmental radiation monitoring has been suggested.

  2. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Legriel Stéphane

    2011-08-01

    Full Text Available Abstract Background Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT in critically ill immunocompromised patients. Methods This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years. The general severity (SAPSII and organ dysfunction (LOD scores on day 1 were 45 (35-62.7 and 4 (2-6, respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%, HIV infection (31 patients, 26%, and solid cancers (26 patients, 21.8%. Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%; 52 patients (43.7% had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC curve was 0.851 (0.78-0.92. In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006. PCT concentrations were not significantly correlated with hospital mortality. Conclusion Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

  3. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients.

    Science.gov (United States)

    Bele, Nicolas; Darmon, Michael; Coquet, Isaline; Feugeas, Jean-Paul; Legriel, Stéphane; Adaoui, Nadir; Schlemmer, Benoît; Azoulay, Elie

    2011-08-24

    Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients. This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality. Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

  4. Stress, coping and presenteeism in nurses assisting critical and potentially critical patients

    Directory of Open Access Journals (Sweden)

    Juliane Umann

    2014-10-01

    Full Text Available Objective to verify the associations between stress, Coping and Presenteeism in nurses operating on direct assistance to critical and potentially critical patients. Method this is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010 with 129 hospital nurses. The Inventory of stress in nurses, Occupational and Coping Questionnaire Range of Limitations at Work were used. For the analysis, the Kolmogorov-Smirnov test, correlation coefficient of Pearson and Spearman, Chi-square and T-test were applied. Results it was observed that 66.7% of the nurses showed low stress, 87.6% use control strategies for coping stress and 4.84% had decrease in productivity. Direct and meaningful relationships between stress and lost productivity were found. Conclusion stress interferes with the daily life of nurses and impacts on productivity. Although the inability to test associations, the control strategy can minimize the stress, which consequently contributes to better productivity of nurses in the care of critical patients and potentially critical.

  5. Call 4 Concern: patient and relative activated critical care outreach.

    Science.gov (United States)

    Odell, Mandy; Gerber, Karin; Gager, Melanie

    Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients. Patients and their relatives have the greatest knowledge of patients, and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems. However, this ability has been largely overlooked. Call 4 Concern (C4C) is a scheme where patients and relatives can call critical care teams directly if they are concerned about a patient's condition- it is believed to be the first of its kind in the UK. A C4C feasibility project ran for six months, covering patients being transferred from the intensive care unit to general wards. C4C has the potential to prevent clinical deterioration and is valued by patients and relatives. Concerns of ward staff could be managed through project management. As it is relatively new, this field offers further opportunities for research.

  6. Patient Experience: A Critical Indicator of Healthcare Performance.

    Science.gov (United States)

    Guler, Pamela H

    2017-01-01

    Patient experience has become a critical differentiator for healthcare organizations, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. Creating and sustaining a consistently exceptional experience that promotes patient engagement and the best outcomes is far more than just "satisfying" patients, going well beyond amenities that may be provided.Perception of care experience is often shaped by methods we use to address the biopsychosocial needs of patients. Building relationships and communicating well with our patients and families are primary approaches. In a complex healthcare situation, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.Patients who are fully informed and feel connected to their caregivers are often less anxious than those who are disengaged. Informed and engaged patients are enabled to participate in their healthcare. Organizations that focus on developing an accountable culture-one that inspires caregivers to communicate in a way that connects to patients' mind, body, and spirit while leveraging standard, evidence-based patient experience practices-find that patients' perception of care, or "the patient experience," is vastly improved.Adventist Health System has embarked on a journey to patient experience excellence with a commitment to whole-person care and standard patient experience practice across the system. Recognized with several national awards, we continue to strengthen our approach toward bringing all of our campuses and patient settings to sustained high-level performance. We have found that a combination of strong, accountable leadership; a focus on employee culture; engagement of physicians; standardized patient experience practices and education; and meaningful use of patient feedback are top

  7. Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.

    Science.gov (United States)

    Araújo-Junqueira, L; De-Souza, Daurea A

    2012-01-01

    Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.

  8. [Lipid and glucose profile in patients with ischemic cerebrovascular accidents in Dakar].

    Science.gov (United States)

    Ousmane, Cisse; Lemine, Dadah Samy Mohamed; Fatoumata, Ba; Makhtar, Ba El Hadji; Soda, Diop Marieme; Side, Diagne Ngor; Dieynaba, Sow Adjaratou; Modji, Basse Anna; Kamadore, Touré; Moustapha, Ndiaye; Gallo, Diop Amadou; Mansour, Ndiaye Mouhamadou

    2016-01-01

    Cerebrovascular accident (CVA) is defined as the rapid development of localized or global clinical signs of neurological dysfunction with no apparent cause other than that of vascular origin. A variety of risk factors have been identified and associated with the occurrence of Ischemic CVA, including glucose and lipid metabolism disturbances. We conducted a retrospective study at the Clinic of Neurology, Fann. Our study focused on medical records of patients with ICVA confirmed by imaging, hospitalized from January 1 to December 31 2010. All patients underwent complete lipid profile (total cholesterol, triglycerides, HDL; LDL level was calculated using Friedwald formula), kidney function tests and fasting blood sugar test were performed within 48 hours of admission. Data were analysed using univariate technique and then using bivariate technique tanks to SPSS 16.0 software. We collected 235 files. We here report a case series of patients between ages 10-99 years, with an average age of 67,06 years. Males were 42,55%, sex-ratio was 0,74 in favour of women. 26% of cases had impaired fasting glucose levels during the acute phase of ICVA. The lipid profile showed an increase in total cholesterol level in 52.34% of patients. Low levels of HDL cholesterol were found in 34.47% of patients. Hypertriglyceridemia was only observed in 3% of patients. LDL levels were high in 12,76% of patients. Atherogenicity index was high in 25,53% of patients. Disturbances of blood glucose and lipid profile are often associated with ICVA and should be taken into account to ensure better secondary prevention.

  9. Antithrombin III for critically ill patients

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Wetterslev, Jørn; Ravn, Frederikke B

    2016-01-01

    PURPOSE: Antithrombin III (AT III) is an anticoagulant with anti-inflammatory properties. We assessed the benefits and harms of AT III in critically ill patients. METHODS: We searched from inception to 27 August 2015 in CENTRAL, MEDLINE, EMBASE, CAB, BIOSIS and CINAHL. We included randomized...... participants). However, for all other outcome measures and analyses, the results did not reach statistical significance. CONCLUSIONS: There is insufficient evidence to support AT III substitution in any category of critically ill participants including those with sepsis and DIC. AT III did not show an impact...

  10. The validation and the limits of SPECT for patients suffering from cerebrovascular accidents

    International Nuclear Information System (INIS)

    Mizukawa, Norihiko; Yano, Ichiro; Tenjin, Hiroshi

    1989-01-01

    Contemporaneous single photon emission computed tomography (SPECT) and positron emission tomography (PET) were performed in 10 patients with cerebrovascular accidents (CVA), whose ages ranged from 11 to 67 years. I-123-isopropyl-iodoamphetamine (IMP) and/or Tc-99m hexamethylpropyleneamine oxime (HM-PAO) were used for SPECT. Cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate for oxygen (CMRO 2 ) were measured by an O-15 labelled gas continuous-inhalation method. SPECT images were quite similar to CBF and CMRO 2 during the chronic stage of CVA. Two patietns with vasospasm during the subacute stage had apparently low CBF and CMRO 2 on PET, but did not have low perfusion on SPECT. Luxury perfusion areas were detected in 4 subacute stage patients and one chronic stage patient. A redistribution of IMP was detected in two patients with infarction during subacute stage. CMRO 2 value in such an area was 2.0 ml/100 g/min. Low CBF and/or CMRO 2 areas were well visualized by IMP rather than by HM-PAO SPECT. (N.K.)

  11. Nutritional risk assessment in critically ill cancer patients: systematic review

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic

  12. Measurements of {sup 60}Co in spoons activated by neutrons during the JCO criticality accident at Tokai-mura in 1999

    Energy Technology Data Exchange (ETDEWEB)

    Gasparro, J.; Hult, M. E-mail: mikael.hult@irmm.jrc.be; Komura, K.; Arnold, D.; Holmes, L.; Johnston, P.N.; Laubenstein, M.; Neumaier, S.; Reyss, J.-L.; Schillebeeckx, P.; Tagziria, H.; Van Britsom, G.; Vasselli, R

    2004-07-01

    Neutron activated items from the vicinity of the place where the JCO criticality accident occurred have been used to determine the fluence of neutrons around the facility and in nearby residential areas. By using underground laboratories for measuring the activation products, it is possible to extend the study to also cover radionuclides with very low activities from long-lived radionuclides. The present study describes {gamma}-ray spectrometry measurements undertaken in a range of underground laboratories for the purpose of measuring {sup 60}Co more than 2 years after the criticality event. The measurements show that neutron fluence determined from {sup 60}Co activity is in agreement with previous measurements using the short-lived radionuclides {sup 51}Cr and {sup 59}Fe. Limits on contamination of the samples with {sup 60}Co are evaluated and shown to not greatly affect the utility of neutron fluence determinations using {sup 60}Co activation.

  13. Fluid and electrolyte disturbances in critically ill patients.

    Science.gov (United States)

    Lee, Jay Wook

    2010-12-01

    Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal hemodynamics and tissue perfusion. Early goal-directed therapy has been shown to be effective in patients with severe sepsis or septic shock. On the other hand, liberal fluid administration is associated with adverse outcomes such as prolonged stay in the ICU, higher cost of care, and increased mortality. Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy. Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Cardiac manifestations should be identified and treated before initiating stepwise diagnostic evaluation of dyskalemias. Divalent ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients.

  14. Constipation and its implications in the critically ill patient.

    Science.gov (United States)

    Mostafa, S M; Bhandari, S; Ritchie, G; Gratton, N; Wenstone, R

    2003-12-01

    Motility of the lower gut has been little studied in intensive care patients. We prospectively studied constipation in an intensive care unit of a university hospital, and conducted a national survey to assess the generalizability of our findings. Constipation occurred in 83% of the patients. More constipated patients (42.5%) failed to wean from mechanical ventilation than non-constipated patients (0%), Pconstipated than non-constipated patients (10 vs 6.5 days and 27.5 vs 12.5%, respectively (NS)). The survey found similar observations in other units. Delays in weaning from mechanical ventilation and enteral feeding were reported by 28 and 48% of the units surveyed, respectively. Constipation has implications for the critically ill.

  15. Accidents - Chernobyl accident

    International Nuclear Information System (INIS)

    2004-01-01

    This file is devoted to the Chernobyl accident. It is divided in four parts. The first part concerns the accident itself and its technical management. The second part is relative to the radiation doses and the different contaminations. The third part reports the sanitary effects, the determinists ones and the stochastic ones. The fourth and last part relates the consequences for the other European countries with the case of France. Through the different parts a point is tackled with the measures taken after the accident by the other countries to manage an accident, the cooperation between the different countries and the groups of research and studies about the reactors safety, and also with the international medical cooperation, specially for the children, everything in relation with the Chernobyl accident. (N.C.)

  16. Upper extremity open fractures in hospitalized road traffic accident patients: adult versus pediatric cases.

    Science.gov (United States)

    Rubin, Guy; Peleg, Kobi; Givon, Adi; Rozen, Nimrod

    2017-10-24

    Fractures in pediatrics show epidemiological characteristics which are different from fractures in adults. The objective of this study was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients. Data on 103,465 RTA patients between 1997 and 2013 whose records were entered in a centralized country trauma database were reviewed. Data on open UEFs related to mode of injury (car, motorcycle, bicycle, and pedestrian) was compared between adult (18+ years) and pediatric (0-17 years) RTA patients. Of 103,465 RTA cases, 17,263 (16.7%) had UEFs. Of 73,087 adults, 13,237 (18.1%) included UEFs and of 30,378 pediatric cases, 4026 (13.2%) included UEFs (p open fractures. Adults had a greater risk for open fractures (2221, 13%) than the pediatric cases (522, 10.3%) (p open UEFs than the pediatric group (11 vs 8%, p = 0.0012). This study demonstrates the difference between adult and pediatric open fractures in hospitalized RTAs. We showed that adults had a greater risk for open UEFs compared to children, and the adult pedestrian group particularly had a significantly higher risk for open UEFs than the pediatric group.

  17. [Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident].

    Science.gov (United States)

    Mayayo, Emilio; Stchigel, Alberto M; Cano, José F; Bernal-Escoté, Xana; Guarro, Josep

    2013-01-03

    Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

  18. High seroprevalence of Toxoplasma gondii infection in a subset of Mexican patients with work accidents and low socioeconomic status.

    Science.gov (United States)

    Alvarado-Esquivel, Cosme; Torres-Castorena, Alejandro; Liesenfeld, Oliver; Estrada-Martínez, Sergio; Urbina-Álvarez, Jesús D

    2012-01-11

    Toxoplasma gondii has been associated with reflex impairment and traffic accidents. It is unknown whether Toxoplasma infection might be associated with work accidents. Therefore, using a case-control seroprevalence study design, 133 patients with a recent work accident and 266 control subjects of the general population from the same region were examined with enzyme-linked immunoassays for the presence and levels of anti-Toxoplasma IgG antibodies and anti-Toxoplasma IgM antibodies. Socio-demographic, work, clinical and behavioral characteristics from each worker were obtained. Eleven (8.3%) of 133 patients, and 14 (5.3%) of 266 controls had anti-T. gondii IgG antibodies. Anti-T. gondii IgG levels were higher than 150 IU/ml in 8 (6%) patients and 10 (3.8%) controls. Anti-T. gondii IgM antibodies were found in one (0.8%) of the workers, and in 6 (2.3%) of the controls. No statistically significant differences in the IgG seroprevalences, frequencies of high IgG levels, and IgM seroprevalences among patients and controls were found. In contrast, a low socio-economic level in patients with work accidents was associated with Toxoplasma seropositivity (P = 0.01). Patients with work accidents and low socioeconomic status showed a significantly (OR = 3.38; 95% CI: 0.84-16.06; P = 0.04) higher seroprevalence of T. gondii infection than controls of the same socioeconomic status (15.1% vs. 5%, respectively). Multivariate analysis showed a positive association of T. gondii infection with boar meat consumption (OR = 3.04; 95% CI: 1.03-8.94; P = 0.04). In contrast, a negative association between T. gondii infection and national trips (OR = 0.40; 95% CI: 0.17-0.96; P = 0.04), sausage consumption (OR = 0.20; 95% CI: 0.05-0.68; P = 0.01), and ham consumption (OR = 0.16; 95% CI: 0.05-0.51; P = 0.002) was found. In the study described here seropositivity to T. gondii was associated to work accidents in a subset of patients with low socioeconomic status. This is the first report of an

  19. Relatives to Critically Ill Patients Have No Sense of Coherence

    DEFF Research Database (Denmark)

    Laursen, Jannie; Andresen, Kristoffer; Rosenberg, Jacob

    2016-01-01

    shown that relatives do not always receive the attention they need from health professionals. There is a lack of studies that focus on relatives' satisfaction and involvement during their family members' hospitalization. Design. A mixed methods design was chosen. Methods. A quantitative study...... of the dissatisfaction, a qualitative approach was used and the in-depth interviews revealed three themes: lack of continuity and structure, responsibility of coordination, and relatives feeling left on their own with no guiding and support. Conclusion. Health professionals' key role in relation to relatives must......Aims and Objective. To investigate the relatives' satisfaction and involvement on a general surgery ward regarding the critically ill patient. Introduction. Relatives to critically ill patients are affected both physically and mentally during the hospitalization of a family member. Research has...

  20. Effect of hyperbaric oxygen therapy on whole blood cyanide concentrations in carbon monoxide intoxicated patients from fire accidents

    DEFF Research Database (Denmark)

    Lawson-Smith, Pia; Jansen, Erik C; Hilsted, Linda

    2010-01-01

    Hydrogen cyanide (HCN) and carbon monoxide (CO) may be important components of smoke from fire accidents. Accordingly, patients admitted to hospital from fire accidents may have been exposed to both HCN and CO. Cyanide (CN) intoxication results in cytotoxic hypoxia leading to organ dysfunction...... and possibly death. While several reports support the use of hyperbaric oxygen therapy (HBO) for the treatment of severe CO poisoning, limited data exist on the effect of HBO during CN poisoning. HBO increases the elimination rate of CO haemoglobin in proportion to the increased oxygen partial pressure...

  1. Fluid and Electrolyte Disturbances in Critically Ill Patients

    OpenAIRE

    Lee, Jay Wook

    2010-01-01

    Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal...

  2. Critical care admission of South African (SA) surgical patients ...

    African Journals Online (AJOL)

    Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. D.L. Skinner, K de Vasconcellos, R Wise, T.M. Esterhuizen, C Fourie, A Goolam Mahomed, P.D. Gopalan, I Joubert, H Kluyts, L.R. Mathivha, B Mrara, J.P. Pretorius, G Richards, O Smith, M.G.L. Spruyt, R.M. Pearse, ...

  3. Procalcitonin-guided antibiotic treatment in critically ill patients.

    Science.gov (United States)

    Hohn, Andreas; Heising, Bernhard; Schütte, Jan-Karl; Schroeder, Olaf; Schröder, Stefan

    2017-02-01

    In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period. This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed. PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated. Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.

  4. Management Issues in Critically Ill Pediatric Patients with Trauma.

    Science.gov (United States)

    Ahmed, Omar Z; Burd, Randall S

    2017-10-01

    The management of critically ill pediatric patients with trauma poses many challenges because of the infrequency and diversity of severe injuries and a paucity of high-level evidence to guide care for these uncommon events. This article discusses recent recommendations for early resuscitation and blood component therapy for hypovolemic pediatric patients with trauma. It also highlights the specific types of injuries that lead to severe injury in children and presents challenges related to their management. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Wang, Bin; Jia, Ming; Jia, Shijie; Wan, Jiuhe; Zhou, Xiao; Luo, Zhimin; Zhou, Ye; Zhang, Jianqun

    2014-06-01

    To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events. A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB. Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925). This

  6. Amikacin treatment of Serratia septicemia in critically ill patients.

    Science.gov (United States)

    Mosquera, J M; de Villota, E D; de la Serna, J L; Diez-Balda, V; Tomás, M I; Galdos, P; Rubio, J J

    1981-09-01

    Serratia marcescens septicemia represents a serious problem in high risk critical care patients. Treatment is difficult because Serratia is usually resistant to most antibiotics. Amikacin is at present the most effective antibiotic in vitro against gentamycin-resistant Serratia, although significant loss of activity may occur in vivo in the group of compromised patients, whose ultimate prognosis may depend eventually upon other associated conditions. In this Medical ICU, 15 patients with Serratia septicemia who were treated with in vitro effective antibiotics (14 were given amikacin) had a mortality of 60%, while 5 patients who received ineffective in vitro antibiotics had a mortality of 100%. In this ICU, 80% of the Serratia isolates were resistant to gentamycin, while only 2.8% were resistant to amikacin. Because amikacin-resistant strains of Serratia have already emerged, appropriate use of this antibiotic is essential in order not to promote the selection of amikacin-resistant strains.

  7. Bilateral Diaphragmatic Paralysis in a Patient With Critical Illness Polyneuropathy

    Science.gov (United States)

    Chen, Hsuan-Yu; Chen, Hung-Chen; Lin, Meng-Chih; Liaw, Mei-Yun

    2015-01-01

    Abstract Bilateral diaphragmatic paralysis (BDP) manifests as respiratory muscle weakness, and its association with critical illness polyneuropathy (CIP) was rarely reported. Here, we present a patient with BDP related to CIP, who successfully avoided tracheostomy after diagnosis and management. A 71-year-old male presented with acute respiratory failure after sepsis adequately treated. Repeated intubation occurred because of carbon dioxide retention after each extubation. After eliminating possible factors, septic shock-induced respiratory muscle weakness was suspected. Physical examination, a nerve conduction study, and chest ultrasound confirmed our impression. Pulmonary rehabilitation and reconditioning exercises were arranged, and the patient was discharged with a diagnosis of BDP. The diagnosis of BDP is usually delayed, and there are only sporadic reports on its association with polyneuropathy, especially in patients with preserved limb muscle function. Therefore, when physicians encounter patients that are difficult to wean from mechanical ventilation, CIP associated with BDP should be considered in the differential diagnosis. PMID:26252301

  8. [Prenatal cerebrovascular accidents diagnosed in the early infant stage: a series of 10 patients].

    Science.gov (United States)

    Pina-Jover, María; Martinez-Del Villar, María; Lillo-Laguna, Lucía; Jadraque-Rodriguez, Rocío; Martinez-Pastor, Pedro; Jover-Cerda, Jenaro; Gomez-Gosalvez, Francisco

    2013-07-01

    INTRODUCTION. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. PATIENTS AND METHODS. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. RESULTS. None of the 10 patients studied presented any relevant events in the mothers' medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. CONCLUSIONS. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible.

  9. Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients.

    Science.gov (United States)

    Leonhardt, Silke; Veltzke-Schlieker, Wilfried; Adler, Andreas; Schott, Eckart; Hetzer, Roland; Schaffartzik, Walter; Tryba, Michael; Neuhaus, Peter; Seehofer, Daniel

    2015-03-31

    In recent years the development of secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has increasingly been perceived as a separate disease entity. About possible trigger mechanisms of SSC-CIP has been speculated, systematic investigations on this issue are still lacking. The purpose of this study was to evaluate the prevalence and influence of promoting factors. Temporality, consistency and biological plausibility are essential prerequisites for causality. In this study, we investigated the temporality and consistency of possible triggers of SSC-CIP in a large case series. Biological plausibility of the individual triggers is discussed in a scientific context. SSC-CIP cases were recruited retrospectively from 2633 patients who underwent or were scheduled for liver transplantation at the University Hospital Charité, Berlin. All patients who developed secondary sclerosing cholangitis in association with intensive care treatment were included. Possible trigger factors during the course of the initial intensive care treatment were recorded. Sixteen patients (68% males, mean age 45.87 ± 14.64 years) with a confirmed diagnosis of SSC-CIP were identified. Of the 19 risk factors investigated, particularly severe hypotension with a prolonged decrease in mean arterial blood pressure (MAP) to <65 mmHg and systemic inflammatory response syndrome (SIRS) were established as possible triggers of SSC-CIP. The occurrence of severe hypotension appears to be the first and most significant step in the pathogenesis. It seems that severe hypotension has a critical effect on the blood supply of bile ducts when it occurs together with additional microcirculatory disturbances. In critically ill patients with newly acquired cholestasis the differential diagnosis of SSC-CIP should be considered when they have had an episode of haemodynamic instability with a prolonged decrease in MAP, initial need for large amounts of blood transfusions or colloids, and early

  10. Patient's dignity in intensive care unit: A critical ethnography.

    Science.gov (United States)

    Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali

    2017-01-01

    Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

  11. Postulated accidents

    International Nuclear Information System (INIS)

    Ullrich, W.

    1980-01-01

    This lecture on 'Postulated Accidents' is the first of a series of lectures on the dynamic and transient behaviour of nuclear power plants, especially pressurized water reactors. The main points covered will be: Reactivity Accidents, Transients (Intact Loop) and Loss of Cooland Accidents (LOCA) including small leak. This lecture will discuss the accident analysis in general, the definition of the various operational phases, the accident classification, and, as an example, an accident sequence analysis on the basis of 'Postulated Accidents'. (orig./RW)

  12. Nuclear accident: dosimetric and medical aspects

    International Nuclear Information System (INIS)

    Oliveira, A.R. de.

    The conservation aspect of the treatment of patients who received whole-body exposure is presented. Such treatment to be started during the first hours after the accident (prodomal phase), as well as the nonconventional measures to be adopted when the critical phase of acute irradiation syndrome is reached. (E.G.) [pt

  13. Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network

    Directory of Open Access Journals (Sweden)

    Márcia Cristina Rodrigues Fausto

    Full Text Available Abstract Objectives: to analyze the itineraries of patients with cerebrovascular accident (CVA in the Interstate health region in San Francisco Valley. Methods: this study uses the qualitative approach through the construction of Therapeutic Itineraries (IT. In the IT mapping the observation was prioritized on the different points and forms to access health service in search of care. Results: sixteen semi-structured interviews with healthcare users were conducted. There were diverse forms to access and provide services at the Rede Interestadual de Atenção à Saúde do Vale do Médio São Francisco-PEBA (Interstate Healthcare Network Region in the San Francisco Valley, which could be characterized by disorganized and uncoordinated care in the analyzed cases, despite the guarantee of hospital care. The Primary Health Care (APS teams are present at a care point with most of the patients' itineraries, however, little integration to the regionalized network and they were unable to perform their functions and coordinate the care. It is observed pilgrimage assistance, fragmented care and difficulties in receiving care after post hospitalization which is essential for the patients’ rehabilitation. Conclusions: traces of fragments of the regional health system are important warning signs that points out fragility in PEBA and demonstrate persistent gaps in the public health system to fulfil the responsibility and guarantee individuals’ right for health.

  14. Hyperglycemia in critical patients: Determinants of insulin dose choice

    Directory of Open Access Journals (Sweden)

    Aline Klitzke Paliosa

    Full Text Available Summary Objective: To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Method: Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level. Patients with one or more episodes of hyperglycemia (blood glucose greater than 180 mg/dL were included as a convenience sample, not consecutively. Those with continuous insulin prescription were excluded from analysis. Results: We included 64 records of hyperglycemia observed in 22 patients who had at least one episode of hyperglycemia. The median administered subcutaneous regular human insulin was 6 IU and among the factors evaluated only blood glucose levels were associated with the choice of insulin dose administered. Conclusion: Clinical characteristics such as diet, medications and diagnosis of diabetes mellitus are clearly ignored in the decision-making regarding insulin dose to be administered for glucose control in critically ill patients with hyperglycemia.

  15. Assessing burden in families of critical care patients.

    Science.gov (United States)

    Kentish-Barnes, Nancy; Lemiale, Virginie; Chaize, Marine; Pochard, Frédéric; Azoulay, Elie

    2009-10-01

    To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients. PubMed (1979-2009). We included all quantitative studies that used a validated instrument to evaluate the prevalence of, and risk factors for, burden on families. We extracted the descriptions of the instruments used and the main results. Family burden after critical illness can be detected reliably and requires preventive strategies and specific treatments. Using simple face-to-face interviews, intensivists can learn to detect poor comprehension and its determinants. Instruments for detecting symptoms of anxiety, depression, or stress can be used reliably even by physicians with no psychiatric training. For some symptoms, the evaluation should take place at a distance from intensive care unit discharge or death. Experience with families of patients who died in the intensive care unit and data from the literature have prompted studies of bereaved family members and the development of interventions aimed at decreasing guilt and preventing complicated grief. We believe that burden on families should be assessed routinely. In clinical studies, using markers for burden measured by validated tools may provide further evidence that effective communication and efforts to detect and to prevent symptoms of stress, anxiety, or depression provide valuable benefits to families.

  16. How do we approach thrombocytopenia in critically ill patients?

    Science.gov (United States)

    Thachil, Jecko; Warkentin, Theodore E

    2017-04-01

    A low platelet count is a frequently encountered haematological abnormality in patients treated in intensive treatment units (ITUs). Although severe thrombocytopenia (platelet count classical view for thrombocytopenia in this setting is consumption associated with thrombin-mediated platelet activation, but other concepts, including platelet adhesion to endothelial cells and leucocytes, platelet aggregation by increased von Willebrand factor release, red cell damage and histone release, and platelet destruction by the complement system, have recently been described. The management of severe thrombocytopenia is platelet transfusion in the presence of active bleeding or invasive procedure, but the risk-benefit of prophylactic platelet transfusions in this setting is uncertain. In this review, the incidence and mechanisms of thrombocytopenia in patients with ITU, its prognostic significance and the impact on organ function is discussed. A practical approach based on the authors' experience is described to guide management of a critically ill patient who develops thrombocytopenia. © 2016 John Wiley & Sons Ltd.

  17. [Fish oil containing lipid emulsions in critically ill patients: Critical analysis and future perspectives].

    Science.gov (United States)

    Manzanares, W; Langlois, P L

    2016-01-01

    Third-generation lipid emulsions (LE) are soybean oil sparing strategies with immunomodulatory and antiinflammatory effects. Current evidence supporting the use of intravenous (i.v) fish oil (FO) LE in critically ill patients requiring parenteral nutrition or receiving enteral nutrition (pharmaconutrient strategy) mainly derives from small phase ii clinical trials in heterogenous intensive care unit patient's population. Over the last three years, there have been published different systematic reviews and meta-analyses evaluating the effects of FO containing LE in the critically ill. Recently, it has been demonstrated that i.v FO based LE may be able to significantly reduce the incidence of infections as well as mechanical ventilation days and hospital length of stay. Nonetheless, more robust evidence is required before giving a definitive recommendation. Finally, we strongly believe that a dosing study is required before new phase iii clinical trials comparing i.v FO containing emulsions versus other soybean oil strategies can be conducted. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  18. A CRITICAL ANALYSIS OF PATIENT SATISFACTION WITH DIABETES CARE

    Directory of Open Access Journals (Sweden)

    Cotiu Madalina-Alexandra

    2015-07-01

    Full Text Available Consumer satisfaction represents one of the core principles of marketing as it is acknowledged that organizations survive and prosper only by properly meeting the needs and wants of their customers. The same logic can be applied to the healthcare sector, especially in the current context of increased public scrutiny and funding pressure. Furthermore, research shows that patient satisfaction is linked to positive effects from both a marketing and a medical point of view. From a marketing point of view, patient satisfaction is closely linked to positive word of mouth and likelihood to recommend, while from a medical poinbt of view, research suggests that satisfied patients are more inclined toward treatment adherence, are less likely to seek another opinion elsewhere thus delaying treatment, while medical staff tend to have a higher morale. Yet, research regarding patient satisfaction with a particular illness is scarce with studies rarely building on previous results. The article takes on this challenge and aims to critically analyse several empirical studies conducted on patient satisfaction with diabetes care in order to synthesize results on particular determinants and suggest areas for further research. Diabetes is currently one of the most spread chronic disease around the world, while also affecting both old and younger patients. At the same time, it is a chronic disease characterised by the need for disease management efforts on behalf of the patients as well as high treatment adherence in order to avoid complications. It is also a costly chronic disease especially because of the numerous complications which patients may arrive to face during their struggle with this disease. In order to achieve the aim of this article we have chosen to adopt a marketing approach meaning that we see diabetes patients as clients of the medical institutions. Results show that diabetes particularities call for a broader view on patient satisfaction

  19. [Variation of muscle mass and weight in critical patient].

    Science.gov (United States)

    Valls-Matarín, J; del Cotillo-Fuente, M; Grané-Mascarell, N; Quintana, S

    2015-01-01

    Quantify the muscle mass and body weight variation in critically ill patients and to identify associated factors. A descriptive follow-up study. Data for demographic variables, body weight, fluid balance, daily kilocalories, the amount of sedation and muscle relaxants received and motor physiotherapy applied were collected. Three consecutive measurements were performed in the brachial biceps and quadriceps rectus by using ultrasound, upon admission and every 5 days until discharge. 68 patients were included. Average age was of 73.5 [57-78,5] years. The median length of stay was 9.5 [5.5 -15] days. The median 16 (SD=5.7) daily kilocalories per kg/weight, 91.2% received sedation, 44.1% received muscle relaxants and 20% received physiotherapy. The patients presented a muscle wasting of 4.9 (SD=3.9)mm, p <.001 in the brachial biceps and 5.6 (SD=4.8)mm, p <.001 in the quadriceps rectus. Regression analysis selected the length of stay and the muscle relaxants are the most influential variables in the brachial biceps muscle wasting (R2=0.4), and length of stay as the most influential in the quadriceps rectus muscle wasting (R2=0.3). Patient's mean body weight on admission was of 81.1 (SD=15)kg and 81.2 (SD=14.2)kg on discharge, p=.95. The critically ill patient presents a significant muscle waste related with the length of stay and the treatment received with muscle relaxants. Patients are being discharged with a similar body weight to which they were admitted but with a significant reduction of muscle mass. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  20. Caloric requirement of the critically ill septic patient

    International Nuclear Information System (INIS)

    Shizgal, H.M.; Martin, M.F.

    1988-01-01

    The caloric requirement of the critically ill septic patient was determined by measuring body composition, by multiple isotope dilution, before and at 2-wk intervals while receiving total parenteral nutrition (TPN) in 86 septic and 57 nonseptic malnourished patients. All patients received a TPN solution containing 25% dextrose and 2.75% crystalline amino acids. The body composition of the nonseptic patients, who received 51.9 +/- 1.5 kcal/kg.day, improved significantly, while that of the septic patients, receiving 46.8 +/- 1.1 kcal/kg.day was only maintained. The relationship between caloric intake and the restoration of a malnourished body cell mass (BCM) was determined for each group by correlating, using multiple linear regression, the mean daily change in the BCM with the caloric intake and the nutritional state, as determined by body composition. According to the resultant regressions, an intake of 35.1 and 50.7 kcal/kg.day was required to maintain the BCM of the septic and nonseptic patients, respectively. To restore a depleted BCM, caloric intakes in excess of this amount are required

  1. Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients.

    Science.gov (United States)

    Lopes, Ana Martins; Silva, Diana; Sousa, Gabriela; Silva, Joana; Santos, Alice; Abelha, Fernando José

    2017-08-31

    Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes. This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression. A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001). A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients. Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

  2. Trend data for administration of medications in patients with acute cerebrovascular accidents and its sequelae

    Directory of Open Access Journals (Sweden)

    Levytska Oksana

    2017-06-01

    Full Text Available The trends in drug utilization in patients with acute cerebrovascular accidents (ACVA and its sequelae were investigated in the Neurological Department of Lviv Regional Hospital, Ukraine, in 2007 and 2015. From the 10 anatomical groups of the Anatomical Therapeutic Chemical (ATC classification system, in 2007, 181 medications were prescribed for treatment of ACVA and concomitant diseases, compared to 198 medications in 2015. The medications of Group C (Cardiovascular system were of the maximal proportion in both analyzed periods (28.1% in 2007 and 29.8% in 2015. Moreover, the largest proportion of the prescribed medications of the 3rd level groups of the ATC classification system were of group В01А - “Antithrombotic agents” (7.2% in 2007 and 6.6% in 2015. Furthermore, three medications (Magnesium sulfate, L-lysini aescinas and Potassium chloride were prescribed for 50% and more patients in both analyzed periods, while the prescriptions of other medications were characterized by high variability. АТС/DDD analysis also revealed the tendency toward an increase in prescription and drug utilization of the main medication groups, and that these were used for nonspecific and specific therapy for ACVA, as well as for secondary prevention (antihypertensives, anticoagulants, antiplatelet agents and statins. Totally, the drug utilization of these medication groups was 38.5% in 2007 and 58.0%, respectively, in 2015, compared to the overall number of DDDs. The results of our study suggest the existence of a positive tendency in prescriptions, and of compliance with the current principles of treatment, in patients with ACVA, in Ukraine.

  3. Doripenem pharmacokinetics in critically ill patients receiving continuous hemodiafiltration (CHDF).

    Science.gov (United States)

    Hidaka, Seigo; Goto, Koji; Hagiwara, Satoshi; Iwasaka, Hideo; Noguchi, Takayuki

    2010-01-01

    Objectives of the prospective, open-label study were to investigate pharmacokinetics of doripenem and determine appropriate doripenem regimens during continuous hemodiafiltration (CHDF) in critically ill patients with renal failure (creatinine clearance times during one dosing interval were measured in order to calculate pharmacokinetic parameters and clearance via hemodiafiltration. Mean half-life (+/-standard deviation) of doripenem was 7.9+/-3.7 hours. Total body clearance of doripenem was 58.0+/-12.7 ml/min, including clearance of 13.5+/-1.6 ml/min via CHDF. An IV dose of 250 mg of doripenem every 12 hours during CHDF provided adequate plasma concentrations for critically ill patients with renal failure, without resulting in accumulation upon steady-state. Thus, under the conditions tested, CHDF appeared to have little effect on doripenem clearance. Therefore, the blood level of doripenem can be satisfactorily controlled by adjustment of doripenem dose and dosing interval, in accordance with residual renal function in patients receiving CHDF.

  4. Pharmacologic management of constipation in the critically ill patient.

    Science.gov (United States)

    Patanwala, Asad E; Abarca, Jacob; Huckleberry, Yvonne; Erstad, Brian L

    2006-07-01

    To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU). Retrospective medical record review. MICU of an academic medical center. Ninety-five patients admitted to the MICU from July 1-October 31, 2004. Fifty patients satisfied the inclusion criteria. Patient-specific data such as age, weight, sex, length of MICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, dietary intake, opioid intake, laxative intake, and bowel movements were recorded during the first 96 hours of admission. Logistic regression analysis was used to compare patients who did and did not have a bowel movement. Of the 50 patients, 25 did not have a bowel movement during the first 96 hours of MICU admission. Patients given a stimulant laxative (senna, bisacodyl) and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a bowel movement (odds ratio [OR] 26.6, 95% confidence interval [CI] 3.2-221, p=0.002). Opioid intake, expressed as logarithmic morphine equivalents, was negatively associated with occurrence of a bowel movement (OR 0.76, 95% CI 0.59-0.97, p=0.027). Disease severity, as determined by APACHE II score, was also negatively associated with a bowel movement (OR 0.84, 95% CI 0.7-0.99, p=0.04). Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.

  5. Residual neutron-induced radionuclides in a soil sample collected in the vicinity of the criticality accident site in Tokai-mura, Japan: A Progress Report

    International Nuclear Information System (INIS)

    Nakanishi, Takashi; Hosotani, Risa; Komura, Kazuhisa; Muroyama, Toshiharu; Kofuji, Hisaki; Murata, Yoshimasa; Kimura, Shinzo; Kumar Sahoo, Sarata; Yonehara, Hidenori; Watanabe, Yoshito; Ban-nai, Tada-aki

    2000-01-01

    Residual neutron-induced radionuclides were measured in a soil sample collected in the vicinity of the location where a criticality accident occurred (in Tokai-mura, from 30 September to 1 October, 1999). Concentrations of 24 Na, 140 La, 122 Sb, 59 Fe, 124 Sb, 46 Sc, 65 Zn, 134 Cs and 60 Co in the soil sample were determined by γ-ray spectrometry, and neutron activation analysis was carried out for selected target elements in the sample. Tentative estimates of the apparent thermal and epithermal neutron fluences which reached the sample were obtained through combined analyses of 59 Fe/ 58 Fe, 124 Sb/ 123 Sb, 46 Sc/ 45 Sc, 65 Zn/ 64 Zn, 134 Cs/ 133 Cs and 60 Co/ 59 Co

  6. Dose evaluation based on {sup 24}Na activity in the human body at the JCO criticality accident in Tokai-mura

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Takumaro; Tsujimura, Norio; Tasaki, Takashi; Kanai, Katsuta; Kurihara, Osamu; Hayashi, Naomi; Shinohara, Kunihiko [Japan Nuclear Cycle Development Inst., Tokai, Ibaraki (Japan). Tokai Works

    2001-09-01

    {sup 24}Na in the human body, activated by neutrons emitted at the JCO criticality accident, was observed for 62 subjects, where 148 subjects were measured by the whole body counter of JNC Tokai Works. The 148 subjects, including JCO employees and the contractors, residents neighboring the site and emergency service officers, were measured by the whole-body counter. The neutron-energy spectrum around the facility was calculated using neutron transport codes (ANISN and MCNP), and the relation between an amount of activated sodium in human body and neutron dose was evaluated from the calculated neutron energy spectrum and theoretical neutron capture probability by the human body. The maximum {sup 24}Na activity in the body was 7.7 kBq (83 Bq({sup 24}Na)/g({sup 23}Na)) and the relevant effective dose equivalent was 47 mSv. (author)

  7. Dose evaluation on the basis of {sup 24}Na activity in the human body for the criticality accident at JCO Tokai nuclear fuel processing plant

    Energy Technology Data Exchange (ETDEWEB)

    Momose, T.; Tsujimura, N.; Tasaki, T.; Kanai, K.; Hayashi, N.; Shinohara, K. [Japan Nuclear Cycle Development Inst., Tokai, Ibaraki (Japan)

    2001-11-01

    {sup 24}Na in the human body, activated by neutrons emitted at the JCO criticality accident, was observed for 62 subjects, where 148 subjects were measured by the whole body counter of JNC Tokai Works. The 148 subjects, including JCO employees and the contractors, residents neighboring the site and emergency service officers, were measured by the whole-body counter. The neutron-energy spectrum around the facility was calculated using neutron transport codes (ANISN and MCNP), and the relation between an amount of activated sodium in human body and neutron dose was evaluated from the calculated neutron energy spectrum and theoretical neutron capture probability by the human body. The maximum {sup 24}Na activity in the body was 7.7 kBq (83 Bq({sup 24}Na)/g({sup 23}Na)) and the relevant effective dose equivalent was 47 mSv. (author)

  8. Dose evaluation on the basis of 24Na activity in the human body for the criticality accident at JCO Tokai nuclear fuel processing plant

    International Nuclear Information System (INIS)

    Momose, T.; Tsujimura, N.; Tasaki, T.; Kanai, K.; Hayashi, N.; Shinohara, K.

    2001-01-01

    24 Na in the human body, activated by neutrons emitted at the JCO criticality accident, was observed for 62 subjects, where 148 subjects were measured by the whole body counter of JNC Tokai Works. The 148 subjects, including JCO employees and the contractors, residents neighboring the site and emergency service officers, were measured by the whole-body counter. The neutron-energy spectrum around the facility was calculated using neutron transport codes (ANISN and MCNP), and the relation between an amount of activated sodium in human body and neutron dose was evaluated from the calculated neutron energy spectrum and theoretical neutron capture probability by the human body. The maximum 24 Na activity in the body was 7.7 kBq (83 Bq( 24 Na)/g( 23 Na)) and the relevant effective dose equivalent was 47 mSv. (author)

  9. Cerebrovascular accidents in patients treated for choroidal neovascularization with ranibizumab in randomized controlled trials.

    Science.gov (United States)

    Bressler, Neil M; Boyer, David S; Williams, David F; Butler, Steven; Francom, Steven F; Brown, Benton; Di Nucci, Flavia; Cramm, Timothy; Tuomi, Lisa L; Ianchulev, Tsontcho; Rubio, Roman G

    2012-10-01

    To analyze cerebrovascular accidents (CVAs) pooled from large, randomized, controlled clinical trials of ranibizumab treatment for neovascular age-related macular degeneration. Events in five trials (FOCUS, MARINA, ANCHOR, PIER, and SAILOR) were analyzed using a standard safety monitoring process. Exact methods, stratified by study, were used to test for treatment differences based on odds ratios. A stepwise logistic regression model was fit to classify subjects' risk for CVA based on medical history. Treatment differences in CVA rates at 1 year or 2 years were evaluated within risk groups using stratified exact methods. Pooled 2-year CVA rates were <3%; odds ratios (95% confidence intervals) for CVA risk were 1.2 (0.4-4.4) for ranibizumab 0.3-mg versus control, 2.2 (0.8-7.1) for 0.5 mg versus control, and 1.5 (0.8-3.0) for 0.5-mg versus 0.3-mg ranibizumab. No substantial increased risk of CVA for 0.5 mg versus 0.3 mg was identified in pooled analyses or any of the individual trials. In pooled analyses, the difference between 0.5-mg ranibizumab and control was larger (7.7 [1.2-177]) among high-risk CVA patients. This analysis provided some evidence, although not definitive, of a potential increased risk of CVA with ranibizumab versus control or with 0.5-mg versus 0.3-mg ranibizumab. Continued monitoring for CVA within clinical trials seems warrented.

  10. Characteristics of critically ill patients in ICUs in mainland China.

    Science.gov (United States)

    Du, Bin; An, Youzhong; Kang, Yan; Yu, Xiangyou; Zhao, Mingyan; Ma, Xiaochun; Ai, Yuhang; Xu, Yuan; Wang, Yushan; Qian, Chuanyun; Wu, Dawei; Sun, Renhua; Li, Shusheng; Hu, Zhenjie; Cao, Xiangyuan; Zhou, Fachun; Jiang, Li; Lin, Jiandong; Chen, Erzhen; Qin, Tiehe; He, Zhenyang; Zhou, Lihua

    2013-01-01

    We sought to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China. A 2-month (July 1, 2009, to August 31, 2009) prospective, observational cohort study. Twenty-two ICUs in Mainland China. Adult patients admitted to participating ICUs during the study period with an ICU length of stay >24 hrs. None. Patient characteristics, including demographics, underlying diseases, severity of illness, admission status, complications, intervention and treatment during ICU stay, and clinical outcome were recorded in case report form. The primary outcome measure was all-cause hospital mortality. Independent predictors for hospital mortality were determined with multivariate logistic regression analysis. One thousand two hundred ninety-seven patients met the inclusion criteria for the study, 821 (63.3%) were male, and mean age was 58.5 ± 19.2 yrs. Mean Acute Physiology and Chronic Health Evaluation II score was 18.0 ± 8.1, and mean Sequential Organ Failure Assessment score was 6.5 ± 3.8. One third of the patients were postoperative ICU admissions. Seven hundred sixty-five patients (59.0%) developed infections, followed by severe sepsis or septic shock (484, 37.3%), acute kidney injury (398, 30.7%), and acute lung injury/acute respiratory distress syndrome (351, 27.1%). Mechanical ventilation was used in almost three fourths of the patients, whereas any type of renal replacement therapy was used in 173 patients (13.3%). Hospital mortality was 20.3%. Multivariate logistic regression analysis found that Acute Physiology and Chronic Health Evaluation II score, solid tumor, severe sepsis/septic shock, acute lung injury/acute respiratory distress syndrome, and acute kidney injury were independent risk factors for hospital mortality. Critically ill patients in ICUs in Mainland China exhibited a case mix similar to those of Western countries, although there are significant differences in intensive care unit

  11. The follow-up of in vivo measurements on the patients of the Goiania accident

    International Nuclear Information System (INIS)

    Oliveira, C.A.N.; Melo, D.R.; Dantas, B.M.; Nani, G.J.; Lipsztein, J.L.; Laurer, G.R.

    2000-01-01

    A radiological accident occurred in September 1987 in the city of Goiania, Brazil, due to violation of a 50.9 TBq 137 Cs source used for medical therapy. This accident resulted internal and external contamination as well as irradiation of members of the public. Some people had radiation bums after rubbing the fragments of the source on their skin. Successive skin decontamination were carried on until there was no external detection of $ radiation. In August 1990, with the objective of verifying the long term retention of Cs in the scares, a detection system to perform in vivo measurements in specific regions of the body, with enough sensitivity to discriminate surface and deep contamination, based on the ratio K α /K β ( 137m Ba characteristic X-rays) was set up in Goiania. This system was also used to obtain information of the distribution of residual activities of 137 Cs in the body, 3 years after the intake. The detector applied in this set of measurements system consisted of a HPGe type N, collimated with a 20 cm x 0.5 mm layer of cooper. Ten people were selected for this study based on their remaining 137 Cs body burden, which was obtained using a 8''x4'' NaI(Tl) detector, and on the presence of radiation bum scares. The selected individuals laid down on a thin matrix under the detection system. The HPGe was positioned over and close to the region of interest, which was different for each patient. Two of the subjects showed evidence of significant caesium activity still remaining in wound sites. These results were obtained through the detection of the 137m Ba characteristic X-rays from the decay of 137 Cs. Four of the 10 individuals measured exhibited high levels of X-ray activity in the surface area above the liver. The measurement of these low energy X-rays (30 keV) from an organ as deep in the body as the liver indicates a significant amount of activity in that organ and also that caesium is probably not homogeneously distributed. (author)

  12. Visualization of Traffic Accidents

    Science.gov (United States)

    Wang, Jie; Shen, Yuzhong; Khattak, Asad

    2010-01-01

    Traffic accidents have tremendous impact on society. Annually approximately 6.4 million vehicle accidents are reported by police in the US and nearly half of them result in catastrophic injuries. Visualizations of traffic accidents using geographic information systems (GIS) greatly facilitate handling and analysis of traffic accidents in many aspects. Environmental Systems Research Institute (ESRI), Inc. is the world leader in GIS research and development. ArcGIS, a software package developed by ESRI, has the capabilities to display events associated with a road network, such as accident locations, and pavement quality. But when event locations related to a road network are processed, the existing algorithm used by ArcGIS does not utilize all the information related to the routes of the road network and produces erroneous visualization results of event locations. This software bug causes serious problems for applications in which accurate location information is critical for emergency responses, such as traffic accidents. This paper aims to address this problem and proposes an improved method that utilizes all relevant information of traffic accidents, namely, route number, direction, and mile post, and extracts correct event locations for accurate traffic accident visualization and analysis. The proposed method generates a new shape file for traffic accidents and displays them on top of the existing road network in ArcGIS. Visualization of traffic accidents along Hampton Roads Bridge Tunnel is included to demonstrate the effectiveness of the proposed method.

  13. Comparison of sedation strategies for critically ill patients

    DEFF Research Database (Denmark)

    Hutton, Brian; Burry, Lisa D.; Kanji, Salmaan

    2016-01-01

    Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug...... their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We...... of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair...

  14. [Tissue oxygen saturation in the critically ill patient].

    Science.gov (United States)

    Gruartmoner, G; Mesquida, J; Baigorri, F

    2014-05-01

    Hemodynamic resuscitation seeks to correct global macrocirculatory parameters of pressure and flow. However, current evidence has shown that despite the normalization of these global parameters, microcirculatory and regional perfusion alterations can persist, and these alterations have been independently associated with a poorer patient prognosis. This in turn has lead to growing interest in new technologies for exploring regional circulation and microcirculation. Near infra-red spectroscopy allows us to monitor tissue oxygen saturation, and has been proposed as a noninvasive, continuous and easy-to-obtain measure of regional circulation. The present review aims to summarize the existing evidence on near infra-red spectroscopy and its potential clinical role in the resuscitation of critically ill patients in shock. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  15. Counterregulatory hormones in insulin-treated diabetic patients admitted to an accident and emergency department with hypoglycaemia

    DEFF Research Database (Denmark)

    Hvidberg, A; Christensen, N J; Hilsted, Jannik

    1998-01-01

    The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B)...... significantly elevated concentrations of adrenaline and glucagon were found in diabetic patients admitted with severe hypoglycaemia to an Accident and Emergency Department.......). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and counterregulatory hormones were measured before...

  16. Pharmacokinetics of Intravenous Posaconazole in Critically Ill Patients.

    Science.gov (United States)

    Sime, Fekade B; Stuart, Janine; Butler, Jenie; Starr, Therese; Wallis, Steven C; Pandey, Saurabh; Lipman, Jeffrey; Roberts, Jason A

    2018-06-01

    To date, there is no information on the intravenous (i.v.) posaconazole pharmacokinetics for intensive care unit (ICU) patients. This prospective observational study aimed to describe the pharmacokinetics of a single dose of i.v. posaconazole in critically ill patients. Patients with no history of allergy to triazole antifungals and requiring systemic antifungal therapy were enrolled if they were aged ≥18 years, central venous access was available, they were not pregnant, and they had not received prior posaconazole or drugs interacting with posaconazole. A single dose of 300 mg posaconazole was administered over 90 min. Total plasma concentrations were measured from serial plasma samples collected over 48 h, using a validated chromatographic method. The pharmacokinetic data set was analyzed by noncompartmental methods. Eight patients (7 male) were enrolled with the following characteristics: median age, 46 years (interquartile range [IQR], 40 to 51 years); median weight, 68 kg (IQR, 65 to 82 kg); and median albumin concentration, 20 g/liter (IQR, 18 to 24 g/liter). Median (IQR) pharmacokinetic parameter estimates were as follows: observed maximum concentration during sampling period ( C max ), 1,702 ng/ml (1,352 to 2,141 ng/ml); area under the concentration-time curve from zero to infinity (AUC 0-∞ ), 17,932 ng · h/ml (13,823 to 27,905 ng · h/ml); clearance (CL), 16.8 liters/h (11.1 to 21.7 liters/h); and volume of distribution ( V ), 529.1 liters (352.2 to 720.6 liters). The V and CL were greater than 2-fold and the AUC 0-∞ was 39% of the values reported for heathy volunteers. The AUC 0-∞ was only 52% of the steady-state AUC 0-24 reported for hematology patients. The median of estimated average steady-state concentrations was 747 ng/ml (IQR, 576 to 1,163 ng/ml), which is within but close to the lower end of the previously recommended therapeutic range of 500 to 2,500 ng/ml. In conclusion, we observed different pharmacokinetics of i.v. posaconazole in

  17. Worldwide audit of blood transfusion practice in critically ill patients.

    Science.gov (United States)

    Vincent, Jean-Louis; Jaschinski, Ulrich; Wittebole, Xavier; Lefrant, Jean-Yves; Jakob, Stephan M; Almekhlafi, Ghaleb A; Pellis, Tommaso; Tripathy, Swagata; Rubatto Birri, Paolo N; Sakr, Yasser

    2018-04-19

    The aim was to describe transfusion practice in critically ill patients at an international level and evaluate the effects of red blood cell (RBC) transfusion on outcomes in these patients. This was a pre-planned sub-study of the Intensive Care Over Nations audit, which involved 730 ICUs in 84 countries and included all adult patients admitted between 8 May and 18 May 2012, except admissions for routine postoperative surveillance. ICU and hospital outcomes were recorded. Among the 10,069 patients included in the audit, data related to transfusion had been completed for 9553 (mean age 60 ± 18 years, 60% male); 2511 (26.3%) of these had received a transfusion, with considerable variation among geographic regions. The mean lowest hemoglobin on the day of transfusion was 8.3 ± 1.7 g/dL, but varied from 7.8 ± 1.4 g/dL in the Middle East to 8.9 ± 1.9 g/dL in Eastern Europe. Hospital mortality rates were higher in transfused than in non-transfused patients (30.0% vs. 19.6%, p < 0.001) and increased with increasing numbers of transfused units. In an extended Cox proportional hazard analysis, the relative risk of in-hospital death was slightly lower after transfusion in the whole cohort (hazard ratio 0.98, confidence interval 0.96-1.00, p = 0.048). There was a stepwise decrease in the hazard ratio for mortality after transfusion with increasing admission severity scores. More than one fourth of critically ill patients are transfused during their ICU stay, with considerable variations in transfusion practice among geographic regions. After adjustment for confounders, RBC transfusions were associated with a slightly lower relative risk of in-hospital death, especially in the most severely ill patients, highlighting the importance of taking the severity of illness into account when making transfusion decisions.

  18. Prevalence of oral health-related conditions that could trigger accidents for patients with moderate-to-severe dementia.

    Science.gov (United States)

    Kobayashi, Naoki; Soga, Yoshihiko; Maekawa, Kyoko; Kanda, Yuko; Kobayashi, Eiko; Inoue, Hisako; Kanao, Ayana; Himuro, Yumiko; Fujiwara, Yumi

    2017-03-01

    This study was performed to determine the prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents in hospitalised patients with moderate-severe dementia. Dementia patients may not recognise risks in the mouth, such as tooth mobility or ill-fitting dental prostheses and/or dentures. In addition to the risk of choking, injury by sharp edges of collapsed teeth or prosthodontics could pose risks. However, many previous publications were limited to case reports or series. Ninety-two consecutive hospitalised dementia patients (M: 52, F: 40, median age: 82.5 years, range: 62-99 years, from 2011 to 2014), referred for dentistry for dysphagia rehabilitation, were enrolled in this study. Participants referred for dental treatment with dental problems detected by ward staff were excluded. All participants had a Global Clinical Dementia Rating Score >2. Their dental records were evaluated retrospectively for issues that may cause incidents and/or accidents. Problems in the mouth, for example tooth stumps, dental caries, and ill-fitting dentures, were detected in 51.1% of participants (47/92). Furthermore, 23.9% (22/92) showed risk factors that could lead to incidents and/or accidents, for example falling out of teeth and/or prosthodontics or injury by sharp edges of teeth and/or prosthodontics. Hospitalised moderate-severe dementia patients had a high prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents. © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  19. Immune state of patients of vegeto-vascular dystonia, clean-up workers of the Chernobyl accident

    International Nuclear Information System (INIS)

    Sakhno, T.A.; Davydova, T.I.; Bazika, D.A.; Chumak, A.A.

    1995-01-01

    Immune state of 272 clean-up workers, participants of the Chernobyl Power Plant accident, suffering from vegeto-vascular dystonia is studied. Comparison groups were formed by 20 healthy clean-up workers, 25 vegeto-vascular dystonia patients non-participating in the clean-up works, and 60 healthy donors. Immune state disturbances in the vegeto-vascular dystonia patients have unidirectional changing but among the clear-up workers their expression was much significant coinciding with the more severe clinical courses of disease comparing to the patients non-participating in the clean-up works

  20. Arterial carboxyhemoglobin level and outcome in critically ill patients.

    Science.gov (United States)

    Melley, Daniel D; Finney, Simon J; Elia, Androula; Lagan, Anna L; Quinlan, Gregory J; Evans, Timothy W

    2007-08-01

    Arterial carboxyhemoglobin is elevated in patients with critical illness. It is an indicator of the endogenous production of carbon monoxide by the enzyme heme oxygenase, which modulates the response to oxidant stress. The objective was to explore the hypothesis that arterial carboxyhemoglobin level is associated with inflammation and survival in patients requiring cardiothoracic intensive care. Prospective, observational study. A cardiothoracic intensive care unit. All patients admitted over a 15-month period. None. Arterial carboxyhemoglobin, bilirubin, and standard biochemical, hematologic, and physiologic markers of inflammation were measured in 1,267 patients. Associations were sought between levels of arterial carboxyhemoglobin, markers of the inflammatory response, and clinical outcome. Intensive care unit mortality was associated with lower minimum and greater maximal carboxyhemoglobin levels (p carboxyhemoglobin was associated with an increased risk of death from all causes (odds risk of death, 0.391; 95% confidence interval, 0.190-0.807; p = .011). Arterial carboxyhemoglobin correlated with markers of the inflammatory response. Both low minimum and high maximum levels of arterial carboxyhemoglobin were associated with increased intensive care mortality. Although the heme oxygenase system is protective, excessive induction may be deleterious. This suggests that there may be an optimal range for heme oxygenase-1 induction.

  1. Prophylactic use of laxative for constipation in critically ill patients

    Directory of Open Access Journals (Sweden)

    Masri Yasser

    2010-01-01

    Full Text Available Background : This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU and the impact of early versus late bowel movement on patient′s outcome. Methods : The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for >72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h. The parameters measured during the study were admission diagnosis, age, gender, comorbid conditions, admission Simplified Acute Physiologic Score (SAPS II, sedative and narcotic agents with doses and duration, timing and tolerance of nutrition, daily assessment of bowel movement, total use of prokinetic, doses of suppositories, and enema for first bowel movement, total number of days on ventilator, weaning failures, extubation or tracheostomy, ICU length of stay, and death or discharge. Results : A total of 100 patients were enrolled, 50 patients in each control and interventional group. Mean age was 38.8 years, and both groups had male predominance. Mean SAPS II score for both was 35. Mean dose of Fentanyl (323.8 ± 108.89 mcg/h in control and 345.83 ± 94.43 mcg/h in interventional group and mean dose of Midazolam (11.1 ± 4.04 mg/h in control and 12.4 ± 3.19 mg/h in interventional group. There were only two (4% patients in control, while nine (18% patients in interventional group who had bowel movement in <72 h (P < 0.05. Mean ventilator days were 16.19, and 17.36 days in control and interventional groups, respectively. Subgroup analysis showed that the patients who moved bowel in <5 days in both groups had mean ventilator days of 18.5, whereas it was 15.88 days for the patients who moved bowel after 5 days in both groups (P< 0.05. Mean ICU days for control was 21.15 ± 10.44 and 20

  2. Secondary sclerosing cholangitis in critically ill patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Gudnason HO

    2017-06-01

    Full Text Available Hafsteinn O Gudnason,1 Einar S Björnsson1,2 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landspitali, University Hospital of Iceland, 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland Abstract: Secondary sclerosing cholangitis (SSC is a term used for a group of chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation, which can lead to biliary cirrhosis. A newly recognized form of SSC is secondary sclerosing cholangitis in critically ill patients (SSC-CIP. Pathogenesis is believed to involve ischemic injury of intrahepatic bile ducts associated with prolonged hypotension, vasopressors administration, and/or mechanical ventilation in patients treated in the intensive care unit (ICU. Patients diagnosed with SSC-CIP have no prior history of liver disease and no known pathologic process or injury responsible for bile duct obstruction prior to ICU treatment. Reasons leading to ICU treatment are many including multitrauma, burn injury, cardiac surgery, severe pneumonia, other infections, or bleeding after abdominal surgery. Patients have in common prolonged ICU admission. SSC-CIP is associated with rapid progression to liver cirrhosis and poor survival with limited treatment options except a liver transplantation. Transplant-free survival is around 17–40 months, which is lower than in other SSC patients. During the initial stages of the disease, the clinical symptoms and biochemical profile are not specific and easily missed. Biliary casts formation may be considered pathognomonic for SSC-CIP since most patients have them in early stages of the disease. Increased awareness and early detection of the disease and its complications is considered to be crucial to improve the poor prognosis. Keywords: secondary sclerosing cholangitis, SSC-CIP, chronic cholestatic disease, sclerosing cholangitis

  3. [Patient satisfaction in hospital: critical incident technique or standardised questionnaire?].

    Science.gov (United States)

    Eckhardt-Abdulla, R; Bock, M; Bauer, M

    2008-03-01

    Questionnaires are usually used for the measurement of patient satisfaction, however, it is increasingly being recognized that the critical incident technique (CIT) also provides valuable insight. Questionnaires of the "Hamburger questionnaire on hospital stay" were distributed to 650 consecutive patients before discharge. Additionally 103 interviews were conducted in which the patients were asked to describe positive and negative incidents during their hospital stay. The results of both methods were then compared. A total of 369 patients returned the questionnaire and 103 patients participated in the interviews. The duration of a single interview was between 5 and 45 min with a mean of 12.7 min+/-10.1 min standard deviation (SD). Cronbach's alpha of the questionnaire was 0.9. A total of 424 incidents were reported, 301 of them were negative compared to 123 positive events. The questionnaires and interviews yielded partly similar and partly different results at category and subcategory levels concerning the areas of weaknesses and strengths in quality performance. The CIT was more concrete but did not give results for all aspects of quality. The CIT, but not the questionnaire, was able to detect 40/56 (71%) of the positive and 33/75 (44%) of the negative reports regarding medical performance and 25/42 (60%) of the positive and 15/51 (29.4%) of the negative reports of the performance of the nurses were revealed by the CIT and not by the questionnaires. The CIT gives valuable insights into the patient's perspective of strengths and weaknesses in hospital care, which might be overlooked by the questionnaire alone. However, the CIT is probably not suited for routine use because it is very time-consuming.

  4. Evaluation of the concrete shield compositions from the 2010 criticality accident alarm system benchmark experiments at the CEA Valduc SILENE facility

    International Nuclear Information System (INIS)

    Miller, Thomas Martin; Celik, Cihangir; Dunn, Michael E; Wagner, John C; McMahan, Kimberly L; Authier, Nicolas; Jacquet, Xavier; Rousseau, Guillaume; Wolff, Herve; Savanier, Laurence; Baclet, Nathalie; Lee, Yi-kang; Trama, Jean-Christophe; Masse, Veronique; Gagnier, Emmanuel; Naury, Sylvie; Blanc-Tranchant, Patrick; Hunter, Richard; Kim, Soon; Dulik, George Michael; Reynolds, Kevin H.

    2015-01-01

    In October 2010, a series of benchmark experiments were conducted at the French Commissariat a l'Energie Atomique et aux Energies Alternatives (CEA) Valduc SILENE facility. These experiments were a joint effort between the United States Department of Energy Nuclear Criticality Safety Program and the CEA. The purpose of these experiments was to create three benchmarks for the verification and validation of radiation transport codes and evaluated nuclear data used in the analysis of criticality accident alarm systems. This series of experiments consisted of three single-pulsed experiments with the SILENE reactor. For the first experiment, the reactor was bare (unshielded), whereas in the second and third experiments, it was shielded by lead and polyethylene, respectively. The polyethylene shield of the third experiment had a cadmium liner on its internal and external surfaces, which vertically was located near the fuel region of SILENE. During each experiment, several neutron activation foils and thermoluminescent dosimeters (TLDs) were placed around the reactor. Nearly half of the foils and TLDs had additional high-density magnetite concrete, high-density barite concrete, standard concrete, and/or BoroBond shields. CEA Saclay provided all the concrete, and the US Y-12 National Security Complex provided the BoroBond. Measurement data from the experiments were published at the 2011 International Conference on Nuclear Criticality (ICNC 2011) and the 2013 Nuclear Criticality Safety Division (NCSD 2013) topical meeting. Preliminary computational results for the first experiment were presented in the ICNC 2011 paper, which showed poor agreement between the computational results and the measured values of the foils shielded by concrete. Recently the hydrogen content, boron content, and density of these concrete shields were further investigated within the constraints of the previously available data. New computational results for the first experiment are now available

  5. Continuous infusion of antibiotics in critically ill patients.

    Science.gov (United States)

    Smuszkiewicz, Piotr; Szałek, Edyta; Tomczak, Hanna; Grześkowiak, Edmund

    2013-02-01

    Antibiotics are the most commonly used drugs in intensive care unit patients and their supply should be based on pharmacokinetic/pharmacodynamic rules. The changes that occur in septic patients who are critically ill may be responsible for subtherapeutic antibiotic concentrations leading to poorer clinical outcomes. Evolving in time the disturbed pathophysiology in severe sepsis (high cardiac output, glomerular hyperfiltration) and therapeutic interventions (e.g. haemodynamically active drugs, mechanical ventilation, renal replacement therapy) alters antibiotic pharmacokinetics mainly through an increase in the volume of distribution and altered drug clearance. The lack of new and efficacious drugs and increased bacterial resistance are current problems of contemporary antibiotic therapy. Although intermittent administration is a standard clinical practice, alternative methods of antibiotic administration are sought, which may potentialise effects and reduce toxicity as well as contribute to inhibition of bacterial resistance. A wide range of studies prove that the application of continuous infusion of time-dependent antibiotics (beta-lactams, glycopeptides) is more rational than standard intermittent administration. However, there are also studies which do not confirm the advantage of one method over the other. In spite of controversy the continuous administration of this group of antibiotics is common practice, because the results of both studies point to the higher efficacy of this method in critically ill patients. Authors reviewed the literature to determine whether any clinical benefits exist for administration of time-dependent antibiotics by continuous infusion. Definite specification of the clinical advantage of administration this way over standard dosage requires a large-scale multi-centre randomised controlled trial.

  6. PROTEIN NEEDS OF CRITICALLY ILL PATIENTS RECEIVING PARENTERAL NUTRITION.

    Science.gov (United States)

    Germano Borges de Oliveira Nascimento Freitas, Renata; Negrão Nogueira, Roberto José; Hessel, Gabriel

    2015-07-01

    assess whether the current protein intake recommendations may improve the biochemical parameters of critical patients receiving parenteral nutrition. longitudinal study with three evaluations made (during the first 72 hours, on the 7th and the 14th days of PN). The following tests were applied: albumin, C-reactive protein, prealbumin, total cholesterol, HDL, triglycerides, lymphocytes, and glutathione peroxidase. The severity was determined by SOFA. The statistical analysis included the Spearman and Mann-Whitney tests, as well as ANOVA (analysis of variance). among the 53 patients evaluated, 20 (37.74%) died. The mean calorie was 24.68 ± 9.78 kcal/kg (beginning of PN), 26.49 ± 8.89 kcal/kg (3rd to 7th days of PN), and 30.9 ± 12.19 kcal/kg (7th to 14th days of PN). The mean protein was 1.19 ± 0.44 g/kcal/kg (first 72 hours of PN), 1.29 ± 0.44 g/kcal/kg (3rd to 7th days of PN) and 1.49 ± 0.69 g/kcal/kg (7th to 14th days of PN). Prealbumin, albumin, total cholesterol and HDL were below the reference values, while the CRP levels were high. Throughout the three evaluation times, there was no a significant improvement on the levels of laboratory examinations. A strong and negative correlation was found between SOFA and prealbumin (r = -0.64, p = 0.05). the protein offer, according to the traditional recommendations, was not enough to improve the biochemical parameters of critical patients undergoing parenteral nutrition. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  7. Final Report for the Testing of the Y-12 Criticality Accident Alarm System Detectors at the Godiva IV Burst Reactor (IER-443)

    Energy Technology Data Exchange (ETDEWEB)

    Scorby, John C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hickman, David [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hudson, Becka [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Beller, Tim [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Goda, Joetta [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Haught, Chris [Y-12 National Security Complex, Oak Ridge, TN (United States); Woodrow, Christopher [Y-12 National Security Complex, Oak Ridge, TN (United States); Ward, Dann [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Wilson, Chris [Atomic Weapons Establishment (AWE), Berkshire (United Kingdom); Clark, Leo [Atomic Weapons Establishment (AWE), Berkshire (United Kingdom)

    2018-01-05

    This report documents the experimental conditions and final results for the performance testing of the Y-12 Criticality Accident Alarm System (CAAS) detectors at the Godiva IV Burst Reactor at the National Criticality Experimental Research Center (NCERC) at the Nevada National Security Site (NNSS). The testing followed a previously issued test plan and was conducted during the week of July 17, 2017, with completion on Thursday July 20. The test subjected CAAS detectors supplied by Y-12 to very intense and short duration mixed neutron and gamma radiation fields to establish compliance to maximum radiation and minimum pulse width requirements. ANSI/ANS- 8.3.1997 states that the “system shall be sufficiently robust as to actuate an alarm signal when exposed to the maximum radiation expected”, which has been defined at Y-12, in Documented Safety Analyses (DSAs), to be a dose rate of 10 Rad/s. ANSI/ANS-8.3.1997 further states that “alarm actuation shall occur as a result of a minimum duration transient” which may be assumed to be 1 msec. The pulse widths and dose rates provided by each burst during the test exceeded those requirements. The CAAS detectors all provided an immediate alarm signal and remained operable after the bursts establishing compliance to the requirements and fitness for re-deployment at Y-12.

  8. Blood tranfusion in critically ill patients: state of the art.

    Science.gov (United States)

    Hajjar, Ludhmila Abrahão; Auler Junior, Jose Otávio Costa; Santos, Luciana; Galas, Filomena

    2007-08-01

    Anemia is one of the most common abnormal findings in critically ill patients, and many of these patients will receive a blood transfusion during their intensive care unit stay. However, the determinants of exactly which patients do receive transfusions remains to be defined and have been the subject of considerable debate in recent years. Concerns and doubts have emerged regarding the benefits and safety of blood transfusion, in part due to the lack of evidence of better outcomes resulting from randomized studies and in part related to the observations that transfusion may increase the risk of infection. As a result of these concerns and of several studies suggesting better or similar outcomes with a lower transfusion trigger, there has been a general tendency to decrease the transfusion threshold from the classic 10 g/dL to lower values. In this review, we focus on some of the key studies providing insight into current transfusion practices and fueling the current debate on the ideal transfusion trigger.

  9. [The interarm blood pressure difference in the critically ill patient].

    Science.gov (United States)

    Valls Matarín, Josefa; del Cotillo Fuente, Mercedes; Quintana Riera, Salvador; de la Sierra Iserte, Alejandro

    2014-02-04

    To evaluate the prevalence of a difference in systolic blood pressure (SBPd) ≥ 10 mmHg between arms in patients admitted in a Critical Care Unit and to examine the clinical characteristics associated with such blood pressure difference. Observational cross-sectional study. Two blood pressure measurements in each arm were carried out at unit admission. The firstly measured arm was chosen at random. One-hundred and sixty-eight patients were studied, with a mean age of 61 (SD=16), 67.3% male and 45% with a previous hypertension diagnosis. On admission, 27.4% presented SBPd ≥ 10 mmHg. Among them, 54% had higher SBP in the right arm and 46% in the left one. A SBPd ≥ 10 mmHg was associated with a previous hypertension diagnosis (67.4 versus 36.9%; Parms. This feature is associated with a previous hypertension diagnosis and reduced consciousness. It should be assessed in the future if the choice of a control arm would help improve patient's care as it would become a more accurate guide for hemodynamic management. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  10. Coronary Artery Disease in critical patients of Iran

    International Nuclear Information System (INIS)

    Zahra, P.M.; Azizollah, A.S.; Masoud, R.; Hamed, S.

    2012-01-01

    Objective: To identify the risk factors for Coronary Artery Diseases (CAD), such as hypertension, hyperlipidaemia, smoking, age, obesity, immobility and diabetes mellitus, in critical patients of Sistan-Baluchistan (SB), Iran. Methods: This cross-sectional research was performed in 2006. The sampling method was convenience, and involved 616 hospitalised patients in the CCUs of hospitals of Sistan-Baluchistan province. Data was collected by structured interview and a checklist which included personal characteristics and risk factors like lifestyles as well as biochemical and physiological factors for CAD. SPSS software, Chi-square and exact fisher tests were used for analysis. Results: Frequency of risk factors among patients with CAD was found to be high in the study area. Also, the results showed that the prevalence of some risk factors, such as diabetes mellitus 198 (32.5%), hypertension 266 (43.7%) and obesity 131 (22.9%), was significantly higher in women than men. Besides, there was a significant relationship between smoking, 317(52.3%) and low mobility 503 (83.3%), with gender (p=0.001). Conclusion: Clinical and para-clinical data indicated that the adult population has a high level of CAD risk factors in the Sistan-Baluchistan province which may require urgent steps to address national control measures regarding CAD. Implementation of a prevention programme is necessary in order to reduce the risk factors. Also, health education is necessary, specially for women. (author)

  11. Patients' Perceptions of Nurses' Behaviour That Influence Patient Participation in Nursing Care: A Critical Incident Study

    Directory of Open Access Journals (Sweden)

    Inga E. Larsson

    2011-01-01

    Full Text Available Patient participation is an important basis for nursing care and medical treatment and is a legal right in many Western countries. Studies have established that patients consider participation to be both obvious and important, but there are also findings showing the opposite and patients often prefer a passive recipient role. Knowledge of what may influence patients' participation is thus of great importance. The aim was to identify incidents and nurses' behaviours that influence patients' participation in nursing care based on patients' experiences from inpatient somatic care. The Critical Incident Technique (CIT was employed. Interviews were performed with patients (=17, recruited from somatic inpatient care at an internal medical clinic in West Sweden. This study provided a picture of incidents, nurses' behaviours that stimulate or inhibit patients' participation, and patient reactions on nurses' behaviours. Incidents took place during medical ward round, nursing ward round, information session, nursing documentation, drug administration, and meal.

  12. Accident management

    International Nuclear Information System (INIS)

    Lutz, R.J.; Monty, B.S.; Liparulo, N.J.; Desaedeleer, G.

    1989-01-01

    The foundation of the framework for a Severe Accident Management Program is the contained in the Probabilistic Safety Study (PSS) or the Individual Plant Evaluations (IPE) for a specific plant. The development of a Severe Accident Management Program at a plant is based on the use of the information, in conjunction with other applicable information. A Severe Accident Management Program must address both accident prevention and accident mitigation. The overall Severe Accident Management framework must address these two facets, as a living program in terms of gathering the evaluating information, the readiness to respond to an event. Significant international experience in the development of severe accident management programs exist which should provide some direction for the development of Severe Accident Management in the U.S. This paper reports that the two most important elements of a Severe Accident Management Program are the Emergency Consultation process and the standards for measuring the effectiveness of individual Severe Accident Management Programs at utilities

  13. Cardiovascular system and physical working capacity in patients who had acute radiation syndrome as the result of Chernobyl accident

    International Nuclear Information System (INIS)

    Belyi, D.; Gergel, O.; Kovalenko, A.

    1996-01-01

    The functional state of cardiovascular system has been studied since 1986 in 168 patients who had acute radiation syndrome as the result of Chernobyl accident. There was revealed a progressive increase of cardiovascular system pathology. The number of patients with pathological signs at ECG increased from 4.8 % in 1987 to 11.3 % in 1994 and with myocardial hypertrophy from 1.2 % to 22.6 %. The number of patients with coronary heart disease increased on 17.2% and with essential hypertension on 15.5%. The physical working capacity reduced to 50-60 % of a due level for healthy persons. Two patients suffered from acute myocardial infarction during this period of observation. Thirteenth patients died from 1987 to 1995. Among them 4 patient died in a result of acute cardiac failure. The development of cardiovascular pathology has no any correlation with a dose of exposure. Three factors of cardiovascular pathology growth are supposed

  14. Unavoidable Accident

    OpenAIRE

    Grady, Mark F.

    2009-01-01

    In negligence law, "unavoidable accident" is the risk that remains when an actor has used due care. The counterpart of unavoidable accident is "negligent harm." Negligence law makes parties immune for unavoidable accident even when they have used less than due care. Courts have developed a number of methods by which they "sort" accidents to unavoidable accident or to negligent harm, holding parties liable only for the latter. These sorting techniques are interesting in their own right and als...

  15. Study of lymphocyte sensitization to protein S-100 in the patients with cerebrovascular diseases, suffered due to Chernobyl NPP accident

    International Nuclear Information System (INIS)

    Khomenko, V.Yi.

    2004-01-01

    Among the persons with cerebrovascular diseases, suffered due to Chernobyl NPP accident two groups of patients were revealed: with DNA coloration coefficients in response to protein S-100 stimulation below and above 1. Patients with DNA coloration coefficients <1 were older, they had statistically significant lower monocytes and T-activated lymphocytes absolute counts as well as increased content of cholesterol-2 and circulating immune complexes. Charges found there suggested possible existence of different pathways of immune response to antigenic stimulation by S-100 protein

  16. Dose-dependent analysis of acute medical effects of mixed neutron-gamma radiation from selected severe 235U or 239Pu criticality accidents in USSR, United States, and Argentina.

    Science.gov (United States)

    Barabanova, Tatyana; Wiley, Albert L; Bushmanov, Andrey

    2012-04-01

    Eight of the most severe cases of acute radiation disease (ARS) known to have occurred in humans (as the result of criticality accidents) had survival times less than 120 h (herein defined as "early death"). These accidents were analyzed and are discussed with respect to the specific accident scenarios and the resulting accident-specific, mixed neutron-gamma radiation clinical dose distributions. This analysis concludes that the cardiovascular system appears to be the most critical organ system failure for causing "early death" following approximate total body, mixed gamma-neutron radiation doses greater than 40-50 Gy. The clinical data also suggest that there was definite chest dose dependence in the resulting survival times for these eight workers, who unfortunately suffered profound radiation injury and unusual clinical effects from such high dose radiation exposures. In addition, "toxemic syndrome" is correlated with the irradiation of large volumes of soft tissues. Doses to the hands or legs greater than 80-100 Gy or radiation lung injury also play significant but secondary roles in causing "early death" in accidents delivering chest doses greater than 50 Gy.

  17. Radiation accidents

    International Nuclear Information System (INIS)

    Saenger, E.L.

    1986-01-01

    It is essential that emergency physicians understand ways to manage patients contaminated by radioactive materials and/or exposed to external radiation sources. Contamination accidents require careful surveys to identify the metabolic pathway of the radionuclides to guide prognosis and treatment. The level of treatment required will depend on careful surveys and meticulous decontamination. There is no specific therapy for the acute radiation syndrome. Prophylactic antibodies are desirable. For severely exposed patients treatment is similar to the supportive care given to patients undergoing organ transplantation. For high-dose extremity injury, no methods have been developed to reverse the fibrosing endarteritis that eventually leads to tissue death so frequently found with this type of injury. Although the Three Mile Island episode of March 1979 created tremendous public concern, there were no radiation injuries. The contamination outside the reactor building and the release of radioiodine were negligible. The accidental fuel element meltdown at Chernobyl, USSR, resulted in many cases of acute radiation syndrome. More than 100,000 people were exposed to high levels of radioactive fallout. The general principles outlined here are applicable to accidents of that degree of severity

  18. Ultrasound and supine chest radiograph in road traffic accident patients: a reliable and convenient way to diagnose pleural effusion

    International Nuclear Information System (INIS)

    Mumtaz, U.; Zahur, Z.; Raza, M.A.

    2017-01-01

    Background: Portable bed side ultrasound and supine chest radiograph of 80 traumatic patients excluding very clinically unstable patients who subsequently underwent CT scan chest was done for traumatic effusion showing that ultrasound had a higher sensitivity than CXR, 88.23% and 77.94%, respectively, and a similar specificity of 100% and 100%, respectively. Objective of the study is to compare the diagnostic accuracy of high resolution ultrasound and supine chest x-ray in detection of pleural effusion in road traffic accident patients keeping plain CT chest as gold standard. Methods: This study was conducted in PIMS and PAEC General Hospital, Islamabad from 1st January to 15th December 2015. The current study examined total of 80 trauma (blunt and penetrating) patients coming to emergency departments of both hospitals specifically those who had road traffic accident history. Their portable bed side ultrasound and supine chest radiograph were performed for assessing pleural effusion and subsequently CT scan chest was done for confirmation as it's a gold standard. Results: Using CT findings as gold standard the sensitivity, specificity, positive predictive value and negative predictive value was assessed for both ultrasonography and chest radiography and found to be 88.23%,100%, 100%, 40% and 77.94%, 100%, 100%, 55.55% respectively with diagnostic accuracy of ultrasound 90% as compared to 81.25% for supine chest x-rays when compared with gold standard. Conclusion: Ultrasound and chest x-ray can be used as a useful and suitable adjunct to CT in road traffic accident patients as these are easily available, non-invasive, no contrast required, can be performed on bed side and carries no or little radiation risk. (author)

  19. Thermoluminescent dosimetry of critical organs in CT pediatric patients

    International Nuclear Information System (INIS)

    Azorin, Juan; Tabares, Musel

    2008-01-01

    This paper presents the determination of absorbed dose in critical organs of pediatric patients submitted to head computed tomography (CT) studies. This research included patients up to 16 years old submitted to head CT studies using a Siemens Somaton 16 plus multislice CT scanner. Doses were measured using locally made LiF: Mg,Cu,P + PTFE thermoluminescent dosimeters (TLD) due to its tissue equivalence and low fading. Results showed that both the organ absorbed doses and the volume computed tomography dose index (CTDI vol ) determined for simple studies were half of those obtained for contrasted studies. In the case of head three-dimensional reconstruction CT studies the CTDI vol value obtained was almost the same that the obtained for simple CT studies but the organ doses were significantly different. These results suggest that the CTDI vol value is a good indication for choosing the exposure parameters of the CT studies and is useful in the determination of the effective dose but it is not related with the organ doses. (author)

  20. [Vitamin D deficiency and morbimortality in critically ill paediatric patients].

    Science.gov (United States)

    García-Soler, Patricia; Morales-Martínez, Antonio; Rosa-Camacho, Vanessa; Lillo-Muñoz, Juan Antonio; Milano-Manso, Guillermo

    2017-08-01

    To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU. An observational prospective study in a tertiary children's University Hospital PICU conducted in two phases: i: cohorts study, and ii: prevalence study. The study included 340 critically ill children with ages comprising 6 months to 16 years old. Chronic kidney disease, known parathyroid disorders, and vitamin D supplementation. Total 25-hydroxyvitamin D [25(OH)D] was measured in the first 48hours of admission to a PICU. Parathormone, calcium, phosphate, blood gases, blood count, C-reactive protein, and procalcitonin were also analysed. A record was also made of demographic features, characteristics of the episode, and complications during the PICU stay. The overall prevalence rate of vitamin D deficiency was 43.8%, with a mean of 22.28 (95% CI 21.15-23.41) ng/ml. Patients with vitamin D deficiency were older (61 vs 47 months, P=.039), had parents with a higher level of academic studies (36.5% vs 20%, P=.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P=.037), a longer PICU stay (3 vs 2 days, P=.001), and higher morbidity (61.1% vs 30.4%, P<001) than the patients with sufficient levels of 25(OH)D. Patients who died had lower levels of 25(OH)D (14±8.81ng/ml versus 22.53±10.53ng/ml, P=.012). Adjusted OR for morbidity was 5.44 (95%CI; 2.5-11.6). Vitamin D deficiency is frequent in critically ill children, and it is related to both morbidity and mortality, although it remains unclear whether it is a causal relationship or it is simply a marker of severity in different clinical situations. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Nursering assistance to the radiological accident patients in Goias-Brazil

    International Nuclear Information System (INIS)

    Graciotti, M.E.

    1989-01-01

    A report of a personal experience, during two months of nursering care to the radiological accident victims, due to the disruption of a caesium-137 source, is presented. The biological radiation effects, the radiation hazards due to the doses received and the Kind of exposure, are studied. (M.A.C.) [pt

  2. Approach to treatment of a patient with burns from a radiological accident

    International Nuclear Information System (INIS)

    Roberto, Maria Angelica

    2009-01-01

    Lesions by exposure to ionizing radiation can result from an atomic bomb blast, an industrial accident such as Chernobyl, or from cancer therapy. The gravity of lesions depends on the exposure time and on the deposited energy. A short review is made on the approach to treatment in the Hospital Sao Jose, Lisbon. (author)

  3. Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review.

    Science.gov (United States)

    Gaudry, Stéphane; Messika, Jonathan; Ricard, Jean-Damien; Guillo, Sylvie; Pasquet, Blandine; Dubief, Emeline; Boukertouta, Tanissia; Dreyfuss, Didier; Tubach, Florence

    2017-12-01

    Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-important outcomes are reported in published randomized controlled trials (RCTs) in critically ill patients. Literature search was conducted to identify eligible trials indexed from January to December 2013. Articles were eligible if they reported an RCT involving critically ill adult patients. We excluded phase II, pilot and physiological crossover studies. We assessed study characteristics. All primary and secondary outcomes were collected, described and classified using six categories of outcomes including patient-important outcomes (involving mortality at any time on the one hand and quality of life, functional/cognitive/neurological outcomes assessed after ICU discharge on the other). Of the 716 articles retrieved in 2013, 112 RCTs met the inclusion criteria. Most common topics were mechanical ventilation (27%), sepsis (19%) and nutrition (17%). Among the 112 primary outcomes, 27 (24%) were patient-important outcomes (mainly mortality, 21/27) but only six (5%) were patient-important outcomes besides mortality assessed after ICU discharge (functional disability = 4; quality of life = 2). Among the 598 secondary outcomes, 133 (22%) were patient-important outcomes (mainly mortality, 92/133) but only 41 (7%) were patient-important outcomes besides mortality assessed after ICU discharge (quality of life = 20, functional disability = 14; neurological/cognitive performance = 5; handicap = 1; post-traumatic stress = 1). Seventy-three RCTs (65%) reported at least one patient-important outcome but only 11 (10%) reported at least one patient-important outcome besides mortality assessed after ICU discharge. Patient-important outcomes are rarely primary

  4. Risk of intracranial hemorrhage and cerebrovascular accidents in non-small cell lung cancer brain metastasis patients.

    Science.gov (United States)

    Srivastava, Geetika; Rana, Vishal; Wallace, Suzy; Taylor, Sarah; Debnam, Matthew; Feng, Lei; Suki, Dima; Karp, Daniel; Stewart, David; Oh, Yun

    2009-03-01

    Brain metastases confer significant morbidity and a poorer survival in non-small cell lung cancer (NSCLC). Vascular endothelial growth factor-targeted antiangiogenic therapies (AAT) have demonstrated benefit for patients with metastatic NSCLC and are expected to directly inhibit the pathophysiology and morbidity of brain metastases, yet patients with brain metastases have been excluded from most clinical trials of AAT for fear of intracranial hemorrhage (ICH). The underlying risk of ICH from NSCLC brain metastases is low, but needs to be quantitated to plan clinical trials of AAT for NSCLC brain metastases. Data from MD Anderson Cancer Center Tumor Registry and electronic medical records from January 1998 to March 2006 was interrogated. Two thousand one hundred forty-three patients with metastatic NSCLC registering from January 1998 to September 2005 were followed till March 2006. Seven hundred seventy-six patients with and 1,367 patients without brain metastases were followed till death, date of ICH, or last date of study, whichever occurred first. The incidence of ICH seemed to be higher in those with brain metastasis compared with those without brain metastases, in whom they occurred as result of cerebrovascular accidents. However, the rates of symptomatic ICH were not significantly different. All ICH patients with brain metastasis had received radiation therapy for them and had been free of anticoagulation. Most of the brain metastasis-associated ICH's were asymptomatic, detected during increased radiologic surveillance. The rates of symptomatic ICH, or other cerebrovascular accidents in general were similar and not significantly different between the two groups. In metastatic NSCLC patients, the incidence of spontaneous ICH appeared to be higher in those with brain metastases compared with those without, but was very low in both groups without a statistically significant difference. These data suggest a minimal risk of clinically significant ICH for NSCLC

  5. [Neuro-otological Studies of Patients Suffering from Dizziness with Cerebrospinal Fluid Hypovolemia after Traffic Accident-associated Whiplash Injuries].

    Science.gov (United States)

    Yokota, Jun-Ichi; Shimoda, Satoe

    2015-05-01

    Vertigo and dizziness are common clinical manifestations after traffic accident-associated whiplash injury. Recently, Shinonaga et al. (2001) suggested that more than 80% of patients with whiplash injury complaining of these symptoms showed cerebrospinal (CSF) hypovolemia on radioisotope (RI) cisternography (111In-DTPA). However, neuro-otological studies to investigate the pathophysiological mechanisms underlying these symptoms have been insufficient. In the present study, patients complaining of these symptoms with CSF hypovolemia after traffic accidents were investigated with posturography and electronystagmography (ENG). Fourteen patients (4 men, 10 women; 24-52 yr) were examined with posturography and showed parameters (tracking distance & area) significantly (p<0.01) larger than those of healthy subjects. Among them, five cases (1 man, 4 women; 31-52 yr) were further investigated with ENG. The slow phase peak velocities of optokinetic nystagmus (OKN) and optokinetic-after nystagmus (OKAN) were significantly (p<0.01) reduced (62.64±6.9 SD deg/sec, 60.76±10.74 SD deg/sec, respectively) and frequencies of OKN were reduced (139.7±10.75 SD), while the ocular smooth pursuit was relatively preserved. Magnetic resonance images (sagittal view) of these five patients demonstrated the downward displacement of the cerebellar tonsils and flattening of the pons, which are characteristic features of CSF hypovolemia, called "brain sagging." Our results suggest that brain sagging due to CSF hypovolemia impairs vestibular and vestibulocerebellar functions, which may cause dizziness and vertigo.

  6. Decreasing adhesions and avoiding further surgery in a pediatric patient involved in a severe pedestrian versus motor vehicle accident

    Directory of Open Access Journals (Sweden)

    Amanda D. Rice

    2014-02-01

    Full Text Available In this case study, we report the use of manual physical therapy in a pediatric patient experiencing complications from a life-threatening motor vehicle accident that necessitated 19 surgeries over the course of 12 months. Post-surgical adhesions decreased the patient’s quality of life. He developed multiple medical conditions including recurrent partial bowel obstructions and an ascending testicle. In an effort to avoid further surgery for bowel obstruction and the ascending testicle, the patient was effectively treated with a manual physical therapy regimen focused on decreasing adhesions. The therapy allowed return to an improved quality of life, significant decrease in subjective reports of pain and dysfunction, and apparent decreases in adhesive processes without further surgery, which are important goals for all patients, but especially for pediatric patients.

  7. The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma: a population-based study.

    Science.gov (United States)

    Brown, Paul D; Blanchard, Miran; Jethwa, Krishan; Flemming, Kelly D; Brown, Cerise A; Kline, Robert W; Jacobson, Debra J; St Sauver, Jennifer; Pollock, Bruce E; Garces, Yolanda I; Stafford, Scott L; Link, Michael J; Erickson, Dana; Foote, Robert L; Laack, Nadia N I

    2014-03-01

    To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age > 60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03; P 60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with long-term follow-up, SBTs are a rare event regardless of treatment modality.

  8. Clinical usefulness of creatine Kinase BB determination by a Ria method in serum of patients with cerebrovascular accidents

    International Nuclear Information System (INIS)

    Nuti, A.; Giraldi, C.; Piccini, P.; Bonucelli, U.; Clerico, A.; Del Chicca, M. G.

    1988-01-01

    The measurement of creatine kinase BB isoenzyme (CK-BB) using RIA methods could have diagnostic utility as a biological marker of cerebral damage. The aim of the present study is to evaluate whether frequent sampling (4 samples/day for 3 days) permits a better correlation between serum CK B B values and the clinical outcomes of patients with cerebrovascular accidents. 16 in-patients (12 men and 4 women) with stroke (15 of an ischemic nature and 1 hemorrhagic) have benn studied. The presence of stroke was confirmed by clinical symptoms and by CAT results. Blood samples were drawn at 6 and 12 a.m. and at 6 and 12 p.m. over 3 consecutive days after hospitalization. Values of serum CK-BB above the normal range (>7 ng/ml) were found in the 5 of the 16 (31.3%) patients studied. The mean CK-BB value observed in the patients' group was significantly higher than that found in a group of 112 control subjects (controls, mean+-SD=2.1+-1.7 ng/ml vs patients 3.3+-3.4 ng/ml, unpaired t-test p<0.025). We observed a very wide range of serum CKBB levels in most of the patients studied. Some prominent peaks of CK-BB concetrations were found in patients' outcame (Spearman correlation coefficient r-s=0.618, p<0,01). Although our results indicate that the measurement of CK-BB concentrations cannot be considered a sensitive marker of stroke, the significant correlation between serum CK-BB values and outcome suggests that high CK-BB levels could be a sign of worse prognosis in patients with cerebrovascular accidents

  9. Clinical usefulness of creatine Kinase BB determination by a Ria method in serum of patients with cerebrovascular accidents

    Energy Technology Data Exchange (ETDEWEB)

    Nuti, A; Giraldi, C; Piccini, P; Bonucelli, U; Clerico, A; Del Chicca, M G

    1988-01-01

    The measurement of creatine kinase BB isoenzyme (CK-BB) using RIA methods could have diagnostic utility as a biological marker of cerebral damage. The aim of the present study is to evaluate whether frequent sampling (4 samples/day for 3 days) permits a better correlation between serum CK/sub B/B values and the clinical outcomes of patients with cerebrovascular accidents. 16 in-patients (12 men and 4 women) with stroke (15 of an ischemic nature and 1 hemorrhagic) have benn studied. The presence of stroke was confirmed by clinical symptoms and by CAT results. Blood samples were drawn at 6 and 12 a.m. and at 6 and 12 p.m. over 3 consecutive days after hospitalization. Values of serum CK-BB above the normal range (>7 ng/ml) were found in the 5 of the 16 (31.3%) patients studied. The mean CK-BB value observed in the patients' group was significantly higher than that found in a group of 112 control subjects (controls, mean+-SD=2.1+-1.7 ng/ml vs patients 3.3+-3.4 ng/ml, unpaired t-test p<0.025). We observed a very wide range of serum CKBB levels in most of the patients studied. Some prominent peaks of CK-BB concetrations were found in patients' outcame (Spearman correlation coefficient r-s=0.618, p<0,01). Although our results indicate that the measurement of CK-BB concentrations cannot be considered a sensitive marker of stroke, the significant correlation between serum CK-BB values and outcome suggests that high CK-BB levels could be a sign of worse prognosis in patients with cerebrovascular accidents. 24 refs.

  10. Preventing accidents

    Science.gov (United States)

    2005-08-01

    As the most effective strategy for improving safety is to prevent accidents from occurring at all, the Volpe Center applies a broad range of research techniques and capabilities to determine causes and consequences of accidents and to identify, asses...

  11. Latent cardiac dysfunction as assessed by echocardiography in bed-bound patients following cerebrovascular accidents: comparison with nutritional status.

    Science.gov (United States)

    Masugata, Hisashi; Senda, Shoichi; Goda, Fuminori; Yoshihara, Yumiko; Yoshikawa, Kay; Fujita, Norihiro; Himoto, Takashi; Okuyama, Hiroyuki; Taoka, Teruhisa; Imai, Masanobu; Kohno, Masakazu

    2007-07-01

    The aim of this study was to elucidate the cardiac function in bed-bound patients following cerebrovascular accidents. In accord with the criteria for activities of daily living (ADL) of the Japanese Ministry of Health, Labour and Welfare, 51 age-matched poststroke patients without heart disease were classified into 3 groups: rank A (house-bound) (n = 16, age, 85 +/- 6 years), rank B (chair-bound) (n = 16, age, 84 +/- 8 years), and rank C (bed-bound) (n = 19, age, 85 +/- 9 years). Using echocardiography, the left ventricular (LV) diastolic function was assessed by the ratio of early filling (E) and atrial contraction (A) transmitral flow velocities (E/A) of LV inflow. LV systolic function was assessed by LV ejection fraction (LVEF), and the Tei index was also measured to assess both LV systolic and diastolic function. No difference was observed in the E/A and LVEF among the 3 groups. The Tei index was higher in rank C (0.56 +/- 0.17) than in rank A (0.39 +/- 0.06) and rank B (0.48 +/- 0.17), and a statistically significant difference was observed between rank A and rank C (P cerebrovascular accidents. The Tei index may be a useful index of cardiac dysfunction in bed-bound patients because it is independent of the cardiac loading condition.

  12. Empowering Critical Thinking Skills with Computerized Patient Simulators

    Science.gov (United States)

    Farrar, Francisca Cisneros; Suggs, Leslie

    2010-01-01

    Students struggle with the mastery of critical thinking skills which are essential to their academic success. University faculty are challenged to create teaching strategies to help students build critical thinking skills. Nursing faculty at Austin Peay State University in Clarksville, Tennessee looked to research and technology for ways to…

  13. Being a fellow patient to a critically ill patient leads to feelings of anxiety - An interview study

    DEFF Research Database (Denmark)

    Laursen, Jannie; Bonnevie Lundby, Trine; Danielsen, Anne Kjaergaard

    2016-01-01

    Objectives To explore in-patients’ experiences being a fellow patient to patients who become critically ill. Design The study was designed as a qualitative phenomenological study. Setting The study was conducted in a surgical ward of a hospital in Denmark. Subjects Fifteen fellow patients...... to patients, who became critically ill. Results Three key themes emerged from the analysis of the data: patients’ interaction, anxiety, and professional support. These findings demonstrated the importance of understanding how patients experienced being a fellow patient to patients, who become critically ill......, their views on interacting with such a patient, how the patients who become critically ill influenced them, and what kind of support they needed from the health professionals. Conclusion The findings highlighted the different emotions and feelings experienced by fellow patients. It showed how the impact...

  14. Accident management for severe accidents

    International Nuclear Information System (INIS)

    Bari, R.A.; Pratt, W.T.; Lehner, J.; Leonard, M.; Disalvo, R.; Sheron, B.

    1988-01-01

    The management of severe accidents in light water reactors is receiving much attention in several countries. The reduction of risk by measures and/or actions that would affect the behavior of a severe accident is discussed. The research program that is being conducted by the US Nuclear Regulatory Commission focuses on both in-vessel accident management and containment and release accident management. The key issues and approaches taken in this program are summarized. 6 refs

  15. [Nutritional support response in critically ill patients; differences between medical and surgical patients].

    Science.gov (United States)

    Zamora Elson, M; Serón Arbeloa, C; Labarta Monzón, L; Garrido Ramírez de Arellano, I; Lander Azcona, A; Marquina Lacueva, M I; López Claver, J C; Escós Orta, J

    2012-01-01

    To assess the nutritional response of a group of critically ill patients, as well as the differences in the response to nutritional support between medical and surgical patients. One-year long retrospective study including critically ill patients on artificial nutrition for 7 days. Throughout the first week, three nutritional biochemical controls were done that included albumin, prealbumin, transferrin, cholesterol, and electrolytes. Other data gathered were: nutritional risk index, age, gender, weight, height, APACHE, delay of onset of nutritional support, access route, predicted and real caloric intake, medical or surgical patient, hospital stay, duration of the central venous catheter, urinary tube, and/or mechanical ventilation, incidence and density of incidence of nosocomial infections. Sixty-three patients were studied, 30 (47%) medical and 33 (53%) surgical/trauma patients, with a usage of EN higher among medical patients (16/30, 53% vs. 5/33, 15%), PN higher among surgical patients (25/33, 76%), and mixed nutrition similar in both groups (5 medical and 3 surgical patients) (p = 0.001). There were no differences between medical and surgical patients regarding: both predicted and real caloric and nitrogenous intake, APACHE, delay of onset of nutrition, phosphorus, magnesium or glucose levels, mortality and incidence of nosocomial infections. There were no differences either in hospital stay or use of mechanical ventilation, although these tended to be lower in surgical patients. The baseline biochemical parameters did not show differences between both groups, although they were worse among surgical patients. These patients presented during the study period steady albumin levels with improvement in the remaining parameters, whereas medical patients showed a decrease in albumin and transferrin levels, steady prealbumin levels, and slightly improvement in cholesterol levels. We have observed higher usage of PN among surgical patients, which showed worse

  16. Nuclear fuel cycle facility accident analysis handbook

    International Nuclear Information System (INIS)

    Ayer, J.E.; Clark, A.T.; Loysen, P.; Ballinger, M.Y.; Mishima, J.; Owczarski, P.C.; Gregory, W.S.; Nichols, B.D.

    1988-05-01

    The Accident Analysis Handbook (AAH) covers four generic facilities: fuel manufacturing, fuel reprocessing, waste storage/solidification, and spent fuel storage; and six accident types: fire, explosion, tornado, criticality, spill, and equipment failure. These are the accident types considered to make major contributions to the radiological risk from accidents in nuclear fuel cycle facility operations. The AAH will enable the user to calculate source term releases from accident scenarios manually or by computer. A major feature of the AAH is development of accident sample problems to provide input to source term analysis methods and transport computer codes. Sample problems and illustrative examples for different accident types are included in the AAH

  17. Status of antiviral immunity in patients with non-alcoholic liver fatty disease, who were Chornobyl NPP accident liquidators

    Directory of Open Access Journals (Sweden)

    A.A. Chumak

    2017-11-01

    Full Text Available 34 men were examined, who after participating in the liquidation of the Chornobyl NPP accident developed non-alcoholic fatty liver disease. The state of antiviral defense was evaluated by the levels of immunoglobulin (Ig G and IgM antibodies in the blood serum. In most patients with non-alcoholic steatohepatitis, who were Chornobyl NPP accident liquidators, antibodies of the IgG, but not IgM class to the persistent mixed infection with herpes simplex virus types 1 and 2, cytomegaly and Epstein-Barr were found. A positive correlation was established between the antibody titers to the herpes simplex virus types 1 and 2 (anti-HSV-1/2 IgG and cytomegalovirus (anti-CMV IgG (rs = 0.383, p = 0.040, as well as between the antibodies titers to the nuclear antigen of Epstein-Barr virus (anti-EBV NA IgG and antibodies to core antigen of Epstein-Barr (anti-EBV VCA IgG (rs = 0.584, p = 0.002 in patients with persistent mixed infection of these herpesviruses.

  18. Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

    NARCIS (Netherlands)

    de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

  19. MDCT findings in sports and recreational accidents

    Energy Technology Data Exchange (ETDEWEB)

    Bensch, Frank V; Koivikko, Mika P; Koskinen, Seppo K (Dept. of Radiology, Toeoeloe Hospital, Helsinki (Finland)), email: frank.bensch@hus.fi

    2011-12-15

    Background. Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. Purpose. To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. Material and Methods. All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. Results. Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P < 0.001). Only age groups <21 years and 41-50 years differed in injury severity from the other age groups (P = 0.004 and P = 0.063, respectively). Of all trauma mechanisms, only bicycling had a significantly increased risk of injury (P < 0.001). Conclusion. Injuries in sports and recreational accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved

  20. MDCT findings in sports and recreational accidents.

    Science.gov (United States)

    Bensch, Frank V; Koivikko, Mika P; Koskinen, Seppo K

    2011-12-01

    Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved in these accidents, we recommend ruling out of internal injury by MDCT as the primary imaging modality.

  1. MDCT findings in sports and recreational accidents

    International Nuclear Information System (INIS)

    Bensch, Frank V; Koivikko, Mika P; Koskinen, Seppo K

    2011-01-01

    Background. Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. Purpose. To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. Material and Methods. All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. Results. Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P < 0.001). Only age groups <21 years and 41-50 years differed in injury severity from the other age groups (P = 0.004 and P = 0.063, respectively). Of all trauma mechanisms, only bicycling had a significantly increased risk of injury (P < 0.001). Conclusion. Injuries in sports and recreational accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved

  2. Knowledge translation interventions for critically ill patients: a systematic review*.

    Science.gov (United States)

    Sinuff, Tasnim; Muscedere, John; Adhikari, Neill K J; Stelfox, Henry T; Dodek, Peter; Heyland, Daren K; Rubenfeld, Gordon D; Cook, Deborah J; Pinto, Ruxandra; Manoharan, Venika; Currie, Jan; Cahill, Naomi; Friedrich, Jan O; Amaral, Andre; Piquette, Dominique; Scales, Damon C; Dhanani, Sonny; Garland, Allan

    2013-11-01

    We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care. We searched electronic databases (to July, 2010) without language restrictions and hand-searched reference lists of relevant studies and reviews. Two reviewers independently identified randomized controlled trials and observational studies comparing any ICU-based knowledge translation intervention (e.g., protocols, guidelines, and audit and feedback) to management without a knowledge translation intervention. We focused on clinical topics that were addressed in greater than or equal to five studies. Pairs of reviewers abstracted data on the clinical topic, knowledge translation intervention(s), process of care measures, and patient outcomes. For each individual or combination of knowledge translation intervention(s) addressed in greater than or equal to three studies, we summarized each study using median risk ratio for dichotomous and standardized mean difference for continuous process measures. We used random-effects models. Anticipating a small number of randomized controlled trials, our primary meta-analyses included randomized controlled trials and observational studies. In separate sensitivity analyses, we excluded randomized controlled trials and collapsed protocols, guidelines, and bundles into one category of intervention. We conducted meta-analyses for clinical outcomes (ICU and hospital mortality, ventilator-associated pneumonia, duration of mechanical ventilation, and ICU length of stay) related to interventions that were associated with improvements in processes of care. From 11,742 publications, we included 119 investigations (seven randomized controlled trials, 112 observational studies) on nine clinical topics. Interventions that included protocols with or without education improved continuous process measures (seven observational studies and one randomized controlled trial; standardized

  3. Characteristics and risk factors of cerebrovascular accidents after percutaneous coronary interventions in patients with history of stroke.

    Science.gov (United States)

    Zhang, Hua; Feng, Li-qun; Bi, Qi; Wang, Yu-ping

    2010-06-01

    Percutaneous coronary intervention (PCI) is a well-established method for managing coronary diseases. However, the increasing use of PCI has led to an increased incidence of acute cerebrovascular accidents (CVA) related to PCI. In this study, we investigated the characteristics and risk factors of CVA after PCI in patients with known stroke history. Between January 1, 2005 and March 1, 2009, 621 patients with a history of stroke underwent a total of 665 PCI procedures and were included in this retrospective study. Demographic and clinical characteristics, previous medications, procedures, neurologic deficits, location of lesion and in-hospital clinical outcomes of patients who developed a CVA after the cardiac catheterization laboratory visit and before discharge were reviewed. Acute CVA was diagnosed in 53 (8.5%) patients during the operation or the perioperative period. Seventeen patients suffered from transient ischemic attack, thirty-four patients suffered from cerebral infarction and two patients suffered from cerebral hemorrhage. The risk factors for CVA after PCI in stroke patients were: admission with an acute coronary syndrome, use of an intra-aortic balloon pump, urgent or emergency procedures, diabetes mellitus, and poor left ventricular systolic function, arterial fibrillation, previous myocardial infarction, dyslipidemia, tobacco use, and no/irregular use of anti-platelet medications. The incidence of CVA during and after PCI in patients with history of stroke is much higher than that in patients without history of stroke. Patients with atrial fibrillation, previous myocardial infarction, diabetes mellitus, dyslipidemia, tobacco use, and no or irregular use of anti-platelet medications were at higher risk for recurrent stroke. This study showed a strong association between acute coronary syndromes and in-hospital stroke after PCI.

  4. Nuclear accidents

    International Nuclear Information System (INIS)

    1987-01-01

    On 27 May 1986 the Norwegian government appointed an inter-ministerial committee of senior officials to prepare a report on experiences in connection with the Chernobyl accident. The present second part of the committee's report describes proposals for measures to prevent and deal with similar accidents in the future. The committee's evaluations and proposals are grouped into four main sections: Safety and risk at nuclear power plants; the Norwegian contingency organization for dealing with nuclear accidents; compensation issues; and international cooperation

  5. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...

  6. Radiological accidents balance in medicine

    International Nuclear Information System (INIS)

    Nenot, J.C.

    1995-01-01

    This work deals with the radiological accidents in medicine. In medicine, the radiation accidents on medical personnel and patients can be the result of over dosage and bad focusing of radiotherapy sealed sources. Sometimes, the accidents, if they are unknown during a time enough for the source to be spread and to expose a lot of persons (in the case of source dismantling for instance) can take considerable dimensions. Others accidents can come from bad handling of linear accelerators and from radionuclide kinetics in some therapies. Some examples of accidents are given. (O.L.). 11 refs

  7. Medical management of patients overexposed to irradiation in acute and subacute accidents

    Energy Technology Data Exchange (ETDEWEB)

    Genyao, Ye; Guilin, Wang; Shimin, Huang; Xiyuan, Cheng; Bingzhi, Mao; Yingqi, Li [North Taiping Road Hospital, Beijing, BJ (China)

    1991-11-01

    The authors summarize the experiences in the medical management of 7 radiation accidents resulting in 5 cases of acute radiation sickness, 3 cases of subacute radiation sickness and 8 cases of overexposed persons with estimated physical doses below 1 Gy in the past 5 years. The therapeutic measures including the application of antiradiation drugs such as estriol and herbal medicine '208', measures to improve the microcirculation and transfusion of fetal liver cells, etc., were emphasized in the treatment of acute radiation sickness. For subacute radiation sickness, large doses of stanozolum (18 mg/d) in combination with 654-2 (60 mg/d) were administered as the principal therapeutic agents. The advances in the medical management of acute accidentally overexposed cases in China are briefly reviewed and discussed.

  8. Procalcitonin increase in early identification of critically ill patients at high risk of mortality

    DEFF Research Database (Denmark)

    Jensen, Jens Ulrik; Heslet, Lars; Jensen, Tom Hartvig

    2006-01-01

    To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients.......To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients....

  9. Haloperidol for delirium in critically ill patients - protocol for a systematic review

    DEFF Research Database (Denmark)

    Barbateskovic, M; Kraus, S R; Collet, M O

    2018-01-01

    , relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. METHODS: We will search for randomised clinical trials...... decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients....

  10. Sleep disturbances in critically ill patients in ICU: how much do we know?

    DEFF Research Database (Denmark)

    Boyko, Y.; Ording, H.; Jennum, Poul

    2012-01-01

    the underlying literature. There are no studies of level 1 evidence proving the positive impact of the tested interventions on the critically ill patients sleep pattern. Thus, disturbed sleep in critically ill patients with all the severe consequences remains an unresolved problem and needs further investigation.......Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns...... in critically ill patients including abnormal circadian rhythm, high arousal and awakening index, reduced Slow Wave Sleep, and Rapid Eye Movement sleep. The purpose of this study is to summarise different aspects of sleep-awake disturbances, causes and handling methods in critically ill patients by reviewing...

  11. Tracheostomy in special groups of critically ill patients: Who, when, and where?

    Science.gov (United States)

    Longworth, Aisling; Veitch, David; Gudibande, Sandeep; Whitehouse, Tony; Snelson, Catherine; Veenith, Tonny

    2016-01-01

    Tracheostomy is one of the most common procedures undertaken in critically ill patients. It offers many theoretical advantages over translaryngeal intubation. Recent evidence in a heterogeneous group of critically ill patients, however, has not demonstrated a benefit for tracheostomy, in terms of mortality, length of stay in Intensive Care Unit (ICU), or incidence of ventilator-associated pneumonia. It may be a beneficial intervention in articular subsets of ICU patients. In this article, we will focus on the evidence for the timing of tracheostomy and its effect on various subgroups of patients in critical care. PMID:27275076

  12. Accident and emergency management

    International Nuclear Information System (INIS)

    Andersen, V.; Moellenbach, K.; Heinonen, R.; Jakobsson, S.; Kukko, T.; Berg, Oe.; Larsen, J.S.; Westgaard, T.; Magnusson, B.; Andersson, H.; Holmstroem, C.; Brehmer, B.; Allard, R.

    1988-06-01

    There is an increasing potential for severe accidents as the industrial development tends towards large, centralised production units. In several industries this has led to the formation of large organisations which are prepared for accidents fighting and for emergency management. The functioning of these organisations critically depends upon efficient decision making and exchange of information. This project is aimed at securing and possibly improving the functionality and efficiency of the accident and emergency management by verifying, demonstrating, and validating the possible use of advanced information technology in the organisations mentioned above. With the nuclear industry in focus the project consists of five main activities: 1) The study and detailed analysis of accident and emergency scenarios based on records from incidents and rills in nuclear installations. 2) Development of a conceptual understanding of accident and emergency management with emphasis on distributed decision making, information flow, and control structure sthat are involved. 3) Development of a general experimental methodology for evaluating the effects of different kinds of decision aids and forms of organisation for emergency management systems with distributed decision making. 4) Development and test of a prototype system for a limited part of an accident and emergency organisation to demonstrate the potential use of computer and communication systems, data-base and knowledge base technology, and applications of expert systems and methods used in artificial intelligence. 5) Production of guidelines for the introduction of advanced information technology in the organisations based on evaluation and validation of the prototype system. (author)

  13. Lessons learned from radiological accidents at medical exposures in radiotherapy

    International Nuclear Information System (INIS)

    Fagundes, J.S.; Ferreira, A.F.; Lima, C.M.A.; Silva, F.C.A. da

    2017-01-01

    An exposure is considered accidental in radiotherapy when there is a substantial deviation in the prescription of treatment. In this work, an analysis of published radiological accidents, both in Brazil and internationally, was performed during medical exposures in radiotherapy treatments, removing the main lessons learned. Of the research carried out, we highlight Brazil with four radiological accidents and one death in the period between 2011 and 2014; the United States of America with 169 accidents with two deaths from 2000 to 2010 and France from 2001 to 2014 had 569 deaths without patients. Lessons learned have been described, for example, that maintenance personnel training should specify limitations or restrictions on the handling or adjustment of critical parts on the accelerator. It is recommended to apply the 10 main lessons learned due to radiological accidents during medical exposures in radiotherapy treatments to avoid future events

  14. Validation and the limits of SPECT for patients suffering from cerebrovascular accidents. Evaluations based on simultaneous PET and SPECT examinations

    Energy Technology Data Exchange (ETDEWEB)

    Mizukawa, Norihiko; Yano, Ichiro; Tenjin, Hiroshi (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1989-02-01

    Contemporaneous single photon emission computed tomography (SPECT) and positron emission tomography (PET) were performed in 10 patients with cerebrovascular accidents (CVA), whose ages ranged from 11 to 67 years. I-123-isopropyl-iodoamphetamine (IMP) and/or Tc-99m hexamethylpropyleneamine oxime (HM-PAO) were used for SPECT. Cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate for oxygen (CMRO{sub 2}) were measured by an O-15 labelled gas continuous-inhalation method. SPECT images were quite similar to CBF and CMRO{sub 2} during the chronic stage of CVA. Two patietns with vasospasm during the subacute stage had apparently low CBF and CMRO{sub 2} on PET, but did not have low perfusion on SPECT. Luxury perfusion areas were detected in 4 subacute stage patients and one chronic stage patient. A redistribution of IMP was detected in two patients with infarction during subacute stage. CMRO{sub 2} value in such an area was 2.0 ml/100 g/min. Low CBF and/or CMRO{sub 2} areas were well visualized by IMP rather than by HM-PAO SPECT. (N.K.).

  15. [Metabolic control in the critically ill patient an update: hyperglycemia, glucose variability hypoglycemia and relative hypoglycemia].

    Science.gov (United States)

    Pérez-Calatayud, Ángel Augusto; Guillén-Vidaña, Ariadna; Fraire-Félix, Irving Santiago; Anica-Malagón, Eduardo Daniel; Briones Garduño, Jesús Carlos; Carrillo-Esper, Raúl

    Metabolic changes of glucose in critically ill patients increase morbidity and mortality. The appropriate level of blood glucose has not been established so far and should be adjusted for different populations. However concepts such as glucose variability and relative hypoglycemia of critically ill patients are concepts that are changing management methods and achieving closer monitoring. The purpose of this review is to present new data about the management and metabolic control of patients in critical areas. Currently glucose can no longer be regarded as an innocent element in critical patients; both hyperglycemia and hypoglycemia increase morbidity and mortality of patients. Protocols and better instruments for continuous measurement are necessary to achieve the metabolic control of our patients. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  16. Proliferation and differentiation of adipose tissue in prolonged lean and obese critically ill patients.

    Science.gov (United States)

    Goossens, Chloë; Vander Perre, Sarah; Van den Berghe, Greet; Langouche, Lies

    2017-12-01

    In prolonged non-obese critically ill patients, preservation of adipose tissue is prioritized over that of the skeletal muscle and coincides with increased adipogenesis. However, we recently demonstrated that in obese critically ill mice, this priority was switched. In the obese, the use of abundantly available adipose tissue-derived energy substrates was preferred and counteracted muscle wasting. These observations suggest that different processes are ongoing in adipose tissue of lean vs. overweight/obese critically ill patients. We hypothesize that to preserve adipose tissue mass during critical illness, adipogenesis is increased in prolonged lean critically ill patients, but not in overweight/obese critically ill patients, who enter the ICU with excess adipose tissue. To test this, we studied markers of adipogenesis in subcutaneous and visceral biopsies of matched lean (n = 24) and overweight/obese (n = 24) prolonged critically ill patients. Secondly, to further unravel the underlying mechanism of critical illness-induced adipogenesis, local production of eicosanoid PPARγ agonists was explored, as well as the adipogenic potential of serum from matched lean (n = 20) and overweight/obese (n = 20) critically ill patients. The number of small adipocytes, PPARγ protein, and CEBPB expression were equally upregulated (p ≤ 0.05) in subcutaneous and visceral adipose tissue biopsies of lean and overweight/obese prolonged critically ill patients. Gene expression of key enzymes involved in eicosanoid production was reduced (COX1, HPGDS, LPGDS, ALOX15, all p ≤ 0.05) or unaltered (COX2, ALOX5) during critical illness, irrespective of obesity. Gene expression of PLA2G2A and ALOX15B was upregulated in lean and overweight/obese patients (p ≤ 0.05), whereas their end products, the PPARγ-activating metabolites 15s-HETE and 9-HODE, were not increased in the adipose tissue. In vitro, serum of lean and overweight/obese prolonged critically ill

  17. Most important needs of family members of critical patients in light of the critical care family needs inventory.

    Science.gov (United States)

    Padilla Fortunatti, Cristóbal Felipe

    2014-01-01

    This work sought to identify the most important needs for family members of adult critical patients as described in the literature pursuant to the dimensions established in the "Critical Care Family Needs Inventory" (CCFNI) by Molter and Leske. A literature review was carried out by using the CCFNI instrument. The databases used were: Pubmed, CINAHL, Proquest Nursing & Allied Health Source, Proquest Psychology Journals, LILACS, Science Direct, Ovid SP, PsyicINFO, and SciELO. The following limitations for the search were identified: adult patients, articles in English and Spanish, with abstract and complete text available and which had been published from 2003 to June 2013; 15 articles were included. The family's hope on desired results and sincere communication with the healthcare staff turned out to be the most relevant needs, while the least important were related to comfort and having support structures or systems. Most of the studies were conducted in Asia and North America revealing differences in the order of importance assigned to each necessity. Certain sociodemographic and cultural characteristics impact upon how family members rank their needs; this also occurs with the nature of the most important needs for the family and the factors determining their prioritization. The articles included in this review mention the frequent interaction with the family and their holistic view of the person beyond the illness, determine that nurses are the most appropriate professionals to know and satisfy the family needs of critical patients.

  18. Most Important Needs of Family Members of Critical Patients in Light of the Critical Care Family Needs Inventory

    Directory of Open Access Journals (Sweden)

    Cristóbal Felipe Padilla Fortunatti

    2014-07-01

    Full Text Available Objective. This work sought to identify the most important needs for family members of adult critical patients as described in the literature pursuant to the dimensions established in the "Critical Care Family Needs Inventory" (CCFNI by Molter and Leske. Methodology. A literature review was carried out by using the CCFNI instrument. The databases used were: Pubmed, CINAHL, Proquest Nursing & Allied Health Source, Proquest Psychology Journals, LILACS, Science Direct, Ovid SP, PsyicINFO, and SciELO. The following limitations for the search were identified: adult patients, articles in English and Spanish, with abstract and complete text available and which had been published from 2003 to June 2013; 15 articles were included. Results. The family's hope on desired results and sincere communication with the healthcare staff turned out to be the most relevant needs, while the least important were related to comfort and having support structures or systems. Most of the studies were conducted in Asia and North America revealing differences in the order of importance assigned to each necessity. Certain sociodemographic and cultural characteristics impact upon how family members rank their needs; this also occurs with the nature of the most important needs for the family and the factors determining their prioritization. Conclusion. The articles included in this review mention the frequent interaction with the family and their holistic view of the person beyond the illness, determine that nurses are the most appropriate professionals to know and satisfy the family needs of critical patients.

  19. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

    OpenAIRE

    Weijs, Peter JM; Looijaard, Wilhelmus GPM; Dekker, Ingeborg M; Stapel, Sandra N; Girbes, Armand R; Straaten, Heleen M Oudemans-van; Beishuizen, Albertus

    2014-01-01

    Introduction Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. Methods This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT s...

  20. A proactive transfer policy for critical patient flow management.

    Science.gov (United States)

    González, Jaime; Ferrer, Juan-Carlos; Cataldo, Alejandro; Rojas, Luis

    2018-02-17

    Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy. Due to the high dimensionality of the optimization problem involved, an approximate dynamic programming approach is used to derive an approximation of the optimal decision policy, which indicates that a certain number of beds should be kept free in the different units as a function of the next period demand estimate. Testing the model on two instances of different sizes demonstrates that the optimal number of patient transfers between units changes when the emergency patient arrival rate for transfer to other units changes at a single unit, but remains stable if the change is proportionally the same for all units. In a simulation using real data for a hospital in Chile, significant improvements are achieved by the model in key emergency department performance indicators such as patient wait times (reduction higher than 50%), patient capacity (21% increase) and queue abandonment (from 7% down to less than 1%).

  1. The TMI-2 accident

    International Nuclear Information System (INIS)

    Loureiro, L.A.

    1986-01-01

    A critical study about the technical and man-related facts in order to establish what is considered the worst commercial nuclear power accident until 1986. Radiological consequences and stress to the public are considered in contrast to antinuclear groups. This descriptive and technical study has the purpose to document written and oral opinions obtained abroad and then explain to the public in an easy language terminology. Preliminary study describing safety related systems fails and the accident itself with minute to minute description, conduct to the consequences and then, to learned lessons

  2. Helicopter emergency medical services response to equestrian accidents.

    Science.gov (United States)

    Lyon, Richard M; Macauley, Ben; Richardson, Sarah; de Coverly, Richard; Russell, Malcolm

    2015-04-01

    Horse riding is a common leisure activity associated with a significant rate of injury. Helicopter emergency medical services (HEMS) may be called to equestrian accidents. Accurate HEMS tasking is important to ensure appropriate use of this valuable medical resource. We sought to review HEMS response to equestrian accidents and identify factors associated with the need for HEMS intervention or transport of the patient to a major trauma centre. Retrospective case review of all missions flown by Kent, Surrey & Sussex Air Ambulance Trust over a 1-year period (1 July 2011 to 1 July 2012). All missions were screened for accidents involving a horse. Call details, patient demographics, suspected injuries, clinical interventions and patient disposition were all analysed. In the 12-month data collection period there were 47 equestrian accidents, representing ∼3% of the total annual missions. Of the 42 cases HEMS attended, one patient was pronounced life extinct at the scene. In 15 (36%) cases the patient was airlifted to hospital. In four (10%) cases, the patient underwent prehospital anaesthesia. There were no specific predictors of HEMS intervention. Admission to a major trauma centre was associated with the rider not wearing a helmet, a fall onto their head or the horse falling onto the rider. Equestrian accidents represent a significant proportion of HEMS missions. The majority of patients injured in equestrian accidents do not require HEMS intervention, however, a small proportion have life-threatening injuries, requiring immediate critical intervention. Further research is warranted, particularly regarding HEMS dispatch, to further improve accuracy of tasking to equestrian accidents.

  3. [Cranial-cerebral trauma after a traffic accident: perceptions of patients, family, physicians and professionals].

    Science.gov (United States)

    Lefebvre, Hélène; Pelchat, Diane; Swaine, Bonnie; Gélinas, Isabelle; Levert, Marie Josée

    2004-09-01

    This is a study of medical care when road accident incidents result in traumatic brain injury (TBI). We investigated the personal perceptions of those involved in acute care episodes and subsequent rehabilitation. We conducted simultaneous semi-structured interviews with individuals who had sustained a TBI (8) and their families (8). We then conducted semi-structured individual interviews with the professionals (22) and physicians (9) who attended them. Results reveal the difficulties encountered by the different people involved, from the standpoint of the rehabilitation of both the person who with the TBI and their families, the relationships among the various actors, and the continuity of care. The results disclose the importance of including the family and the TBI casualty in the care process by endorsing their participation and by setting up suitable structures that prioritize a meaningful partnership among the individuals, families, physicians, professionals and health care organizations and in which each person can play a role as an agent in the care of the person with the TBI. An important element, which came out again in our results, is that the shortage of information provided to the families can jeopardize establishing a relationship of trust among the actors. Furthermore, many of the family members were upset that the health intervention was entirely focussed on the TBI casualty: none of the professionals were concerned with what the families were going through, either during the acute care or rehabilitation. Another major problem is lack of communication, not just amongst the professionals, but also between institutions which seem to function in isolation. Lack of resources, the limited availability of those that are offered, and social policies are also detrimental to the reintegration of the TBI individual into the community. Finally, many of the professionals reported that they had not been trained to assist families in this situation.

  4. Rapid evaluation of the neutron dose following a criticality accident by measurement of {sup 24}Na activity; Evaluation rapide de la dose de neutrons a la suite d'un accident de criticite par mesure de l'activite de {sup 24}Na

    Energy Technology Data Exchange (ETDEWEB)

    Estournel, R [Centre de Production de Plutonium de Marcoule, Service de Protection contre les Rayonnements, 30 (France); Henry, Ph [Centre de Production de Plutonium de Marcoule, Section Medicale et Sociale, 30 (France); Beau, P; Ergas, A [Commissariat a l' Energie Atomique, Service d' Hygiene Atomique, Dept. de la Protection Sanitaire, Chusclan, (France)

    1966-07-01

    By external measurement of the gamma activity of {sup 24}Na induced in the human organs by a neutron flux during a criticality accident, it is possible to evaluate the personal dose received. Detectors designed for everyday use in health physics can be applied to these measurements, and this is described in the first part of the work. The response of a certain number of induced-activity detectors is presented. The induced activity-dose relationship is studied theoretically in the second part taking into account the neutron spectrum to which the individual has been subjected. The characteristic spectra of three possible types of accident have been used for deducing this relationship. The results obtained show that the method is sufficiently sensitive for present purposes. The accuracy of this method for calculating the dose received during an experiment is discussed. (authors) [French] La mesure par detection externe de l'activite gamma du sodium 24 induit dans l'organisme humain par un flux de neutrons lors d'un accident de criticite rend possible l'evaluation de la dose recue par un individu irradie. L'utilisation de detecteurs d'un emploi courant en radioprotection fait l'objet d'une experimentation qui constitue la premiere partie de cette etude. La reponse d'un certain nombre de detecteurs a une activite induite connue est presentee. La relation dose-activite induite, est etudiee, de maniere theorique, dans la seconde partie, correlativement au spectre des neutrons qui ont atteint l'individu irradie. Les spectres caracteristiques de trois types d'accidents possibles ont ete retenus pour l'etablissement de ces relations. Les resultats obtenus montrent que la methode satisfait avec une sensibilite suffisante au but recherche. La precision avec laquelle on peut ainsi calculer la dose recue au cours d'un accident de criticite est discutee. (auteurs)

  5. Changes in circulating blood volume after infusion of hydroxyethyl starch 6% in critically ill patients

    DEFF Research Database (Denmark)

    Christensen, P; Andersson, J; Rasmussen, S E

    2001-01-01

    The cardiovascular response to a volume challenge with hydroxyethyl starch (HES) (200/0.5) 6% depends on the relation between the volume of HES 6% infused and the expansion of the blood volume in critically ill patients. However, only relatively limited data exist on the plasma expanding effect...... of infusion of HES 6% in critically ill patients. The purpose of the study was to evaluate the variation in the expansion of the circulating blood volume (CBV) in critically ill patients after infusion of 500 ml of colloid (HES (200/0.5) 6%) using the carbon monoxide method....

  6. Time to look beyond one-year mortality in critically ill hematological patients?

    Science.gov (United States)

    Moors, Ine; Benoit, Dominique D

    2014-02-11

    The spectacular improvement in long-term prognosis of patients with hematological malignancies since the 1980s, coupled with the subsequent improvement over the past decade in short- and mid-term survival in cases of critical illness, resulted in an increasing referral of such patients to the ICU. A remaining question, however, is how these patients perform in the long term with regard to survival and quality of life. Here we discuss the present multicenter study on survival beyond 1 year in critically ill patients with hematological malignancies. We conclude with suggestions on how we can further improve the long-term outcome of these patients.

  7. Normal accidents

    International Nuclear Information System (INIS)

    Perrow, C.

    1989-01-01

    The author has chosen numerous concrete examples to illustrate the hazardousness inherent in high-risk technologies. Starting with the TMI reactor accident in 1979, he shows that it is not only the nuclear energy sector that bears the risk of 'normal accidents', but also quite a number of other technologies and industrial sectors, or research fields. The author refers to the petrochemical industry, shipping, air traffic, large dams, mining activities, and genetic engineering, showing that due to the complexity of the systems and their manifold, rapidly interacting processes, accidents happen that cannot be thoroughly calculated, and hence are unavoidable. (orig./HP) [de

  8. MR imaging and radiography of patients with cervical hyperextension-flexion injuries after car accidents

    Energy Technology Data Exchange (ETDEWEB)

    Borchgrevink, G E [The Emergency Clinic, Trondheim Univ. Hospital (Norway); Smevik, O [MR-Centre Medical Section, Trondheim Univ. Hospital (Norway); Nordby, A [Dept. of Radiology, Trondheim Univ. Hospital (Norway); Rinck, P A [MR-Centre Medical Section, Trondheim Univ. Hospital (Norway); Stiles, T C [Dept. of Psychiatry and Behavioural Medicine, Trondheim Univ. (Norway); Lereim, I [The Emergency Clinic, Trondheim Univ. Hospital (Norway)

    1995-07-01

    Fifty-two patients underwent MR imaging and conventional radiography of the neck within 4 days after a hyperextension-flexion injury. The patients also had follow-up investigations during the first 2 years. The images did not reveal any serious lesions in any of them. Based on the main MR and radiographical findings the patients were divided into 4 groups; no findings, posture abnormalities, spondylosis and disc pathology (from MR images) or reduced intervertebral space (from the radiographs). The outcomes of the different groups were compared with reference to neck stiffness, neck pain and headache during a 2-year follow-up period. The patient groups did not correspond completely when diagnosed from MR imaging and radiography. However, patients with pre-existing spondylosis had more symptoms when examined by both modalities. Based on the radiographs, the group with posture abnormalities had significant fewer symptoms than the other groups. (orig.).

  9. Dietary Guidelines for Breast Cancer Patients: A Critical Review.

    Science.gov (United States)

    Limon-Miro, Ana Teresa; Lopez-Teros, Veronica; Astiazaran-Garcia, Humberto

    2017-07-01

    Current dietary guidelines for breast cancer patients (BCPs) fail to address adequate dietary intakes of macro- and micronutrients that may improve patients' nutritional status. This review includes information from the PubMed and Biomed Central databases over the last 15 y concerning dietary guidelines for BCPs and the potential impact of a personalized, nutrient-specific diet on patients' nutritional status during and after antineoplastic treatment. Results indicated that BCPs should receive a nutritional assessment immediately after diagnosis. In addition, they should be encouraged to pursue and maintain a healthy body weight [body mass index (BMI; in kg/m 2 ) 20-24.9], preserving their lean mass and avoiding an increase in fat mass. Therefore, after nutritional status diagnosis, a conservative energy restriction of 500-1000 kcal/d could be considered in the dietary intervention when appropriate. Based on the reviewed information, we propose a personalized nutrition intervention for BCPs during and after antineoplastic treatment. Specifications in the nutritional therapy should be based on the patients' nutritional status, dietary habits, schedule, activities, and cultural preferences. BCPs' daily energy intake should be distributed as follows: vegetables (∼75 g/serving) should be encouraged. Garlic and cruciferous vegetables must also be part of the nutrition therapy. Adequate dietary intakes of food-based macro- and micronutrients rich in β-carotene and vitamins A, E, and C can both prevent deterioration in BCPs' nutritional status and improve their overall health and prognosis. © 2017 American Society for Nutrition.

  10. Functional adrenal insufficiency among critically ill patients with ...

    African Journals Online (AJOL)

    Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study. Conclusion: The diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies ...

  11. Vital Signs Monitoring and Interpretation for Critically Ill Patients

    DEFF Research Database (Denmark)

    Vilic, Adnan

    . An introduced queue-based multiple linear regression (qMLR) model achieved best results with a root mean square error (RMSE) of RMSE = 3.11 on a Scandinavian Stroke Scale (SSS) where degree of disability ranged from 0 - 46. Worse outcomes were observed in patients who had pulse > 80 and a negative correlation...

  12. Diphenylcyclopropenone in patients with alopecia areata. A critically appraised topic

    NARCIS (Netherlands)

    Kuin, R. A.; Spuls, P. I.; Limpens, J.; van Zuuren, E. J.

    2015-01-01

    To assess the efficacy and safety of topical diphenylcyclopropenone (DPCP) in patients with alopecia areata. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. The quality of evidence was rated with Grading of Recommendations

  13. Brain computer tomography in critically ill patients - a prospective cohort study

    NARCIS (Netherlands)

    Purmer, Ilse M.; van Iperen, Erik P.; Beenen, Ludo F. M.; Kuiper, Michael J.; Binnekade, Jan M.; Vandertop, Peter W.; Schultz, Marcus J.; Horn, Janneke

    2012-01-01

    Background: Brain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh

  14. Control of criticality; Kawalan kegentingan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1988-12-31

    The chapter briefly discussed the following subjects: basic and the principle of criticality, natural uranium, neutron utilization, criticality data for systems, criticality accidents, criticality control i.e. mass, volume and geometry control .

  15. JAERI's activities in JCO accident

    International Nuclear Information System (INIS)

    2000-09-01

    The Japan Atomic Energy Research Institute (JAERI) was actively involved in a variety of technical supports and cooperative activities, such as advice on terminating the criticality condition, contamination checks of the residents and consultation services for the residents, as emergency response actions to the criticality accident at the uranium processing facility operated by the JCO Co. Ltd., which occurred on September 30, 1999. These activities were carried out in collaborative ways by the JAERI staff from the Tokai Research Establishment, Naka Fusion Research Establishment, Oarai Research Establishment, and Headquarter Office in Tokyo. As well, the JAERI was engaged in the post-accident activities such as identification of accident causes, analyses of the criticality accident, and dose assessment of exposed residents, to support the Headquarter for Accident Countermeasures of the Science and Technology Agency (STA), the Accident Investigation Committee and the Health Control Committee of the Nuclear Safety Commission of Japan (NSC). This report compiles the activities, that the JAERI has conducted to date, including the discussions on measures for terminating the criticality condition, evaluation of the fission number, radiation monitoring in the environment, dose assessment, analyses of criticality dynamics. (author)

  16. Clinical significance of changes of serum lipoprotein (a) levels in patients with cerebral vascular accidents

    International Nuclear Information System (INIS)

    Li Qian; Chen Xinghua

    2004-01-01

    Objective: To investigate the relationship between changes of serum lipoprotein (a) levels and development of stroke. Methods: Lipoprotein (a) levels were determined with ELISA in 100 patients with stroke and 60 controls. Results: The serum LP (a) levels in patients with stroke complicated with diabetes were also significantly higher than those in patients with stroke but without diabetes (P<0.01). Conclusion: The levels of serum LP(a) was a relatively independent risk factor, and it could be of some prognostic value. (authors)

  17. The Untapped Potential of Patient and Family Engagement in the Organization of Critical Care.

    Science.gov (United States)

    Haines, Kimberley J; Kelly, Phillipa; Fitzgerald, Peter; Skinner, Elizabeth H; Iwashyna, Theodore J

    2017-05-01

    There is growing interest in patient and family participation in critical care-not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise definitive review of patient and family organizational participation in critical care as a high-risk population and other vulnerable groups. A pragmatic, codesigned model for critical care is offered as a suggested approach for clinicians, researchers, and policy-makers. To inform this review, a systematic search of Ovid Medline, PubMed, and Embase was undertaken in April 2016 using the MeSH terms: patient participation and critical care. A second search was undertaken in PubMed using the terms: patient participation and organizational models to search for other examples of engagement in vulnerable populations. We explicitly did not seek to include discussions of bedside patient-family engagement or shared decision-making. Two reviewers screened citations independently. Included studies either actively partnered with patients and families or described a model of engagement in critical care and other vulnerable populations. Data or description of how patient and family engagement occurred and/or description of model were extracted into a standardized form. There was limited evidence of patient and family engagement in critical care although key recommendations can be drawn from included studies. Patient and family engagement is occurring in other vulnerable populations although there are few described models and none which address issues of risk. A model of patient and family engagement in critical care does not exist, and we propose a pragmatic, codesigned model that takes into account issues of psychologic safety in this population. Significant opportunity exists to document processes of engagement that reflect a changing paradigm of

  18. A 24-year-old Female Traumatic Patient Following a Car Accident

    Directory of Open Access Journals (Sweden)

    Atousa Akhgar

    2018-04-01

    Full Text Available A healthy 24-year-old female presented at the emergency department (ED after a car accident with ambulance while injured severely after the bus got run over her lower limb. As the trauma team was activated, her primary survey was started: Ac (Airway and cervical collar: She was awake and could talk. Cervical collar was fixed, oxygenation with face mask was started. B (Breathing: Her chest rising was symmetrical without any laceration or abrasion. Chest auscultation was clear and there was no tenderness or crepitation on palpation. No tracheal shift was found. She had normal respiratory rate and O2 saturation of 94% at ambient air. C (Circulation: Two large bore IV lines were inserted and blood samples were obtained. Her vital signs were BP = 60/40 mmHg, PR = 130/min, RR = 12. E-FAST was performed which was negative for free fluid in abdomen, pelvis and thorax, tamponade, and hemopneumothorax. Her pelvis was unstable on examination and pelvic wrapping was performed with sheath. IV fluid therapy with normal saline was started followed by 3 units of packed RBC transfusion. More pack cells and FFP were also requested. D (Disability: She had Glasgow coma scale of 15/15 with normal size and reactive pupil. No neurologic deficit was found except disability of lower extremities due to crush injury. E (Exposure: She had no midline spinal tenderness with normal sphincter anal tone, but there was a laceration in the perineum which extended to the vagina. Portable chest and pelvic x-ray as an adjutant to primary survey were performed which showed type C pelvic fracture. On her secondary survey, she had abrasion on her scalp, 1.5 cm laceration on her right tibia, deformity of her right thigh, and laceration in her genitalia with some vaginal bleeding. Direct pressure was applied and all lacerations were packed. According to negative e-FAST and pelvic fracture and shock, since the angiography was not available, it was decided to fix the pelvis with

  19. Gastric residual volume in critically ill patients: a dead marker or still alive?

    Science.gov (United States)

    Elke, Gunnar; Felbinger, Thomas W; Heyland, Daren K

    2015-02-01

    Early enteral nutrition (EN) is consistently recommended as first-line nutrition therapy in critically ill patients since it favorably alters outcome, providing both nutrition and nonnutrition benefits. However, critically ill patients receiving mechanical ventilation are at risk for regurgitation, pulmonary aspiration, and eventually ventilator-associated pneumonia (VAP). EN may increase these risks when gastrointestinal (GI) dysfunction is present. Gastric residual volume (GRV) is considered a surrogate parameter of GI dysfunction during the progression of enteral feeding in the early phase of critical illness and beyond. By monitoring GRV, clinicians may detect patients with delayed gastric emptying earlier and intervene with strategies that minimize or prevent VAP as one of the major risks of EN. The value of periodic GRV measurements with regard to risk reduction of VAP incidence has frequently been questioned in the past years. Increasing the GRV threshold before interrupting gastric feeding results in marginal increases in EN delivery. More recently, a large randomized clinical trial revealed that abandoning GRV monitoring did not negatively affect clinical outcomes (including VAP) in mechanically ventilated patients. The results have revived the discussion on the role of GRV monitoring in critically ill, mechanically ventilated patients receiving early EN. This review summarizes the most recent clinical evidence on the use of GRV monitoring in critically ill patients. Based on the clinical evidence, it discusses the pros and cons and further addresses whether GRV is a dead marker or still alive for the nutrition management of critically ill patients. © 2014 American Society for Parenteral and Enteral Nutrition.

  20. Initial evaluation and management of the critical burn patient.

    Science.gov (United States)

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. Evaluation and handling of constipation in critical patients.

    Science.gov (United States)

    Pérez-Sánchez, J; Fernández-Boronat, J; Martínez-Méndez, E; Marín-Cagigas, M L; Mota-Puerto, D; Pérez-Román, M C; Martínez-Estalella, G

    To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). Constipation is a real multifactorial problem. We recommend: • Intensified surveillance in patients with drugs that promote constipation. • Use high-fiber diets from the outset. • Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Accident Statistics

    Data.gov (United States)

    Department of Homeland Security — Accident statistics available on the Coast Guard’s website by state, year, and one variable to obtain tables and/or graphs. Data from reports has been loaded for...

  3. Radiation accidents

    International Nuclear Information System (INIS)

    Nenot, J.C.

    1996-01-01

    Analysis of radiation accidents over a 50 year period shows that simple cases, where the initiating events were immediately recognised, the source identified and under control, the medical input confined to current handling, were exceptional. In many cases, the accidents were only diagnosed when some injuries presented by the victims suggested the radiological nature of the cause. After large-scale accidents, the situation becomes more complicated, either because of management or medical problems, or both. The review of selected accidents which resulted in severe consequences shows that most of them could have been avoided; lack of regulations, contempt for rules, human failure and insufficient training have been identified as frequent initiating parameters. In addition, the situation was worsened because of unpreparedness, insufficient planning, unadapted resources, and underestimation of psychosociological aspects. (author)

  4. Kinetic therapy improves oxygenation in critically ill pediatric patients.

    Science.gov (United States)

    Schultz, Theresa Ryan; Lin, Richard; Francis, Barbara A; Hales, Roberta L; Colborn, Shawn; Napoli, Linda A; Helfaer, Mark A

    2005-07-01

    To compare changes in oxygenation after manual turning and percussion (standard therapy) and after automated rotation and percussion (kinetic therapy). Randomized crossover trial. General and cardiac pediatric intensive care units. Intubated and mechanically ventilated pediatric patients who had an arterial catheter and no contraindications to using a PediDyne bed. Patients were placed on a PediDyne bed (Kinetic Concepts) and received 18 hrs blocks of standard and kinetic therapy in an order determined by randomization. Arterial blood gases were measured every 2 hrs during each phase of therapy. Oxygenation index and arterial-alveolar oxygen tension difference [P(A-a)O(2)] were calculated. Indexes calculated at baseline and after each 18-hr phase of therapy were analyzed. Fifty patients were enrolled. Data from 15 patients were either not collected or not used due to reasons that included violation of protocol and inability to tolerate the therapies in the study. Indexes of oxygenation were not normally distributed and were compared using Wilcoxon signed rank testing. Both therapies led to improvements in oxygenation, but only those from kinetic therapy achieved statistical significance. In patients receiving kinetic therapy first, median oxygenation index decreased from 7.4 to 6.19 (p = .015). The median P(A-a)O(2) decreased from 165.2 to 126.4 (p = .023). There were continued improvements in oxygenation after the subsequent period of standard therapy, with the median oxygenation index decreasing to 5.52 and median P(A-a)O(2) decreasing to 116.0, but these changes were not significant (p = .365 and .121, respectively). When standard therapy was first, the median oxygenation index decreased from 8.83 to 8.71 and the median P(a-a)o(2) decreased from 195.4 to 186.6. Neither change was significant. Median oxygenation index after the subsequent period of kinetic therapy was significantly lower (7.91, p = .044) and median P(A-a)O(2) trended lower (143.4, p = .077

  5. A Retrospective study of Pressure ulcers in critically ill patients in a ...

    African Journals Online (AJOL)

    A Retrospective study of Pressure ulcers in critically ill patients in a ... reduced tissue perfusion, neurologic deficits, faecal or urinary incontinence. This study determined the prevalence and risk factors for the development of pressure ulcer in ...

  6. Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: A retrospective study

    NARCIS (Netherlands)

    P.J. van der Geest (Patrick); N.G.M. Hunfeld (Nicola); S.E. Ladage (Sophie E.); A.B.J. Groeneveld (Johan)

    2016-01-01

    markdownabstract_Background:_ In critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is

  7. Effect of a Probiotic Preparation (VSL#3 on Cardiovascular Risk Parameters in Critically-Ill Patients

    Directory of Open Access Journals (Sweden)

    Sarvin Sanaie

    2013-07-01

    Conclusion: Administration of probiotics in critically ill patients reduced the levels of TG and hs-CRP and increased HDL-C levels. However, no significant change was detected in levels of total cholesterol or LDL-C.

  8. Hypophosphatemia and duration of respiratory failure and mortality in critically ill patients

    DEFF Research Database (Denmark)

    Federspiel, C K; Itenov, T S; Thormar, K

    2018-01-01

    BACKGROUND: Hypophosphatemia has been associated with prolonged duration of respiratory failure and increased mortality in critically ill patients, but there is very limited evidence supporting the negative effects of low phosphate. We examined the association between hypophosphatemia at ICU...

  9. Diaphragm Muscle Fiber Weakness and Ubiquitin-Proteasome Activation in Critically Ill Patients

    NARCIS (Netherlands)

    Hooijman, P.E.; Beishuizen, A.; Witt, C.C.; de Waard, M.C.; Girbes, A.R.J.; Spoelstra-de Man, A.M.E.; Niessen, H.W.; Manders, E.; van Hees, H.W.H.; van den Brom, C.E.; Silderhuis, V.; Lawlor, M.W.; Labeit, S.; Stienen, G.J.M.; Hartemink, K.J.; Paul, M.A.; Heunks, L.M.A.; Ottenheijm, C.A.C.

    2015-01-01

    RATIONALE: The clinical significance of diaphragm weakness in critically ill patients is evident: it prolongs ventilator dependency, and increases morbidity and duration of hospital stay. To date, the nature of diaphragm weakness and its underlying pathophysiologic mechanisms are poorly understood.

  10. The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients

    NARCIS (Netherlands)

    Lima, Alexandre; van Bommel, Jasper; Sikorska, Karolina; van Genderen, Michel; Klijn, Eva; Lesaffre, Emmanuel; Ince, Can; Bakker, Jan

    2011-01-01

    We conducted this observational study to investigate tissue oxygen saturation during a vascular occlusion test in relationship with the condition of peripheral circulation and outcome in critically ill patients. Prospective observational study. Multidisciplinary intensive care unit in a university

  11. Sports Accidents

    CERN Multimedia

    Kiebel

    1972-01-01

    Le Docteur Kiebel, chirurgien à Genève, est aussi un grand ami de sport et de temps en temps médecin des classes genevoises de ski et également médecin de l'équipe de hockey sur glace de Genève Servette. Il est bien qualifié pour nous parler d'accidents de sport et surtout d'accidents de ski.

  12. Management of critically ill surgical patients Case reports.

    Science.gov (United States)

    Mangiante, Gerardo; Padoan, Roberto; Mengardo, Valentina; Bencivenga, Maria; de Manzoni, Giovanni

    2016-01-01

    The acute abdomen (AA) still remains a challenging situation for surgeons. New pathological conditions have been imposed to our attention in this field in recent years. The definition of abdominal compartmental syndrome (ACS) in surgical practice and the introduction of new biological matrices, with the concepts of tension-free (TS) repair of incisional hernias, prompted us to set up new therapeutic strategies for the treatment of patients with AA. Thus we reviewed the cases of AA that we observed in recent years in which we performed a laparostomy in order to prevent or to treat an ACS. They are all cases of acute abdomen (AA), but from different origin, including chronic diseases, as in the course of inflammatory bowel disease (IBD), and acute pancreatitis. In all the cases, the open abdominal cavity was covered with a polyethylene sheet. The edges of the wound were sutured to the plastic sheet, and a traction exerted by a device that causes a negative pressure was added. This method was adopted in several cases without randomization, and resulted in excellent patient's outcomes. Abdominal compartmental syndrome, Acute abdomen, Laparostomy.

  13. Chest tube care in critically ill patient: A comprehensive review

    Directory of Open Access Journals (Sweden)

    Hanan Mohammed Mohammed

    2015-10-01

    Full Text Available Breathing is automatic. We don’t usually think too much about it unless we develop a problem. Lack of adequate ventilation and impairment of our respiratory system can quickly become life-threatening. There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae, a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. It is important for the clinician to determine the most appropriate tube size to use prior to intubation. The position of the chest tube is related to the function that the chest tube performs. When managing the care of patients who have chest tubes it is important to fully understand what to do in case problems arise. It is also important to be able to assess when the chest tube is ready to be discontinued. Nurses and other healthcare professionals who are responsible for the safe delivery of care should be knowledgeable about respiratory pathophysiology, signs of respiratory compromise, and the care and management of interventions that may be utilized to ensure adequate respiration.

  14. Early Prediction of Sepsis Incidence in Critically Ill Patients Using Specific Genetic Polymorphisms.

    Science.gov (United States)

    David, Vlad Laurentiu; Ercisli, Muhammed Furkan; Rogobete, Alexandru Florin; Boia, Eugen S; Horhat, Razvan; Nitu, Razvan; Diaconu, Mircea M; Pirtea, Laurentiu; Ciuca, Ioana; Horhat, Delia; Horhat, Florin George; Licker, Monica; Popovici, Sonia Elena; Tanasescu, Sonia; Tataru, Calin

    2017-06-01

    Several diagnostic methods for the evaluation and monitoring were used to find out the pro-inflammatory status, as well as incidence of sepsis in critically ill patients. One such recent method is based on investigating the genetic polymorphisms and determining the molecular and genetic links between them, as well as other sepsis-associated pathophysiologies. Identification of genetic polymorphisms in critical patients with sepsis can become a revolutionary method for evaluating and monitoring these patients. Similarly, the complications, as well as the high costs associated with the management of patients with sepsis, can be significantly reduced by early initiation of intensive care.

  15. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients.

    Science.gov (United States)

    Gosselink, R; Bott, J; Johnson, M; Dean, E; Nava, S; Norrenberg, M; Schönhofer, B; Stiller, K; van de Leur, H; Vincent, J L

    2008-07-01

    The Task Force reviewed and discussed the available literature on the effectiveness of physiotherapy for acute and chronic critically ill adult patients. Evidence from randomized controlled trials or meta-analyses was limited and most of the recommendations were level C (evidence from uncontrolled or nonrandomized trials, or from observational studies) and D (expert opinion). However, the following evidence-based targets for physiotherapy were identified: deconditioning, impaired airway clearance, atelectasis, intubation avoidance, and weaning failure. Discrepancies and lack of data on the efficacy of physiotherapy in clinical trials support the need to identify guidelines for physiotherapy assessments, in particular to identify patient characteristics that enable treatments to be prescribed and modified on an individual basis. There is a need to standardize pathways for clinical decision-making and education, to define the professional profile of physiotherapists, and increase the awareness of the benefits of prevention and treatment of immobility and deconditioning for critically ill adult patients.

  16. [Experience of Regional Vascular Centre in assisting patients with severe cerebrovascular accidents in Novosibirsk].

    Science.gov (United States)

    Doronin, B M; Marushak, A A; Popova, T F; Gribacheva, I A; Petrova, E V

    2016-01-01

    The analysis of the work of the neurological department of the Novosibirsk regional vascular center of City Clinical Hospital #1 for the period from 2013 to 2015 was done. We analyzed the annual reports of the regional vascular center, dynamics of cerebrovascular disease patterns, lethality, about the provision of medical care to patients with stroke, the use of high-tech methods of diagnosis and treatment. Ascertain the progress achieved and the perspectives of further improving the quality of care to patients with stroke due to wider use of methods of rehabilitation in the acute stage of stroke.

  17. Dental and facial injuries following sports accidents: a study of 130 patients.

    Science.gov (United States)

    Hill, C M; Crosher, R F; Mason, D A

    1985-08-01

    Details of injuries to the face and teeth have been collected over a five-year period. One hundred and thirty patients were seen with injuries resulting from 21 different sports. Estimates of the numbers of people playing various team sports in the Bradford area suggest that the incidence of facial injuries is most common in rugby, followed by soccer and cricket. Miniature motor cycling and horse-riding are the most dangerous individual sports. The ages of injured patients varied widely in different sports, but the severity of injuries sustained is less than those due to other causes.

  18. Violations of macro- and micronutrient support in patients with nodular thyroid pathology from regions injured after the Chornobyl accident

    Directory of Open Access Journals (Sweden)

    V.I. Kravchenko

    2017-09-01

    Full Text Available Background. The purpose of our study was to determine the state of macro- and micronutrient support of patients with nodular thyroid pathology from the regions injured after the Chornobyl accident. Materials and methods. 65 habitants of the Chernihiv area were examined: 40 — without thyroid pathology (15 men and 25 women aged 36.62 ± 0.60 years, and 25 (5 men and 20 women — with the diagnosed nodular goiter. Results. Research of urinary iodine excretion showed that a median in the control group was 95.6 µg/l, among patients with nodular goiter — 89.3 µg/l, indicating the presence of moderate iodine deficiency. Blood thyroglobulin level in patients of control group was 9.26 ± 0.99 ng/l, among patients with nodular goiter — 23.03 ± 4.70 ng/l. Thyroid-stimulating hormone level higher than 4.0 mIU/l was in 8.9 % of patients with nodular goiter and in 5.0 % of persons from the control group. The data of ultrasonic researches demonstrated that the average thyroid volume in patients of control group was 10.1 ± 0.3 cm3, among patients with nodular goiter — 18.6 ± 1.7 cm3. In the group of patients with nodular goiter, the decreased (p < 0.0001 level of macronutrients in blood plasma was detected: calcium was 67.26 ± 3.21 µg/l and magnesium — 14.88 ± 0.35 µg/l, as well as of microelements: zinc content was 0.72 ± 0.04 µg/l (p < 0.0001 and iron — 0.54 ± 0.06 µg/l (p < 0.05, in comparison with the results in the control group. Conclusions. The relative risk (χ2 criterion for the four-course table of connectivity with Fisher’s correction of nodular goiter development at subzero content of calcium was 2.24 (95% confidence interval (CI 1.58–2.61, the risk of nodular goiter development at subzero levels of magnesium — 2.56 (95% CI 1.77–3.03.

  19. Nutritional Support of the Critically Ill Pediatric Patient: Foundations and Controversies

    Directory of Open Access Journals (Sweden)

    Iván José Ardila Gómez

    2017-04-01

    Full Text Available Critically ill children require nutritional support that will give them nutritional and non-nutritional support to successfully deal with their disease. In the past few years, we have been able to better understand the pathophysiology of critical illness, which has made possible the establishment of nutritional strategies resulting in an improved nutritional status, thus optimizing the pediatric intensive care unit (PICU stay and decreasing morbidity and mortality. Critical illness is associated with significant metabolic stress. It is crucial to understand the physiological response to stress to create nutritional recommendations for critically ill pediatric patients in the PICU.

  20. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    DEFF Research Database (Denmark)

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U

    2010-01-01

    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  1. Workbench experiments on interaction of nuclear fuel with channel reactor materials: the LFCM congestions criticality and accident scenario in both re-examinations

    International Nuclear Information System (INIS)

    Baryakhtar, V.; Gonchar, V.; Zhidkov, A.

    2002-01-01

    The heavy radioecological consequences of 1986 accident were mainly stipulated by destruction of both a significant part of fuel envelopes and fuel matrix due to high-temperature interaction with silicates, when nuclear fuel has lost an important property to keep the fission products inside its volume. In this respect the silicate material application in thermal-insulating filling is a crucial fault had been made when Chornobyl NPP channel reactor designing

  2. Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients.

    Science.gov (United States)

    Gómez-Garrido, Marta; Rodilla-Fiz, Ana M; Girón-Lacasa, María; Rodríguez-Rubio, Laura; Martínez-Blázquez, Anselmo; Martínez-López, Fernando; Pardo-Ibáñez, María Dolores; Núñez-Marín, Juan M

    2017-05-01

    Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Benefit of revascularisation to critical limb ischaemia patients evaluated by a patient-oriented scoring system.

    Science.gov (United States)

    Chisci, E; Perulli, A; Iacoponi, F; Setacci, F; de Donato, G; Palasciano, G; Cappelli, A; Setacci, C

    2012-05-01

    The concept of patency and limb salvage are physician-oriented endpoints in critical limb ischaemia (CLI). These endpoints have failed to enhance function after revascularisation. The aim of this study was to create a scoring system to predict 1-year functional status and to assess the benefit to patients possible by revascularisation. During the period 2007-2009, 480 consecutive patients (mean age ± SD, 83.2 ± 8.7 years) underwent repair for CLI. Preoperative, operative and functional status characteristics and post-operative outcomes were recorded. The following patient-oriented outcomes were investigated pre- and postoperatively: basic and instrumental activities of daily living (BADL and IADL) and ambulatory and living status. Statistical analysis was performed to assess predictors of functional benefit from revascularisation. The variables significant on multivariable analysis were used to generate a scoring system to pre and postoperatively grade individual patient risk of losing baseline functional status at 1 year (CLI functional score). Ninety-three of 480 patients (19.3%) were in Rutherford class IV, 208 (43.3%) in class V and 179 (37.4%) in class VI. Surgical, endovascular and hybrid operations were performed in 108 (22.5%), 319 (66.5%) and 53 (11%) patients, respectively; mean follow-up was 408 ± 363 days. Improved or unchanged functional status was observed in 276 patients (57.5%). Preoperative mean ± SD BADL and IADL (4.26 ± 1.98 and 3.92 ± 2.69, respectively) were modified from mean values at 1-year follow-up (4.19 ± 2.06 and 4.12 ± 3, respectively) (p = 0.401 and p 80% indicates that patients are likely to lose functional abilities and require assistance for ambulation or ADL, as well as risking outcomes such as major amputation, new CLI-related hospitalisation or re-operation (p 2 cm, infection and poor tibial runoff), American Society of Anesthesiologists (ASA) score > II, previous cerebrovascular event and heart

  4. Fungal Peritonitis: Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis.

    Science.gov (United States)

    Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Schmid, Roland M; Huber, Wolfgang

    2016-01-01

    Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22-28; pperitonitis could be significantly more often found in patients with SFP (65%; pperitonitis was significantly more often in patients with SFP (85%; pperitonitis.

  5. Pharmacy intervention on antimicrobial management of critically ill patients

    Directory of Open Access Journals (Sweden)

    Ijo I

    2011-06-01

    Full Text Available Frequent, suboptimal use of antimicrobial drugs has resulted in the emergence of microbial resistance, compromised clinical outcomes and increased costs, particularly in the intensive care unit (ICU. Mounting on these challenges is the paucity of new antimicrobial agents.Objectives: The study aims to determine the impact of prospective pharmacy-driven antimicrobial stewardship in the ICU on clinical and potential financial outcomes. The primary objectives were to determine the mean length of stay (LOS and mortality rate in the ICU resulting from prospective pharmacy interventions on antimicrobial therapy. The secondary objective was to calculate the difference in total drug acquisition costs resulting from pharmacy infectious diseases (ID-related interventions.Methods: In collaboration with an infectious disease physician, the ICU pharmacy team provided prospective audit with feedback to physicians on antimicrobial therapies of 70 patients over a 4-month period in a 31-bed ICU. In comparison with published data, LOS and mortality of pharmacy-monitored ICU patients were recorded. Daily cost savings on antimicrobial drugs and charges for medication therapy management (MTM services were added to calculate potential total cost savings. Pharmacy interventions focused on streamlining, dose optimization, intravenous-to-oral conversion, antimicrobial discontinuation, new recommendation and drug information consult. Antimicrobial education was featured in oral presentations and electronic newsletters for pharmacists and clinicians.Results: The mean LOS in the ICU was 6 days, which was lower than the published reports of LOS ranging from 11 to 36 days. The morality rate of 14% was comparable to the reported range of 6 to 20% in published literature. The total drug cost difference was a negative financial outcome or loss of USD192 associated with ID-related interventions.Conclusion: In collaboration with the infectious disease physician, prospective

  6. Caring touch as a bodily anchor for patients after sustaining a motor vehicle accident with minor or no physical injuries - a mixed methods study.

    Science.gov (United States)

    Airosa, Fanny; Arman, Maria; Sundberg, Tobias; Öhlén, Gunnar; Falkenberg, Torkel

    2016-03-22

    Patients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of "caring touch" (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries. A mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch. Patients reported that caring touch may assist in trauma recovery by functioning as a physical "anchor" on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is "turned off" to becoming "awake". By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident. ClinicalTrials.gov Id: NCT02610205 . Date 25 November 2015.

  7. Elderly patients attended in emergency health services in Brazil: a study for victims of falls and traffic accidents.

    Science.gov (United States)

    de Freitas, Mariana Gonçalves; Bonolo, Palmira de Fátima; de Moraes, Edgar Nunes; Machado, Carla Jorge

    2015-03-01

    The article aims to describe the profile of elderly victims of falls and traffic accidents from the data of the Surveillance Survey of Violence and Accidents (VIVA). The VIVA Survey was conducted in the emergency health-services of the Unified Health System in the capitals of Brazil in 2011. The sample of elderly by type of accident was subjected to the two-step cluster procedure. Of the 2463 elderly persons in question, 79.8% suffered falls and 20.2% were the victims of traffic accidents. The 1812 elderly who fell were grouped together into 4 clusters: Cluster 1, in which all had disabilities; Cluster 2, all were non-white and falls took place in the home; Cluster 3, younger and active seniors; and Cluster 4, with a higher proportion of seniors 80 years old or above who were white. Among cases of traffic accidents, 446 seniors were grouped into two clusters: Cluster 1 of younger elderly, drivers or passengers; Cluster 2, with higher age seniors, mostly pedestrians. The main victims of falls were women with low schooling and unemployed; traffic accident victims were mostly younger and male. Complications were similar in victims of falls and traffic accidents. Clusters allow adoption of targeted measures of care, prevention and health promotion.

  8. Radiological accidents: methodologies of radio nuclides dis incorporation

    International Nuclear Information System (INIS)

    Jimenez F, E. A.; Paredes G, L.; Cortes, A.

    2014-08-01

    Derived of the radioactive or nuclear material management, exists the risk that accidents can happen where people cases are presented with internal radioactive contamination, who will receive specialized medical care to accelerate the radioactive dis incorporation with the purpose of diminishing the absorbed dose and the associate biological effects. In this work treatments of radioactive dis incorporation were identified, in function of the radionuclide, radiation type, radioactive half life, biological half life, critical organ, ingestion duct and patient type. The factor time is decisive for the effectiveness of the selected treatment in the blockade stage (before the accident) or dis incorporation (after the accident); this factor is related with the radioactive and biological half lives. So to achieve dis incorporation efficiencies of more to 70%, the patient clinical treatment will begin before the first third of the biological half life of the radionuclide that generated the internal contamination. (Author)

  9. Pressure ulcer dressings in critical patients: a cost analysis

    Directory of Open Access Journals (Sweden)

    Dinara Raquel Araújo Silva

    Full Text Available Abstract OBJECTIVE To assess the direct cost of dressings in pressure ulcer treatment. METHOD This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. RESULTS The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002, with a mean of USD 11.9 (±7.4. The most common topical treatments used were essential fatty acids and papain. CONCLUSION Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management.

  10. Critical care admission of South African (SA surgical patients: Results of the SA Surgical Outcomes Study

    Directory of Open Access Journals (Sweden)

    David Lee Skinner

    2017-05-01

    Full Text Available Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA. Methods. The SA Surgical Outcomes Study (SASOS was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5% were admitted to critical care units; of these admissions, 144 (56.5% were planned, and 111 (43.5% unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001. Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001. Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867.

  11. Clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning and prognosis analysis after rescue.

    Science.gov (United States)

    Dong, Hui; Weng, Yi-Bing; Zhen, Gen-Shen; Li, Feng-Jie; Jin, Ai-Chun; Liu, Jie

    2017-06-01

    This study reports the clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning, and analyzes the prognosis after rescue.The general data of 68 patients with severe organophosphorus poisoning treated in our hospital were retrospectively analyzed. These patients were divided into 2 groups: treatment group, and control group. Patients in the control group received routine emergency treatment, while patients in the treatment group additionally received hemoperfusion plus hemodialysis on the basis of routine emergency treatment. The curative effects in these 2 groups and the prognosis after rescue were compared.Compared with the control group, atropinization time, recovery time of cholinesterase activity, recovery time of consciousness, extubation time, and length of hospital stay were shorter (P poisoning rebound rate was significantly lower (P treatment group.Hemoperfusion and hemodialysis on the basis of routine emergency treatment for critical patients with organophosphorus poisoning can improve rescue outcomes and improve the prognosis of patients, which should be popularized.

  12. Socioeconomic consequences of nuclear reactor accidents

    International Nuclear Information System (INIS)

    Tawil, J.J.; Callaway, J.W.; Coles, B.L.; Cronin, F.J.; Currie, J.W.; Imhoff, K.L.; Lewis, P.M.; Nesse, R.J.; Strenge, D.L.

    1984-06-01

    This report identifies and characterizes the off-site socioeconomic consequences that would likely result from a severe radiological accident at a nuclear power plant. The types of impacts that are addressed include economic impacts, health impacts, social/psychological impacts and institutional impacts. These impacts are identified for each of several phases of a reactor accident - from the warning phase through the post-resettlement phase. The relative importance of the impact during each accident phase and the degree to which the impact can be predicted are indicated. The report also examines the methods that are currently used for assessing nuclear reactor accidents, including development of accident scenarios and the estimating of socioeconomic accident consequences with various models. Finally, a critical evaluation is made regarding the use of impact analyses in estimating the contribution of socioeconomic consequences to nuclear accident reactor accident risk. 116 references, 7 figures, 15 tables

  13. Effects of square stepping exercise in patients with sequel of cerebrovascular accident

    Directory of Open Access Journals (Sweden)

    Grazieli Silva Túbero

    Full Text Available Introduction Cerebral stroke is the interruption of blood flow to the brain and can be classified into hemorrhagic and ischemic. It may result in serious body balance and cognition complications. Kinesiotherapy is a privileged means of rehabilitation.Objective Verify the effects of Square Stepping Exercise (SSE on cognitive functions, depressive symptoms and the body balance of cerebral stroke sequel patients.Methods Thirteen brain stroke sequel patients were divided into two groups: SSE (SSEG n = 8 and conventional physiotherapy group (PG, n = 5. The SSEG participated only of the SSE training protocol, while the PG participated of its physical therapy routine group, both for 4 months. They were evaluated using the Mini Mental State Examination (MMSE, the Brief Cognitive Screening Battery (BBRC, the Geriatric Depression Scale (GDS,Berg Balance Scale(BBS and Timed Up and Go(TUG.Results The U Mann Whitney test showed no significant differences between groups. In intragroup analysis, the Wilcoxon test showed significant improvement in global cognitive status for PG (p < 0.042, and for SSEG there were positive results for verbal fluency (p < 0.04 and in TUG for number of steps (p < 0.04 and the time (p < 0.02.Conclusion The SSE seems to benefit dynamic balance, influencing gait agility, cognition related to verbal fluency and may have contributed to maintain other cognitive functions.

  14. Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units.

    Science.gov (United States)

    Mosleh, S; Alja'afreh, M; Lee, A J

    2015-12-01

    The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. A comparative, descriptive cross-sectional study. Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Mortality after major amputation in elderly patients with critical limb ischemia

    NARCIS (Netherlands)

    S. Klaphake (Sanne); de Leur, K. (Kevin); P.G.H. Mulder (Paul); G.H. Ho (Gwan); H.G.W. de Groot (Hans); E.J. Veen (Eelco J.); H.J.M. Verhagen (Hence); L. van der Laan (Lyckle)

    2017-01-01

    markdownabstractBackground: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown.

  16. Innovative solutions--the art of improvisation: patient and family preferences for visitation in critical care.

    Science.gov (United States)

    Heitman, Linda; McClard, Catherine

    2009-01-01

    Critical care nurses identified that, although a liberal visitation policy was followed, patients and families occasionally expressed preferences for verbal communication, rather than have the visitor physically present in the unit. Previously tested communication devices interfered with operating equipment resulting in poor reception. The purpose of this project was to find an effective method for patients to verbally communicate with visitors.

  17. Unilateral mydriasis secondary to ipratropium bromide in a critically ill patient

    Directory of Open Access Journals (Sweden)

    Luciano Santana-Cabrera

    2012-01-01

    Full Text Available Unilateral dilated pupil in a critical patient under sedation is an important clinical sign that requires prompt evaluation. An exhaustive assessment must be performed, including neurological examination and imaging tests, and pharmacological causes must be ruled out. We describe a case of unilateral fixed dilated pupil secondary to the administration of a nebulized cholinergic antagonist, ipratropium bromide, in an unconscious patient.

  18. A RATIONAL BASIS FOR THE MEASUREMENT OF FREE PHENYTOIN CONCENTRATION IN CRITICALLY ILL TRAUMA PATIENTS

    NARCIS (Netherlands)

    ZIELMANN, S; MIELCK, F; KAHL, R; KAZMAIER, S; SYDOW, M; KOLK, J; BURCHARDI, H

    Phenytoin binding to serum proteins and factors influencing protein binding were investigated in 38 critically ill trauma patients. In 24% of these patients, the free fraction of phenytoin was less-than-or-equal-to 10%, whereas in 76%, the free phenytoin fraction was increased >10%-up to 24%.

  19. Pressure ulcer dressings in critical patients: a cost analysis.

    Science.gov (United States)

    Silva, Dinara Raquel Araújo; Bezerra, Sandra Marina Gonçalves; Costa, Jéssica Pereira; Luz, Maria Helena Barros Araújo; Lopes, Vanessa Caminha Aguiar; Nogueira, Lidya Tolstenko

    2017-06-12

    To assess the direct cost of dressings in pressure ulcer treatment. This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL) were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002), with a mean of USD 11.9 (±7.4). The most common topical treatments used were essential fatty acids and papain. Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management. Avaliar o custo direto com curativos no tratamento de lesões por pressão. Estudo observacional descritivo, realizado em Unidade de Terapia Intensiva do nordeste do Brasil, de novembro a dezembro de 2015. Foi aplicada a Pressure Ulcer Scale for Healing e formulário para caracterização e avaliação de custos. Os valores da moeda brasileira (R$) foram convertidos para a moeda norte-americana (US$) à taxa de US$0,26/R$. Foram realizadas análises univariadas e bivariadas. Compuseram a amostra 15 pacientes com lesões, no mínimo, estágio 2. Houve redução significativa dos custos com materiais de curativos entre as avaliações inicial e final (p=0,002), com média de US$11,9 (±7,4). As terapias tópicas mais frequentes foram ácidos graxos essenciais e papaína. Verificou-se redução de custos proporcional aos estágios das lesões. Enfatiza-se o papel do enfermeiro na elaboração de planos de cuidados baseados em evidências para melhor gerenciamento do cuidado. Evaluar el costo directo de curativos para el tratamiento de lesiones por

  20. Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management.

    Science.gov (United States)

    Chiu, Ada W; Contreras, Sofia; Mehta, Sangeeta; Korman, Jennifer; Perreault, Marc M; Williamson, David R; Burry, Lisa D

    2017-12-01

    To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . We restricted articles to those in English and dealing with humans. We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, α-2 agonists, and protocolized weaning were studied. We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, α-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.

  1. Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy

    DEFF Research Database (Denmark)

    Rudolph, Volker; Huntgeburth, Michael; von Bardeleben, Ralph Stephan

    2014-01-01

    AIMS: As periprocedural risk is low, MitraClip implantation is often performed in critically ill, not fully recompensated patients, who are in NYHA functional class IV at the time of the procedure, to accelerate convalescence. We herein sought to evaluate the procedural and 30-day outcome.......3%. CONCLUSION: MitraClip therapy is feasible and safe even in critically ill, not fully recompensated patients and leads to symptomatic improvement in over two-thirds of these patients; however, it is associated with an elevated 30-day mortality....

  2. Nursing diagnoses in patients with cerebral vascular accident: an integrative review.

    Science.gov (United States)

    Lima, Ana Carolina Maria Araújo Chagas Costa; Silva, Aurilene Lima da; Guerra, Débora Rodrigues; Barbosa, Islene Victor; Bezerra, Karine de Castro; Oriá, Mônica Oliveira Batista

    2016-01-01

    to verify the nursing diagnoses in patients affected by CVAs. this is an integrative review of the literature. The search was conducted on LILACS, Scielo, Medline, CINAHL, and Scopus databases between February and March 2015, using the following keywords: "Enfermagem", "Acidente Vascular Cerebral", "Diagnóstico de Enfermagem"; and "Nursing", "Stroke", and "Nursing Diagnosis". we found 9 articles published between 2009 and 2015; most of them were Brazilian, cross-sectional, and exploratory, with a level of evidence of 6. The evidence from the publications was classified as: "Evaluation and validation of specific nursing diagnoses for subjects affected by CVAs" and "Application of the nursing process on subjects affected by CVAs". we noticed the publications focused on nursing diagnoses related to motor disorders, such as risk of falls and impaired physical mobility. Domains regarding safety/protection (domain 11) and sleep/resting (domain 4) were present in most evaluated publications.

  3. [Medical and socio-economic effects of early rehabilitation of patients with acute cerebral vascular accidents].

    Science.gov (United States)

    Popov, A V; Cherednichenko, T V; Lishnevskiĭ, S A; Khomenko, T V; Prigornitskaia, Ia I

    2012-01-01

    Acute ischemic brain injury (stroke, stroke), a leader among the causes of morbidity and mortality in the world. This pathology is one of the most pressing health and social problems that cause enormous economic damage to society, due to the high fatality rate, significant disability and social maladjustment of patients, which is based in most cases are the motor and cognitive impairment. Despite the fact that, currently established risk factors and pathophysiological basis of this disease, the availability of effective methods of diagnosing illness, still a practicing neurologist in some cases difficult to find adequate therapy that could effectively reach a well-established neurological deficit. Therefore the search for treatments that effectively reduce the health and social consequences of vascular damage to the brain, is one of the priority areas of neurology.

  4. Seeing beyond monitors-Critical care nurses' multiple skills in patient observation: Descriptive qualitative study.

    Science.gov (United States)

    Alastalo, Mika; Salminen, Leena; Lakanmaa, Riitta-Liisa; Leino-Kilpi, Helena

    2017-10-01

    The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. Data from semi-structured interviews were analysed using thematic analysis. Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. PATHOPHYSIOLOGY AND PRINCIPLES OF THERAPY OF A NEUROGENIC HYPERACTIVE URINARY BLADDER IN PATIENTS AFTER CEREBROVASCULAR ACCIDENT

    Directory of Open Access Journals (Sweden)

    P. G. Shchvartz

    2017-01-01

    Full Text Available Neurogenic hyperactiv e bladder in different clinical variations is a characteristic com plication of restorativ e and residual periods of ischemic stroke and an important diagnostic criterion in vascular dementia. Mechanisms of formation of individual symptoms included in this syndrome is due to ischemic damage to cortical, subcortical and brainstem (the nucleus of Barrington centres of urination and associative areas of the brain, and the functional dissociation of these structures due to demyelination of the Central conductors of the afferent and efferent impulses. As a result of deficit of cerebral effects (such as brake and activating, is a violation of the implementation of the reflexes of urination (including carrying out continence, ongoing spinal (sympathetic, parasympathetic and somatic. The article presents a new concept of formation of the syndrome of hyperactive bladder on the basis of violations of the implementation of the 4 reflexes of urination, which provides the normal retention of urine and are responsible for the accumulation function of the bladder. First we analyzed the main point of application of drugs of anticholinergic and sympathomimetic actions in the reflexes of urination and mechanisms of restoration of function of the lower urinary tract in patients with acute and chronic v ascular diseases of the brain.

  6. Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

    Science.gov (United States)

    Allaire, Joanna L

    2015-09-01

    Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study.

  7. The Patient-Centered Medical Home Neighbor: A Critical Concept for a Redesigned Healthcare Delivery System

    Science.gov (United States)

    2011-01-25

    Sharing Knowledge: Achieving Breakthrough Performance 2010 Military Health System Conference The Patient -Centered Medical Home Neighbor: A Critical...DATE 25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE The Patient -Centered Medical Home Neighbor: A...Conference What is the Patient -Centered Medical Home?  …a vision of health care as it should be  …a framework for organizing systems of care at both the

  8. Long term psychological effects of a no sedation protocol in critically ill Patients

    DEFF Research Database (Denmark)

    Stroem, Thomas; Stylsvig, Mette; Toft, Palle

    2011-01-01

    interviewed (13 from each group). No difference was found with respect to quality of life (SF-36). Both mental and physical components were non-significant. Becks depression index was low in both groups (1 patient in intervention group vs. 3 patients in the control group were depressed, P=0.32). Evaluated...... applied to critically ill patients undergoing mechanical ventilation does not increase the risk of long term psychological sequelae after intensive care compared to standard treatment with sedation....

  9. The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students.

    Science.gov (United States)

    Shinnick, Mary Ann; Woo, Mary A

    2013-09-01

    Human patient simulation (HPS) is becoming a popular teaching method in nursing education globally and is believed to enhance both knowledge and critical thinking. While there is evidence that HPS improves knowledge, there is no objective nursing data to support HPS impact on critical thinking. Therefore, we studied knowledge and critical thinking before and after HPS in prelicensure nursing students and attempted to identify the predictors of higher critical thinking scores. Using a one-group, quasi-experimental, pre-test post-test design, 154 prelicensure nursing students (age 25.7± 6.7; gender=87.7% female) from 3 schools were studied at the same point in their curriculum using a high-fidelity simulation. Pre- and post-HPS assessments of knowledge, critical thinking, and self-efficacy were done as well as assessments for demographics and learning style. There was a mean improvement in knowledge scores of 6.5 points (Pcritical thinking scores. A logistic regression with 10 covariates revealed three variables to be predictors of higher critical thinking scores: greater "age" (P=0.01), baseline "knowledge" (P=0.04) and a low self-efficacy score ("not at all confident") in "baseline self-efficacy in managing a patient's fluid levels" (P=.05). This study reveals that gains in knowledge with HPS do not equate to changes in critical thinking. It does expose the variables of older age, higher baseline knowledge and low self-efficacy in "managing a patient's fluid levels" as being predictive of higher critical thinking ability. Further study is warranted to determine the effect of repeated or sequential simulations (dosing) and timing after the HPS experience on critical thinking gains. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Police recording of road accident in-patients : investigation into the completeness, representativity, and reliability of police records of hospitalized traffic victims. Article published in Accident Analysis and Prevention, 1984/06. 16(3) pp167-184.

    NARCIS (Netherlands)

    Maas, M.W. & Harris, S.

    1984-01-01

    Many road safety research projects make use of the official police road accident data. Their use is often restricted to the data of fatal accidents and fatalities because it is the only complete registration, and the extent of underreporting of injury accidents is unknown. The need to extend the use

  11. Dropping The Bomb? On Critical and Cinematic Reactions to Michael Ondaatje's The English Patient

    OpenAIRE

    Pesch, Josef

    2018-01-01

    This paper analyses Anthony Minghella's film adaptation of Michael Ondaatje’s The English Patient. It aims at establishing patterns of transformation and strategies of adaptation. Not only the nostalgie romanticisation, but also the de-politicisation of the novel is critically scrutinized. As dropping all reference to the atomic bomb from the film is the most blatant example of deviation from the novel, critical and political background is provided which may explain this act of self-censorshi...

  12. Temporary Decompression in Critically Ill Patients: Retrospective Comparison of Ileostomy and Colostomy.

    Science.gov (United States)

    Lin, Zhi-Liang; Yu, Wen-Kui; Shi, Jia-Liang; Chen, Qi-Yi; Tan, Shan-Jun; Li, Ning

    2014-05-01

    In critically ill patients, gastrointestinal function plays an important role in multiple organ dysfunction syndrome. Patients suffering from acute lower gastrointestinal dysfunction need to be performed a temporary fecal diversion after the failure of conservative treatment. This study aims to determine which type of fecal diversion is associated with better clinical outcomes in critically ill patients. Data of critically ill patients requiring surgical decompression following acute lower gastrointestinal dysfunction between January 2008 and June 2013 were retrospectively analyzed. Comparison was made between ileostomy group and colostomy group regarding the stoma-related complications and the recovery after stoma creation. 63 patients consisted of temporary ileostomy group (n = 35) and temporary colostomy group (n = 28) were included in this study. First bowel movement and length of enteral nutrition intolerance after fecal diversion were both significantly shorter in the ileostomy group than in the colostomy group (1.70 ± 0.95 vs. 3.04 ± 1.40; p colostomy group. Both procedures provide an effective defunctioning of the distant gastrointestinal tract with a low complication incidence. We prefer a temporary ileostomy to temporary colostomy for acute lower gastrointestinal dysfunction in critically ill patients.

  13. Vitamin D deficiency is independently associated with mortality among critically ill patients

    Directory of Open Access Journals (Sweden)

    Rafael Barberena Moraes

    2015-05-01

    Full Text Available OBJECTIVE: Studies suggest an association between vitamin D deficiency and morbidity/mortality in critically ill patients. Several issues remain unexplained, including which vitamin D levels are related to morbidity and mortality and the relevance of vitamin D kinetics to clinical outcomes. We conducted this study to address the association of baseline vitamin D levels and vitamin D kinetics with morbidity and mortality in critically ill patients. METHOD: In 135 intensive care unit (ICU patients, vitamin D was prospectively measured on admission and weekly until discharge from the ICU. The following outcomes of interest were analyzed: 28-day mortality, mechanical ventilation, length of stay, infection rate, and culture positivity. RESULTS: Mortality rates were higher among patients with vitamin D levels 12 ng/mL (32.2% vs. 13.2%, with an adjusted relative risk of 2.2 (95% CI 1.07-4.54; p< 0.05. There were no differences in the length of stay, ventilation requirements, infection rate, or culture positivity. CONCLUSIONS: This study suggests that low vitamin D levels on ICU admission are an independent risk factor for mortality in critically ill patients. Low vitamin D levels at ICU admission may have a causal relationship with mortality and may serve as an indicator for vitamin D replacement among critically ill patients.

  14. Trismus: An unusual presentation following road accident

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    Thakur Jagdeep

    2007-01-01

    Full Text Available Trismus due to trauma usually follows road accidents leading to massive faciomaxillary injury. In the literature there is no report of a foreign body causing trismus following a road accident, this rare case is an exception. We present a case of isolated presentation of trismus following a road accident. This case report stresses on the thorough evaluation of patients presenting with trismus following a road accident.