WorldWideScience

Sample records for incident reporting project

  1. New York integrated incident management system evaluation project final report

    Science.gov (United States)

    2007-03-23

    The Integrated Incident Management System (IIMS) enables incident response personnel to transmit data about an incident to other responders and dispatchers on a real-time basis. When an incident is entered into IIMS, the system uses GPS to identify t...

  2. Semantic Language and Tools for Reporting Human Factors Incidents Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Incidents related to impaired human performance in space operations can be caused by environmental conditions, situational challenges, and operational deficiencies....

  3. Plutonium Reclamation Facility incident response project progress report

    Energy Technology Data Exchange (ETDEWEB)

    Austin, B.A.

    1997-11-25

    This report provides status of Hanford activities in response to process deficiencies highlighted during and in response to the May 14, 1997, explosion at the Plutonium Reclamation Facility. This report provides specific response to the August 4, 1997, memorandum from the Secretary which requested a progress report, in 120 days, on activities associated with reassessing the known and evaluating new vulnerabilities (chemical and radiological) at facilities that have been shut down, are in standby, are being deactivated or have otherwise changed their conventional mode of operation in the last several years. In addition, this report is intended to provide status on emergency response corrective activities as requested in the memorandum from the Secretary on August 28, 1997. Status is also included for actions requested in the second August 28, 1997, memorandum from the Secretary, regarding timely notification of emergencies.

  4. [Risk management in the operation room. Results of a pilot project of interdisciplinary "incident reporting"].

    Science.gov (United States)

    Horstmann, R; Hofinger, G; Mäder, M; Gaidzik, P W; Waleczek, H

    2006-08-01

    Methods for error analysis are suitable to increase patients' safety as well as staff satisfaction and may avoid, in a sense of process control, financial damage to the hospital. The aim of the presented pilot study was to establish and evaluate an incident reporting system as a first step towards a new safety culture. In June 2003 an incident reporting system was introduced in the central surgical suite, in which the surgical and anaesthesiologic departments took part as well medical and nursing staff. Besides conceiving a report form, a "board of confidence" was elected, kick-off meetings were held and a baseline study on the basis of industrial psychological knowledge was initialised. The process of creating confidence is arduous and depends elementarily on sincere cooperation of management staff, especially of the heads of the departments. The exclusive participation of only two medical departments led to conflicts. Therefore, after finishing the pilot study, the system was expanded to the whole surgical suite including all operating departments. In order to increase the motivation for the strictly voluntarily participation, the frequency of regular echoes to the staff was optimised. To achieve high acceptance in the whole staff, the board of confidence needs a clearly defined position within the system of quality management. For the first time in Germany an incident reporting system under participation of several medical departments has been installed. After finishing the pilot project, in future we will be able to evaluate changes caused by this system. Simultaneously an electronic database for reported adverse events and strategies to avoid them are being developed based on similar systems in aviation industry. In near future, the system will be of increasing importance likewise for inpatient units and non-operative departments.

  5. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project.

    Science.gov (United States)

    Decker, Wyatt W; Campbell, Ronna L; Manivannan, Veena; Luke, Anuradha; St Sauver, Jennifer L; Weaver, Amy; Bellolio, M Fernanda; Bergstralh, Eric J; Stead, Latha G; Li, James T C

    2008-12-01

    Reported incidences of anaphylaxis range from 3.2 to 20 per 100,000 population. The incidence and trend over time has meaningful public health implications but has not been well characterized because of a lack of a standard definition and deficiencies in reporting of events. We sought to determine the incidence and cause of anaphylaxis over a 10-year period. We performed a population-based incidence study that was conducted in Rochester, Minnesota, from 1990 through 2000. Anaphylaxis episodes were identified on the basis of symptoms and signs of mast cell and basophil mediator release plus mucocutaneous, gastrointestinal tract, respiratory tract, or cardiovascular system involvement. Two hundred eleven cases of anaphylaxis were identified (55.9% in female subjects). The mean age was 29.3 years (SD, 18.2 years; range, 0.8-78.2 years). The overall age- and sex-adjusted incidence rate was 49.8 (95% CI, 45.0-54.5) per 100,000 person-years. Age-specific rates were highest for ages 0 to 19 years (70 per 100,000 person-years). Ingested foods accounted for 33.2% (70 cases), insect stings accounted for 18.5% (39 cases), medication accounted for 13.7% (29 cases), radiologic contrast agent accounted for 0.5% (1 case), "other" causes accounted for 9% (19 cases), and "unknown" causes accounted for 25.1% (53 cases). The "other" group included cats, latex, cleaning agents, environmental allergens, and exercise. There was an increase in the annual incidence rate during the study period from 46.9 per 100,000 persons in 1990 to 58.9 per 100,000 persons in 2000 (P = .03). The overall incidence rate is 49.8 per 100,000 person-years, which is higher than previously reported. The annual incidence rate is also increasing. Food and insect stings continue to be major inciting agents for anaphylaxis.

  6. Analysis of Aviation Safety Reporting System Incident Data Associated with the Technical Challenges of the Atmospheric Environment Safety Technology Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2014-01-01

    This study analyzed aircraft incidents in the NASA Aviation Safety Reporting System (ASRS) that apply to two of the three technical challenges (TCs) in NASA's Aviation Safety Program's Atmospheric Environment Safety Technology Project. The aircraft incidents are related to airframe icing and atmospheric hazards TCs. The study reviewed incidents that listed their primary problem as weather or environment-nonweather between 1994 and 2011 for aircraft defined by Federal Aviation Regulations (FAR) Parts 121, 135, and 91. The study investigated the phases of flight, a variety of anomalies, flight conditions, and incidents by FAR part, along with other categories. The first part of the analysis focused on airframe-icing-related incidents and found 275 incidents out of 3526 weather-related incidents over the 18-yr period. The second portion of the study focused on atmospheric hazards and found 4647 incidents over the same time period. Atmospheric hazards-related incidents included a range of conditions from clear air turbulence and wake vortex, to controlled flight toward terrain, ground encounters, and incursions.

  7. Police Incident Reports Written

    Data.gov (United States)

    Town of Chapel Hill, North Carolina — This table contains incident reports filed with the Chapel Hill Police Department. Multiple incidents may have been reported at the same time. The most serious...

  8. Analysis of Aviation Safety Reporting System Incident Data Associated With the Technical Challenges of the Vehicle Systems Safety Technology Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2014-01-01

    This analysis was conducted to support the Vehicle Systems Safety Technology (VSST) Project of the Aviation Safety Program (AVsP) milestone VSST4.2.1.01, "Identification of VSST-Related Trends." In particular, this is a review of incident data from the NASA Aviation Safety Reporting System (ASRS). The following three VSST-related technical challenges (TCs) were the focus of the incidents searched in the ASRS database: (1) Vechicle health assurance, (2) Effective crew-system interactions and decisions in all conditions; and (3) Aircraft loss of control prevention, mitigation, and recovery.

  9. EP&R Standards Project Report: Technical Review of National Incident Management Standards

    Energy Technology Data Exchange (ETDEWEB)

    Stenner, Robert D.

    2007-04-24

    The importance and necessity for a fully developed and implemented National Incident Management System (NIMS) has been demonstrated in recent years by the impact of national events such as Hurricane Katrina in 2005. Throughout the history of emergency response to major disasters, especially when multiple response organizations are involved, there have been systemic problems in the consistency and uniformity of response operations. Identifying national standards that support the development and implementation of NIMS is key to helping solve these systemic problems. The NIMS seeks to provide uniformity and consistency for incident management by using common terminology and protocols that will enable responders to coordinate their efforts to ensure an efficient response.

  10. PROJECT REPORT

    African Journals Online (AJOL)

    medakubu

    We here present a very preliminary report on a field project entitled 'Vanishing. Voices from Ghana's Middle Belt', an Endangered Languages Documentation Project funded by the Endangered Languages Documentation Program based at the School of. Oriental and African Studies, University of London. It is being carried ...

  11. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

  12. A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital.

    Science.gov (United States)

    Nakajima, K; Kurata, Y; Takeda, H

    2005-04-01

    When patient safety programs were mandated for Japanese health care institutions, a safety culture, a tool for collecting incident reports, an organizational arrangement for multidisciplinary collaboration, and interventional methods for improvement had to be established. Observational study of effects of new patient safety programs. Osaka University Hospital, a large government-run teaching hospital. A voluntary and anonymous web-based incident reporting system was introduced. For the new organizational structure a clinical risk management committee, a department of clinical quality management, and area clinical risk managers were established with their respective roles clearly defined to advance the plan-do-study-act cycle and to integrate efforts. For preventive action, alert procedures, staff education, ward rounds by peers, a system oriented approach for reducing errors, and various feedback channels were introduced. Continuous incident reporting by all hospital staff has been observed since the introduction of the new system. Several error inducing situations have been improved: wrong choice of drug in computer prescribing, maladministration of drugs due to a look-alike appearance or confusion about the manipulation of a medical device, and poor after hours service of the blood transfusion unit. Staff participation in educational seminars has been dramatically improved. Ward rounds have detected problematic procedures which needed to be dealt with. Patient safety programs based on a web-based incident reporting system, responsible persons, staff education, and a variety of feedback procedures can help promote a safety culture, multidisciplinary collaboration, and strong managerial leadership resulting in system oriented improvement.

  13. Integrated Incident Management System (IIMS) web client application development, deployment and evaluation Staten Island (SI) demonstration project : final report.

    Science.gov (United States)

    2015-09-27

    This evaluation report provides background on the development and findings. The aim of the UTRC project was to develop and : deploy Portable IIMS based on Smartphone web applications. Previously, traditional IIMS was deployed in the field vehicles : ...

  14. Fire Incident Reporting Manual

    Science.gov (United States)

    1984-02-01

    the result of an incident that requires (or should require) treatment by a practitioner of medicine , a registered emergency medical technician, or a...UNANNOUNCED AIRCRAFT EMERGENCYS ~~PRIOR TO TAKE OFF OR AFTERLADN 5 FUEL OPERATIONS REQUIRING 1AREING G A FIRE10 ARRESTING GEAR’BARRIER FR . ENGAGEMENTS AND

  15. Analysis of Aviation Safety Reporting System Incident Data Associated with the Technical Challenges of the System-Wide Safety and Assurance Technologies Project

    Science.gov (United States)

    Withrow, Colleen A.; Reveley, Mary S.

    2015-01-01

    The Aviation Safety Program (AvSP) System-Wide Safety and Assurance Technologies (SSAT) Project asked the AvSP Systems and Portfolio Analysis Team to identify SSAT-related trends. SSAT had four technical challenges: advance safety assurance to enable deployment of NextGen systems; automated discovery of precursors to aviation safety incidents; increasing safety of human-automation interaction by incorporating human performance, and prognostic algorithm design for safety assurance. This report reviews incident data from the NASA Aviation Safety Reporting System (ASRS) for system-component-failure- or-malfunction- (SCFM-) related and human-factor-related incidents for commercial or cargo air carriers (Part 121), commuter airlines (Part 135), and general aviation (Part 91). The data was analyzed by Federal Aviation Regulations (FAR) part, phase of flight, SCFM category, human factor category, and a variety of anomalies and results. There were 38 894 SCFM-related incidents and 83 478 human-factorrelated incidents analyzed between January 1993 and April 2011.

  16. Review of methodologies for analysis of safety incidents at NPPs. Final report of a co-ordinated research project 1998-2001

    International Nuclear Information System (INIS)

    2002-03-01

    The safe operation of nuclear power plants around the world and the prevention of incidents in these installations remain key concerns for the nuclear community. In this connection, the feedback of operating experience plays a major role: every nuclear power plant or nuclear utility needs to have a system in place for collecting information on unusual events, whether these are incidents or merely deviations from normal operation. Reporting to the regulatory body of important events and lessons learned is normally carried out through the national reporting schemes based on regulatory reporting requirements. The most important lessons learned are further shared internationally, through, for example, the Joint IAEA/NEA Incident Reporting System (IRS) or the event information exchange of the World Association of Nuclear Operators (WANO). In order to properly assess the event, an adequate event investigation methodology has to be applied, which leads to the identification of correct root causes. Once these root causes have been ascertained, appropriate corrective actions can be established and corresponding lessons can be drawn. The overall goal of root cause analysis is the prevention of events or their recurrence and thus the overall improvement in plant safety. In 1998, the IAEA established a co-ordinated research project with the objective of exploring root cause methodologies and techniques currently in use in Member States, evaluating their strengths and limitations and developing criteria for appropriate event investigation methodologies. This report is the outcome of four years of co-ordinated research which involved 15 national and international research organizations

  17. Radiological incident preparedness for community hospitals: a demonstration project.

    Science.gov (United States)

    Jafari, Mary Ellen

    2010-08-01

    In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

  18. National Fire Incident Reporting System (NFIRS)

    Data.gov (United States)

    Department of Homeland Security — The National Fire Incident Reporting System (NFIRS) is a reporting standard that fire departments use to uniformly report on the full range of their activities, from...

  19. Cancer incidence in Canada: trends and projections (1983-2032

    Directory of Open Access Journals (Sweden)

    Lin Xie

    2015-01-01

    attributable to general population screening with the Papanicolaou (Pap test and successful treatment of screening-detected premalignant lesions. The immunization of school-aged children with the vaccine for human papilloma virus (HPV is anticipated to further reduce the incidence of cervical cancer. Implications for cancer control strategies: The projected aging and growth of the population are expected to lead to a progressive and significant increase in the total number of new cancer cases in Canada over the next 25 years. Consequently, this report indicates the need to continue to strengthen cancer control strategies and leverage resources to meet future health care requirements and reduce the burden of cancer in Canada. Although incidence rates are projected to decrease for many cancers, the rates for some cancers, for example, thyroid, liver, uterus, pancreas, kidney and leukemia, are estimated to increase. Additional etiological research is needed to better understand risk factors and guide prevention efforts. This monograph underscores the importance of cancer prevention by curbing smoking; promoting healthy eating, physical activity and weight management; enhancing uptake of cancer screening; and increasing coverage of HPV vaccination. The implication of future changes in our demographic profiles and cancer trends should be addressed from the full spectrum of cancer control, including research and surveillance, prevention and early detection, treatment, and psychosocial, palliative and medical care.

  20. Specialty-based, voluntary incident reporting in neonatal intensive care: description of 4846 incident reports

    NARCIS (Netherlands)

    Snijders, C.; van Lingen, R. A.; Klip, H.; Fetter, W. P. F.; van der Schaaf, T. W.; Molendijk, H. A.; Kok, J. H.; te Pas, E.; Pas, H.; van der Starre, C.; Bloemendaal, E.; Lopes Cardozo, R. H.; Molenaar, A. M.; Giezen, A.; Maat, H. E.; Molendijk, A.; Lavrijssen, S.; Mulder, A. L. M.; de Kleine, M. J. K.; Koolen, A. M. P.; Schellekens, M.; Verlaan, W.; Vrancken, S.; Schotman, L.; van der Zwaan, A.; van der Tuijn, Y.; Tibboel, D.; Kollen, B. J.

    2009-01-01

    OBJECTIVES: To examine the characteristics of incidents reported after introduction of a voluntary, non-punitive incident reporting system for neonatal intensive care units (NICUs) in the Netherlands; and to investigate which types of reported incident pose the highest risk to patients in the NICU.

  1. NEA incident reporting system: Three years' experience

    International Nuclear Information System (INIS)

    Otsuka, Y.; Haeussermann, W.

    1984-01-01

    The paper presents an overview of the NEA Incident Reporting System (IRS) which was set up to collect, assess and disseminate on safety-related incidents in nuclear power plants. The IRS information exchange is significant in two senses. First, it enables regulatory authorities and utilities in participating countries to take appropriate action to prevent the reported mishaps occurring again elsewhere. Secondly, the continuous collection and systematic analysis of such information allows identification of areas of concern where safety research should be strengthened. There are two stages in the IRS information exchange. First, the national IRS Co-ordinator selects information on significant incidents, in accordance with a common reporting threshold, from the abnormal occurrences reported to the regulatory body, to be distributed through the NEA Secretariat. This screening is intended to exclude minor events, so that only significant information is sent to participating countries. Secondly, a group of experts periodically reviews the incidents reported during the preceding twelve months to identify major areas of concern. To assist this process, a computer-based data retrieval system is being developed for IRS incident reports. The paper gives some details of the IRS mechanism and discusses reporting criteria and the information included in a report. Areas of concern derived from reported incidents, an outline of the data retrieval system, and examples of feedback of lessons learned and possibilities for international co-operation are also discussed. (author)

  2. Incident Reporting in Mashhad Hospitals

    Directory of Open Access Journals (Sweden)

    Davoodi R

    2013-10-01

    Full Text Available Objectives: In this study, our aim was to evaluate and classify the voluntary error reports in the hospitals of Mashhad University of Medical Sciences. Patients have the right to receive health care in accordance to the best standards. Health care carries a risk of harm for patient safety, and with respect to today’s stressful systems with a large number of patients, it would be inevitable. The meaning of risk management is to predict adverse events and reduce their occurrence.Materials and Methods: A voluntary medical error reporting form was designed and approved by the clinical governance team of Mashhad Medical University. They were then distributed inside hospitals in the way in which everyone (health providers and patients could access them easily. The forms were collected and classified monthly in all wards. Classification was performed on the base of type, outcome and reporter. Data gathering took place from spring to autumn 2012. The data was analyzed by the SPSS software. Results: 2500 errors were extracted from 1000 voluntary error reporting forms of the 12 hospitals of Mashhad Medical University. The most frequent error type was treatment errors (36% related to drug administration, standard procedures and surgical events. Conclusions: Error reporting as a basic activity has an important role in discovering pitfalls of the health care system. To promote the reporting culture, its non punitive base must become clear for all professors and staff members, because this kind of reporting could lead to fewer medical errors and higher staff awareness about probable errors.

  3. Factors influencing incident reporting in surgical care.

    Science.gov (United States)

    Kreckler, S; Catchpole, K; McCulloch, P; Handa, A

    2009-04-01

    To evaluate the process of incident reporting in a surgical setting. In particular: the influence of event outcome on reporting behaviour; staff perception of surgical complications as reportable events. Anonymous web-based questionnaire survey. General Surgical Department in a UK teaching hospital. Of 203 eligible staff, 55 (76.4%) doctors and 82 (62.6%) nurses participated. Knowledge and use of local reporting system; propensity to report incidents which vary by outcome (harm, no harm, harm prevented); propensity to report surgical complications; practical and psychological barriers to reporting. Nurses were significantly more likely to know of the local reporting system and to have recently completed a report than doctors. The level of harm (F(1.8,246) = 254.2, pvs 53%, z = 4.633, psystems.

  4. Prometheus Project final report

    Science.gov (United States)

    Taylor, Randall

    2005-01-01

    This Final Report serves as an executive summary of the Prometheus Project's activities and deliverables from November 2002 through September 2005. It focuses on the challenges from a technical and management perspective, what was different and innovative about this project, and identifies the major options, decisions, and accomplishments of the Project team as a whole. However, the details of the activities performed by DOE NR and its contractors will be documented separately in accordance with closeout requirements of the DOE NR and consistent with agreements between NASA and NR.

  5. Critical Incident Reporting Systems: Perceived Competing Social ...

    African Journals Online (AJOL)

    The safe operation of complex socio-technical systems is dependent upon the reporting of safety critical incidents by operators within a system. Through the action of reporting, systems develop the capability as a learning organisation to improve human and organisational performance. The aim of the study is therefore to ...

  6. How to Report a Pesticide Incident Involving Exposures to People

    Science.gov (United States)

    Pesticides incidents must be reported by pesticide registrants. Others, such as members of the public and environmental professionals, would like to report pesticide incidents. This website will facilitate such incident reporting.

  7. CAFE Project : final report

    NARCIS (Netherlands)

    A. Weber; R. Carter; C.J. Stanford; A. Weber

    2003-01-01

    textabstract[MAS E-0302] This is the final public report of the CAFE project (ESPRIT 7023). CAFE developed a secure conditional access architecture and implemented a multi-currency electronic purse system based on smart cards and infrared wallets. The electronic purse was tested in user trials at

  8. Project Cowboy. Completion report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1960-11-01

    Project Cowboy was an experiment undertaken to validate a seimic decoupling theory. The theory postulates that the seismic effects of any explosive energy release can be reduced by detonation in a cavity (decoupled) instead of in a packed and tamped (coupled) cavity. Project Cowboy consisted of detonating a series of chemical high explosives emplaced in a deep ({similar_to}800 ft.) underground spherical cavity and of comparing the seismic effects of these explosions with the effects of the detonation of identical charges packed into tamped drill holes. This report describes the project management activities in 1959 and 1960, the engineering planning, expenditures, and excavation progress at the salt deposit site in Louisiana. (LCL)

  9. Final project report

    Energy Technology Data Exchange (ETDEWEB)

    Nitin S. Baliga and Leroy Hood

    2008-11-12

    The proposed overarching goal for this project was the following: Data integration, simulation and visualization will facilitate metabolic and regulatory network prediction, exploration, and formulation of hypotheses. We stated three specific aims to achieve the overarching goal of this project: (1) Integration of multiple levels of information such as mRNA and protein levels, predicted protein-protein interactions/associations and gene function will enable construction of models describing environmental response and dynamic behavior. (2) Flexible tools for network inference will accelerate our understanding of biological systems. (3) Flexible exploration and queries of model hypotheses will provide focus and reveal novel dependencies. The underlying philosophy of these proposed aims is that an iterative cycle of experiments, experimental design, and verification will lead to a comprehensive and predictive model that will shed light on systems level mechanisms involved in responses elicited by living systems upon sensing a change in their environment. In the previous years report we demonstrated considerable progress in development of data standards, regulatory network inference and data visualization and exploration. We are pleased to report that several manuscripts describing these procedures have been published in top international peer reviewed journals including Genome Biology, PNAS, and Cell. The abstracts of these manuscripts are given and they summarize our accomplishments in this project.

  10. Work Project Report

    CERN Document Server

    Sallinen, Roosa-Maria

    2015-01-01

    I worked in High Power Converters section (HPC). My supervisors were Karsten Kahle and Charles-Mathieu Genton. Our team consisted of us and Francisco Rafael Blanquez Delgado who also helped me if I had any problems. The team’s main assignment is to design the new Static Var Compensator (SVC) for MEQ59 in Meyrin. The idea is to standardise all the SVCs needed at CERN in order to make the design, installation and maintenance easier and more cost effective. This report describes my project at CERN.

  11. Hazmat Yearly Incident Summary Reports - Data Mining Tool

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  12. Hazmat 10 Year Incident Summary Reports - Data Mining Tool

    Data.gov (United States)

    Department of Transportation — Series of Incident data and summary statistics reports produced which provide statistical information on incidents by type, year, geographical location, and others....

  13. Final Project Report

    DEFF Research Database (Denmark)

    Duer, Karsten

    1997-01-01

    , engineering and architectural basis which will support the appropriate use of aerogels in windows, solar collectors and passive solar applications, with the aim of saving or producing thermal energy for use in buildings". This objective is in very good agreement with the general scope of task 18 but where...... and thermal properties of aerogel as a material for window applications 3.Construction of an aerogel DGU and measurement of key performance parameters. The goal for the aerogel DGU was to reach a Total Solar Energy Transmittance above 0.75 and a U-value below 0.5 W/m²K. These are values that can......The report summarizes the work that has been carried out within the project "B1 AEROGELS" as a part of the IEA SH&CP Task 18 "Advanced Glazing and Associated Materials For SolarAnd Building Applications". By providing at the same time thermal insulation and transparency the silica aerogel is a very...

  14. IRRSUD Project - Final report

    CERN Document Server

    Loyer, F

    2002-01-01

    IRRSUD is an irradiation facility which makes use of the low energy (0.5 MeV/n - 1 MeV/n) beams from the GANIL IRRSUD injectors. It is financed by the group GARI (Group of Ion Research Applications) and was established as a joint-venture of GANIL and CIRIL to develop the applied physics and ion based industrial applications. Among research directions framed by IRRSUD one can mention; the nano-technologies i.e. utilisation of the modifications induced in materials exposed to ion bombardment; realization of microporous membranes and low-D materials; aging of materials by irradiation. Also, the low energy ions issued from the injector matches very well the fission fragments in reactors. In addition IRRSUD could be used as testing facility for injectors.. The report is structured as follows: 1. Outline; 1.2. Project's main features; 1.3. Ion beam characterization; 2. Technical solutions; 2.1. Denominations; 2.2. Beam optics; 2.3. Beam bending magnets; 2.4. Beam instrumentation; 2.5. Current supply; 2.6. Vacuum sy...

  15. A nationwide medication incidents reporting system in the netherlands

    NARCIS (Netherlands)

    K.C. Cheung (Ka Chun); P.M.L.A. van den Bemt (Patricia); M.L. Bouvy (Marcel); M.E. Wensing (Michel); P.A. de Smet (Peter)

    2011-01-01

    textabstractObjective Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central

  16. A nationwide medication incidents reporting system in The Netherlands

    NARCIS (Netherlands)

    Cheung, K.C.; Bemt, P.M. van den; Bouvy, M.L.; Wensing, M.J.P.; Smet, P.A.G.M. de

    2011-01-01

    Objective Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication

  17. Orion Project Status Report

    Science.gov (United States)

    Stiewing, Albert; Hopkins, Jeffrey L.

    2015-05-01

    Originally started in 2012 as the Betelgeuse Project, interest in the other bright stars of Orion soon expanded the Project stars to include a total of six of the brightest stars in Orion. The name was then changed to the Orion Project. Orion is one of the most famous constellations. Its declination along the celestial equator is such that it is visible from most of northern and southern hemispheres. In addition, the stars of Orion are very bright and interesting. The Orion Project now includes the stars Betelgeuse, Rigel, Saiph and the three stars of Orion's belt, Mintaka, Alnilam and Alnitak. The projects objectives are both to help the observer produce quality photometric and spectroscopic data and to produce archival quality photometric (BVRIJH bands) and spectroscopy (low, mid and high-resolution) data. This paper is a summary of the Orion Project status.

  18. Diabetes incidence and projections from prevalence surveys in Fiji.

    Science.gov (United States)

    Morrell, Stephen; Lin, Sophia; Tukana, Isimeli; Linhart, Christine; Taylor, Richard; Vatucawaqa, Penina; Magliano, Dianna J; Zimmet, Paul

    2016-11-25

    Type 2 diabetes mellitus (T2DM) incidence is traditionally derived from cohort studies that are not always feasible, representative, or available. The present study estimates T2DM incidence in Fijian adults from T2DM prevalence estimates assembled from surveys of 25-64 year old adults conducted over 30 years (n = 14,288). T2DM prevalence by five-year age group from five population-based risk factor surveys conducted over 1980-2011 were variously adjusted for urban-rural residency, ethnicity, and sex to previous censuses (1976, 1986, 1996, 2009) to improve representativeness. Prevalence estimates were then used to calculate T2DM incidence based on birth cohorts from the age-period (Lexis) matrix following the Styblo technique, first used to estimate annual risk of tuberculosis infection (incidence) from sequential Mantoux population surveys. Poisson regression of year, age, sex, and ethnicity strata (n = 160) was used to develop projections of T2DM prevalence and incidence to 2020 based on various scenarios of population weight measured by body mass index (BMI) change. T2DM prevalence and annual incidence increased in Fiji over 1980-2011. Prevalence was higher in Indians and men than i-Taukei and women. Incidence was higher in Indians and women. From regression analyses, absolute reductions of 2.6 to 5.1% in T2DM prevalence (13-26% lower), and 0.5-0.9 per 1000 person-years in incidence (8-14% lower), could be expected in 2020 in adults if mean population weight could be reduced by 1-4 kg, compared to the current period trend in weight gain. This is the first application of the Styblo technique to calculate T2DM incidence from population-based prevalence surveys over time. Reductions in population BMI are predicted to reduce T2DM incidence and prevalence in Fiji among adults aged 25-64 years.

  19. Loss of Situation Awareness in Pilots: Analysis of Incident Reports

    Science.gov (United States)

    Villeda, Eric B.

    1996-01-01

    Introduction Approximately 75% of all aviation accidents and incidents are attributable to human failures in monitoring, managing, and operating system. Tactical decision errors were found to be a factor in 25 of 37 major US air transport accidents between 1978 and 1990. These two facts demonstrate the inability of some pilots to maintain situation awareness. Situation awareness (SA) is defined as 'the perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future". Thus, when a pilot loses SA, he or she is unable to ether perceive, comprehend, or project the status of the aircraft. In pilots terms, he or she has 'fallen behind the airplane'. Our study this summer involved an analysis of 190 NASA Aviation Safety Reporting System (ASRS) reports.

  20. HARVARD PROJECT PHYSICS PROGRESS REPORT.

    Science.gov (United States)

    Harvard Univ., Cambridge, MA.

    THIS REPORT OF HARVARD PROJECT PHYSICS PRESENTS DRAFTS OF THREE SPEECHES DELIVERED TO THE AMERICAN ASSOCIATION OF PHYSICS TEACHERS (AAPT) MEETING, FEBRUARY, 1967. THE ADDRESS BY GERALD HOLTON DEALS WITH THE AIMS AND PROGRESS OF THE PROJECT. DISCUSSED ARE (1) PROJECT PARTICIPANTS, (2) AIMS AND CONTENT, (3) THE NEW EMPHASIS, (4) SURVEY OF COURSE…

  1. ACCESS Project: Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Weller, Heiko [Robert Bosch, LLC, Farmington Hills, MI (United States)

    2015-04-01

    The ACCESS project addressed the development, testing, and demonstration of the proposed advanced technologies and the associated emission and fuel economy improvement at an engine dynamometer and on a full-scale vehicle. Improve fuel economy by 25% with minimum performance penalties Achieve SULEV level emissions with gasoline Demonstrate multi-mode combustion engine management system

  2. Final Year Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Hubsch, Tristan [Howard University

    2013-06-20

    In the last years of this eighteen-year grant project, the research efforts have focused mostly on the study of off-shell representations of supersymmetry, both on the worldline and on the world- sheet, i.e., both in supersymmetric quantum mechanics and in supersymmetric field theory in 1+1-dimensional spacetime.

  3. Debt collection project report

    Energy Technology Data Exchange (ETDEWEB)

    1980-05-01

    In October 1979 the Office of Management and Budget initiated a review of debt collection within the Federal Government. A DOE Debt Collection Project Team was established, and seven activites were selected for review. These were Albuquerque Operations Office; Bonneville Power Administration; Chicago Operations and Regional Office; Naval Petroleum Reserves, California; Oak Ridge Operations Office; Washington Financial Services Division; and Western Area Power Administration. The team visited each of these activities to collect data on the size, age, and types of receivables managed and procedures for billing, aging, and handling overdue accounts. Various deficiencies were found to exist at several of the DOE entities that are not consistent with good management practices in the performance of their debt collection functions. Also, the Debt Collection Project Team identified a wide variation in the procedures followed by DOE activities in the management of accounts receivable, and a wide variation in the effectiveness of the debt management functions. 1 figure, 17 tables. (RWR)

  4. Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Small, R. Justin [Woods Hole Oceanographic Institution, MA (United States); Bryan, Frank [Woods Hole Oceanographic Institution, MA (United States); Tribbia, Joseph [Woods Hole Oceanographic Institution, MA (United States); Park, Sungsu [Woods Hole Oceanographic Institution, MA (United States); Dennis, John [Woods Hole Oceanographic Institution, MA (United States); Saravanan, R. [Woods Hole Oceanographic Institution, MA (United States); Schneider, Niklas [Woods Hole Oceanographic Institution, MA (United States); Kwon, Young-Oh [Woods Hole Oceanographic Institution, MA (United States)

    2015-06-01

    Most climate models are currently run with grid spacings of around 100km, which, with today’s computing power, allows for long (up to 1000 year) simulations, or ensembles of simulations to explore climate change and variability. However this grid spacing does not resolve important components of the weather/climate system such as atmospheric fronts and mesoscale systems, and ocean boundary currents and eddies. The overall aim of this project has been to look at the effect of these small-scale features on the weather/climate system using a suite of high and low resolution climate models, idealized models and observations. This project was only possible due to the highly scalable aspect of the CAM Spectral Element dynamical core, and the significant resources allocated at Yellowstone and NERSC for which we are grateful.

  5. Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Bogucz, E A

    2010-12-13

    This project pursued innovations to improve energy efficiency and indoor environmental quality (IEQ) in commercial and residential buildings. For commercial buildings, the project developed a testbed for “intelligent nested environmental systems technologies (iNEST),” which monitor and control energy flows and IEQ across a cascade of spaces from individuals’ desktops to office suites to floors to whole buildings. An iNEST testbed was constructed at Syracuse University and was used to assess the use of devices such as personal badges and CO2 sensors to study how reduced energy use and improved IEQ could be achieved. For residential buildings, resources were targeted in support of DoE’s Builders Challenge Program and to recruit Syracuse, NY builders. Three homes in Syracuse’s Near Westside neighborhood were also registered under the program by Syracuse University team, with an additional home registered by one of the builders. Findings from the work at the iNEST testbed facility, and results from other related projects were disseminated through Syracuse Center of Excellence in Environmental and Energy Systems (SyracuseCoE) 2008 Annual Symposium, the 9th International Healthy Buildings 2009 Conference & Exhibition, and through SyracuseCoE’s website and eNewsletters to inform the broader community of researchers, designers and builders. These public communication activities helped enhance the understanding of high performance buildings and facilitate further market acceptance.

  6. Final Project Report

    DEFF Research Database (Denmark)

    Workspace

    2003-01-01

    of the Disappearing Computer to be that of  “Augmenting reality”, where “Augmented reality” meant:  •  Augmented user – positioning, visualising. •  Augmented environment, Panels, tables and site-pack •  Augmented Artifacts - RFID , tagging, tracking •  Augmented communications – efficient exchange and integration......The primary focus of the WORKSPACE project was to augment the working  environment through the development of spatial computing components, initially for  members of the design professions, but with wider applicability to a range of work  domains.     The project interpreted the requirements...... of the above.    The philosophy was to make the computer disappear by both making it large and  embedding it into the environment (e.g. furniture).  The project has successfully achieved its objectives, and has developed a range of  demonstrator prototypes, some of which is in daily use by practitioners within...

  7. 49 CFR 191.9 - Distribution system: Incident report.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Distribution system: Incident report. 191.9... CONDITION REPORTS § 191.9 Distribution system: Incident report. (a) Except as provided in paragraph (c) of... report required by this section need not be submitted with respect to master meter systems or LNG...

  8. Final project report

    Energy Technology Data Exchange (ETDEWEB)

    Podzorov, Vitaly [Rutgers Univ., New Brunswick, NJ (United States)

    2012-10-28

    The scope of this project is to investigate fundamental aspects of self-assembled monolayers (SAMs) grown at the surface of organic semiconductors and other electronic materials, recently discovered in our group (Fig. 1) [1]. Understanding the growth mechanism and structure of these SAMs, as well as investigating the effect of SAM-induced high surface conductivity, are the main thrusts of the project. An additional thrust of the project is to find new ways of surface doping or surface gating of novel semiconductors, in which electronic traps at the interface would be passivated. Molecular self assembly is an exciting research area of modern materials science, playing an important role in a variety of emerging applications, such as organic and molecular electronics, bioengineering, sensors and actuators. The current effort in this field has been focused on two experimental platforms: SAMs on metals (e.g., Au) and SAMs on inorganic oxides (e.g., SiO2). We have recently discovered the third platform, molecular self-assembly at the surface of carbon-based electronic materials (organic semiconductors, graphene and CNTs), which opens new opportunities for fundamental research and applications (Fig. 1) [1, 2, 3]. One of the most intriguing aspects of the new discovery is that formation of an FTS self-assembled monolayer on these materials induces a high-density mobile charges, with n up to 1014 cm-2, resulting in a large surface conductivity, σ ≈ 10-5 S·square-1 [1]. The effect is due to an interfacial electron transfer from the semiconductor to the SAM, resulting in a 0.54 V potential drop across the 1.3 nm-thick SAM, as recently revealed by Kelvin probe microscopy in rubrene [4].

  9. Novalignin project. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Stigsson, Lars [KIRAM AB, Saltsjoebaden (Sweden)

    2002-02-01

    The NovaFiber process is a new and sustainable technology for manufacturing of chemical pulp incorporating an efficient route for recovery of energy and pulping chemicals. The process is substantially sulphur chemicals free and this creates a great potential for recovery of sulphur free lignin for internal use as a fuel or export from the mill. The NovaLignin project has been launched to evaluate this potential from a technical and economical perspective. The NovaLignin research and development effort has been partly financed by NUTEK, Energimyndigheten and Mistra. A major feature of the new lignin is the absence of organically bound sulphur compounds in the material increasing the scope of potential uses for the lignin as a precursor for fine chemicals preparation or as a sulphur free biomass based fuel. Two major forest industry laboratories in Scandinavia have conducted the laboratory cooking and lignin extraction work in the present project. The lignin extracted from the NovaFiber process, NovaLignin, has been characterised and evaluated for use in different applications. The consequences of lignin extraction in different mill configurations with a recovery boiler or a black liquor gasification system for chemicals recovery is outlined below. The NovaFiber pulp mill is compared to a reference mill based on conventional kraft pulping on the same wood raw material. The mill capacity is 2000 t/d bleached softwood pulp. The lime kiln is fired with bark and the remaining falling bark is sold, or if there is a deficit, more bark is purchased. Initial laboratory studies conducted at ATO-DLO, the Netherlands, clearly show a great potential for NovaLignin as a functional additive in thermoplastics. NovaFiber and Kraft lignin act as an UV stabiliser for polyethylene at a comparable level as an expensive commercial stabiliser, such as HALS. This means that NovaFiber lignin has a very good price/performance ratio. Experiments show that NovaFiber lignin has good potential

  10. Summer Project Report

    CERN Document Server

    Islam, Wasikul

    2015-01-01

    In this project we mainly prepared and classified several materials, important links for understanding accelerators for different age group. Accelarators now-a-days are very much important tool for not only particle physics laboratories but also for the common people for its extended applications. So, it is very much important to make people know the basics of accelerators, its basic principles, objectives and different varieties. As different age group of people have different level of understandings, so it was necessary to develop materials differently for categories based on age group. Hence, for three different categories we have separately prepared different presentations and collected important all the useful weblinks, videos, animations, games etc. related to accelerators and put them to our new webpage : https://twiki.cern.ch/twiki/bin/view/Main/Material

  11. Project radon final report

    International Nuclear Information System (INIS)

    Ekholm, S.; Rossby, U.

    1990-01-01

    The main radiation problem in Sweden is due to radon in dwellings. At the Swedish State Power Board, R, D and D about radon has been going on since 1980. The work has concentrated on the important questions: How to find building with enhanced radon levels?; How to accurately decide on measures that will give adequate cleaning-up results, using appropriate measurement procedures; What cleaning-up effect is possible to achieve with an electro-filter?; and What cleaning-up effects are possible to achieve with different types of ventilation systems? The R, D and D-work, has been pursued in cooperation with universities of technology in Denmark and Finland, equipment manufacturers, consultants and authorities concerned. It was decided in December 1986 to give an offer to some SSPB-employees to investigate the radon situation of their dwellings, in order to test methods of measurement and cleaning-up under realistic conditions and to develop the methods to commercial maturity. The investigation was named 'Project Radon' and was carried out in three years with costs amounting to 1 M dollars. During the project less comprehensive radon measurements, named 'trace-measurements' were undertaken in about 1300 dwellings and more elaborate measurements, leading to suggestions of actions to be taken, in about 400 dwellings. Out of the suggestions, about 50 are carried out including control measurement after actions taken. The control measurement have shown that the ability to suggest appropriate actions is very successful - in just one case was a minor additional action necessary. The high reliability is achieved by always doing elaborate measurements before suggested mitigation method is decided on. (authors)

  12. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics.

    Science.gov (United States)

    Paulson, Kelly G; Park, Song Youn; Vandeven, Natalie A; Lachance, Kristina; Thomas, Hannah; Chapuis, Aude G; Harms, Kelly L; Thompson, John A; Bhatia, Shailender; Stang, Andreas; Nghiem, Paul

    2018-03-01

    Merkel cell carcinoma (MCC) incidence rates are rising and strongly age-associated, relevant for an aging population. Determine MCC incidence in the United States and project incident cases through the year 2025. Registry data were obtained from the SEER-18 Database, containing 6600 MCC cases. Age- and sex-adjusted projections were generated using US census data. During 2000-2013, the number of reported solid cancer cases increased 15%, melanoma cases increased 57%, and MCC cases increased 95%. In 2013, the MCC incidence rate was 0.7 cases/100,000 person-years in the United States, corresponding to 2488 cases/year. MCC incidence increased exponentially with age, from 0.1 to 1.0 to 9.8 (per 100,000 person-years) among age groups 40-44 years, 60-64 years, and ≥85 years, respectively. Due to aging of the Baby Boomer generation, US MCC incident cases are predicted to climb to 2835 cases/year in 2020 and 3284 cases/year in 2025. We assumed that the age-adjusted incidence rate would stabilize, and thus, the number of incident cases we projected might be an underestimate. An aging population is driving brisk increases in the number of new MCC cases in the United States. This growing impact combined with the rapidly evolving therapeutic landscape warrants expanded awareness of MCC diagnosis and management. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jin [University of California Santa Cruz; Zhao, Yiping [University of Georgia at Athens

    2014-12-05

    In this entire project period from 2005-2014, we have made significant progress in developing novel nanostructures of metal oxides (MOs) for solar hydrogen generation based on photoelectrochemical (PEC). Materials investigated are focused on 1D and 0D MO nanostructures of TiO2, WO3, ZnO, and Fe2O3 in conjunction with quantum dot (QD) sensitization and chemical doping (N or H) to alter their electronic band structures for both visible light absorption and for facilitating interfacial charge transport. In addition, we have used plasmonic metal nanostructures to enhance the PEC performance by improving light absorption of QDs via enhanced scattering of the plamonic metal. Most importantly, we have discovered a multipronged strategy for improving PEC performance: using plasmonic metal nanostructure to enhance light absorption, QDs to improve charge transfer, and chemical doping to increase charge transport in metal oxides for PEC. The combination is critical for overall high efficiency of PEC. This strategy is developed and demonstrated for the first time to our best knowledge.

  14. Summer Student Project Report

    CERN Document Server

    Cai, Yiming

    2014-01-01

    In order to know the influence of penguin contribution to the measurement of CP violation phase in Bs to J/Psi phi. We need to measure it in Bs to J/Psi Kst. And we also need to know the ratio of these two branch ratios. To get the branch ratio of Bs to J/Psi phi, we use the data of Bs to J/Psi KK and correct it by a p-wave/s-wave factor. This report shows the results of this p-wave/s-wave correction ratio.

  15. RECON Pilot Project. Final Report.

    Science.gov (United States)

    Avram, Henriette D.

    One of the specific recommendations in the Retrospective Conversion (RECON) feasibility report (ED 032 895) was that a pilot project be established to test various conversion techniques, ideally covering the highest priority material (English-language monograph records from 1960-68). A two-year pilot project was initiated in August 1969. This…

  16. Dehydration project report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-31

    Catalytic Industrial Group became interested in the ability to use its catalytic infrared technology for the removal of moisture in substances after having had very positive experience in removing moisture from water-based coatings which are becoming increasingly popular as industry strives to comply with clean air mandates. The first attempts were crude but showed that the moisture could be removed, and intriguing enough that they started to think about a conveying-based system that would remove moisture from products. The initial tests were designed around sawdust. The authors felt that the market in particleboard and in the MDF board by itself justified the research into this concept. The Kansas Department of Health and Environment has been kept apprised of the on-going development of the infrared drying system by Catalytic Industrial Group. There were some early delays in the delivery of equipment needed to build the prototype machine. The design changes identified during the experimental phase of the development of the infrared dryer have been resolved and a process-testing device has been developed. This technical report outlines the progress made to date.

  17. Designed Incident Reporting System in P2TKN BATAN

    International Nuclear Information System (INIS)

    Supriatna, Piping; Sudarsyamsu S; Bambang S; Karyana, Edy

    2000-01-01

    Incident Reporting System is a routine activating for record all incident of Nuclear Plant Characteristic of the incident Reporting System (IRS) recording can be made locally, regionally or national scope. IRS recording of nuclear activity responsible to Nuclear Safety Technology Development Center (NSTDC). In this report has been designed IRS for nuclear incident in Batan, which the socialization in the field will be done step by step. The first step will be applied in NSTCD scope, the second step will be applied in PPTA Serpong area, and the third step will be applied in Batan area

  18. Patient safety incidents are common in primary care: A national prospective active incident reporting survey.

    Directory of Open Access Journals (Sweden)

    Philippe Michel

    Full Text Available The study objectives were to describe the incidence and the nature of patient safety incidents (PSIs in primary care general practice settings, and to explore the association between these incidents and practice or organizational characteristics.GPs, randomly selected from a national influenza surveillance network (n = 800 across France, prospectively reported any incidents observed each day over a one-week period between May and July 2013. An incident was an event or circumstance that could have resulted, or did result, in harm to a patient, which the GP would not wish to recur. Primary outcome was the incidence of PSIs which was determined by counting reports per total number of patient encounters. Reports were categorized using existing taxonomies. The association with practice and organizational characteristics was calculated using a negative binomial regression model.127 GPs (participation rate 79% reported 317 incidents of which 270 were deemed to be a posteriori judged preventable, among 12,348 encounters. 77% had no consequences for the patient. The incidence of reported PSIs was 26 per 1000 patient encounters per week (95% CI [23‰ -28‰]. Incidents were three times more frequently related to the organization of healthcare than to knowledge and skills of health professionals, and especially to the workflow in the GPs' offices and to the communication between providers and with patients. Among GP characteristics, three were related with an increased incidence in the final multivariable model: length of consultation higher than 15 minutes, method of receiving radiological results (by fax compared to paper or email, and being in a multidisciplinary clinic compared with sole practitioners.Patient safety incidents (PSIs occurred in mean once every two days in the sampled GPs and 2% of them were associated with a definite possibility for harm. Studying the association between organizational features of general practices and PSIs remains a

  19. Automatic Analysis of Critical Incident Reports: Requirements and Use Cases.

    Science.gov (United States)

    Denecke, Kerstin

    2016-01-01

    Increasingly, critical incident reports are used as a means to increase patient safety and quality of care. The entire potential of these sources of experiential knowledge remains often unconsidered since retrieval and analysis is difficult and time-consuming, and the reporting systems often do not provide support for these tasks. The objective of this paper is to identify potential use cases for automatic methods that analyse critical incident reports. In more detail, we will describe how faceted search could offer an intuitive retrieval of critical incident reports and how text mining could support in analysing relations among events. To realise an automated analysis, natural language processing needs to be applied. Therefore, we analyse the language of critical incident reports and derive requirements towards automatic processing methods. We learned that there is a huge potential for an automatic analysis of incident reports, but there are still challenges to be solved.

  20. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...

  1. FutureGen Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Cabe, Jim; Elliott, Mike

    2010-09-30

    This report summarizes the comprehensive siting, permitting, engineering, design, and costing activities completed by the FutureGen Industrial Alliance, the Department of Energy, and associated supporting subcontractors to develop a first of a kind near zero emissions integrated gasification combined cycle power plant and carbon capture and storage project (IGCC-CCS). With the goal to design, build, and reliably operate the first IGCC-CCS facility, FutureGen would have been the lowest emitting pulverized coal power plant in the world, while providing a timely and relevant basis for coal combustion power plants deploying carbon capture in the future. The content of this report summarizes key findings and results of applicable project evaluations; modeling, design, and engineering assessments; cost estimate reports; and schedule and risk mitigation from initiation of the FutureGen project through final flow sheet analyses including capital and operating reports completed under DOE award DE-FE0000587. This project report necessarily builds upon previously completed siting, design, and development work executed under DOE award DE-FC26- 06NT4207 which included the siting process; environmental permitting, compliance, and mitigation under the National Environmental Policy Act; and development of conceptual and design basis documentation for the FutureGen plant. For completeness, the report includes as attachments the siting and design basis documents, as well as the source documentation for the following: • Site evaluation and selection process and environmental characterization • Underground Injection Control (UIC) Permit Application including well design and subsurface modeling • FutureGen IGCC-CCS Design Basis Document • Process evaluations and technology selection via Illinois Clean Coal Review Board Technical Report • Process flow diagrams and heat/material balance for slurry-fed gasifier configuration • Process flow diagrams and heat/material balance

  2. Serious incidents after death: content analysis of incidents reported to a national database.

    Science.gov (United States)

    Yardley, Iain E; Carson-Stevens, Andrew; Donaldson, Liam J

    2018-02-01

    Objectives To describe serious incidents occurring in the management of patient remains after their death. Design Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.

  3. A nationwide medication incidents reporting system in The Netherlands.

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M L A; Bouvy, Marcel L; Wensing, Michel; De Smet, Peter A G M

    2011-01-01

    Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication incidents registration (CMR) was developed. This article describes the architecture, implementation and current status of the CMR in The Netherlands and compare it with similar systems in other countries. Adequate IT is required to sufficiently support a multicenter reporting system. The CMR system consists of a website, a database, a web-based reporting form, an application to import reports generated in other reporting systems, an application to generate an overview of reported medication incidents, and a national warning system for healthcare providers. From the start of CMR 90 of all 93 (96.8%) hospitals and 872 of 1948 (44.8%) community pharmacies participated. Between March 2006 and March 2010 the CMR comprised 15,694 reports of incidents. In the period from March 2010 to March 2011, 1642 reports were submitted by community pharmacies in CMR and the hospitals submitted 2517 reports. CMR is similar to various systems in other countries, but it seems to use more IT applications. The CMR is developing into a nationwide reporting system of medication incidents in The Netherlands, in which hospitals, community pharmacies, mental healthcare organizations and general practitioners participate. The architecture of the system met the requirements of a nationwide reporting system across different healthcare providers.

  4. C2-Related Incidents Reported by UAS Pilots

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. This presentation focuses on incidents that involved the management of the command and control (C2) link. The identified issues include loss of link, interference from undesired transmissions, voice latency, accidental control transfer, and the use of the lost link timer, or lost link OK features.

  5. Clinical incidents involving students on placement: an analysis of incident reports to identify potential risk factors.

    Science.gov (United States)

    Gaida, J E; Maloney, S; Lo, K; Morgan, P

    2015-06-01

    Students are sometimes involved in incidents during clinical training. To the authors' knowledge, no quantitative studies of incidents specifically involving physiotherapy students on clinical placement are available in the literature. A retrospective audit (2008 to 2011) of incident reports involving physiotherapy students was conducted to identify the nature and features of incidents. The study aimed to determine if injuries to a student or patient were more or less likely when the supervisor was in close proximity, and whether students with lower academic performance in their preclinical semester were more likely to be involved in an incident. There were 19 care-delivery-related and three equipment-related incidents. There were no incidents of violent, aggressive or demeaning behaviour towards students. The incident rate was 9.0/100,000 student-hours for third-year students and 6.8/100,000 student-hours for fourth-year students. The majority of incidents (55%) occurred from 11 am to 12-noon and from 3 pm to 3.30 pm. Incidents more often resulted in patient or student injury when the supervisor was not in close proximity (approximately 50% vs approximately 20%), although the difference was not significant (P=0.336). The academic results of students involved in incidents were equivalent to the whole cohort in their preclinical semester {mean 75 [standard deviation (SD) 6] vs 76 (SD 7); P=0.488}. The unexpected temporal clustering of incidents warrants further investigation. Student fatigue may warrant attention as a potential contributor; however, contextual factors, such as staff workload, along with organisational systems, structures and procedures may be more relevant. The potential relationship between supervisor proximity and injury also warrants further exploration. The findings of the present study should be integrated into clinical education curricula and communicated to clinical educators. Copyright © 2014 Chartered Society of Physiotherapy. Published by

  6. SU-E-P-07: Retrospective Analysis of Incident Reports at a Radiology Department: Feedback From Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Kakinohana, Y; Toita, T; Heianna, J; Murayama, S [School of medicine, University of the Ryukyus, Nishihara-cho, Okinawa (Japan)

    2015-06-15

    Purpose: To provide an overview of reported incidents that occurred in a radiology department and to describe the most common causal source of incidents. Methods: Incident reports from the radiology department at the University of the Ryukyus Hospital between 2008 and 2013 were collected and analyzed retrospectively. The incident report form contains the following items, causal factors of the incident and desirable corrective actions to prevent recurrence of similar incidents. These items allow the institution to investigate/analyze root causes of the incidents and suggest measures to be taken to prevent further, similar incidents. The ‘causal factors of the incident’ item comprises multiple selections from among 24 selections and includes some synonymous selections. In this study, this item was re-categorized into four causal source types: (i) carelessness, (ii) lack of skill or knowledge, (iii) deficiencies in communication, and (iv) external factors. Results: There were a total of 7490 incident reports over the study period and 276 (3.7%) were identified as originating from the radiology department. The most frequent causal source type was carelessness (62%). The other three types showed similar frequencies (10–14%). The staff members involved in incidents indicate three predominant desirable corrective actions to prevent or decrease the recurrence of similar incidents. These are ‘improvement in communication’ (24%), ‘staff training/education’ (19%), and ‘daily medical procedures’ (22%), and the most frequent was ‘improvement in communication’. Even though the most frequent causal factor was related to carelessness, the most desirable corrective action indicated by the staff members was related to communication. Conclusion: Our finding suggests that the most immediate causes are strongly related to carelessness. However, the most likely underlying causes of incidents would be related to deficiencies in effective communication. At our

  7. Pediatric safety incidents from an intensive care reporting system.

    Science.gov (United States)

    Skapik, Julia Lynn; Pronovost, Peter J; Miller, Marlene R; Thompson, David A; Wu, Albert W

    2009-06-01

    Adverse events impose a great burden on patients and the health care system, but not enough is known about how to address incidents involving pediatric patients. This study examined the demographic factors, types of events, contributing system factors, and harm associated with incidents that occur in pediatric intensive care units. Cross-sectional analysis of 2 years of data on all pediatric safety incidents and near misses reported to the voluntary provider-recorded Intensive Care Unit Safety Reporting System in regards to harm and contributing factors. In 464 incidents reported from 23 intensive care units to the Intensive Care Unit Safety Reporting System, patients were physically injured in one third of incidents and harmed in some way in two thirds of incidents. Medication errors were the most common incident type, but were associated with less harm than other event types. Line, tube, and airway events comprised one third of incidents and were associated with more harm than other types. Patient contributing factors were a strong predictor of harm; training and education factors were also commonly cited. In multivariate analysis, patient factors were the strongest predictor of harm adjusting for age, sex, and race. Pediatric patients are commonly harmed in intensive care units. There are several potential ways to improve safety including protocols for high-risk procedures involving lines and tubes, improved monitoring, and staffing, training and communication initiatives. Providers may be able to identify patients at increased risk for harm and intervene to protect patient safety.

  8. Gender Differences in Reporting of Battering Incidences.

    Science.gov (United States)

    Edleson, Jeffrey L.; Brygger, Mary Pat

    1986-01-01

    Examined difference between male and female reports of violence and threats directed by the man toward the woman. In many categories, significantly more women were found at intake to report more threats and violence than their male partners. After extensive intervention these differences were not found in the more severe categories of violence.…

  9. General practitioner reported incidence of Lyme carditis in the Netherlands.

    Science.gov (United States)

    Hofhuis, A; Arend, S M; Davids, C J; Tukkie, R; van Pelt, W

    2015-11-01

    Between 1994 and 2009, incidence rates of general practitioner (GP) consultations for tick bites and erythema migrans, the most common early manifestation of Lyme borreliosis, have increased substantially in the Netherlands. The current article aims to estimate and validate the incidence of GP-reported Lyme carditis in the Netherlands. We sent a questionnaire to all GPs in the Netherlands on clinical diagnoses of Lyme borreliosis in 2009 and 2010. To validate and adjust the obtained incidence rate, medical records of cases of Lyme carditis reported by GPs in this incidence survey were reviewed and categorised according to likelihood of the diagnosis of Lyme carditis. Lyme carditis occurred in 0.2 % of all patients with GP-reported Lyme borreliosis. The adjusted annual incidence was six GP-reported cases of Lyme carditis per 10 million inhabitants, i.e. approximately ten cases per year in 2009 and 2010. We report the first incidence estimate for Lyme carditis in the Netherlands, validated by a systematic review of the medical records. Although Lyme carditis is an uncommon manifestation of Lyme borreliosis, physicians need to be aware of this diagnosis, in particular in countries where the incidence of Lyme borreliosis has increased during the past decades.

  10. Safety culture and learning from incidents: the role of incident reporting and causal analyses

    International Nuclear Information System (INIS)

    Wilpert, B.

    1994-01-01

    Nuclear industry more than any other industrial branch has developed and used predictive risk analysis as a method of feedforward control of safety and reliability. Systematic evaluation of operating experience, statistical documentation of component failures, systematic documentation and analysis of incidents are important complementary elements of feedback control: we are dealing here with adjustment and learning from experience, in particular from past incidents. Using preliminary findings from ongoing research at the Research Center Systems Safety at the Berlin University of Technology the contribution discusses preconditions for an effective use of lessons to be learnt from closely matched incident reporting and in depth analyses of causal chains leading to incidents. Such conditions are especially standardized documentation, reporting and analyzing methods of incidents; structured information flows and feedback loops; abstaining from culpability search; mutual trust of employees and management; willingness of all concerned to continually evaluate and optimize the established learning system. Thus, incident related reporting and causal analyses contribute to safety culture, which is seen to emerge from tightly coupled organizational measures and respective change in attitudes and behaviour. (author) 2 figs., 7 refs

  11. The evaluation of a web-based incident reporting system.

    Science.gov (United States)

    Kuo, Ya-Hui; Lee, Ting-Ting; Mills, Mary Etta; Lin, Kuan-Chia

    2012-07-01

    A Web-based reporting system is essential to report incident events anonymously and confidentially. The purpose of this study was to evaluate a Web-based reporting system in Taiwan. User satisfaction and impact of system use were evaluated through a survey answered by 249 nurses. Incident events reported in paper and electronic systems were collected for comparison purposes. Study variables included system user satisfaction, willingness to report, number of reports, severity of the events, and efficiency of the reporting process. Results revealed that senior nurses were less willing to report events, nurses on internal medicine units had higher satisfaction than others, and lowest satisfaction was related to the time it took to file a report. In addition, the Web-based reporting system was used more often than the paper system. The percentages of events reported were significantly higher in the Web-based system in laboratory, environment/device, and incidents occurring in other units, whereas the proportions of reports involving bedsores and dislocation of endotracheal tubes were decreased. Finally, moderate injury event reporting decreased, whereas minor or minimal injury event reporting increased. The study recommends that the data entry process be simplified and the network system be improved to increase user satisfaction and reporting rates.

  12. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Directory of Open Access Journals (Sweden)

    Jamie E McFadden-Hiller

    Full Text Available Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents. We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula, primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99, with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping

  13. Spatial Distribution of Black Bear Incident Reports in Michigan.

    Science.gov (United States)

    McFadden-Hiller, Jamie E; Beyer, Dean E; Belant, Jerrold L

    2016-01-01

    Interactions between humans and carnivores have existed for centuries due to competition for food and space. American black bears are increasing in abundance and populations are expanding geographically in many portions of its range, including areas that are also increasing in human density, often resulting in associated increases in human-bear conflict (hereafter, bear incidents). We used public reports of bear incidents in Michigan, USA, from 2003-2011 to assess the relative contributions of ecological and anthropogenic variables in explaining the spatial distribution of bear incidents and estimated the potential risk of bear incidents. We used weighted Normalized Difference Vegetation Index mean as an index of primary productivity, region (i.e., Upper Peninsula or Lower Peninsula), primary and secondary road densities, and percentage land cover type within 6.5-km2 circular buffers around bear incidents and random points. We developed 22 a priori models and used generalized linear models and Akaike's Information Criterion (AIC) to rank models. The global model was the best compromise between model complexity and model fit (w = 0.99), with a ΔAIC 8.99 units from the second best performing model. We found that as deciduous forest cover increased, the probability of bear incident occurrence increased. Among the measured anthropogenic variables, cultivated crops and primary roads were the most important in our AIC-best model and were both positively related to the probability of bear incident occurrence. The spatial distribution of relative bear incident risk varied markedly throughout Michigan. Forest cover fragmented with agriculture and other anthropogenic activities presents an environment that likely facilitates bear incidents. Our map can help wildlife managers identify areas of bear incident occurrence, which in turn can be used to help develop strategies aimed at reducing incidents. Researchers and wildlife managers can use similar mapping techniques to

  14. Development of Incident Report Database for Organizational Learning

    Science.gov (United States)

    Otsuka, Yuichi; Abe, Tomotaka; Noguchi, Hiroshi; Makinouchi, Akifumi

    The necessity of an incident reporting system has recently been increasing for hospitals. Japan Council for Quality Health Care (JCQHC) started operating a national incident reporting system to which domestic hospitals would report their incidents. However, the reporting system obtained an additional problem for the hospitals. They managed their own systems which collected reports by papers. The purposes of the reporting systems was to analyze considerable causes involved in incidents to improve the quality of patient safety management. On the contrary, the national reporting system aimed at collecting a statistical tendency of normal incidents. Simultaneously operating the two systems would be too much workload for safety managers. The load may have the managers rest only a short time for summarizing occurrences, not enough for analyzing their causes. However, to the authors' knowledge, there has not been an integrating policy of the two forms to adapt them to practical situations in patient safety management. The scope of this paper is to establish the integrated form in order to use in analyzing the causes of incidents as well as reporting for the national system. We have developed new data base system using XML + XSLT and Java Servlet. The developed system is composed of three computers; DB server , DB client and Data sending server. To investigate usability of the developed system, we conducted a monitoring test by real workers in reporting workplaces. The result of subjective evaluations by examinees was so preferable for the developed system. The results of usability test and the achievement of increasing the number of reports after the introduction can demonstrate the enough effectiveness of the developed system for supporting the activity of patient safety management.

  15. Development and test of a classification scheme for human factors in incident reports

    International Nuclear Information System (INIS)

    Miller, R.; Freitag, M.; Wilpert, B.

    1997-01-01

    The Research Center System Safety of the Berlin University of Technology conducted a research project on the analysis of Human Factors (HF) aspects in incident reported by German Nuclear Power Plants. Based on psychological theories and empirical studies a classification scheme was developed which permits the identification of human involvement in incidents. The classification scheme was applied in an epidemiological study to a selection of more than 600 HF - relevant incidents. The results allow insights into HF related problem areas. An additional study proved that the application of the classification scheme produces results which are reliable and independent from raters. (author). 13 refs, 1 fig

  16. Engineering risk assessment for emergency disposal projects of sudden water pollution incidents.

    Science.gov (United States)

    Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng

    2017-06-01

    Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.

  17. Extreme project. Progress report 2006

    International Nuclear Information System (INIS)

    Eyrolle, F.; Masson, O.; Charmasson, S.

    2007-01-01

    The E.X.T.R.E.M.E. project introduced in 2005 to the S.E.S.U.R.E. / L.E.R.C.M. has for objectives to acquire data on the consequences of the extreme climatic meteorological episodes on the distribution of the artificial radioisotopes within the various compartments of the geosphere. This report presents the synthesis of the actions developed in 2006 in positioning and in co financing of the project by means of regional or national research programs (C.A.R.M.A., E.X.T.R.E.M.A., E.C.C.O.R.E.V.I.), of data acquisition, valuation and scientific collaboration. (N.C.)

  18. WP1 – Final project report

    NARCIS (Netherlands)

    Drachsler, Hendrik; Scheffel, Maren; Orrego, Carola; Stieger, Lina; Hartkopf, Kathleen; Henn, Patrick; Hynes, Helen; Przibilla, Monika; Geiger, Uschi; Schroeder, Hanna; Sopka, Sasa

    2015-01-01

    This report contains the complete project reporting of the PATIENT project from October 2012 until end of March 2015. It provides a summary of all project activities and achievements that are based on the previous WP deliverables such as the project progress reports from WP1 (D1.01) and the quality

  19. Which factors affect reported headache incidences after lumbar myelography?

    International Nuclear Information System (INIS)

    Sand, T.

    1989-01-01

    Nineteen publications were reviewed and subjected to a combined statistical analysis (meta-analysis) regarding the influence of study design factors upon reported headache and total symptom incidences after lumbar iohexol myelography. A significant association was found between reported side effects on one hand and needle diameter, follow-up time and the method of questioning respectively on the other. The combination of long follow-up time and specific questioning and the combination between larger diameter (20G) needles and long follow-up time, both seemed to be strong predictors for reporting high side effect incidences. Nine studies were similarly analyzed regarding the influence of early ambulation and contrast type upon reported headache incidences. Early ambulation significantly increased headache after iohexol or iopamidol lumbar myelography as opposed to metrizamide myelography. (orig.)

  20. Possible solutions for barriers in incident reporting by residents

    NARCIS (Netherlands)

    Martowirono, K.; Jansma, J.D.; van Luijk, S.J.; Wagner, C.; Bijnen, A.B.

    2012-01-01

    Rationale, aims and objectives: Incident reporting can contribute to safer health care. Since the rate of reporting by residents is low, it is useful to investigate which barriers exist and how these can be solved. Methods: Data were collected in a large teaching hospital in the Netherlands. The

  1. Critical Incident Reporting in Anaesthesia: A Prospective Internal Audit

    Directory of Open Access Journals (Sweden)

    Sunanda Gupta

    2009-01-01

    Full Text Available Critical incident monitoring is useful in detecting new problems, identifying near misses′ and analyzing factors or events leading to mishaps, which can be instructive for trainees. This study was aimed at investigating potential risk factors and analyze events leading to pen-operative critical incidents in order to develop a critical incident reporting system. W conducted a one year prospective analysis of voluntarily reported 24- hour-perioperative critical inci-dents, occurring in patients subjected to anaesthesia. During a one year period from December 2006 to December 2007, 14,134 anaesthetics were administered and 112(0.79% critical incidents were reported with complete recov-ery in 71.42%(n=80 and mortality in 28.57% (n=32 cases. Incidents occurred maximally in 0-10 years age (23.21%, ASA 1(61.61%, in general surgery patients (43.75%, undergoing emergency surgery (52.46% and during day time (75.89%. Incidence was more in the operating theatre (77.68%, during maintenance (32.04% and post-operative phase (25.89% and in patients who received general anaesthesia (75.89%. Critical incidents occurred clue to fac-tors related to anaesthesia (42.85%, patient (37.50% and surgery (16.96°lo. Among anaesthesia related critical incidents (42.85% n=48/112, respiratory events were maximum (66.66% mainly at induction (37.5% and emer-gence (43.75%, and factors responsible were human error (85.41%, pharmacological factors (10.41% and equip-ment error (4.17%. Incidence of mortality was 22.6 per10, 000 anaesthetics (32/14,314, mostly attributable to risk factors in patient (59.38% as compared to anaesthesia (25% and surgery (9.38%. There were 8 anaesthesia related deaths (5.6 per 10, 000 anaesthetics where human error (75% attributed to lack of judgment (67.50% was an important causative factor. We conclude that critical incident reporting system may be a valuable part of quality assurance to develop policies to prevent recurrence and enhance patient

  2. Piloting an online incident reporting system in Australasian emergency medicine.

    Science.gov (United States)

    Schultz, Timothy J; Crock, Carmel; Hansen, Kim; Deakin, Anita; Gosbell, Andrew

    2014-10-01

    Medical-specific incident reporting systems are critical to understanding error in healthcare but underreporting by doctors reduces their value. We conducted a pilot study of the implementation of an online ED-specific incident reporting system in Australasian hospitals and evaluated its use. The reporting system was based on the literature and input of experts. Thirty-one hospital EDs were approached to pilot the Emergency Medicine Events Register (EMER). The pilot evaluated: website usage and analytics, reporting behaviours and rates, the quality of information collected in EMER. Semi-structured interviews of three site champions responsible for implementing EMER were conducted. Seventeen EDs expressed interest; however, due to delays and other barriers reporting only occurred at three sites. Over 354 days, the website received 362 unique visitors and 77 incidents. The median time to report was 4.6 min. The reporting rate was 0.07 reports per doctor month, suggesting a reporting rate of 0.08% of ED presentations. Data quality, as measured by the number of completed non-mandatory fields and ability to classify incidents, was very high. The interviews identified enablers (the EMER system, site champions) and barriers (chiefly the context of EM) to EMER uptake. Collecting patient safety information by frontline doctors is essential to actively engage the profession in patent safety. Although the EMER system allowed easy online reporting of high quality incident data by doctors, site recruitment and system uptake proved difficult. System use by ED doctors requires dedicated and conscious effort from the profession. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  3. Brentwood Lessons Learned Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Rivkin, Carl H. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Caton, Melanie C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ainscough, Christopher D. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Marcinkoski, Jason [Dept. of Energy (DOE), Washington DC (United States)

    2017-09-26

    The purpose of this report is to document lessons learned in the installation of the hydrogen fueling station at the National Park Service Brentwood site in Washington, D.C., to help further the deployment of hydrogen infrastructure required to support hydrogen and other fuel cell technologies. Hydrogen fueling is the most difficult infrastructure component to build and permit. Hydrogen fueling can include augmenting hydrogen fueling capability to existing conventional fuel fueling stations as well as building brand new hydrogen fueling stations. This report was produced as part of the Brentwood Lessons Learned project. The project consisted of transplanting an existing modular hydrogen fueling station from Connecticut to the National Park Service Brentwood site. This relocation required design and construction at the Brentwood site to accommodate the existing station design as well as installation and validation of the updated station. One of the most important lessons learned was that simply moving an existing modular station to an operating site was not necessarily straight-forward - performing the relocation required significant effort and cost. The station has to function at the selected operating site and this functionality requires a power supply, building supports connecting to an existing alarm system, electrical grounding and lighting, providing nitrogen for purging, and providing deionized water if an electrolyzer is part of the station package. Most importantly, the station has to fit into the existing site both spatially and operationally and not disrupt existing operations at the site. All of this coordination and integration requires logistical planning and project management. The idea that a hydrogen fueling station can be simply dropped onto a site and made immediately operational is generally not realistic. Other important lessons learned include that delineating the boundaries of the multiple jurisdictions that have authority over a project for

  4. International Chernobyl project [AEA report

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The IAEA have co-ordinated the first international assessment of the radiological consequences of the Chernobyl accident in the affected areas outside the 30km prohibited zone around the reactor. These areas have a total population of about 1 million people, living in approximately 2700 settlements. The main aim of the project was to answer the question 'Is it safe for the population to go on living in the affected areas?'. The project did not investigate radiological health effects among more than 100 000 people evacuated from the 30 km prohibited zone. Nor did it study effects among the emergency personnel temporarily brought into the region for accident management and recovery work (the so-called 'liquidators'). Project teams reviewed official data on environmental contamination from 500 settlements, data collection practices and reporting and also official information on radiation doses received by people living in seven settlements. Other project teams reviewed official data at key medical centres and institutes. Then they examined people both from surveyed contaminated settlement and from surveyed control settlements. The team concluded that there were significant non-radiation related health disorders in populations of both contaminated and control settlements. None of the disorders could be attributed directly to radiation exposure. In particular, no evidence was found for a significant increase in foetal abnormalities; infant and prenatal mortality rates had fallen since the accident. Children were found to be generally healthy with no abnormalities in either thyroid stimulating or thyroid hormones. The accident had created substantial negative psychological consequences, manifesting themselves in terms of anxiety and stress due to continuing high levels of uncertainty. (author)

  5. A review and discussion of flight management system incidents reported to the Aviation Safety Reporting System

    Science.gov (United States)

    1992-02-01

    This report covers the activities related to the description, classification and : analysis of the types and kinds of flight crew errors, incidents and actions, as : reported to the Aviation Safety Reporting System (ASRS) database, that can occur as ...

  6. Media actors' perceptions of their roles in reporting food incidents.

    Science.gov (United States)

    Wilson, Annabelle M; Henderson, Julie; Coveney, John; Meyer, Samantha B; Webb, Trevor; Calnan, Michael; Caraher, Martin; Lloyd, Sue; McCullum, Dean; Elliott, Anthony; Ward, Paul R

    2014-12-18

    Previous research has shown that the media can play a role in shaping consumer perceptions during a public health crisis. In order for public health professionals to communicate well-informed health information to the media, it is important that they understand how media view their role in transmitting public health information to consumers and decide what information to present. This paper reports the perceptions of media actors from three countries about their role in reporting information during a food incident. This information is used to present ideas and suggestions for public health professionals working with media during food incidents. Thirty three semi-structured interviews with media actors from Australia, New Zealand and the United Kingdom were conducted and analysed thematically. Media actors were recruited via purposive sampling using a sampling strategy, from a variety of formats including newspaper, television, radio and online. Media actors said that during a food incident, they play two roles. First, they play a role in communicating information to consumers by acting as a conduit for information between the public and the relevant authorities. Second, they play a role as investigators by acting as a public watchdog. Media actors are an important source of consumer information during food incidents. Public health professionals can work with media by actively approaching them with information about food incidents; promoting to media that as public health professionals, they are best placed to provide the facts about food incidents; and by providing angles for further investigation and directing media to relevant and correct information to inform such investigations. Public health professionals who adapt how they work with media are more likely to influence media to portray messages that fit what they would like the public to know and that are in line with public health recommendations and enable consumers to engage in safe and health promoting

  7. Incident reports--correcting processes and reducing errors.

    Science.gov (United States)

    Dunn, Debra

    2003-08-01

    Although it may be human nature to make mistakes, it also is human nature to create solutions, identify alternatives, and meet future challenges. This article describes systems approaches to assessing the ways in which an organization operates and explains the types of failures that cause errors. The steps that guide managers in adapting an incident reporting system that incorporates continuous quality improvement are identified.

  8. (WINDPEP Project performance report). Final report

    Energy Technology Data Exchange (ETDEWEB)

    Speelmon, J.L.

    1983-06-28

    The goals and results of the WINDPEP project are presented. The project promoted the use of wind generators to produce electricity for residences and small businesses located in Federal Region X. (BCS)

  9. Safety Incident Management Team Report for NIMLT Case 50796

    LENUS (Irish Health Repository)

    2017-01-17

    This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH.\\r\

  10. Spray casting project final report

    International Nuclear Information System (INIS)

    Churnetski, S.R.; Thompson, J.E.

    1996-08-01

    Lockheed Martin Energy Systems, Inc. (Energy Systems), along with other participating organizations, has been exploring the feasibility of spray casting depleted uranium (DU) to near-net shape as a waste minimization effort. Although this technology would be useful in a variety of applications where DU was the material of choice, this effort was aimed primarily at gamma-shielding components for use in storage and transportation canisters for high-level radioactive waste, particularly in the Multipurpose Canister (MPC) application. In addition to the waste-minimization benefits, spray casting would simplify the manufacturing process by allowing the shielding components for MPC to be produced as a single component, as opposed to multiple components with many fabrication and assembly steps. In earlier experiments, surrogate materials were used to simulate the properties (specifically reactivity and density) of DU. Based on the positive results from those studies, the project participants decided that further evaluation of the issues and concerns that would accompany spraying DU was warranted. That evaluation occupied substantially all of Fiscal Year 1995, yielding conceptual designs for both an intermediate facility and a production facility and their associated engineering estimates. An intermediate facility was included in this study to allow further technology development in spraying DU. Although spraying DU to near-net shape seems to be feasible, a number of technical, engineering, and safety issues would need to be evaluated before proceeding with a production facility. This report is intended to document the results from the spray-casting project and to provide information needed by anyone interested in proceeding to the next step

  11. Project SHARE - An interim report

    Science.gov (United States)

    Bouck, Gail P.; Stevenson, Jim; Gillick, David

    1987-05-01

    Project SHARE, a program sponsored jointly by the International Institute of Communications and Intersat, has been undertaken to foster telecommunications development in rural and remote areas of the world. Completed projects such as Teleeducation in the People's Republic of China and The American Society of Microbiology in Africa are discussed as well as projects currently in progress. Projects under active planning include Education in Pakistan through the Pakistan Space and Upper Atmosphere Research Commission and The Sky Channel of the Pacific.

  12. Committee's report on ruthenium fall-out incident

    International Nuclear Information System (INIS)

    Borkowski, C.J.; Crawford, J.H.; Livingston, R.; Ritchie, R.H.; Rupp, A.F.; Taylor, E.H.

    1983-07-01

    Investigations of the fall-out incident of November 11 and 12, 1959, by responsible parties (Health Physics Division and Operations Division personnel) established beyond reasonable doubt that the incident had its origin in the expulsion of particles, heavily contaminated with ruthenium, which had been detached from the walls of the electric fan housing and ducts in the off-gas system associated with the brick stack. All available evidence indicates that the particles were loosened during maintenance work on the exhaust damper and the bearings of the electric fan and were carried up the stack in two bursts as particulate fall-out when this fan was put back into service. Radiographic and chemical analysis showed the activity to be almost entirely ruthenium (Ru 106 ) and its daughter rhodium (Rh 106 ) with very little, if any, strontium being present. This report summarizes the findings and sets forth the conclusions and recommendations of the Committee asked to investigate the incident

  13. Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework.

    Science.gov (United States)

    Taylor, Diana; Upadhyay, Ushma D; Fjerstad, Mary; Battistelli, Molly F; Weitz, Tracy A; Paul, Maureen E

    2017-07-01

    To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first

  14. Prototype road weather performance management tool : project report : draft report.

    Science.gov (United States)

    2016-09-30

    This report is the Project Report for the Road Weather Performance Management (RW-PM) Tool developed for the project on Development and Demonstration of a Prototype Road Weather Performance Management Application that Uses Connected Vehicle Data (RW-...

  15. Incident reporting behaviours following the Francis report: A cross-sectional survey.

    Science.gov (United States)

    Archer, Gareth; Colhoun, Alison

    2017-11-17

    Previous studies have shown a lack of engagement in the reporting process. There is limited evidence about whether attitudes and behaviours of doctors in the UK towards incident reporting have changed following the events at Mid Staffordshire National Health Service Foundation Trust and the recommendations that followed. We conducted a relatively large survey of doctors, aiming to assess whether doctors recognised incidents and reported them accordingly, along with their behaviours towards reporting and their suggestions of how incident reporting may be improved. A cross-sectional survey of doctors was undertaken in 11 hospitals in the north of England. The participants (n = 581) were invited to take part in an electronic questionnaire. Demographics were obtained, and engagement with the incident reporting process was assessed, including an estimate of the number of incidents which were witnessed but not actually reported. Factors which influenced reporting behaviours were recorded. Free-text comments were encouraged. A mixed method analysis of the responses was performed. Doctors do not appear to be engaging with the incident reporting process-in particular, junior doctors. The main reason given for not completing forms was not having enough time (38.2% of respondents), primarily due to the length and complexity of forms. Many doctors, 43.7%, witnessed more than 5 incidents, but only 13.3% of doctors submitted more than 5 reports. Free text comments revealed 4 themes which impact upon reporting behaviours: organisational issues, form structure, a culture of blame, and a lack of feedback. Several suggestions for improvement were made. Little has changed in the attitudes and behaviours of doctors. Improving incident reporting form structure to make it more user-friendly and improving feedback may engage doctors and lead to an improved safety culture. The way the medical profession reports serious and other incidents still needs to be improved. © 2017 John Wiley

  16. AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project

    Directory of Open Access Journals (Sweden)

    Cardoso Mauro Nogueira

    2006-01-01

    Full Text Available This paper presents AIDS incidence and mortality among injecting drug users (IDUs reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, São José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30, homelessness (RR = 6.16, and report of previous sexual relations with same-sex partners (RR = 6.21 were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00, lack of income (RR = 2.65, HIV seropositive status (RR = 4.52, and no history of incarceration (RR = 3.71 were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.

  17. AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project.

    Science.gov (United States)

    Cardoso, Mauro Nogueira; Caiaffa, Waleska Teixeira; Mingoti, Sueli Aparecida

    2006-04-01

    This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, São José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.

  18. Final Project Report for Award ER65581

    Energy Technology Data Exchange (ETDEWEB)

    Stoy, Paul C. [Montana State Univ., Bozeman, MT (United States)

    2017-07-13

    The attached final project report describes contributions of Montana State University (MSU) to the project "Bridging land-surface fluxes and aerosol concentrations to triggering convective rainfall" (PI: Fuentes).

  19. Projections of increased and decreased dengue incidence under climate change.

    Science.gov (United States)

    Williams, C R; Mincham, G; Faddy, H; Viennet, E; Ritchie, S A; Harley, D

    2016-10-01

    Dengue is the world's most prevalent mosquito-borne disease, with more than 200 million people each year becoming infected. We used a mechanistic virus transmission model to determine whether climate warming would change dengue transmission in Australia. Using two climate models each with two carbon emission scenarios, we calculated future dengue epidemic potential for the period 2046-2064. Using the ECHAM5 model, decreased dengue transmission was predicted under the A2 carbon emission scenario, whereas some increases are likely under the B1 scenario. Dengue epidemic potential may decrease under climate warming due to mosquito breeding sites becoming drier and mosquito survivorship declining. These results contradict most previous studies that use correlative models to show increased dengue transmission under climate warming. Dengue epidemiology is determined by a complex interplay between climatic, human host, and pathogen factors. It is therefore naive to assume a simple relationship between climate and incidence, and incorrect to state that climate warming will uniformly increase dengue transmission, although in general the health impacts of climate change will be negative.

  20. The Thai anesthesia incident monitoring study of perioperative allergic reactions: an analysis of 1996 incidents reports.

    Science.gov (United States)

    Lapisatepun, Worawut; Charuluxananan, Somrat; Kusumaphanyo, Chaiyapruk; Ittichaikulthol, Wichai; Suksompong, Sirilak; Ratanachai, Prapa

    2008-10-01

    Analyze the clinical course, management, outcome, and contributing factors of perioperative allergic reactions in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). A prospective descriptive multicenter study was conducted in 51 hospitals across Thailand Voluntary, anonymous reports of any adverse or undesirable events during the first 24 hours of anesthesia were sent to the Thai AIMS data management unit. Possible perioperative allergic reactions were extracted and examined independently by three peer reviewers. Forty-three reports of possible perioperative allergic reactions from the 2,537 incidents reported to the Thai AIMS (1.6%) were reviewed. There was a female predominance (1.9:1). The most common features were cutaneous manifestations (93%), arterial hypotension (20.1%), and bronchospasm (11.6%) respectively. The severity grades were 69.8% in grade I, 4.7% in grade II, and 25.6% in grade III. The three most suspected causative agents were neuromuscular blocking agents (39.5%, 30.2%-succinylcholine), antibiotics (27.9%), and opioids (18.6%) respectively. All but one responded well to treatment with complete recovery. One patient suffered acute myocardial infarction and had to stay at the hospital for longer than one week. None had further allergic reaction. Perioperative allergic reactions accounted for 1.6% of anesthetic adverse events. The most common features were cutaneous manifestations. A quarter of these were life-threatening but responded well to treatment. The most common suspected causative agent was succinylcholine.

  1. Project LIFT: Year 1 Report

    Science.gov (United States)

    Norton, Michael; Piccinino, Kelly

    2014-01-01

    Research for Action (RFA) is currently in the second year of a five-year external evaluation of the Project Leadership and Investment for Transformation (LIFT) Initiative in the Charlotte-Mecklenburg School District (CMS). Project LIFT is a public-private partnership between CMS and the local philanthropic and business communities in Charlotte,…

  2. Project LIFT: Year Two Report

    Science.gov (United States)

    Norton, Michael; Piccinino, Kelly

    2014-01-01

    Research for Action (RFA) has completed its second year of a five-year external evaluation of the Project Leadership and Investment for Transformation (LIFT) Initiative in the Charlotte-Mecklenburg School District (CMS). Project LIFT is a public-private partnership between CMS and the local philanthropic and business communities in Charlotte,…

  3. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  4. Genome Radio Project: Quarterly report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-01

    The process of conducting background research for the programs of the Genome Radio Project is continuing. The most developed of the program ``backgrounders`` have been reviewed by series and program advisors from various fields. Preliminary and background interviews have been conducted with dozens of potential program participants and advisors. Structurally, efforts are being directed toward developing and formalizing the project and series advisor relationships so that the best use can be made of those experts who have offered to assist the project in its presentation of program content. The library of research materials has been expanded considerably, creating a useful resource library for the producers.

  5. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical?

    DEFF Research Database (Denmark)

    Maaløe, R; la Cour, M; Hansen, A

    2006-01-01

    The purpose of the present study was to measure the incidence and type of incidents that occurred in relation to anaesthesia and surgery during a 1-year period in six Danish hospitals. Furthermore, we wanted to identify risk factors for incidents, as well as risk factors for incidents being deemed...

  6. CERN Summer Student Project Report

    CERN Document Server

    Parton, Thomas

    2015-01-01

    My Summer Student project was divided between two areas: work on Thin Gap Chamber (TGC) Level-1 muon triggers for the ATLAS experiment, and data acquisition (DAQ) for an RPC muon detector at the Gamma Irradiation Facility (GIF++)

  7. NRC source term assessment for incident response dose projections

    International Nuclear Information System (INIS)

    Easley, P.; Pasedag, W.

    1984-01-01

    The NRC provides advice and assistance to licensees and State and local authorities in responding to accidents. The TACT code supports this function by providing source term projections for two situations during early (15 to 60 minutes) accident response: (1) Core/containment damage is indicated, but there are no measured releases. Quantification of a predicted release permits emergency response before people are exposed. With TACT, response personnel can estimate releases based on fuel and cladding conditions, coolant boundary and containment integrity, and mitigative systems operability. For this type of estimate, TACT is intermediate between default assumptions and time-consuming mechanistic codes. (2) A combination of plant status and limited release data are available. For this situation, iterations between predictions based on known conditions which are compared to measured releases gives reasonable confidence in supplemental source term information otherwise unavailable: nuclide mix, releases not monitored, and trending or abrupt changes. The assumptions and models used in TACT, and examples of its use, are given in this paper

  8. Hualapai Wind Project Feasibility Report

    Energy Technology Data Exchange (ETDEWEB)

    Davidson, Kevin [Hualapai Tribe; Randall, Mark [Daystar Consulting; Isham, Tom [Power Engineers; Horna, Marion J [MJH Power Consulting LLC; Koronkiewicz, T [SWCA Environmental, Inc.; Simon, Rich [V-Bar, LLC; Matthew, Rojas [Squire Sanders Dempsey; MacCourt, Doug C. [Ater Wynne, LLP; Burpo, Rob [First American Financial Advisors, Inc.

    2012-12-20

    The Hualapai Department of Planning and Economic Development, with funding assistance from the U.S. Department of Energy, Tribal Energy Program, with the aid of six consultants has completed the four key prerequisites as follows: 1. Identify the site area for development and its suitability for construction. 2. Determine the wind resource potential for the identified site area. 3. Determine the electrical transmission and interconnection feasibility to get the electrical power produced to the marketplace. 4. Complete an initial permitting and environmental assessment to determine the feasibility for getting the project permitted. Those studies indicated a suitable wind resource and favorable conditions for permitting and construction. The permitting and environmental study did not reveal any fatal flaws. A review of the best power sale opportunities indicate southern California has the highest potential for obtaining a PPA that may make the project viable. Based on these results, the recommendation is for the Hualapai Tribal Nation to move forward with attracting a qualified wind developer to work with the Tribe to move the project into the second phase - determining the reality factors for developing a wind project. a qualified developer will bid to a utility or negotiate a PPA to make the project viable for financing.

  9. Exercise Intensity and Incidence of Metabolic Syndrome: The SUN Project.

    Science.gov (United States)

    Hidalgo-Santamaria, María; Fernandez-Montero, Alejandro; Martinez-Gonzalez, Miguel A; Moreno-Galarraga, Laura; Sanchez-Villegas, Almudena; Barrio-Lopez, María T; Bes-Rastrollo, Maira

    2017-04-01

    Emerging evidence suggests that vigorous physical activity may be associated with higher cardioprotective benefits than moderate physical activity. This study aimed to assess the long-term relationship between the intensity of leisure time physical activity (LTPA) and the risk of developing metabolic syndrome (MS) in a prospective cohort study. The Seguimiento Universidad de Navarra (SUN) Project comprises Spanish university graduates. Participants (n=10,145) initially free of MS were followed for a minimum of 6 years (2008-2014). Analysis was conducted in 2015. Physical activity was assessed though a validated questionnaire. The intensity of each physical activity was measured in METs. The intensity of LTPA was estimated by the ratio between total METs/week and total hours of LTPA/week, obtaining the mean METs/hour of LTPA. MS was defined according to the harmonizing definition. The association between the intensity of LTPA (METs/hour) and MS was assessed with logistic regression models adjusting for potential confounders. Among 10,145 participants initially free of any MS criteria, 412 new MS cases were observed. Vigorous LTPA was associated with a 37% relatively lower risk (AOR=0.63, 95% CI=0.44, 0.89) compared with light LTPA. For a given total energy expenditure, independent of the time spent on it, participants who performed vigorous LTPA exhibited a higher reduction in the risk of MS than those who performed light to moderate LTPA. Vigorous LTPA was significantly associated with lower risk of developing MS after a 6-year follow-up period. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  10. A longitudinal assessment of alcohol intake and incident depression: the SUN project

    Directory of Open Access Journals (Sweden)

    Gea Alfredo

    2012-11-01

    Full Text Available Abstract Background Longitudinal studies assessing the long-term association between alcohol intake and depression are scarce. The type of beverage may also be important. Therefore we aimed to prospectively evaluate the influence of alcohol intake on incident depression in a Mediterranean cohort. Methods We assessed 13,619 university graduates (mean age: 38 years, 42% men participating in a Spanish prospective epidemiological cohort (the SUN Project, initially free of depression. They were recruited between 1999–2008 and biennially followed-up during 2001–2010. At baseline, a 136-item validated food–frequency questionnaire was used to assess alcohol intake. Wine was the preferred beverage. Participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression and restricted cubic splines analyses were performed over 82,926 person-years. Results Only among women, an U-shaped relationship between total alcohol intake and depression risk was found (P=0.01. Moderate alcohol intake (5–15 g/day was associated with lower risk (Hazard Ratio: 0.62; 95% Confidence Interval: 0.43-0.89. No association was apparent for higher intakes of alcohol or for any specific type of alcoholic beverage. Conclusions Moderate alcohol intake might protect against depression among women. Further confirmatory studies are needed.

  11. Report of incidence and mortality in China cancer registries, 2009

    Science.gov (United States)

    Zheng, Rongshou; Zhang, Siwei; Zhao, Ping; Li, Guanglin; Wu, Lingyou; He, Jie

    2013-01-01

    Objective The National Central Cancer Registry (NCCR) collected cancer registration data in 2009 from local cancer registries in 2012, and analyzed to describe cancer incidence and mortality in China. Methods On basis of the criteria of data quality from NCCR, data submitted from 104 registries were checked and evaluated. There were 72 registries’ data qualified and accepted for cancer registry annual report in 2012. Descriptive analysis included incidence and mortality stratified by area (urban/rural), sex, age group and cancer site. The top 10 common cancers in different groups, proportion and cumulative rates were also calculated. Chinese population census in 1982 and Segi’s population were used for age-standardized incidence/mortality rates. Results All 72 cancer registries covered a total of 85,470,522 population (57,489,009 in urban and 27,981,513 in rural areas). The total new cancer incident cases and cancer deaths were 244,366 and 154,310, respectively. The morphology verified cases accounted for 67.23%, and 3.14% of incident cases only had information from death certifications. The crude incidence rate in Chinese cancer registration areas was 285.91/100,000 (males 317.97/100,000, females 253.09/100,000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 146.87/100,000 and 191.72/100,000 with the cumulative incidence rate (0-74 age years old) of 22.08%. The cancer incidence and ASIRC were 303.39/100,000 and 150.31/100,000 in urban areas whereas in rural areas, they were 249.98/100,000 and 139.68/100,000, respectively. The cancer mortality in Chinese cancer registration areas was 180.54/100,000 (224.20/100,000 in males and 135.85/100,000 in females), age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 85.06/100,000 and 115.65/100,000, and the cumulative incidence rate (0-74 age years old) was 12.94%. The cancer mortality

  12. Green Schools Project Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Verdict, M.

    2000-09-27

    The Alliance to Save Energy has responded to interest in the Green Schools concept from the New England states of Maine, New Hampshire and Vermont. The Alliance conducted a train-the-trainers workshop in Augusta, Maine March 17--18, 1999. This work is part of a Green Schools replication project leveraged by funds from another source, NORDAX, which contributed $80,000 to provide partial support to staff at the Maine Energy Education Project (MEEP), Vermont Energy Education Program (VEEP), and New Hampshire Governor's Office to develop Green Schools Projects. DOE funds were used to conduct training, develop a network of state and local government, business and school partners to support school efficiency activities in those three states.

  13. CGS-MSFSS Project report

    Energy Technology Data Exchange (ETDEWEB)

    Harvey-Collard, Patrick [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-10-27

    From January 2015 to July 2015, I was doing research at Sandia National Laboratories in Albuquerque, United States. My work there consisted of performing experimental measurements using Sandia’s unique silicon quantum computing platform. The project is about coupling donor spin quantum bits, or qubits, to quantum dots in a silicon nanostructure based on conventional microchip technology. During the project, I devised a new quantum state readout mechanism that allow better, longer lived measurement signals. The measurement (or readout) mechanism is key to any qubit architecture. Next, I was able to demonstrate a quantum manipulation of the two-electron spin states of the coupled donor and quantum dot system. This constitutes a breakthrough for donor spin qubits in silicon because it could enable larger systems consisting of many qubits. This project will lead to publications in scientific journals, presentations in international conferences, and generates exciting new opportunities for manipulating nature at the nanoscale.

  14. Summer Student Report - Project Kryolize

    CERN Document Server

    Drozdowski, Pawel

    2016-01-01

    The purpose of this document is to describe the work and results obtained by the author during his summer student internship at CERN. The author of this document was attached to the project Kryolize as a software developer, overtaking the job from a recently departed technical student.

  15. ECOGEN 4th Project Report

    DEFF Research Database (Denmark)

    Krogh, Paul Henning

    The general outcome of the project for the 4th year was as follows: The single species testing programme has been finalized. Generally the various pesticides do not impact the soil fauna at the recommended pesticide field application levels. Neither have the Bt toxin been demonstrated to have neg...

  16. Incident investigation team report: K-reactor D20 spill

    Energy Technology Data Exchange (ETDEWEB)

    Enis, E.

    1990-12-31

    This report discusses a spill of approximately 20 gallons of D2O (moderator) which occurred on February 7, 1990, at 0008 hours. The spill occurred while construction was removing process water lines from the 5B heat exchanger at a location referred to as a Rams Horn to allow the heat exchanger to be realigned. The heat exchangers in the other systems (loops) had been successfully disconnected (lines broken) during the previous two months and had been realigned without incident under the control of job plans similar to the System 5 job plan. Construction personnel reacted positively at the time the spill and successfully rebolted and tightened the leaking flanges on 5B and later on the 5A heat exchangers. This initial reaction stopped the leak and prevented a more severe incident. The spill incident resulted in a Site Alert declaration by the Shift Manager at 0220 hours when the Stack Tritium Monitor indicated a tritium release which exceeded the limits specified. After the event it was determined that a Temporary Procedure Change (TPC) to this DPSOL, had been approved and issued in April 1989. Had this TPC been available to the Shift Manager, the alert would not have been declared. Although the environmental impact of this event was negligible with no real radiological consequences minimal, the causal factors and programmatic deficiencies identified by this investigation show significant weakness in some critical areas.

  17. Incident investigation team report: K-reactor D20 spill

    Energy Technology Data Exchange (ETDEWEB)

    Enis, E.

    1990-01-01

    This report discusses a spill of approximately 20 gallons of D2O (moderator) which occurred on February 7, 1990, at 0008 hours. The spill occurred while construction was removing process water lines from the 5B heat exchanger at a location referred to as a Rams Horn to allow the heat exchanger to be realigned. The heat exchangers in the other systems (loops) had been successfully disconnected (lines broken) during the previous two months and had been realigned without incident under the control of job plans similar to the System 5 job plan. Construction personnel reacted positively at the time the spill and successfully rebolted and tightened the leaking flanges on 5B and later on the 5A heat exchangers. This initial reaction stopped the leak and prevented a more severe incident. The spill incident resulted in a Site Alert declaration by the Shift Manager at 0220 hours when the Stack Tritium Monitor indicated a tritium release which exceeded the limits specified. After the event it was determined that a Temporary Procedure Change (TPC) to this DPSOL, had been approved and issued in April 1989. Had this TPC been available to the Shift Manager, the alert would not have been declared. Although the environmental impact of this event was negligible with no real radiological consequences minimal, the causal factors and programmatic deficiencies identified by this investigation show significant weakness in some critical areas.

  18. EBT-P project status report

    International Nuclear Information System (INIS)

    1983-11-01

    This Elmo Bumpy Torus Report describes the status of the EBT-P Project in September 1983 after phasedown of the Title II design effort. The report is intended to be a principle source of guidance in the event of a decision to resume work on the project

  19. Establishing national medical imaging incident reporting systems: issues and challenges.

    Science.gov (United States)

    Jones, D Neil; Benveniste, Klee A; Schultz, Timothy J; Mandel, Catherine J; Runciman, William B

    2010-08-01

    Radiology incident reporting systems provide one source of invaluable patient safety data that, when combined with appropriate analysis and action, can result in significantly safer health care, which is now an urgent priority for governments worldwide. Such systems require integration into a wider safety, quality, and risk management framework because many issues have global implications, and they also require an international classification scheme, which is now being developed. These systems can be used to inform global research activities as identified by the World Health Organization, many of which intersect with the activities of and issues seen in medical imaging departments. How to ensure that radiologists (and doctors in general) report incidents, and are engaged in the process, is a challenge. However, as demonstrated with the example of the Australian Radiology Events Register, this can be achieved when the reporting system is integrated with their professional organization and its other related activities (such as training and education) and administered by a patient safety organization. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Estimated future incidence of malignant mesothelioma in South Korea: Projection from 2014 to 2033.

    Science.gov (United States)

    Kwak, Kyeong Min; Paek, Domyung; Hwang, Seung-Sik; Ju, Young-Su

    2017-01-01

    Malignant mesothelioma is a malignant tumor on the pleura or the peritoneum caused mostly by asbestos. Although asbestos is not currently used in South Korea, the incidence of mesothelioma is increasing due to its long latent period. This study predicted the incidence of malignant mesothelioma in South Korea over the next 20 years using an age-period-cohort (APC) model. Data regarding mesothelioma incidence from 1994-2013 were acquired from the Korea Central Cancer Registry (KCCR). Demographic data, including prospective resident data, were acquired from the Korean Statistical Information Service (KOSIS) for 1994-2033. An APC model with Møller's power-link function was utilized to predict the incidence of mesothelioma. It was predicted that 2,380 and 1,199 new cases of mesothelioma in men and women, respectively, would occur over the next 20 years. For both sexes, the mesothelioma incidence rate was predicted to be greater in 2029-2033 compared to that in 2009-2013 (men, 0.282 vs 0.563; women, 0.155 vs 0.217). For men, the age-standardized incidence rate was predicted to be slightly greater in 2029-2033 relative to the rate in 2009-2013 (0.228 vs 0.235), while the age-standardized incidence rate in women decreased within the same timeframe (0.113 vs 0.109). The changes in mesothelioma incidence were mostly caused by changes in the population structure due to aging and not by changes in the mesothelioma risk ratio. The results of this study project a continuous increase in mesothelioma incidence in South Korea over the next 20 years. Although the projected increase in mesothelioma incidence was not related to an increase in the mesothelioma risk ratio, continuous preventive efforts are necessary to reduce the exposure to asbestos and prevent the trend from worsening.

  1. The Stripa project annual report 1991

    International Nuclear Information System (INIS)

    1992-05-01

    The Stripa project is an international project being performed under the sponsorship of the OECD Nuclear Energy Agency (NEA). The project concerns research related to the disposal of highly radioactive waste in crystalline rock. The Research and Development Division of the Swedish Nuclear Fuel and Waste Management Company (SKB) has been entrusted with the management of the project, under the direction of representatives from each participating country. The aim of this report is to inform the OECD Nuclear Energy Agency and the participants in the project about the general progress of work during 1991

  2. Improvement in the incident reporting and investigation procedures using process excellence (DMAI2C) methodology

    International Nuclear Information System (INIS)

    Miles, Elizabeth N.

    2006-01-01

    In 1996, Health and Safety introduced an incident investigation process called Learning to Look ( C) to Johnson and Johnson. This process provides a systematic way of analyzing work-related injuries and illness, uncovers root cause that leads to system defects, and points to viable solutions. The process analyzed involves three steps: investigation and reporting of the incident, determination of root cause, and development and implementation of a corrective action plan. The process requires the investigators to provide an initial communication for work-related serious injuries and illness as well as lost workday cases to Corporate Headquarters within 72h of the incident with a full investigative report to follow within 10 days. A full investigation requires a written report, a cause-result logic diagram (CRLD), a corrective action plan (CAP) and a report of incident costs (SafeCost) all due to be filed electronically. It is incumbent on the principal investigator and his or her investigative teams to assemble the various parts of the investigation and to follow up with the relevant parties to ensure corrective actions are implemented, and a full report submitted to Corporate executives. Initial review of the system revealed that the process was not working as designed. A number of reports were late, not signed by the business leaders, and in some instances, all cause were not identified. Process excellence was the process used to study the issue. The team used six sigma DMAI 2 C methodologies to identify and implement system improvements. The project examined the breakdown of the critical aspects of the reporting and investigation process that lead to system errors. This report will discuss the study findings, recommended improvements, and methods used to monitor the new improved process

  3. Photovoltaic demonstration project. Final report

    International Nuclear Information System (INIS)

    Jicarilla Apache Tribe

    2002-01-01

    The Jicarilla Apache Nation is in Rio Arriba County in North Central New Mexico. The photovoltaic project was installed at the Dulce High School in the town of Dulce. Dulce is in the most northern part of the reservation near the New Mexico/Colorado boundary and can be reached from the New Mexico State Capitol in Santa Fe, hence to the town of Chama along U.S. Highway 84 to the junction of U.S. Highway 64. Dulce is about 12 miles west of the junction along U.S. Highway 64. Dulce community is in the mountainous part of the Nation with a population of about 4000. No industry exists in the community, however, a few commercial sites do exist such as a motel, restaurants, gas stations, food and liquor stores

  4. Project Recurso, 1989-1990. Final Evaluation Report. OREA Report.

    Science.gov (United States)

    Rivera, Natasha

    This report presents final (fifth year) results of Project Recurso, a federally funded project which provided 147 Spanish-speaking special education students (grades 3-5) in 12 New York City schools with instruction in English as a Second Language (ESL), Native Language Arts (NLA), and bilingual content area subjects. The project also provided…

  5. Final Technical Report. Project Boeing SGS

    Energy Technology Data Exchange (ETDEWEB)

    Bell, Thomas E. [The Boeing Company, Seattle, WA (United States)

    2014-12-31

    Boeing and its partner, PJM Interconnection, teamed to bring advanced “defense-grade” technologies for cyber security to the US regional power grid through demonstration in PJM’s energy management environment. Under this cooperative project with the Department of Energy, Boeing and PJM have developed and demonstrated a host of technologies specifically tailored to the needs of PJM and the electric sector as a whole. The team has demonstrated to the energy industry a combination of processes, techniques and technologies that have been successfully implemented in the commercial, defense, and intelligence communities to identify, mitigate and continuously monitor the cyber security of critical systems. Guided by the results of a Cyber Security Risk-Based Assessment completed in Phase I, the Boeing-PJM team has completed multiple iterations through the Phase II Development and Phase III Deployment phases. Multiple cyber security solutions have been completed across a variety of controls including: Application Security, Enhanced Malware Detection, Security Incident and Event Management (SIEM) Optimization, Continuous Vulnerability Monitoring, SCADA Monitoring/Intrusion Detection, Operational Resiliency, Cyber Range simulations and hands on cyber security personnel training. All of the developed and demonstrated solutions are suitable for replication across the electric sector and/or the energy sector as a whole. Benefits identified include; Improved malware and intrusion detection capability on critical SCADA networks including behavioral-based alerts resulting in improved zero-day threat protection; Improved Security Incident and Event Management system resulting in better threat visibility, thus increasing the likelihood of detecting a serious event; Improved malware detection and zero-day threat response capability; Improved ability to systematically evaluate and secure in house and vendor sourced software applications; Improved ability to continuously monitor

  6. Decomposable Mandrel Project. Progress report

    International Nuclear Information System (INIS)

    Letts, S.A.; Fearon, E.; Allison, L.; Buckley, S.; Saculla, M.; Cook, R.

    1995-01-01

    We report on our progress in developing a new technology to produce both Nova and NIF scale capsules using a depolymerizable mandrel. In this technique we use poly(α-methylstyrene) (PAMS) beads or shells as mandrels which are overcoated with plasma polymer. The poly(α-methylstyrene) mandrel is then thermally depolymerized to gas phase monomer which diffuses away through the more thermally stable plasma polymer coating, leaving a hollow shell. Since our last report we have concentrated on characterization of the final shell. Starting with PAMS bead mandrels leads to distorted pyrolyzed shells because of thermally induced creep of the CH coating. We found that plasma polymer coatings on hollow shell mandrels shrink isotropically during pyrolysis and maintain sphericity. We are now concentrating our efforts on the use of microencapsulated shells to prepare targets with buried diagnostic layers or inner wall surface texture

  7. Flammable gas project topical report

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, G.D.

    1997-01-29

    The flammable gas safety issue was recognized in 1990 with the declaration of an unreviewed safety question (USQ) by the U. S. Department of Energy as a result of the behavior of the Hanford Site high-level waste tank 241-SY-101. This tank exhibited episodic releases of flammable gas that on a couple of occasions exceeded the lower flammability limit of hydrogen in air. Over the past six years there has been a considerable amount of knowledge gained about the chemical and physical processes that govern the behavior of tank 241-SY-1 01 and other tanks associated with the flammable gas safety issue. This report was prepared to provide an overview of that knowledge and to provide a description of the key information still needed to resolve the issue. Items covered by this report include summaries of the understanding of gas generation, retention and release mechanisms, the composition and flammability behavior of the gas mixture, the amounts of stored gas, and estimated gas release fractions for spontaneous releases. `Me report also discusses methods being developed for evaluating the 177 tanks at the Hanford Site and the problems associated with these methods. Means for measuring the gases emitted from the waste are described along with laboratory experiments designed to gain more information regarding rates of generation, species of gases emitted and modes of gas storage and release. Finally, the process for closing the USQ is outlined as are the information requirements to understand and resolve the flammable gas issue.

  8. Breckinridge Project, initial effort. Report II. Breckinridge Project design basis

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    The Breckinridge Project is a pioneer endeavor involving the engineering, construction, and operation of a commercial facility that will convert 23,000 tons per day of run-of-mine, high-sulfur coal into 50,000 barrels per day of liquid hydrocarbons equivalent to those produced from crude oil. The Initial Effort, now complete, was executed under Cooperative Agreement No. DE-FC05-80OR20717 between the Department of Energy and the Participants, Ashland Synthetic Fuels, Inc., and Airco Energy Company, Inc. The Initial Effort produced a preliminary design, capital estimate, and economic analysis of the commercial plant, as well as a plan for the design, construction, and operation of that plant. The extensive and rigorous attention given to environmental, socioeconomic, safety, and health considerations is indicative of the high priority these issues will continue to receive throughout the life of the project. The Breckinridge Energy Company, a partnership of several major corporations, is being formed to finance, own, and manage the Breckinridge Project. Report II is intended for the reader who is primarily interested in less detailed discussion of the coal liquefaction process and Breckinridge facility than presented in the eleven volumes of Reports IV and V. The overview section describes the project goals and briefly introduces the coal liquefaction process. The report continues with a discussion of the history of the project and the H-COAL process from its concept to the proposed commercialization technology. The report describes the site, the Breckinridge Facility, and concludes with a summary of the eleven reports that contain the deliverable documentation of the Initial Effort or Development Phase of the project.

  9. Project SQUID: Quarterly Progress Report

    Science.gov (United States)

    1950-07-01

    8 of an inch thicko It will be mounted in a pl-ywood panel whose inner surface, coincident with the channel wall,, is mahogany veneer...Flow .-leld (83) 1 ^UARTIRLY mCORErS REPORT ii.STR’-"i:t<TArici; ai,d testi ’.c E^tUip;-::-! I B i #■ Si I \\3k I ■ V 1 rnmm’^M C s* Ps3 •P O» I gs 1

  10. The Oregon Applied Academics Project: Final Report

    Science.gov (United States)

    Pearson, Donna; Richardson, George B.; Sawyer, Jennifer M.

    2013-01-01

    This report contains the findings of the Oregon Applied Academics research and development project which spanned three academic years from 2010 through 2013. The overall purpose of the project was to develop and implement a technical math course that would meet graduation requirements and improve student performance. The State of Oregon has been…

  11. Project Final Report: HPC-Colony II

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Terry R [ORNL; Kale, Laxmikant V [University of Illinois, Urbana-Champaign; Moreira, Jose [IBM T. J. Watson Research Center

    2013-11-01

    This report recounts the HPC Colony II Project which was a computer science effort funded by DOE's Advanced Scientific Computing Research office. The project included researchers from ORNL, IBM, and the University of Illinois at Urbana-Champaign. The topic of the effort was adaptive system software for extreme scale parallel machines. A description of findings is included.

  12. Project Ta-Kos Outreach. Final Report.

    Science.gov (United States)

    Askew, Linda; Husted, Tony; Faris, Cindy

    This final report describes activities and accomplishments of Project Ta-Kos Outreach, a 3-year program to provide consultation and site-specific training for families, educators, and health care providers. Project Ta-kos, through its curriculum and training approach, was designed to increase the probability that children, ages birth through eight…

  13. The NORDLEDEN Project. Final Report

    International Nuclear Information System (INIS)

    Unger, Thomas; Andersson, Owe; Ryden, Bo; Wene, Clas-Otto

    2000-03-01

    The NORDLEDEN project shows the importance and the value of grid-distributed energy trade and increased cooperation among the Nordic countries under CO 2 -emission commitments. The commitments that have been analyzed here are imposed on the stationary energy sector in the Nordic countries, and may range from the targets that were agreed upon in the (aftermath of the) Kyoto negotiations to considerably tougher reduction commitments of approximately 60 percent until the year 2050 relative to 1990-95. The values of increased net electricity trade, common action instead of separately fulfilling the CO 2 commitments, and a Trans-Nordic natural gas transmission line are all separately estimated to be in the range of 5-50 billion (depending on scenario assumptions regarding e.g. energy demand and technological development, and imposed CO 2 restrictions) SEK each. More than twice that amount can be saved if all three cooperative strategies are implemented and utilized at the same time. Thereby, the additional costs of meeting the Kyoto target in the Nordic stationary energy system could at least be halved. The Nordic energy system contains a fairly high degree of flexibility for meeting CO 2 commitments. This study shows that the most cost-efficient way of meeting predefined CO 2 commitments is not through one single or even a handful of future solutions or options. The highest degree of efficiency is achieved by using a considerable amount of different options simultaneously. Hydro power, increased use of biofuels and wind power, end-use conservation and efficiency measures, increased power production from combined heat and power units, as well as increased reliance on natural gas, are all factors that will play an important part in reducing CO 2 emissions in a cost-efficient way. This also includes increased cross-border energy trade and cooperation. Furthermore, long-term options presented by solar and fuel cells and CO 2 sequestering and disposal might also gain

  14. DHS Summer Student Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Kawamoto, S

    2005-08-19

    Tetanus and botulinum neurotoxins are among the most potent toxins known to man (Montecucco et al. al., 1995). Produced by the Clostridium tetani and Clostridium botulinum bacteria, respectively, these toxins concentrate in presynaptic axons and inhibit the release of neurotransmitters leading to paralysis and possibly death. Due to the potency of this lethal class of neurotoxins, we have undertaken a project to develop high affinity ligands that specifically bind to these toxins. Such compounds can have significant implications in both the design of detection systems to monitor for the possible release of these neurotoxins into the public and also the design of possible therapeutics to treat individuals exposed to tetanus or botulinum neurotoxins. The Clostridial neurotoxins are synthesized as 150 kDa proteins that are post-translationally cleaved into N- and C-terminal fragments held together by a single disulfide bond. The tetanus C-terminal fragment (TetC) has been shown to bind specifically to gangliosides present on the neuronal membrane surface and facilitate endocytosis of the toxin (Morris et al., 1980). Once the toxin is internalized in a membrane-bound vesicle, the light chain (N-terminal fragment) translocates to the cytosol where it interferes with neurotransmitter release. Previous work has demonstrated that various small molecule and peptide-based compounds bind to TetC, albeit in different locations. Among these molecules are the anticancer agent doxorubicin (Dox) and the tripeptides WEY and YEW (Figure 1; Cosman et al. al., 2002). The crystal structure of botulinum toxin and Dox (PDB code: 1I1E) demonstrates that Dox binds in a surface groove of in C-terminal fragment that is conserved in both botulinum and tetanus toxins. Similarly, YEW has been shown to bind to a second binding site that is highly conserved and also relatively close to the binding site of Dox. Thus, in our quest to design and synthesize high affinity ligands, we proposed to link

  15. UMTRA project list of reportable occurrences

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    This UMTRA Project List of Reportable occurrences is provided to facilitate efficient categorization of reportable occurrences. These guidelines have been established in compliance with DOE minimum reporting requirements under DOE Order 5000.3B. Occurrences are arranged into nine groups relating to US Department of Energy (DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project operations for active sites. These nine groupings are provided for reference to determined whether an occurrence meets reporting requirement criteria in accordance with the minimum reporting requirements. Event groups and significance categories that cannot or will not occur, and that do not apply to UMTRA Project operations, are omitted. Occurrence categorization shall be as follows: Group 1. Facility Condition; Group 2. Environmental; Group 3. Personnel Safety; Group 4. Personnel Radiation Protection; Group 5. Safeguards and Security; Group 6. Transportation; Group 7. Value Basis Reporting; Group 8. Facility Status; and Group 9. Cross-Category Items.

  16. UMTRA project list of reportable occurrences

    International Nuclear Information System (INIS)

    1994-04-01

    This UMTRA Project List of Reportable occurrences is provided to facilitate efficient categorization of reportable occurrences. These guidelines have been established in compliance with DOE minimum reporting requirements under DOE Order 5000.3B. Occurrences are arranged into nine groups relating to US Department of Energy (DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project operations for active sites. These nine groupings are provided for reference to determined whether an occurrence meets reporting requirement criteria in accordance with the minimum reporting requirements. Event groups and significance categories that cannot or will not occur, and that do not apply to UMTRA Project operations, are omitted. Occurrence categorization shall be as follows: Group 1. Facility Condition; Group 2. Environmental; Group 3. Personnel Safety; Group 4. Personnel Radiation Protection; Group 5. Safeguards and Security; Group 6. Transportation; Group 7. Value Basis Reporting; Group 8. Facility Status; and Group 9. Cross-Category Items

  17. Improving the Reporting Practice in Project Delivery of Offshoring Projects

    OpenAIRE

    Loponen, Mika

    2015-01-01

    This thesis investigates reporting practice in the case company and proposes improvements on it. The case company uses offshore for project operations and recently use of offshoring has been increased significantly. Due to growth in offshore operations some reporting practices has not been developed accordingly. The research method of this thesis was action research due to its cyclical and qualitative nature, which was considered to serve best the needs of this study. The research design ...

  18. Nuclear Safety Project. Annual report 1983

    International Nuclear Information System (INIS)

    1984-06-01

    The annual report 1983 is a detailed description (in German language) of work within the Nuclear Safety Project performed in 1983 in the nuclear safety field by KfK institutes and departments and by external institutes on behalf of KfK. It includes for each individual research activity short summaries in English language on work performed, results obtained and plans for future work. This report was compiled by the project management. (orig.) [de

  19. Nuclear safety project. Annual report 1985

    International Nuclear Information System (INIS)

    1986-07-01

    The annual report 1985 is a detailed description (in German language) of work within the nuclear safety project performed in 1985 in the nuclear safety field by KfK institutes and departments and by external institutes on behalf of KfK. It includes for each individual research activity short summaries in English language on work performed, results obtained and plans for future work. This report was compiled by the project management. (orig./HP) [de

  20. Reporting of Violent and Disruptive Incidents by Public Schools. Report 2005-S-38

    Science.gov (United States)

    New York State Education Department, 2006

    2006-01-01

    The objective of this report was to determine whether the State Education Department (SED) has developed effective processes for (1) ensuring that school districts report violent and disruptive incidents to SED in accordance with State law and regulations, (2) identifying schools that should be designated as persistently dangerous because of their…

  1. Laser fusion project: initial report

    International Nuclear Information System (INIS)

    Boyd, D.C.; Dumbaugh, W.H.; Morgan, D.W.; Spivack, B.D.

    1977-01-01

    The objective of the first year program is to explore and characterize fluoride glass systems to find a glass with the lowest possible nonlinear refractive index, satisfactory chemical durability, and physical properties which enable casting large optical quality pieces. A second part of this objective is to explore techniques for forming optical quality fluoride glass. Beryllium fluoride type glasses offer the best approach. In order to achieve the objectives, the first main task is to provide a facility and equipment to safely work in beryllium fluoride type systems. The main emphasis of this report is a description of facility and equipment along with a schedule for the first year's research. Some preliminary exploration of the beryllium fluoride type glasses has indicated that achievement of the objectives is feasible. Expansion coefficients (25 to 300 0 C) are in the 150 x 10 -7 / 0 C region and annealing points are around 350 0 C. A number of beryllium-free fluoride glasses have also been made in small quantities

  2. Foam shell project: Progress report

    International Nuclear Information System (INIS)

    Overturf, G.; Reibold, B.; Cook, B.; Schroen-Carey, D.

    1994-01-01

    The authors report on their work to produce a foam shell target for two possible applications: (1) as liquid-layered cryogenic target on Omega Upgrade, and (2) as a back-up design for the NIF. This target consists of a roughly 1 mm diameter and 100 μm thick spherical low-density foam shell surrounding a central void. The foam will be slightly overfilled with liquid D 2 or DT, the overfilled excess being symmetrically distributed on the inside of the shell and supported by thermal gradient techniques. The outside of the foam is overcoated with full density polymer which must be topologically smooth. The technology for manufacturing this style of foam shell involves microencapsulation techniques and has been developed by the Japanese at ILE. Their goal is to determine whether this technology can be successfully adapted to meet US ICF objectives. To this end a program of foam shell development has been initiated at LLNL in collaboration with both the General Atomics DOE Target Fabrication Contract Corporation and the Target Fabrication Group at LLE

  3. The fracture zone project - final report

    International Nuclear Information System (INIS)

    Andersson, Peter

    1993-09-01

    This report summarizes the work and the experiences gained during the fracture zone project at the Finnsjoen study site. The project is probably the biggest effort, so far, to characterize a major fracture zone in crystalline bedrock. The project was running between 1984-1990 involving a large number of geological, geohydrological, geochemical, and geomechanical investigation. The methods used for identification and characterization are reviewed and discussed in terms of applicability and possible improvements for future investigations. The discussion is exemplified with results from the investigation within the project. Flow and transport properties of the zone determined from hydraulic tests and tracer tests are discussed. A large number of numerical modelling efforts performed within the fracture zone project, the INTRAVAL project, and the SKB91-study are summarized and reviewed. Finally, occurrence of similar zones and the relevance of major low angle fracture zones in connection to the siting of an underground repository is addressed

  4. Hanford Environmental Dose Reconstruction Project Monthly Report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M. (comp.)

    1990-05-01

    This monthly report summarizes the technical progress and project status for the Hanford Environmental Dose Reconstruction (HEDR) Project being conducted at Pacific Northwest Laboratory (PNL) under the direction of a Technical Steering Panel (TSP). The TSP is composed of experts in numerous technical fields related to this project and represents the interests of the public. The US Department of Energy (DOE) funds the project. The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that populations could have received from nuclear operations at Hanford since 1944. The project is divided into the following technical tasks. These tasks address each of the primary steps in the path from radioactive releases to dose estimates source terms, environmental transport, environmental monitoring data, demographics, agriculture, and food habits, and environmental pathways and dose estimates.

  5. Progress report on research project 'Coupled-channels optical model potentials for calculations with coupling built on soft-rotator model for nucleon induced reactions up to 200 MeV incident energies in A =24-120 mass region'

    International Nuclear Information System (INIS)

    Soukhovitski, E.

    2006-01-01

    Full text: During these nine months the Research Contract activity was developing according to the schedule as fixed in the Contract. Developing a global optical potential for even-even nuclides with A = 24-120 mass for coupled-channels optical model calculations based on coupling built on soft-rotator nuclear model Hamiltonian wave functions we already: 1. Determined Nuclear Hamiltonian parameters describing low-lying collective levels of even-even nuclides with A = 24-120 mass for all nuclides having experimental optical data available. 2. Formatted all the available optical experimental data for even-even nuclides with A = 24-120 mass into input of OPTMAN code for optical potential search option. Data still unavailable in the EXFOR database was submitted to the Nuclear Data Section for inclusion. 3. Derived a local OMP parameters for even-even A = 24-120 mass nuclides. 4. Release the OPTMAN code's user guide with the support of our Japanese collaborators. The User guide was published as JAERI technical report as cited below: E.Sh. Soukhovitskii, S. Chiba, O. Iwamoto, K. Shibata, T. Fukahori, G.B. Morogovskij (JAERI technical report 'Programs OPTMAN and SHEMMAN Version 8 (2004)', JAERI/Data-Code 2005-002, 2005). It is freely available on request from Japanese Nuclear Data Center. Global optical potential for even-even nuclides with A=24-120 mass, which is the main goal of the Contract's first year activity, will be derived based on individual optical potential parameters already determined. This research contract made possible very fruitful international scientific cooperation aimed to incorporate ideas on dispersive relationships between imaginary and real parts of optical potential developed earlier by Roberto Capote (IAEA/NDS) and Jose Manuel Quesada (Seville University) in the CC optical code OPTMAN. The real possibility to use a modified OPTMAN code for high priority practical applications arises. These activities are coordinated through RIPL CRP. We

  6. The development of an incident event reporting system for nursing students.

    Science.gov (United States)

    Chiou, Shwu-Fen; Huang, Ean-Wen; Chuang, Jen-Hsiang

    2009-01-01

    Incident events may occur when nursing students are present in the clinical setting. Their inexperience and unfamiliarity with clinical practice put them at risk for making mistakes that could potentially harm patients and themselves. However, there are deficiencies with incident event reporting systems, including incomplete data and delayed reports. The purpose of this study was to develop an incident event reporting system for nursing students in clinical settings and evaluate its effectiveness. This study was undertaken in three phases. In the first phase, a literature review and focus groups were used to develop the architecture of the reporting system. In the second phase, the reporting system was implemented. Data from incident events that involved nursing students were collected for a 12-month period. In the third phase, a pre-post trial was undertaken to evaluate the performance of the reporting system. The ASP.NET software and Microsoft Access 2003 were used to create an interactive web-based interface and design a database for the reporting system. Email notifications alerted the nursing student's teacher when an incident event was reported. One year after installing the reporting system, the number of reported incident events increased tenfold. However, the time to report the incident event and the time required to complete the reporting procedures were shorter than before implementation of the reporting system. The incident event reporting system appeared to be effective in more comprehensively reporting the number of incident events and shorten the time required for reporting them compared to traditional written reports.

  7. Projecting cancer incidence using age-period-cohort models incorporating restricted cubic splines.

    Science.gov (United States)

    Rutherford, Mark J; Thompson, John R; Lambert, Paul C

    2012-11-05

    Age-period-cohort models provide a useful method for modeling incidence and mortality rates. There is great interest in estimating the rates of disease at given future time-points in order that plans can be made for the provision of the required future services. In the setting of using age-period-cohort models incorporating restricted cubic splines, a new technique for projecting incidence is proposed. The new technique projects the period and cohort terms linearly from 10 years within the range of the available data in order to give projections that are based on recent trends. The method is validated via a comparison with existing methods in the setting of Finnish cancer registry data. The reasons for the improvements seen for the newly proposed method are twofold. Firstly, improvements are seen due to the finer splitting of the timescale to give a more continuous estimate of the incidence rate. Secondly, the new method uses more recent trends to dictate the future projections than previously proposed methods.

  8. Photovoltaic Programme, Edition 2006. Summary report. Project list. Annual project reports 2005 (abstracts)

    Energy Technology Data Exchange (ETDEWEB)

    Nowak, S.

    2006-07-01

    This comprehensive, illustrated report for the Swiss Federal Office of Energy (SFOE) presents an overview of the work done as part of the 2005 research programme, along with the abstracts of the annual reports of the project leaders on research projects. It presents the programme's main points of focus, discusses the work done and the results obtained. Areas covered include cell technology (13 reports), solar modules and building integration (3 reports) , system technology (4 reports) as well as various further projects (5) that are connected with photovoltaics. Four further reports concern international co-operation. Further, several pilot and demonstration (P+D) projects are discussed. Lists of all research and development projects and pilot and demonstration projects are supplied. Work done at several institutions in Switzerland and at leading commercial companies is described.

  9. Prototypical Consolidation Demonstration Project: Final report

    International Nuclear Information System (INIS)

    Gili, J.A.; Poston, V.K.

    1993-11-01

    This is the final report of the Prototypical Consolidation Demonstration Project, which was funded by the US Department of Energy's Office of Civilian Radioactive Waste Management. The project had two objectives: (a) to develop and demonstrate a prototype of production-scale equipment for the dry, horizontal consolidation and packaging of spent nuclear fuel rods from commercial boiling water reactor and pressurized water reactor fuel assemblies, and (b) to report the development and demonstration results to the US Department of Energy, Idaho Operations Office. This report summarizes the activities and conclusions of the project management contractor, EG ampersand G Idaho, Inc., and the fabrication and testing contractor, NUS Corporation (NUS). The report also presents EG ampersand G Idaho's assessments of the equipment and procedures developed by NUS

  10. A safety incident reporting system for primary care. A systematic literature review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care.

    Science.gov (United States)

    Klemp, Kerstin; Zwart, Dorien; Hansen, Jørgen; Hellebek, Torben; Luettel, Dagmar; Verstappen, Wim; Beyer, Martin; Gerlach, Ferdin M; Hoffmann, Barbara; Esmail, Aneez

    2015-09-01

    Incident reporting is widely used in both patient safety improvement programmes, and in research on patient safety. To identify the key requirements for incident reporting systems in primary care; to develop an Internet-based incident reporting and learning system for primary care. A literature review looking at the purpose, design and requirements of an incident reporting system (IRS) was used to update an existing incident reporting system, widely used in Germany. Then, an international expert panel with knowledge on IRS developed the criteria for the design of a new web-based incident reporting system for European primary care. A small demonstration project was used to create a web-based reporting system, to be made freely available for practitioners and researchers. The expert group compiled recommendations regarding the desirable features of an incident reporting system for European primary care. These features covered the purpose of reporting, who should be involved in reporting, the mode of reporting, design considerations, feedback mechanisms and preconditions necessary for the implementation of an IRS. A freely available web-based reporting form was developed, based on these criteria. It can be modified for local contexts. Practitioners and researchers can use this system as a means of recording patient safety incidents in their locality and use it as a basis for learning from errors. The LINNEAUS collaboration has provided a freely available incident reporting system that can be modified for a local context and used throughout Europe.

  11. An Evaluation of Departmental Radiation Oncology Incident Reports: Anticipating a National Reporting System

    International Nuclear Information System (INIS)

    Terezakis, Stephanie A.; Harris, Kendra M.; Ford, Eric; Michalski, Jeff; DeWeese, Theodore; Santanam, Lakshmi; Mutic, Sasa; Gay, Hiram

    2013-01-01

    Purpose: Systems to ensure patient safety are of critical importance. The electronic incident reporting systems (IRS) of 2 large academic radiation oncology departments were evaluated for events that may be suitable for submission to a national reporting system (NRS). Methods and Materials: All events recorded in the combined IRS were evaluated from 2007 through 2010. Incidents were graded for potential severity using the validated French Nuclear Safety Authority (ASN) 5-point scale. These incidents were categorized into 7 groups: (1) human error, (2) software error, (3) hardware error, (4) error in communication between 2 humans, (5) error at the human-software interface, (6) error at the software-hardware interface, and (7) error at the human-hardware interface. Results: Between the 2 systems, 4407 incidents were reported. Of these events, 1507 (34%) were considered to have the potential for clinical consequences. Of these 1507 events, 149 (10%) were rated as having a potential severity of ≥2. Of these 149 events, the committee determined that 79 (53%) of these events would be submittable to a NRS of which the majority was related to human error or to the human-software interface. Conclusions: A significant number of incidents were identified in this analysis. The majority of events in this study were related to human error and to the human-software interface, further supporting the need for a NRS to facilitate field-wide learning and system improvement

  12. An Evaluation of Departmental Radiation Oncology Incident Reports: Anticipating a National Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Terezakis, Stephanie A., E-mail: stereza1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Harris, Kendra M. [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Ford, Eric [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Michalski, Jeff [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); DeWeese, Theodore [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Santanam, Lakshmi; Mutic, Sasa; Gay, Hiram [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-03-15

    Purpose: Systems to ensure patient safety are of critical importance. The electronic incident reporting systems (IRS) of 2 large academic radiation oncology departments were evaluated for events that may be suitable for submission to a national reporting system (NRS). Methods and Materials: All events recorded in the combined IRS were evaluated from 2007 through 2010. Incidents were graded for potential severity using the validated French Nuclear Safety Authority (ASN) 5-point scale. These incidents were categorized into 7 groups: (1) human error, (2) software error, (3) hardware error, (4) error in communication between 2 humans, (5) error at the human-software interface, (6) error at the software-hardware interface, and (7) error at the human-hardware interface. Results: Between the 2 systems, 4407 incidents were reported. Of these events, 1507 (34%) were considered to have the potential for clinical consequences. Of these 1507 events, 149 (10%) were rated as having a potential severity of ≥2. Of these 149 events, the committee determined that 79 (53%) of these events would be submittable to a NRS of which the majority was related to human error or to the human-software interface. Conclusions: A significant number of incidents were identified in this analysis. The majority of events in this study were related to human error and to the human-software interface, further supporting the need for a NRS to facilitate field-wide learning and system improvement.

  13. Incidence et Caracteristiques des Signalements d'Enfants Maltraites: Comparaison Interculturelle (Incidence and Characteristics of Reported Child Abuse: Intercultural Comparisons).

    Science.gov (United States)

    Tourigny, Marc; Bouchard, Camil

    1994-01-01

    Analysis of 953 reports of child abuse in Montreal (Quebec) found the incidence slightly higher among Haitians than French-Canadians. Among Haitians, reporting tended to originate with police or school personnel, and cases consisted mainly of physical abuse. Results suggest that child-rearing practices of Haitian families are in conflict with…

  14. Leven estuary project. Fisheries Department final report

    OpenAIRE

    Bayliss, B.D.

    1997-01-01

    This is the report on the Leven estuary project: Fisheries Department final report produced by the Environment Agency North West in 1997. This report contains information about Leven estuary, river Leven catchment, river Crake catchment and the Ulverston Discharges. The Leven estuary is characterised by being very shallow, and shares the extremely variable tides and currents that characterize the whole of Morecambe Bay. There was little detailed knowledge of the impact on the Leven estuary, a...

  15. Hanford Environmental Dose Reconstruction Project Monthly Report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M. (comp.)

    1990-06-01

    This monthly report summarizes the technical progress and project status for the Hanford Environmental Dose Reconstruction (HEDR) Project being conducted at Pacific Northwest Laboratory (PNL) under the direction of a Technical Steering Panel (TSP). The TSP is composed of experts in numerous technical fields related to this project and represents the interests of the public. The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that populations could have received from nuclear operations at Hanford since 1944. The project is divided into technical tasks which address each of the primary steps in the path from radioactive releases to dose estimates: source terms, environmental transport, environmental monitoring data, demographics, agriculture, and food habits, and environmental pathways and dose estimates.

  16. Project Progress Assessment Report (PPAR) 2014

    International Nuclear Information System (INIS)

    Sall, Baba

    2014-01-01

    This evaluation reports reviews basic information, output achievement, equipment and human resources, comment and recommendations developed in the framework of the project. It highlights outputs Fully achieved and those which are partially achieved or in progress. Regarding comments and recommendations, the project's timeline is generally respected, even though activities may be delayed to adapt to constraints (technical, financial, human resources). The results obtained are in line with expectations thanks to a rigorous scientific approach.

  17. Halifax Lateral Pipeline Project : comprehensive study report

    International Nuclear Information System (INIS)

    1998-12-01

    The National Energy Board has requested the preparation of a comprehensive study report (CSR) for the proposed Halifax Lateral Pipeline Project in support of Maritimes and Northeast Pipeline Company's proposal to construct the lateral pipeline to transport natural gas produced in offshore Nova Scotia to the Tufts Cove electric generating station in the Halifax Regional Municipality. The project will also enhance the access of natural gas to potential markets located along the pipeline route. This CSR was prepared according to guidelines of the Canadian Environmental Assessment Agency. The report presents: (1) an overview of the project, (2) a summary of the regulatory requirements for assessment, (3) a description of the environmental assessment and regulatory process to date, (4) a summary of the predicted residual environmental and socio-economic effects associated with the project, and (5) a summary of the public consultation process. The environmental and socio-economic assessment focused on these eleven issues: groundwater resources, surface water resources, wetlands, soils, air quality, fish habitat, rare herpetiles, mammals, avifauna, rare plants and archaeological heritage resources. The report identified potential interactions between the project and valued socio-economic and environmental components. These were addressed in combination with recommended mitigative measures to reduce potential adverse effects. It was concluded that the overall environmental effects from the proposed project are likely to be minimal and can be effectively managed with good environmental management methods. 14 refs., 5 tabs., 5 figs., 2 appendices

  18. Self-reported incidence of injuries among ballroom dancers | Kuisis ...

    African Journals Online (AJOL)

    Ballroom dancing is an increasingly popular sport around the world. However, unlike other forms of dancing such as ballet and modern, very little is known about the incidence, nature and severity of injuries sustained by dancers. The aims of this study were: 1) to quantify the incidence of injuries 2) to identify the nature of ...

  19. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    International Nuclear Information System (INIS)

    Montgomery, Logan; Kildea, John

    2016-01-01

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  20. 30 CFR 250.187 - What are MMS' incident reporting requirements?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are MMS' incident reporting requirements... Reporting Requirements § 250.187 What are MMS' incident reporting requirements? (a) You must report all... other permit issued by MMS, and that are related to operations resulting from the exercise of your...

  1. Sense of life worth living (ikigai) and incident functional disability in elderly Japanese: The Tsurugaya Project.

    Science.gov (United States)

    Mori, Kentaro; Kaiho, Yu; Tomata, Yasutake; Narita, Mamoru; Tanji, Fumiya; Sugiyama, Kemmyo; Sugawara, Yumi; Tsuji, Ichiro

    2017-04-01

    To test the hypothesis that elderly persons who feel ikigai (a sense of life worth living) have a lower risk of incident functional disability than those who do not. Recent studies have suggested that ikigai impacts on mortality. However, its impact upon disability is unknown. The aim of the present study was to investigate the association between ikigai and incident functional disability among elderly persons. We conducted a prospective cohort study of 830 Japanese elderly persons aged ≥70 years as a comprehensive geriatric assessment in 2003. Information on ikigai was collected by self-reported questionnaire. Data on functional disability were retrieved from the public Long-term Care Insurance database in which participants were followed up for 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of functional disability were calculated for three groups delineated according to the presence of ikigai (“no”, “uncertain” or “yes”) using the Cox proportional hazards regression model. The 11-year incidence of functional disability was 53.3% (442 cases). As compared with the “no” group, the multiple-adjusted HR (95% CI) of incident functional disability was 0.61 (0.36–1.02) for the “uncertain” group and 0.50 (0.30–0.84) for the “yes” group. A stronger degree of ikigai is significantly associated with a lower risk of incident functional disability. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Incidence of HIV infection at the time of incident reporting,in victims ...

    African Journals Online (AJOL)

    Background: HIV/AIDS epidemic and sexual assault have emerged as the most serious public health problems in South Africa. The country has about 5-million HIV infected individuals. About a million women are raped every year. Objective: To study the incidence of HIV infection in victims of sexual assaults. Methods: This ...

  3. Project Progress Assessment Report (PPAR) 2015

    International Nuclear Information System (INIS)

    Sall, Baba

    2015-01-01

    This evaluation reports reviews basic information, output achievement, equipment and human resources, comment and recommendations. It highlights outputs Fully achieved, those which are partially achieved or in progress and also non achieved outputs. Regarding comments and lessons learned, counterpart stated that the overall timeline of the project is respected, even if activities are delayed to adapt to technical, financial and human resources constraints. The results obtained are in line with expectations thanks to a rigorously respected scientific approach. The Collegial Coordination of the project (DSV-LNERV-CIRAD) and the TO are in phase on the conduct of the Project the collection of baseline data is a crucial phase in the implementation of tsetse control programs. It makes it possible to implement a good strategy. The scientific and technical rigor and the good atmosphere within the Project team are also to be retained.

  4. Project Progress Assessment Report (PPAR) 2012

    International Nuclear Information System (INIS)

    Sall, Baba

    2012-01-01

    This evaluation reports reviews basic information, output achievement, equipment and human resources, comment and recommendations. It highlights outputs Fully achieved, those which are partially achieved or in progress and also non achieved outputs. Regarding comments and lessons learned, counterpart stated that the overall timeline of the project is respected, even if activities are delayed to adapt to technical, financial and human resources constraints. The results obtained are in line with expectations thanks to a rigorously respected scientific approach. The Collegial Coordination of the project (DSV-LNERV-CIRAD) and the TO are in phase on the conduct of the Project the collection of baseline data is a crucial phase in the implementation of tsetse control programs. It makes it possible to implement a good strategy. The scientific and technical rigor and the good atmosphere within the Project team are also to be retained.

  5. Smart Gun Technology project. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, D.R.

    1996-05-01

    The goal of the Smart Gun Technology project is to eliminate the capability of an unauthorized user form firing a law officer`s firearm by implementing user-recognizing-and-authorizing (or {open_quotes}smart{close_quotes}) surety technologies. This project was funded by the National Institute of Justice. This report lists the findings and results of the project`s three primary objectives. First, to find and document the requirements for a smart firearm technology that law enforcement officers will value. Second, to investigate, evaluate, and prioritize technologies that meet the requirements for a law enforcement officer`s smart firearm. Third, to demonstrate and document the most promising technology`s usefulness in models of a smart firearm.

  6. 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...

  7. Project schedule and cost estimate report

    International Nuclear Information System (INIS)

    1988-03-01

    All cost tables represent obligation dollars, at both a constant FY 1987 level and an estimated escalation level, and are based on the FY 1989 DOE Congressional Budget submittal of December 1987. The cost tables display the total UMTRA Project estimated costs, which include both Federal and state funding. The Total Estimated Cost (TEC) for the UMTRA Project is approximately $992.5 million (in 1987 escalated dollars). Project schedules have been developed that provide for Project completion by September 1994, subject to Congressional approval extending DOE's authorization under Public Law 95-604. The report contains site-specific demographic data, conceptual design assumptions, preliminary cost estimates, and site schedules. A general project overview is also presented, which includes a discussion of the basis for the schedule and cost estimates, contingency assumptions, work breakdown structure, and potential project risks. The schedules and cost estimates will be revised as necessary to reflect appropriate decisions relating to relocation of certain tailings piles, or other special design considerations or circumstances (such as revised EPA groundwater standards), and changes in the Project mission. 27 figs', 97 tabs

  8. Nuclear safety research project. Annual report 1995

    International Nuclear Information System (INIS)

    Hueper, R.

    1996-08-01

    The reactor safety R and D work of the Karlsruhe Research Centre (FZK) has been part of the Nuclear Safety Research Project (PSF) since 1990. The present annual report 1995 summarizes the R and D results. The research tasks are coordinated in agreement with internal and external working groups. The contributions to this report correspond to the status of early 1996. An abstract in English precedes each of them, whenever the respective article is written in German. (orig.) [de

  9. Critical incidence reporting systems - an option in equine anaesthesia? Results from a panel meeting.

    Science.gov (United States)

    Hartnack, Sonja; Bettschart-Wolfensberger, Regula; Driessen, Bernd; Pang, Daniel; Wohlfender, Franziska

    2013-11-01

    To provide a brief introduction into Critical Incident Reporting Systems (CIRS) as used in human medicine, and to report the discussion from a recent panel meeting discussion with 23 equine anaesthetists in preparation for a new CEPEF-4 (Confidential Enquiry into Perioperative Equine Fatalities) study. Moderated group discussions, and review of literature. The first group discussion focused on the definition of 'preventable critical incidents' and/or 'near misses' in the context of equine anaesthesia. The second group discussion focused on categorizing critical incidents according to an established framework for analysing risk and safety in clinical medicine. While critical incidents do occur in equine anaesthesia, no critical incident reporting system including systematic collection and analysis of critical incidents is in place. Critical incident reporting systems could be used to improve safety in equine anaesthesia - in addition to other study types such as mortality studies. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  10. Subject Access Project. Third Quarterly Report.

    Science.gov (United States)

    Atherton, Pauline

    This third quarterly report for the period January to March 1977 describes the production schedule, records, and estimated costs and times in creating the Subject Access Project data base. Plans for on-line use of the data base and search strategy design are outlined. A table of specifications for preparing the data base for on-line searching is…

  11. Exploring the Influence of Nurse Work Environment and Patient Safety Culture on Attitudes Toward Incident Reporting.

    Science.gov (United States)

    Yoo, Moon Sook; Kim, Kyoung Ja

    2017-09-01

    The aim of this study was to explore the influence of nurse work environments and patient safety culture on attitudes toward incident reporting. Patient safety culture had been known as a factor of incident reporting by nurses. Positive work environment could be an important influencing factor for the safety behavior of nurses. A cross-sectional survey design was used. The structured questionnaire was administered to 191 nurses working at a tertiary university hospital in South Korea. Nurses' perception of work environment and patient safety culture were positively correlated with attitudes toward incident reporting. A regression model with clinical career, work area and nurse work environment, and patient safety culture against attitudes toward incident reporting was statistically significant. The model explained approximately 50.7% of attitudes toward incident reporting. Improving nurses' attitudes toward incident reporting can be achieved with a broad approach that includes improvements in work environment and patient safety culture.

  12. Documentation of in-hospital falls on incident reports: qualitative investigation of an imperfect process.

    Science.gov (United States)

    Haines, Terry P; Cornwell, Petrea; Fleming, Jennifer; Varghese, Paul; Gray, Len

    2008-12-11

    Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  13. Documentation of in-hospital falls on incident reports: Qualitative investigation of an imperfect process

    Directory of Open Access Journals (Sweden)

    Fleming Jennifer

    2008-12-01

    Full Text Available Abstract Background Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. Methods This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Results Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting, secondary (patient injury, and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. Conclusion A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  14. 49 CFR 191.15 - Transmission and gathering systems: Incident report.

    Science.gov (United States)

    2010-10-01

    ...-RELATED CONDITION REPORTS § 191.15 Transmission and gathering systems: Incident report. (a) Except as... 49 Transportation 3 2010-10-01 2010-10-01 false Transmission and gathering systems: Incident report. 191.15 Section 191.15 Transportation Other Regulations Relating to Transportation (Continued...

  15. Automated metadata--final project report

    International Nuclear Information System (INIS)

    Schissel, David

    2016-01-01

    This report summarizes the work of the Automated Metadata, Provenance Cataloging, and Navigable Interfaces: Ensuring the Usefulness of Extreme-Scale Data Project (MPO Project) funded by the United States Department of Energy (DOE), Offices of Advanced Scientific Computing Research and Fusion Energy Sciences. Initially funded for three years starting in 2012, it was extended for 6 months with additional funding. The project was a collaboration between scientists at General Atomics, Lawrence Berkley National Laboratory (LBNL), and Massachusetts Institute of Technology (MIT). The group leveraged existing computer science technology where possible, and extended or created new capabilities where required. The MPO project was able to successfully create a suite of software tools that can be used by a scientific community to automatically document their scientific workflows. These tools were integrated into workflows for fusion energy and climate research illustrating the general applicability of the project's toolkit. Feedback was very positive on the project's toolkit and the value of such automatic workflow documentation to the scientific endeavor.

  16. 49 CFR 225.15 - Accidents/incidents not to be reported.

    Science.gov (United States)

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD ACCIDENTS/INCIDENTS: REPORTS CLASSIFICATION, AND... in or about living quarters not arising from the operation of a railroad; (c) Suicides as determined...

  17. Vegetation baseline report : Connacher great divide project

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-08-01

    This baseline report supported an application by Connacher Oil and Gas Ltd. to the Alberta Energy and Utilities Board (EUB) and Alberta Environment (AENV) for the Great Divide Steam Assisted Gravity Drainage (SAGD) Project. The goal of the report was to document the distribution and occurrence of ecosite phases and wetland classes in the project footprint as well as to document the distribution of rare plants; rare plant communities: and intrusive species and old growth communities, including species of management concern. A methodology of the baseline report was presented, including details of mapping and field surveys. Six vegetation types in addition to the disturbed land unit were identified in the project footprint and associated buffer. It was noted that all vegetation types are common for the boreal forest natural regions. Several species of management concern were identified during the spring rare plant survey, including rare bryophytes and non-native or invasive species. Mitigation was identified through a slight shift of the footprint, transplant of appropriate bryophyte species and implementation of a weed management plan. It was noted that results of future surveys for rare plants will be submitted upon completion. It was concluded that the effects of the project on existing vegetation is expected to be low because of the small footprint, prior disturbance history, available mitigation measures and conservation and reclamation planning. 27 refs., 5 tabs., 4 figs.

  18. Simulation analysis of route diversion strategies for freeway incident management : final report.

    Science.gov (United States)

    1995-02-01

    The purpose of this project was to investigate whether simulation models could : be used as decision aids for defining traffic diversion strategies for effective : incident management. A methodology was developed for using such a model to : determine...

  19. INCIDENT OF SETTLEMENT OF REPETITIOUS CLAIMS: PROJECTIONS AROUND THE EFFICIENCY THEREOF

    Directory of Open Access Journals (Sweden)

    Guilherme Puchalski Teixeira

    2015-12-01

    Full Text Available The current scenario is one of clear incompatibility between litigation and the Judiciary's capacity to absorb such demand. The well-known problem of lengthy proceedings is aggravated by lack of predictability of the jurisdiction in the settlement of identical matters of law. In this context, one of the axes of the new Code of Civil Procedure (Law 13,105/2015 consists of valuing precedents with binding effectiveness, among them the incident of settlement of repetitious claims, which is the subject matter of this article. It is one of the major innovations in Brazilian procedural law. The proceeding of this procedural incident is analyzed in full. Its efficiency and usefulness are projected in its purpose of providing greater predictability to the protection of rights.

  20. Risk factors for radiotherapy incidents and impact of an online electronic reporting system

    International Nuclear Information System (INIS)

    Chang, David W.; Cheetham, Lynn; Marvelde, Luc te; Bressel, Mathias; Kron, Tomas; Gill, Suki; Tai, Keen Hun; Ball, David; Rose, William; Silva, Linas; Foroudi, Farshad

    2014-01-01

    Background and purpose: To ascertain the rate, type, significance, trends and the potential risk factors associated with radiotherapy incidents in a large academic department. Materials and methods: Data for all radiotherapy activities from July 2001 to January 2011 were reviewed from radiotherapy incident reporting forms. Patient and treatment data were obtained from the radiotherapy record and verification database (MOSAIQ) and the patient database (HOSPRO). Logistic regression analyses were performed to determine variables associated with radiotherapy incidents. Results: In that time, 65,376 courses of radiotherapy were delivered with a reported incident rate of 2.64 per 100 courses. The rate of incidents per course increased (1.96 per 100 courses to 3.52 per 100 courses, p < 0.001) whereas the proportion of reported incidents resulting in >5% deviation in dose (10.50 to 2.75%, p < 0.001) had decreased after the introduction of an online electronic reporting system. The following variables were associated with an increased rate of incidents: afternoon treatment time, paediatric patients, males, inpatients, palliative plans, head-and-neck, skin, sarcoma and haematological malignancies. In general, complex plans were associated with higher incidence rates. Conclusion: Radiotherapy incidents were infrequent and most did not result in significant dose deviation. A number of risk factors were identified and these could be used to highlight high-risk cases in the future. Introduction of an online electronic reporting system resulted in a significant increase in the number of incidents being reported

  1. A Descriptive Analysis of Incidents Reported by Community Aged Care Workers.

    Science.gov (United States)

    Tariq, Amina; Douglas, Heather E; Smith, Cheryl; Georgiou, Andrew; Osmond, Tracey; Armour, Pauline; Westbrook, Johanna I

    2015-07-01

    Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care. © The Author(s) 2014.

  2. Sociocultural Factors Influencing Incident Reporting Among Physicians and Nurses: Understanding Frames Underlying Self- and Peer-Reporting Practices.

    Science.gov (United States)

    Hewitt, Tanya; Chreim, Samia; Forster, Alan

    2017-09-01

    Voluntary reporting of incidents is a common approach for improving patient safety. Reporting behaviors may vary because of different frames within and across professions, where frames are templates that individuals hold and that guide interpretation of events. Our objectives were to investigate frames of physicians and nurses who report into a voluntary incident reporting system as well as to understand enablers and inhibitors of self-reporting and peer reporting. This is a qualitative case study-confidential in-depth interviews with physicians and nurses in General Internal Medicine in a Canadian tertiary care hospital. Frames that health care practitioners use in their reporting practices serve as enablers and inhibitors for self-reporting and peer reporting. Frames that inhibit reporting are shared by physicians and nurses, such as the fear of blame frame regarding self-reporting and the tattletale frame regarding peer reporting. These frames are underpinned by a focus on the individual, despite the organizational message of reporting for learning. A learning frame is an enabler to incident reporting. Viewing the objective of voluntary incident reporting as learning allows practitioners to depersonalize incident reporting. The focus becomes preventing recurrence and not the individual reporting or reported on. Physicians and nurses use various frames that bound their views of self and peer incident reporting-further progress should incorporate an understanding of these deep-seated views and beliefs.

  3. What Happened, and Why: Toward an Understanding of Human Error Based on Automated Analyses of Incident Reports. Volume 1

    Science.gov (United States)

    Maille, Nicolas P.; Statler, Irving C.; Ferryman, Thomas A.; Rosenthal, Loren; Shafto, Michael G.; Statler, Irving C.

    2006-01-01

    The objective of the Aviation System Monitoring and Modeling (ASMM) project of NASA s Aviation Safety and Security Program was to develop technologies that will enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. This presents a particular challenge in the aviation system where people are key components and human error is frequently cited as a major contributing factor or cause of incidents and accidents. In the aviation "world", information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. This report describes a conceptual model and an approach to automated analyses of textual data sources for the subjective perspective of the reporter of the incident to aid in understanding why an incident occurred. It explores a first-generation process for routinely searching large databases of textual reports of aviation incident or accidents, and reliably analyzing them for causal factors of human behavior (the why of an incident). We have defined a generic structure of information that is postulated to be a sound basis for defining similarities between aviation incidents. Based on this structure, we have introduced the simplifying structure, which we call the Scenario as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. We believe that it will be possible to design an automated analysis process guided by the structure of the Scenario that will aid aviation-safety experts to understand the systemic issues that are conducive to human error.

  4. Report of Incidence and Mortality in China Cancer Registries, 2008

    Science.gov (United States)

    Chen, Wan-qing; Zheng, Rong-shou; Zhang, Si-wei; Li, Ni; Zhao, Ping; Li, Guang-lin; Wu, Liang-you

    2012-01-01

    Objective Annual cancer incidence and mortality in 2008 were provided by National Central Cancer Registry in China, which data were collected from population-based cancer registries in 2011. Methods There were 56 registries submitted their data in 2008. After checking and evaluating the data quality, total 41 registries’ data were accepted and pooled for analysis. Incidence and mortality rates by area (urban or rural areas) were assessed, as well as the age- and sex-specific rates, age-standardized rates, proportions and cumulative rate. Results The coverage population of the 41 registries was 66,138,784 with 52,158,495 in urban areas and 13,980,289 in rural areas. There were 197,833 new cancer cases and 122,136 deaths in cancer with mortality to incidence ratio of 0.62. The morphological verified rate was 69.33%, and 2.23% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 299.12/100,000 (330.16/100,000 in male and 267.56/100,000 in female) and the age-standardized incidence rates by Chinese standard population (ASIRC) and world standard population (ASIRW) were 148.75/100,000 and 194.99/100,000, respectively. The cumulative incidence rate (0–74 years old) was of 22.27%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the incidence rate in urban was lower than that in rural. The crude cancer mortality was 184.67/100,000 (228.14/100,000 in male and 140.48/100,000 in female), and the age-standardized mortality rates by Chinese standard population (ASMRC) and by world population were 84.36/100,000 and 114.32/100,000, respectively. The cumulative mortality rate (0–74 years old) was of 12.89%. Age-adjusted mortality rates in urban areas were lower than that in rural areas. The most common cancer sites were lung, stomach, colon-rectum, liver, esophagus, pancreas, brain, lymphoma, breast and cervix which accounted for 75% of all cancer incidence. Lung

  5. Incidence du cancer au Canada : tendances et projections (1983-2032)

    OpenAIRE

    Lin Xie; Robert Semenciw; Les Mery

    2015-01-01

    Dans cette monographie, nous présentons, pour 1983 à 2032, un historique et des projections du nombre de nouveaux cas et des taux d'incidence du cancer pour le Canada, à l'exception des cancers de la peau autres que le mélanome (c.-à -d. les carcinomes basocellulaire et spinocellulaire). Ces renseignements visent à faciliter la planification stratégique et l'affectation de ressources et d'infrastructures pour assurer la prestation future de soins de santé et de mesures de lutte contre le canc...

  6. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.

    Science.gov (United States)

    Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

    2017-09-01

    A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%-47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others' behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. © 2017 Annals of Family Medicine, Inc.

  7. [Report of Cancer Incidence and Mortality in China, 2014].

    Science.gov (United States)

    Chen, W Q; Li, H; Sun, K X; Zheng, R S; Zhang, S W; Zeng, H M; Zou, X N; Gu, X Y; He, J

    2018-01-23

    Objective: The registration data of local cancer registries in 2014 were collected by National Central Cancer Registry (NCCR)in 2017 to estimate the cancer incidence and mortality in China. Methods: The data submitted from 449 registries were checked and evaluated, and the data of 339 registries out of them were qualified and selected for the final analysis. Cancer incidence and mortality were stratified by area, gender, age group and cancer type, and combined with the population data of 2014 to estimate cancer incidence and mortality in China. The age composition of standard population of Chinese census in 2000 and Segi's population were used for age-standardized incidence and mortality in China and worldwide, respectively. Results: Total covered population of 339 cancer registries (129 in urban and 210 in rural) in 2014 were 288 243 347 (144 061 915 in urban and 144 181 432 in rural areas). The mortality verified cases (MV%) were 68.01%. Among them, 2.19% cases were identified through death certifications only (DCO%), and the mortality to incidence ratio was 0.61. There were about 3, 804, 000 new cases diagnosed as malignant cancer and 2, 296, 000 cases dead in 2014 in the whole country. The incidence rate was 278.07/100, 000 (males 301.67/100, 000, females 253.29/100, 000) in China, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population were 190.63/100, 000 and 186.53/100, 000, respectively, and the cumulative incidence rate (0-74 age years old) was 21.58%. The cancer incidence and ASIRC in urban areas were 302.13/100, 000 and 196.58/100, 000, respectively, whereas in rural areas, those were 248.94/100, 000 and 182.64/100, 000, respectively. The cancer mortality in China was 167.89/100, 000 (207.24/100, 000 in males and 126.54/100, 000 in females), age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population were 106.98/100, 000 and 106.09/100, 000, respectively. And

  8. Safety and Health Standard 110: Incident/accident reporting and investigation

    Energy Technology Data Exchange (ETDEWEB)

    Sones, K. [West Kootenay Power, BC (Canada)

    1999-10-01

    Incident/accident reporting requirements in effect at West Kootenay Power are discussed. Details provided include definitions of low risk, high risk, and critical events, the incidents to be reported, the nature of the reports, the timelines, the investigation to be undertaken for each type of incident/accident, counselling services available to employees involved in serious incidents, and the procedures to be followed in accidents involving serious injury to non-employees. The emphasis is on the `critical five` high risk events and the procedures relating to them.

  9. Nuclear Safety Project - annual report 1980

    International Nuclear Information System (INIS)

    1981-08-01

    The Annual Report 1980 is a detailed description (in German language) of work within the Nuclear Safety Project performed in 1980 in the nuclear safety field by KfK institutes and departments and by external institutes on behalf of KfK. It includes for each individual research activity short summaries in English language on work completed, essential results, plans for the near future. (orig./RW) [de

  10. Incident reporting by acute pain service at a tertiary care university hospital

    OpenAIRE

    Aliya Ahmed; Muhammad Yasir

    2015-01-01

    Background and Aims: Provision of effective and safe postoperative pain management is the principal responsibility of acute pain services (APSs). Continuous quality assurance is essential for high-quality patient care. We initiated anonymous reporting of critical incidents by APS to ensure continuous quality improvement and here present prospectively collected data on the reported incidents. Our objective was to analyze the frequency and nature of incidents and to see if any harm was caused t...

  11. Combined Final Report for Colony II Project

    Energy Technology Data Exchange (ETDEWEB)

    Kale, Laxmikant [University of Illinois; Jones, Terry [Oak Ridge National Laboratory; Moreira, Jose [IBM Corp.

    2013-10-23

    (This report was originally submmited by the lead PI (Terry Jones, ORNL) on October 22, 2013 to the program manager, Lucy Nowell. It is being submitted from University of Illinois in accordance with instructions). HPC Colony II seeks to provide portable performance for leadership class machines. Our strategy is based on adaptive system software that aims to make the intelligent decisions necessary to allow domain scientists to safely focus on their task at hand and allow the system software stack to adapt their application to the underlying architecture. This report describes the research undertaken towards these objectives and the results obtained over the performance period of the project.

  12. HET/JUPITER project assessment report

    International Nuclear Information System (INIS)

    Baxter, B.J.; Harrington, F.E.; Kaiser, G.G.; Wolf, J.

    1979-05-01

    This report is an assessment of the United States' Hot Engineering Test (HET) and the Federal Republic of Germany's Juelich Pilot Plant Thorium Element Reprocessing (JUPITER) Projects. The assessment was conducted with a view to developing mutually supportive roles in the achievement of hot engineering test objectives. Conclusions of the assessment are positive and identify several technical areas with potential for US/FRG cooperation. Recommendations presented in this report support a cost-effective US/FRG program to jointly develop high temperature gas-cooled reactor fuel recycle technology. (orig.) [de

  13. Fast food consumption and gestational diabetes incidence in the SUN project

    OpenAIRE

    Dominguez, L.J. (Ligia J.); Martinez-Gonzalez, M.A. (Miguel Ángel); Basterra-Gortari, F.J. (Francisco Javier); Gea, A. (Alfredo); Barbagallo, M. (Mario); Bes-Rastrollo, M. (Maira)

    2014-01-01

    Background: Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. Methods: The prospective dynamic ‘‘Seguimiento Universidad de Navarra’’ (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pr...

  14. Carbon disclosure project report 2009 : Canada 200

    International Nuclear Information System (INIS)

    Campbell, G.

    2009-01-01

    The carbon disclosure project conducts an annual survey to determine the strategies and actions of major cap companies in relation to climate change. This report discussed initiatives implemented by Canada's largest companies to prepare for a carbon-constrained future. The report documented results from 97 companies. The aim of the report was to help companies make use of the disclosures as reference points for future carbon markets and regulations relating to reporting requirements. Results of the survey demonstrated that Canada's low-carbon and high-carbon impact sectors have implemented several significant initiatives and best practices for operations. However, widespread engagement in a comprehensive manner has yet to be achieved. Many respondents were in the process of developing a more balanced risk-opportunity agenda in relation to climate change, and nearly half of all respondents have implemented governance arrangements or personal incentives in both both the high-carbon and low-carbon impact sectors. 5 tabs., 26 figs.

  15. Developing, testing, evaluating and optimizing solar heating systems. Project status report for October and November 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-01-01

    This report describes progress on 3 projects: Integrated tank/heat exchanger modeling and experiments for solar thermal storage; Advanced residential solar domestic hot water systems; and Incident angle modifiers (IAMs) by the Monte Carlo method for cylindrical solar collectors. IAMs are used to correct for effects such as shading, back plane reflectance, inter-reflection, etc. Summaries are given for the first two projects; however, a full draft report is given for the third.

  16. Using Pareto Analysis with Trend Analysis: Statistical Techniques to Investigate Incident Reports within a Housing System

    Science.gov (United States)

    Luna, Andrew L.

    1998-01-01

    The purpose of this study was to determine trends and difficulties concerning student incident reports within the residence halls as they relate to the incident reporting system from the Department of Housing and Residential Life at a Southeastern Doctoral I Granting Institution. This study used the frequency distributions of each classified…

  17. 77 FR 38747 - Reports by Air Carriers on Incidents Involving Animals During Air Transport

    Science.gov (United States)

    2012-06-29

    ...-2010-0211] RIN 2105-AE07 Reports by Air Carriers on Incidents Involving Animals During Air Transport... incidents involving animals during air transport, 14 CFR 234.13, to expand the reporting requirement to U.S... seats, to expand the definition of ``animal'' to include all cats and dogs transported by the carrier...

  18. Walk the talk: leaders' enacted priority of safety, incident reporting, and error management.

    Science.gov (United States)

    Van Dyck, Cathy; Dimitrova, Nicoletta G; de Korne, Dirk F; Hiddema, Frans

    2013-01-01

    The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. As hypothesized, leaders' enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders' enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders' role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.

  19. Unit-based incident reporting and root cause analysis: variation at three hospital unit types

    NARCIS (Netherlands)

    Wagner, C.; Merten, H.; Zwaan, L.; Lubberding, S.; Timmermans, D.; Smits, M.

    2016-01-01

    OBJECTIVES: To minimise adverse events in healthcare, various large-scale incident reporting and learning systems have been developed worldwide. Nevertheless, learning from patient safety incidents is going slowly. Local, unit-based reporting systems can help to get faster and more detailed insight

  20. Unit-based incident reporting and root cause analysis: variation at three hospital unit types.

    NARCIS (Netherlands)

    Wagner, C.; Merten, H.; Lubberding, S.; Zwaan, L.; Timmermans, D.; Smits, M.

    2016-01-01

    Objectives To minimise adverse events in healthcare, various large-scale incident reporting and learning systems have been developed worldwide. Nevertheless, learning from patient safety incidents is going slowly. Local, unit-based reporting systems can help to get faster and more

  1. Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

    Science.gov (United States)

    2011-01-01

    Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient

  2. Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

    Directory of Open Access Journals (Sweden)

    Armitage Gerry

    2011-05-01

    Full Text Available Abstract Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS, and a patient incident reporting tool (PIRT - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1 literature will be reviewed to identify similar measures and key contributory factors to error; 2 four patient focus groups will ascertain practicality and feasibility; 3 25 patient interviews will elicit approximately 60 items across 10 domains; 4 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1 individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2 nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50 will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their

  3. Agency procedures for the NRC incident response plan. Final report

    International Nuclear Information System (INIS)

    1983-02-01

    The NRC Incident Response Plan, NUREG-0728/MC 0502 describes the functions of the NRC during an incident and the kinds of actions that comprise an NRC response. The NRC response plan will be activated in accordance with threshold criteria described in the plan for incidents occurring at nuclear reactors and fuel facilities involving materials licensees; during transportation of licensed material, and for threats against facilities or licensed material. In contrast to the general overview provided by the Plan, the purpose of these agency procedures is to delineate the manner in which each planned response function is performed; the criteria for making those response decisions which can be preplanned; and the information and other resources needed during a response. An inexperienced but qualified person should be able to perform functions assigned by the Plan and make necessary decisions, given the specified information, by becoming familiar with these procedures. This rule of thumb has been used to determine the amount of detail in which the agency procedures are described. These procedures form a foundation for the training of response personnel both in their normal working environment and during planned emergency exercises. These procedures also form a ready reference or reminder checklist for technical team members and managers during a response

  4. Survey of reportable incidents in nuclear power plants in Germany in the year 1992

    International Nuclear Information System (INIS)

    1993-01-01

    In 1992, 223 reportable incidents in German nuclear power plant have been reported. There was no radioactivity release exceeding the maximum permissible limits, and there were no hazardous effects on the population or the environment. There was no incident belonging to category S of the official event scale, requiring urgent notification, while there were two incidents requiring immediate notification. All other incidents reported belonged to category N, the lowest on the scale, requiring normal notification. 216 incidents belonged to category 0 of the INES scale, and 7 to INES category 1 (disturbance). The tabulated survey of the report lists the various events and their position on the INES scale. The reportable events have been analysed thoroughly from various viewpoints, but no systematic pattern of weak points could be detected. (orig./HP) [de

  5. Automated metadata--final project report

    Energy Technology Data Exchange (ETDEWEB)

    Schissel, David [General Atomics, San Diego, CA (United States)

    2016-04-01

    This report summarizes the work of the Automated Metadata, Provenance Cataloging, and Navigable Interfaces: Ensuring the Usefulness of Extreme-Scale Data Project (MPO Project) funded by the United States Department of Energy (DOE), Offices of Advanced Scientific Computing Research and Fusion Energy Sciences. Initially funded for three years starting in 2012, it was extended for 6 months with additional funding. The project was a collaboration between scientists at General Atomics, Lawrence Berkley National Laboratory (LBNL), and Massachusetts Institute of Technology (MIT). The group leveraged existing computer science technology where possible, and extended or created new capabilities where required. The MPO project was able to successfully create a suite of software tools that can be used by a scientific community to automatically document their scientific workflows. These tools were integrated into workflows for fusion energy and climate research illustrating the general applicability of the project’s toolkit. Feedback was very positive on the project’s toolkit and the value of such automatic workflow documentation to the scientific endeavor.

  6. Energy Storage and Distributed Energy Generation Project, Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Schwank, Johannes; Mader, Jerry; Chen, Xiaoyin; Mi, Chris; Linic, Suljo; Sastry, Ann Marie; Stefanopoulou, Anna; Thompson, Levi; Varde, Keshav

    2008-03-31

    This report serves as a Final Report under the “Energy Storage and Distribution Energy Generation Project” carried out by the Transportation Energy Center (TEC) at the University of Michigan (UM). An interdisciplinary research team has been working on fundamental and applied research on: -distributed power generation and microgrids, -power electronics, and -advanced energy storage. The long-term objective of the project was to provide a framework for identifying fundamental research solutions to technology challenges of transmission and distribution, with special emphasis on distributed power generation, energy storage, control methodologies, and power electronics for microgrids, and to develop enabling technologies for novel energy storage and harvesting concepts that can be simulated, tested, and scaled up to provide relief for both underserved and overstressed portions of the Nation’s grid. TEC’s research is closely associated with Sections 5.0 and 6.0 of the DOE "Five-year Program Plan for FY2008 to FY2012 for Electric Transmission and Distribution Programs, August 2006.”

  7. The Greenland Analogue Project. Yearly Report 2009

    International Nuclear Information System (INIS)

    2010-12-01

    the parameters and processes needed to achieve a realistic understanding of how an ice sheet may impact a deep repository, and will provide measurements, observations and data that may significantly improve our safety assessments and risk analyses of glaciation scenarios. The project includes three sub-projects (A.C) with specific individual objectives, which collectively aim at contributing knowledge and input to the overall project aim. Figure 1.1 gives an overview of the different aspects of the three GAP sub-projects. The purpose of subdividing the project is that insights and data obtained from the different sub-projects constitute self-consistent data sets, which will be tested and implemented within the individual sub-projects. The overall idea is that the results of all sub-projects used and analyzed together will result in large synergistic effects for the understanding of hydrological conditions during glacial periods. That is also the reason why all sub-projects are performed within the same geographical area (see Figure 1.2). Finally, the GAP project will contribute to a three dimensional process understanding of a glaciated environment by obtaining an integrated view of ice sheet hydrology and groundwater flow and chemistry (Figure 1.1). This report was produced by the GAP team members and presents the outcome of the activities within the GAP during 2009

  8. The Greenland Analogue Project. Yearly Report 2009

    Energy Technology Data Exchange (ETDEWEB)

    2010-12-15

    the parameters and processes needed to achieve a realistic understanding of how an ice sheet may impact a deep repository, and will provide measurements, observations and data that may significantly improve our safety assessments and risk analyses of glaciation scenarios. The project includes three sub-projects (A.C) with specific individual objectives, which collectively aim at contributing knowledge and input to the overall project aim. Figure 1.1 gives an overview of the different aspects of the three GAP sub-projects. The purpose of subdividing the project is that insights and data obtained from the different sub-projects constitute self-consistent data sets, which will be tested and implemented within the individual sub-projects. The overall idea is that the results of all sub-projects used and analyzed together will result in large synergistic effects for the understanding of hydrological conditions during glacial periods. That is also the reason why all sub-projects are performed within the same geographical area (see Figure 1.2). Finally, the GAP project will contribute to a three dimensional process understanding of a glaciated environment by obtaining an integrated view of ice sheet hydrology and groundwater flow and chemistry (Figure 1.1). This report was produced by the GAP team members and presents the outcome of the activities within the GAP during 2009

  9. Geodynamics Project. US progress report, 1977

    Energy Technology Data Exchange (ETDEWEB)

    1977-01-01

    Past work of the US Geodynamics Committee (USGC) is summarized. The USGC devoted considerable discussion at its November 1976, meeting to preparation of an up-to-date statement of the USGC actions developed by USGC reporters. That discussion ultimately led to a number of statements and recommendations, given here. The bulk of this document is comprised of the reporters' reports on the following topics: fine structure of the crust and upper mantle, evolution of oceanic lithosphere, internal processes and properties, crystal growing, large-volume experimentation, application of isotope geochemistry to geodynamics, geodynamic modeling, drilling for scientific purposes, plate boundaries, plate interiors, data centers and repositories, geodynamic activities in the Caribbean area, seismicity and deep structure of the continental margin, and aeromagnetic survey. Appendixes give project correspondents, participants, etc. 23 figures, 2 tables. (RWR)

  10. TMI-2 Vessel Investigation Project integration report

    International Nuclear Information System (INIS)

    Wolf, J.R.; Rempe, J.L.; Stickler, L.A.; Korth, G.E.; Diercks, D.R.; Neimark, L.A.; Akers, D.W.; Schuetz, B.K.; Shearer, T.L.; Chavez, S.A.; Thinnes, G.L.; Witt, R.J.; Corradini, M.L.; Kos, J.A.

    1994-03-01

    The Three Mile Island Unit 2 (TMI-2) Vessel Investigation Project (VIP) was an international effort that was sponsored by the Nuclear Energy Agency of the Organization for Economic Cooperation and Development. The primary objectives of the VIP were to extract and examine samples from the lower head and to evaluate the potential modes of failure and the margin of structural integrity that remained in the TMI-2 reactor vessel during the accident. This report presents a summary of the major findings and conclusions that were developed from research during the VIP. Results from the various elements of the project are integrated to form a cohesive understanding of the vessel's condition after the accident

  11. The Stripa project annual report 1984

    International Nuclear Information System (INIS)

    1985-07-01

    This is an autonomous OECD/NEA project relating to the final disposal of highly radioactive waste. Research is being performed in a granite formation 350 m below the ground surface. The first phase consists of three parts, namely hydrogeological and hydrogeochemical investigations in boreholes, tracer migration tests and large-scale tests of the behaviour of backfill material. The second phase includes the following investigations: detection and characterization of fracture zones, sealing of boreholes and shafts, hydrogoelogical characterization of the Stripa site and isotopic characterization of its groundwaters. The estimated cost of both phases is 111 MSEK and they are scheduled for completion in 1986. A summary of the progress of the project phase I and phase II is given in this report. (G.B.)

  12. TMI-2 Vessel Investigation Project integration report

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, J. R.; Rempe, J. L.; Stickler, L. A.; Korth, G. E.; Diercks, D. R.; Neimark, L. A.; Akers, D W; Schuetz, B. K.; Shearer, T L; Chavez, S. A.; Thinnes, G. L.; Witt, R. J.; Corradini, M L; Kos, J. A. [EG and G Idaho, Inc., Idaho Falls, ID (United States)

    1994-03-01

    The Three Mile Island Unit 2 (TMI-2) Vessel Investigation Project (VIP) was an international effort that was sponsored by the Nuclear Energy Agency of the Organization for Economic Cooperation and Development. The primary objectives of the VIP were to extract and examine samples from the lower head and to evaluate the potential modes of failure and the margin of structural integrity that remained in the TMI-2 reactor vessel during the accident. This report presents a summary of the major findings and conclusions that were developed from research during the VIP. Results from the various elements of the project are integrated to form a cohesive understanding of the vessel`s condition after the accident.

  13. Effectiveness and Sustainability of Education about Incident Reporting at a University Hospital in Japan.

    Science.gov (United States)

    Nakamura, Noriko; Yamashita, Yuichi; Tanihara, Shinichi; Maeda, Chiemi

    2014-07-01

    The aim of this study was to evaluate the effectiveness and sustainability of educational interventions to encourage incident reporting. This was a quasi-experimental design. The study involved nurses working in two gastroenterology surgical wards at Fukuoka University Hospital, Japan. The number of participants on each ward was 26 nurses at baseline. For the intervention group, we provided 15 minutes of education about patient safety and the importance of incident reporting once per month for six months. After the completion of the intervention, we compared incident reporting in the subsequent 12 months for both groups. Questionnaires about reasons/motives for reporting were administered three times, before the intervention, after the intervention, and six months after the intervention for both the intervention group and the control group. For the intervention group, incident reporting during the 6 months after the intervention period increased significantly compared with the baseline. During the same period, the reasons and motives for reporting changed significantly in the intervention group. The increase in reported incidents during the 6- to 12-month period following the intervention was not significant. In the control group, there was no significant difference during follow-up compared with the baseline. A brief intervention about patient safety changed the motives for reporting incidents and the frequency of incidents reported by nurses working in surgical wards in a university hospital in Japan. However, the effect of the education decreased after six months following the education. Regular and long-term effort is required to maintain the effect of education.

  14. Safety incidents involving confused and forgetful older patients in a specialised care setting--analysis of the safety incidents reported to the HaiPro reporting system.

    Science.gov (United States)

    Kinnunen-Luovi, Kaisa; Saarnio, Reetta; Isola, Arja

    2014-09-01

    To describe the safety incidents involving confused and forgetful older patients in a specialised care setting entered in the HaiPro reporting system. About 10% of patients experience a safety incident during hospitalisation, which causes or could cause them harm. The possibility of a safety incident during hospitalisation increases significantly with age. A mild or moderate memory disorder and acute confusion are often present in the safety incidents originating with an older patient. The design of the study was action research with this study using findings from one of the first-phase studies, which included qualitative and quantitative analysed data. Data were collected from the reporting system for safety incidents (HaiPro) in a university hospital in Finland. There were 672 reported safety incidents from four acute medical wards during the years 2009-2011, which were scrutinised. Seventy-five of them were linked to a confused patient and were analysed. The majority of the safety incidents analysed involved patient-related accidents. In addition to challenging behaviour, contributing factors included ward routines, shortage of nursing staff, environmental factors and staff knowledge and skills. Nurses tried to secure the patient safety in many different ways, but the modes of actions were insufficient. Nursing staff need evidence-based information on how to assess the cognitive status of a confused patient and how to encounter such patients. The number of nursing staff and ward routines should be examined critically and put in proportion to the care intensity demands caused by the patient's confused state. The findings can be used as a starting point in the prevention of safety incidents and in improving the care of older patients. © 2013 John Wiley & Sons Ltd.

  15. Birds oiled during the Amoco Cadiz incident: an interim report

    Energy Technology Data Exchange (ETDEWEB)

    Jones, P.H.; Monnat, J.Y.; Cadbury, C.J.; Stowe, T.J.

    1978-11-01

    More than 4500 oiled birds were collected from beaches in Northwest France and the Channel Islands following the oil spillage from the super tanker Amoco Cadiz in March 1978. Some 33 bird species were recorded oiled. A notable feature of the incident was the high proportion of puffins among the birds known to have been oiled. In normal years, puffins are considered to be relatively uncommon off Brittany in spring, and so the high proportion of this species among the casualties was unexpected. A relatively large number of shags and divers were also oiled. (1 map, 8 references, 2 tables)

  16. Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study

  17. Salt repository project closeout status report

    International Nuclear Information System (INIS)

    1988-06-01

    This report provides an overview of the scope and status of the US Department of Energy (DOE's) Salt Repository Project (SRP) at the time when the project was terminated by the Nuclear Waste Policy Amendments Act of 1987. The report reviews the 10-year program of siting a geologic repository for high-level nuclear waste in rock salt formations. Its purpose is to aid persons interested in the information developed during the course of this effort. Each area is briefly described and the major items of information are noted. This report, the three salt Environmental Assessments, and the Site Characterization Plan are the suggested starting points for any search of the literature and information developed by the program participants. Prior to termination, DOE was preparing to characterize three candidate sites for the first mined geologic repository for the permanent disposal of high-level nuclear waste. The sites were in Nevada, a site in volcanic tuff; Texas, a site in bedded salt (halite); and Washington, a site in basalt. These sites, identified by the screening process described in Chapter 3, were selected from the nine potentially acceptable sites shown on Figure I-1. These sites were identified in accordance with provisions of the Nuclear Waste Policy Act of 1982. 196 refs., 21 figs., 11 tabs

  18. Summary Report for Capsule Dry Storage Project

    Energy Technology Data Exchange (ETDEWEB)

    JOSEPHSON, W S

    2003-09-04

    There are 1.936 cesium (Cs) and strontium (Sr) capsules stored in pools at the Waste Encapsulation and Storage Facility (WESF). These capsules will be moved to dry storage on the Hanford Site as an interim measure to reduce risk. The Cs/Sr Capsule Dry Storage Project (CDSP) is conducted under the assumption the capsules will eventually be moved to the repository at Yucca Mountain, and the design criteria include requirements that will facilitate acceptance at the repository. The storage system must also permit retrieval of capsules in the event vitrification of the capsule contents is pursued. A cut away drawing of a typical cesium chloride (CsCI) capsule and the capsule property and geometry information are provided in Figure 1.1. Strontium fluoride (SrF{sub 2}) capsules are similar in design to CsCl capsules. Further details of capsule design, current state, and reference information are given later in this report and its references. Capsule production and life history is covered in WMP-16938, Capsule Characterization Report for Capsule Dry Storage Project, and is briefly summarized in Section 5.2 of this report.

  19. Salt repository project closeout status report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1988-06-01

    This report provides an overview of the scope and status of the US Department of Energy (DOE`s) Salt Repository Project (SRP) at the time when the project was terminated by the Nuclear Waste Policy Amendments Act of 1987. The report reviews the 10-year program of siting a geologic repository for high-level nuclear waste in rock salt formations. Its purpose is to aid persons interested in the information developed during the course of this effort. Each area is briefly described and the major items of information are noted. This report, the three salt Environmental Assessments, and the Site Characterization Plan are the suggested starting points for any search of the literature and information developed by the program participants. Prior to termination, DOE was preparing to characterize three candidate sites for the first mined geologic repository for the permanent disposal of high-level nuclear waste. The sites were in Nevada, a site in volcanic tuff; Texas, a site in bedded salt (halite); and Washington, a site in basalt. These sites, identified by the screening process described in Chapter 3, were selected from the nine potentially acceptable sites shown on Figure I-1. These sites were identified in accordance with provisions of the Nuclear Waste Policy Act of 1982. 196 refs., 21 figs., 11 tabs.

  20. Hanford Environmental Dose Reconstruction Project. Monthly report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S. M.; McMakin, A. H.

    1991-09-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation dose that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is divided into five technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (i.e., dose estimates). The Source Terms Task develops estimates of radioactive emissions from Hanford facilities since 1944. The Environmental Transport Task reconstructs the movements of radioactive particles from the areas of release to populations. The Environmental Monitoring Data Task assemblies, evaluates and reports historical environmental monitoring data. The Demographics, Agriculture and Food Habits Task develops the data needed to identify the populations that could have been affected by the releases. The Environmental Pathways and Dose Estimates Task used the information derived from the other Tasks to estimate the radiation doses individuals could have received from Hanford radiation. This document lists the progress on this project as of September 1991. 3 figs., 2 tabs.

  1. Northeast Oregon Hatchery Project, Final Siting Report.

    Energy Technology Data Exchange (ETDEWEB)

    Watson, Montgomery

    1995-03-01

    This report presents the results of site analysis for the Bonneville Power Administration Northeast Oregon Hatchery Project. The purpose of this project is to provide engineering services for the siting and conceptual design of hatchery facilities for the Bonneville Power Administration. The hatchery project consists of artificial production facilities for salmon and steelhead to enhance production in three adjacent tributaries to the Columbia River in northeast Oregon: the Grande Ronde, Walla Walla, and Imnaha River drainage basins. Facilities identified in the master plan include adult capture and holding facilities; spawning incubation, and early rearing facilities; full-term rearing facilities; and direct release or acclimation facilities. The evaluation includes consideration of a main production facility for one or more of the basins or several smaller satellite production facilities to be located within major subbasins. The historic and current distribution of spring and fall chinook salmon and steelhead was summarized for the Columbia River tributaries. Current and future production and release objectives were reviewed. Among the three tributaries, forty seven sites were evaluated and compared to facility requirements for water and space. Site screening was conducted to identify the sites with the most potential for facility development. Alternative sites were selected for conceptual design of each facility type. A proposed program for adult holding facilities, final rearing/acclimation, and direct release facilities was developed.

  2. Fast Breeder Project status report, 1974

    International Nuclear Information System (INIS)

    Hueper, R.

    A compilation of the papers read at the Status Report of the Fast Breeder Project at the Karlsruhe Nuclear Research Center on March 26, 1974 is presented. The first papers present a general survey of the present state of research and development work performed by the German, Belgian, and Netherlands research centers on the SNR 300 Prototype Fast Breeder Reactor (Kalkar Nuclear Power Station), on the SNR follow-on program, alternative fuels and coolants and basic problems, on work performed by industry with respect to the licensing procedure and construction of the SNR 300, and on commissioning and the planned conversion of KNK, the Compact Sodium Cooled Nuclear Reactor. The detailed papers deal with results elaborated at the institutes of GfK Karlsruhe, SCK/CEN Mol, RCN Petten, and TNO Apeldoorn. Most of these efforts have been concentrated upon fuel pin and materials development and on the physics and safety of fast reactors. The status report concludes with a reference to the future program under the Project. (U.S.)

  3. Human Factors of Remotely Piloted Aircraft Systems: Lessons from Incident Reports

    Science.gov (United States)

    Hobbs, Alan; Null, Cynthia

    2016-01-01

    An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies.

  4. [New avenues to quality assurance--a model project for recording bedsore incidence].

    Science.gov (United States)

    Steingass, S; Klein, B; Hube, G; Pavel, K; Walter, K; Weiss, V

    2002-11-01

    Bedsores can usually be avoided by adequate care and preventive measures. In the context of the local agenda process a local district office (Landratsamt) and inspection units initiated a variety of activities to promote sensitisation in health institutions and contribute to an increase in life quality of the persons concerned. Nearly all nursing care homes, domiciliary services and hospitals participated in a pilot study which was accompanied by the Fraunhofer IAO in Stuttgart. Objectives of the pilot study were to implement internal quality assurance to sensitise for persons the topic and to collect comparable data to achieve benchmarking. Software-tool institutions recorded data on care days, days spent with bedsores according to care level from July till September 01. Major result was that - although institutions had already a decreasing incidence in bedsores since the start of discussing the project - bedsore quotas could be further decreased from 2.15 to 1.84 %.

  5. Operating Experience from Events Reported to the IAEA Incident Reporting System for Research Reactors

    International Nuclear Information System (INIS)

    2015-03-01

    Operating experience feedback is an effective mechanism in providing lessons learned from events and the associated corrective actions to prevent them, helping to improve safety at nuclear installations. The Incident Reporting System for Research Reactors (IRSRR), which is operated by the IAEA, is an important tool for international exchange of operating experience feedback for research reactors. The IRSRR reports contain information on events of safety significance with their root causes and lessons learned which help in reducing the occurrence of similar events at research reactors. To improve the effectiveness of the system, it is essential that national organizations demonstrate an appropriate interest for the timely reporting of events important to safety and share the information in the IRSRR database. At their biennial technical meetings, the IRSRR national coordinators recommended collecting the operating experience from the events reported to the IRSRR and disseminating it in an IAEA publication. This publication highlights the root causes, safety significance, lessons learned, corrective actions and the causal factors for the events reported to the IRSRR up to September 2014. The publication also contains relevant summary information on research reactor events from sources other than the IRSRR, operating experience feedback from the International Reporting System for Operating Experience considered relevant to research reactors, and a description of the elements of an operating experience programme as established by the IAEA safety standards. This publication will be of use to research reactor operating organizations, regulators and designers, and any other organizations or individuals involved in the safety of research reactors

  6. 76 FR 54004 - Agency Information Collection (Report of Medical, Legal, and Other Expenses Incident to Recovery...

    Science.gov (United States)

    2011-08-30

    ... VA Form 21-8416b to report compensation awarded by another entity or government agency for personal... incident to the injury or death, or incident to the collection or recovery of the compensation may be... direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. BILLING CODE 8320-01...

  7. Cancer incidence in south-east Nigeria: a report from Nnewi Cancer ...

    African Journals Online (AJOL)

    Background: This study is the first population based cancer incidence report from a cancer registry in south-east Nigeria. Objective: To evaluate the incidence of some invasive cancers in southeast Nigeria. Methodology: We collected all new cases of invasive cancers between 1st January and 31st December, 2013.

  8. Brief Report: Incidence of and Risk Factors for Autistic Disorder in Neonatal Intensive Care Unit Survivors.

    Science.gov (United States)

    Matsuishi, Toyojiro; Yamashita, Yushiro; Ohtani, Yasuyo; Ornitz, Edward; Kuriya, Norikazu; Murakami, Yoshihiko; Fukuda, Seiichi; Hashimoto, Takeo; Yamashita, Fumio

    1999-01-01

    Analysis of the incidence of autistic disorder (AD) among 5,271 children in a neonatal intensive care unit in Japan found that 18 children were later diagnosed with AD, an incidence more than twice as high as previously reported. Children with AD had a significantly higher history of the meconium aspiration syndrome than the controls. (Author/DB)

  9. Learning from Errors: Critical Incident Reporting in Nursing

    Science.gov (United States)

    Gartmeier, Martin; Ottl, Eva; Bauer, Johannes; Berberat, Pascal Oliver

    2017-01-01

    Purpose: The purpose of this paper is to conceptualize error reporting as a strategy for informal workplace learning and investigate nurses' error reporting cost/benefit evaluations and associated behaviors. Design/methodology/approach: A longitudinal survey study was carried out in a hospital setting with two measurements (time 1 [t1]:…

  10. Final Project Report Project 10749-4.2.2.1 2007-2009

    Energy Technology Data Exchange (ETDEWEB)

    Zacher, Alan H.; Holladay, Johnathan E.; Frye, J. G.; Brown, Heather M.; Santosa, Daniel M.; Oberg, Aaron A.

    2009-05-11

    This is the final report for the DOE Project 10749-4.2.2.1 for the FY2007 - FY2009 period. This report is non-proprietary, and will be submitted to DOE as a final project report. The report covers activities under the DOE Project inside CRADA 269 (Project 53231) as well as project activites outside of that CRADA (Project 56662). This is the final report that is summarized from the non-proprietary quarterlies submitted to DOE over the past 2.5 years, which in turn are summaries from the proprietary technical reporting to UOP.

  11. SU-E-T-511: Inter-Rater Variability in Classification of Incidents in a New Incident Reporting System

    International Nuclear Information System (INIS)

    Pappas, D; Reis, S; Ali, A; Kapur, A

    2015-01-01

    Purpose To determine how consistent the results of different raters are when reviewing the same cases within the Radiation Oncology Incident Learning System (ROILS). Methods Three second-year medical physics graduate students filled out incident reports in spreadsheets set up to mimic ROILS. All students studied the same 33 cases and independently entered their assessments, for a total of 99 reviewed cases. The narratives for these cases were obtained from a published International Commission on Radiological Protection (ICRP) report which included shorter narratives selected from the Radiation Oncology Safety Information System (ROSIS) database. Each category of questions was reviewed to see how consistent the results were by utilizing free-marginal multirater kappa analysis. The percentage of cases where all raters shared full agreement or full disagreement was recorded to show which questions were answered consistently by multiple raters for a given case. The consistency among the raters was analyzed between ICRP and ROSIS cases to see if either group led to more reliable results. Results The categories where all raters agreed 100 percent in their choices were the event type (93.94 percent of cases 0.946 kappa) and the likelihood of the event being harmful to the patient (42.42 percent of cases 0.409 kappa). The categories where all raters disagreed 100 percent in their choices were the dosimetric severity scale (39.39 percent of cases 0.139 kappa) and the potential future toxicity (48.48 percent of cases 0.205 kappa). ROSIS had more cases where all raters disagreed than ICRP (23.06 percent of cases compared to 15.58 percent, respectively). Conclusion Despite reviewing the same cases, the results among the three raters was widespread. ROSIS narratives were shorter than ICRP, which suggests that longer narratives lead to more consistent results. This study shows that the incident reporting system can be optimized to yield more consistent results

  12. SU-E-T-511: Inter-Rater Variability in Classification of Incidents in a New Incident Reporting System

    Energy Technology Data Exchange (ETDEWEB)

    Pappas, D; Reis, S; Ali, A [Hofstra University, Hempstead, NY (United States); Kapur, A [Long Island Jewish Medical Center, New Hyde Park, NY (United States)

    2015-06-15

    Purpose To determine how consistent the results of different raters are when reviewing the same cases within the Radiation Oncology Incident Learning System (ROILS). Methods Three second-year medical physics graduate students filled out incident reports in spreadsheets set up to mimic ROILS. All students studied the same 33 cases and independently entered their assessments, for a total of 99 reviewed cases. The narratives for these cases were obtained from a published International Commission on Radiological Protection (ICRP) report which included shorter narratives selected from the Radiation Oncology Safety Information System (ROSIS) database. Each category of questions was reviewed to see how consistent the results were by utilizing free-marginal multirater kappa analysis. The percentage of cases where all raters shared full agreement or full disagreement was recorded to show which questions were answered consistently by multiple raters for a given case. The consistency among the raters was analyzed between ICRP and ROSIS cases to see if either group led to more reliable results. Results The categories where all raters agreed 100 percent in their choices were the event type (93.94 percent of cases 0.946 kappa) and the likelihood of the event being harmful to the patient (42.42 percent of cases 0.409 kappa). The categories where all raters disagreed 100 percent in their choices were the dosimetric severity scale (39.39 percent of cases 0.139 kappa) and the potential future toxicity (48.48 percent of cases 0.205 kappa). ROSIS had more cases where all raters disagreed than ICRP (23.06 percent of cases compared to 15.58 percent, respectively). Conclusion Despite reviewing the same cases, the results among the three raters was widespread. ROSIS narratives were shorter than ICRP, which suggests that longer narratives lead to more consistent results. This study shows that the incident reporting system can be optimized to yield more consistent results.

  13. Incidence of Self-Reported Diabetes in New York City, 2002, 2004, and 2008

    Science.gov (United States)

    Chamany, Shadi; Driver, Cynthia R.; Kerker, Bonnie; Silver, Lynn

    2012-01-01

    Introduction Prevalence and incidence of diabetes among adults are increasing in the United States. The purpose of this study was to estimate the incidence of self-reported diabetes in New York City, examine factors associated with diabetes incidence, and estimate changes in the incidence over time. Methods We used data from the New York City Community Health Survey in 2002, 2004, and 2008 to estimate the age-adjusted incidence of self-reported diabetes among 24,384 adults aged 18 years or older. Multiple logistic regression analysis was performed to examine factors associated with incident diabetes. Results Survey results indicated that the age-adjusted incidence of diabetes per 1,000 population was 9.4 in 2002, 11.9 in 2004, and 8.6 in 2008. In multivariable-adjusted analysis, diabetes incidence was significantly associated with being aged 45 or older, being black or Hispanic, being overweight or obese, and having less than a high school diploma. Conclusion Our results suggest that the incidence of diabetes in New York City may be stabilizing. Age, black race, Hispanic ethnicity, elevated body mass index, and low educational attainment are risk factors for diabetes. Large-scale implementation of prevention efforts addressing obesity and sedentary lifestyle and targeting racial/ethnic minority groups and those with low educational attainment are essential to control diabetes in New York City. PMID:22698175

  14. Application of an aviation model of incident reporting and investigation to the neurosurgical scenario: method and preliminary data.

    Science.gov (United States)

    Ferroli, Paolo; Caldiroli, Dario; Acerbi, Francesco; Scholtze, Maurizio; Piro, Alfonso; Schiariti, Marco; Orena, Eleonora F; Castiglione, Melina; Broggi, Morgan; Perin, Alessandro; DiMeco, Francesco

    2012-11-01

    Incident reporting systems are universally recognized as important tools for quality improvement in all complex adaptive systems, including the operating room. Nevertheless, introducing a safety culture among neurosurgeons is a slow process, and few studies are available in the literature regarding the implementation of an incident reporting system within a neurosurgical department. The authors describe the institution of an aviation model of incident reporting and investigation in neurosurgery, focusing on the method they have used and presenting some preliminary results. In 2010, the Inpatient Safety On-Board project was developed through cooperation between a team of human factor and safety specialists with aviation backgrounds (DgSky team) and the general manager of the Fondazione Istituto Neurologico Carlo Besta. In 2011, after specific training in safety culture, the authors implemented an aviation-derived prototype of incident reporting within the Department of Neurosurgery. They then developed an experimental protocol to track, analyze, and categorize any near misses that happened in the operating room. This project officially started in January 2012, when a dedicated team of assessors was established. All members of the neurosurgical department were asked to report near misses on a voluntary, confidential, and protected form (Patient Incident Reporting System form, Besta Safety Management Programme). Reports were entered into an online database and analyzed by a dedicated team of assessors with the help of a facilitator, and an aviation-derived root cause analysis was performed. Since January 2012, 14 near misses were analyzed and classified. The near-miss contributing factors were mainly related to human factors (9 of 14 cases), technology (1 of 14 cases), organizational factors (3 of 14 cases), or procedural factors (1 of 14 cases). Implementing an incident reporting system is quite demanding; the process should involve all of the people who work within

  15. Prototype Rail Crossing Violation Warning Application Project Report.

    Science.gov (United States)

    2017-09-05

    This report is the Project Report for the Rail Crossing Violation Warning (RCVW) safety application developed for the project on Rail Crossing Violation Warning Application and Infrastructure Connection, providing a means for equipped connected vehic...

  16. Facility Interface Capability Assessment (FICA) project report

    International Nuclear Information System (INIS)

    Pope, R.B.; MacDonald, R.R.; Viebrock, J.M.; Mote, N.

    1995-09-01

    The US Department of Energy's (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is responsible for developing the Civilian Radioactive Waste Management System (CRWMS) to accept spent nuclear fuel from commercial facilities. The objective of the Facility Interface Capability Assessment (FICA) project was to assess the capability of each commercial spent nuclear fuel (SNF) storage facility, at which SNF is stored, to handle various SNF shipping casks. The purpose of this report is to present and analyze the results of the facility assessments completed within the FICA project. During Phase 1, the data items required to complete the facility assessments were identified and the database for the project was created. During Phase 2, visits were made to 122 facilities on 76 sites to collect data and information, the database was updated, and assessments of the cask-handling capabilities at each facility were performed. Each assessment of cask-handling capability contains three parts: the current capability of the facility (planning base); the potential enhanced capability if revisions were made to the facility licensing and/or administrative controls; and the potential enhanced capability if limited physical modifications were made to the facility. The main conclusion derived from the planning base assessments is that the current facility capabilities will not allow handling of any of the FICA Casks at 49 of the 122 facilities evaluated. However, consideration of potential revisions and/or modifications showed that all but one of the 49 facilities could be adapted to handle at least one of the FICA Casks. For this to be possible, facility licensing, administrative controls, and/or physical aspects of the facility would need to be modified

  17. Facility Interface Capability Assessment (FICA) project report

    Energy Technology Data Exchange (ETDEWEB)

    Pope, R.B. [ed.] [Oak Ridge National Lab., TN (United States); MacDonald, R.R. [ed.] [Civilian Radioactive Waste Management System, Vienna, VA (United States); Viebrock, J.M.; Mote, N. [Nuclear Assurance Corp., Norcross, GA (United States)

    1995-09-01

    The US Department of Energy`s (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is responsible for developing the Civilian Radioactive Waste Management System (CRWMS) to accept spent nuclear fuel from commercial facilities. The objective of the Facility Interface Capability Assessment (FICA) project was to assess the capability of each commercial spent nuclear fuel (SNF) storage facility, at which SNF is stored, to handle various SNF shipping casks. The purpose of this report is to present and analyze the results of the facility assessments completed within the FICA project. During Phase 1, the data items required to complete the facility assessments were identified and the database for the project was created. During Phase 2, visits were made to 122 facilities on 76 sites to collect data and information, the database was updated, and assessments of the cask-handling capabilities at each facility were performed. Each assessment of cask-handling capability contains three parts: the current capability of the facility (planning base); the potential enhanced capability if revisions were made to the facility licensing and/or administrative controls; and the potential enhanced capability if limited physical modifications were made to the facility. The main conclusion derived from the planning base assessments is that the current facility capabilities will not allow handling of any of the FICA Casks at 49 of the 122 facilities evaluated. However, consideration of potential revisions and/or modifications showed that all but one of the 49 facilities could be adapted to handle at least one of the FICA Casks. For this to be possible, facility licensing, administrative controls, and/or physical aspects of the facility would need to be modified.

  18. The LiveWire Project final report

    Energy Technology Data Exchange (ETDEWEB)

    Brown, C.D.; Nelson, T.T. [Enova Technology, San Diego, CA (United States); Kelly, J.C.; Dominguez, H.A. [Paragon Consulting Services, La Verne, CA (United States)

    1997-10-01

    Utilities across the US have begun pilot testing a variety of hardware and software products to develop a two-way communications system between themselves and their customers. Their purpose is to reduce utility operating costs and to provide new and improved services for customers in light of pending changes in the electric industry being brought about by deregulation. A consortium including utilities, national labs, consultants, and contractors, with the support of the Department of Energy (DOE) and the Electric Power Research Institute (EPRI), initiated a project that utilized a hybrid fiber-coax (HFC) wide-area network integrated with a CEBus based local area network within the customers home. The system combined energy consumption data taken within the home, and home automation features to provide a suite of energy management services for residential customers. The information was transferred via the Internet through the HFC network, and presented to the customer on their personal computer. This final project report discusses the design, prototype testing, and system deployment planning of the energy management system.

  19. Energy tariff project - Latvia. Summary report

    International Nuclear Information System (INIS)

    Harne, N.J.

    1996-05-01

    Latvia has only a few indigenous energy resources that are concentrated on hydro-power, wood and peat. The country is therefore strongly dependant on imports of natural gas, oil, coal and electricity. After independence the supply of natural gas, oil and electricity were organised by three state owned joint-stock companies, Latvijas Gaze, Latvijas Nafta and Latvenergo. Partial privatisation of the gas and oil companies has been decided by the Latvian government but so far not implemented. Two types of models have been used within the Energy Tariff Project: The EFOM model that was developed and implemented for Latvia as a part of the EURIO project has been adapted to describe the long term reactions for the electricity and district heating sectors; A system of Customer Calculation Sheets for the analysis of consumer expenditure and utility revenue. The optimization model for the electricity and CHP system is also used to analyze the impact of gas tariffs for the electricity and district heating sector within geographical or institutional limits. In this report the following regions are specified: City of Riga; Other district heating areas; Rest of Latvia. The Danish tariff structure for natural gas was reviewed. The present structure is presently market orientated with direct links to the price movements of alternative fuels for all customer groups. (EG) 50 refs

  20. Report for the NGFA-5 project.

    Energy Technology Data Exchange (ETDEWEB)

    Jaing, C; Jackson, P; Thissen, J; Wollard, J; Gardner, S; McLoughlin, K

    2011-11-15

    The objective of this project is to provide DHS a comprehensive evaluation of the current genomic technologies including genotyping, TaqMan PCR, multiple locus variable tandem repeat analysis (MLVA), microarray and high-throughput DNA sequencing in the analysis of biothreat agents from complex environmental samples. To effectively compare the sensitivity and specificity of the different genomic technologies, we used SNP TaqMan PCR, MLVA, microarray and high-throughput illumine and 454 sequencing to test various strains from B. anthracis, B. thuringiensis, BioWatch aerosol filter extracts or soil samples that were spiked with B. anthracis, and samples that were previously collected during DHS and EPA environmental release exercises that were known to contain B. thuringiensis spores. The results of all the samples against the various assays are discussed in this report.

  1. The Marysville, Montana Geothermal Project. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    1975-09-01

    This report describes the exploration of an anomalous site near Marysville, Montana, where the geothermal heat flow is about 10 times the regional average. The site arouses scientific interest because there are no surface manifestations such as young volcanics, hot springs, geysers, etc., within 20 miles of it. Also, there is significant economic interest in exploring the source of heat as a potential for the generation of electricity. Included herein are independent sections prepared by each contractor. Consequently, there is some overlapping information, generally presented from different viewpoints. The project consists of geophysical surveys in 1973 and 1974, the drilling of the deep well in the summer of 1974 to a depth of 6790 feet, the coring and logging of the well, the supporting scientific studies, and the data analysis. Since so much data are available on the Marysville system, it can serve as a testing and research area to help locate and understand similar systems. (GRA)

  2. Regional Assessment of Supplementation Project. Status report

    Energy Technology Data Exchange (ETDEWEB)

    1991-10-01

    The Fish and Wildlife Program of the Northwest Power Planning Council (NPPC) prescribes several approaches to achieve its goal of doubling the salmon and steelhead runs of the Columbia River. Among those approaches are habitat restoration, improvements in adult and juvenile passage at dams and artificial propagation. Supplementation will be a major part of the new hatchery programs. The purpose of the Regional Assessment of Supplementation Project (RASP) is to provide an overview of ongoing and planned supplementation activities, to construct a conceptual framework and model for evaluating the potential benefits and risks of supplementation and to develop a plan for better regional coordination of research and monitoring and evaluation of supplementation. RASP has completed its first year of work. Progress toward meeting the first year`s objectives and recommendations for future tasks are contained in this report.

  3. Summer Student Project Report by Volodymyr Yurchenko

    CERN Document Server

    Yurchenko, Volodymyr

    2014-01-01

    In 2020, the ALICE experiment at CERN will restart collecting data with an upgraded detector. The ALICE upgrade includes the upgrade of the DAQ, the HLT and the offline systems into a new common Online-Offline computing system (O2). The prototype of this system was created to demonstrate the benefits of using new instruments to improve efficiency of computing system. This document is the report on project done by Volodymyr Yurchenko during Summer Student Program 2014. It describes the scope of fulfilled work concerning testing of the prototype of new computing system to be used during Run 3 in ALICE experiment and exploration of possibilities of using FairRoot and ZeroMQ to build data transport layer in the prototype.

  4. Incident reporting by acute pain service at a tertiary care university hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2015-01-01

    Conclusion: Reporting of untoward incidents and their regular analysis by APS is recommended to ensure high-quality patient care and to provide guidance in making teaching strategies and guidelines to improve patient safety.

  5. Change in Reported Lyme Disease Incidence in the Northeast and Upper Midwest, 1991-2014

    Data.gov (United States)

    U.S. Environmental Protection Agency — This indicator shows how reported Lyme disease incidence has changed by state since 1991, based on the number of new cases per 100,000 people. The total change has...

  6. Department of Veterans Affairs - Monthly Report to Congress of Data Incidents (April 2014)

    Data.gov (United States)

    Department of Veterans Affairs — This is a monthly report that the VA Office of Information Technology provides to congress about data incidents that took place during the month (April 2014). The...

  7. The Greenland analogue project. Yearly report 2010

    International Nuclear Information System (INIS)

    Harper, J.; Brinkerhoff, D.; Johnson, J.; Ruskeeniemi, T.; Engstroem, J.; Kukkonen, I.

    2012-04-01

    A four-year field and modelling study of the Greenland ice sheet and subsurface conditions, Greenland Analogue Project (GAP), has been initiated collaboratively by SKB, Posiva and NWMO to advance the understanding of processes associated with glaciation and their impact on the long-term performance of a deep geological repository. The study site encompasses a land terminus portion of the Greenland ice sheet, east of Kangerlussuaq, and is in many ways considered to be an appropriate analogue of the conditions that are expected to prevail in much of Canada and Fennoscandia during future glacial cycles. The project begins in 2009 and is scheduled for completion in 2012. Our current understanding of the hydrological, hydrogeological and hydrogeochemical processes associated with cold climate conditions and glacial cycles, and their impact on the long-term performance of deep geological repositories for spent nuclear fuel, will be significantly improved by studying a modern analogue. The GAP will conduct the first in situ investigations of some of the parameters and processes needed to achieve a better understanding of how an ice sheet may impact a deep repository, and will provide measurements, observations and data that may significantly improve our safety assessments and risk analyses of glaciation scenarios. This report was produced by the GAP team members and presents an overview of the activities within the GAP during the interval January 1 to December 31, 2010, as well as research results obtained during this time frame. Research for the GAP is ongoing, and additional results related to the data presented here may become available in the future and will be presented in subsequent annual reports. (orig.)

  8. The Greenland analogue project. Yearly report 2010

    Energy Technology Data Exchange (ETDEWEB)

    Harper, J.; Brinkerhoff, D.; Johnson, J. [University of Montana, Missoula (United States); Ruskeeniemi, T.; Engstroem, J.; Kukkonen, I. [Geological Survey of Finland (Finland)] [and others

    2012-04-15

    A four-year field and modelling study of the Greenland ice sheet and subsurface conditions, Greenland Analogue Project (GAP), has been initiated collaboratively by SKB, Posiva and NWMO to advance the understanding of processes associated with glaciation and their impact on the long-term performance of a deep geological repository. The study site encompasses a land terminus portion of the Greenland ice sheet, east of Kangerlussuaq, and is in many ways considered to be an appropriate analogue of the conditions that are expected to prevail in much of Canada and Fennoscandia during future glacial cycles. The project begins in 2009 and is scheduled for completion in 2012. Our current understanding of the hydrological, hydrogeological and hydrogeochemical processes associated with cold climate conditions and glacial cycles, and their impact on the long-term performance of deep geological repositories for spent nuclear fuel, will be significantly improved by studying a modern analogue. The GAP will conduct the first in situ investigations of some of the parameters and processes needed to achieve a better understanding of how an ice sheet may impact a deep repository, and will provide measurements, observations and data that may significantly improve our safety assessments and risk analyses of glaciation scenarios. This report was produced by the GAP team members and presents an overview of the activities within the GAP during the interval January 1 to December 31, 2010, as well as research results obtained during this time frame. Research for the GAP is ongoing, and additional results related to the data presented here may become available in the future and will be presented in subsequent annual reports. (orig.)

  9. Analysis of immediate transfusion incidents reported in a regional blood bank

    Directory of Open Access Journals (Sweden)

    Adriana Lemos de Sousa Neto

    2011-10-01

    Full Text Available BACKGROUND: Blood transfusion is imperative when treating certain patients; however, it is not risk free. In addition to the possible transmission of contagious infectious diseases, incidents can occur immediately after transfusion and at a later time. AIMS: This study aimed to examine the immediate transfusion incidents reported in a regional blood bank in the state of Minas Gerais between December 2006 and December 2009. A retrospective quantitative epidemiological study was conducted. Data were obtained from 202 transfusion incident reports of 42 health institutions served by the blood bank. Data processing and analysis were carried out using the Statistical Package for the Social Sciences (SPSS software. RESULTS: The rate of immediate transfusion incidents reported in the period was 0.24%; febrile non-hemolytic reactions were the most common type of incident (56.4%. The most frequent clinical manifestations listed in transfusion incident reports were chills (26.9% and fever (21.6%. There was a statistically significant association (p-value < 0.05 between the infusion of platelet concentrates and febrile non-hemolytic reactions and between fresh frozen plasma and febrile non-hemolytic reaction. The majority (73.3% of transfused patients who suffered immediate transfusion incidents had already been transfused and 36.5% of the cases had previous transfusion incident reports. CONCLUSIONS: Data from the present study corroborate the implementation of new professional training programs aimed at blood transfusion surveillance. These measures should emphasize prevention, identification and reporting of immediate transfusion incidents aiming to increase blood transfusion quality and safety.

  10. Melancthon Grey Wind Project environmental screening report

    International Nuclear Information System (INIS)

    2005-01-01

    Canadian Hydro has proposed that the Melancthon and Grey Highlands Townships in Dufferin County, Ontario are ideally suited for the installation of a 240 MW wind farm. Assuming a turbine rating of 1.5 MW each, a total of 160 turbines could be installed. The utility has decided to undertake the project in up to 4 phases. This paper focuses on the construction and operation of a 75 MW wind turbine array (50, 1.5 MW turbines) dispersed over an area of about 3,511 hectares in the Melancthon Township. The total expected cost of the first phase is $130 million, with construction scheduled to begin in April 2005 for an in-service date of no later than March 31, 2006 to meet the Wind Power Production Incentive (WPPI) funding requirements. This environmental screening report (ESR) was completed to help Canadian Hydro fulfill regulatory requirements. It presented the project summary, the estimated capacity of the wind farm, and construction schedule. The environmental setting was also presented along with power line routing. This ESR addressed issues that may impact surface and ground water quality, air quality, soil erosion, environmental noise and disposal of waste materials. Issues affecting migratory birds, agricultural resources, community characteristics, construction related traffic, public health, historical resources and viewscapes were also addressed. The general conclusion of the ESR is that the project can be constructed, operated and decommissioned in such a manner as to minimize potentially adverse effects on the environment while enhancing the positive effects both locally and provincially. Migratory bird deaths due to collision with turbines are expected to be negligible and the effects of breeding bird habitat have been minimized through proposed mitigation measures. Environmental noise levels are expected to be within the applicable noise criteria. There will be no negative effect on property values within the viewshed of the turbines. There are many net

  11. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Elnahal, Shereef M., E-mail: selnaha1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Blackford, Amanda [Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2016-04-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  12. Virginia Solar Pathways Project Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Bond, Katharine; Cosby, Sarah

    2018-03-28

    This Report provides a technical review of the final results of a funding award to Virginia Electric and Power Company (Dominion Energy Virginia (DEV) or the Company) for a project under the U.S. Department of Energy’s Solar Energy Technologies Office. The three-year project was formally known as the Virginia Solar Pathways Project (VSPP or the Project). The purpose of the VSPP was to develop a collaborative utility-administered solar strategy (Solar Strategy) for DEV’s service territory in the Commonwealth that could serve as a replicable model for other states with similar policy environments. The U.S. Department of Energy (DOE) funding award enabled DEV to take a focused approach to developing the Solar Strategy for its Virginia service territory. The structure and funding from the DOE award also facilitated valuable input from a formal stakeholder team convened to serve as advisors (Advisory Team) to the VSPP and contribute their perspectives and expertise to both the analysis and strategy development aspects of the Project. The development of the Solar Strategy involved three main goals: • Establish a policy and program framework that would integrate existing solar programs with new options appropriate for the Commonwealth’s policy environment and broader economic development objectives; • Promote wider deployment of solar within a low retail electric rate environment; and • Serve as a sustainable, utility-administered solar model that could be replicated in other states with similar policy environments, including, but not limited to, the entire Southeast region. In support of the VSPP goals, the Project Team commissioned four studies to support the Solar Strategy development. Two studies, completed by Navigant Consulting, focused on the integration of solar into the electric grid. The first solar integration study focused on integration of solar into the distribution grid where the utility system directly connects to and serves end-use customers

  13. Fast Food Consumption and Gestational Diabetes Incidence in the SUN Project

    Science.gov (United States)

    Dominguez, Ligia J.; Martínez-González, Miguel A.; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Bes-Rastrollo, Maira

    2014-01-01

    Background Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. Methods The prospective dynamic “Seguimiento Universidad de Navarra” (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0–3 servings/month), intermediate (>3 servings/month and ≤2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. Results We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81–2.13) and 1.86 (95% CI: 1.13–3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). Conclusion Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes. PMID:25215961

  14. Fast food consumption and gestational diabetes incidence in the SUN project.

    Directory of Open Access Journals (Sweden)

    Ligia J Dominguez

    Full Text Available BACKGROUND: Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. METHODS: The prospective dynamic "Seguimiento Universidad de Navarra" (SUN cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0-3 servings/month, intermediate (>3 servings/month and ≤2 servings/week and high (>2 servings/week. Non-conditional logistic regression models were used to adjust for potential confounders. RESULTS: We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81-2.13 and 1.86 (95% CI: 1.13-3.06 for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007. CONCLUSION: Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.

  15. Fast food consumption and gestational diabetes incidence in the SUN project.

    Science.gov (United States)

    Dominguez, Ligia J; Martínez-González, Miguel A; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Bes-Rastrollo, Maira

    2014-01-01

    Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. The prospective dynamic "Seguimiento Universidad de Navarra" (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0-3 servings/month), intermediate (>3 servings/month and ≤2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81-2.13) and 1.86 (95% CI: 1.13-3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.

  16. Northeast Oregon Hatchery Project conceptual design report. Final report

    International Nuclear Information System (INIS)

    1995-03-01

    This report presents the results of site analysis for the Bonneville Power Administration Northeast Oregon Hatchery Project. The purpose of this project is to provide engineering services for the siting and conceptual design of hatchery facilities for the Bonneville Power Administration. The hatchery project consists of artificial production facilities for salmon and steelhead to enhance production in three adjacent tributaries to the Columbia River in northeast Oregon: the Grande Ronde, Walla Walla, and Imnaha River drainage basins. Facilities identified in the master plan include adult capture and holding facilities; spawning incubation, and early rearing facilities; full-term rearing facilities; and direct release or acclimation facilities. The evaluation includes consideration of a main production facility for one or more of the basins or several smaller satellite production facilities to be located within major subbasins. The historic and current distribution of spring and fall chinook salmon and steelhead was summarized for the Columbia River tributaries. Current and future production and release objectives were reviewed. Among the three tributaries, forty seven sites were evaluated and compared to facility requirements for water and space. Site screening was conducted to identify the sites with the most potential for facility development. Alternative sites were selected for conceptual design of each facility type. A proposed program for adult holding facilities, final rearing/acclimation, and direct release facilities was developed

  17. Northeast Oregon Hatchery Project final siting report. Final report

    International Nuclear Information System (INIS)

    1995-03-01

    This report presents the results of site analysis for the Bonneville Power Administration Northeast Oregon Hatchery Project. The purpose of this project is to provide engineering services for the siting and conceptual design of hatchery facilities for the Bonneville Power Administration. The hatchery project consists of artificial production facilities for salmon and steelhead to enhance production in three adjacent tributaries to the Columbia River in northeast Oregon: the Grande Ronde, Walla Walla, and Imnaha River drainage basins. Facilities identified in the master plan include adult capture and holding facilities; spawning incubation, and early rearing facilities; full-term rearing facilities; and direct release or acclimation facilities. The evaluation includes consideration of a main production facility for one or more of the basins or several smaller satellite production facilities to be located within major subbasins. The historic and current distribution of spring and fall chinook salmon and steelhead was summarized for the Columbia River tributaries. Current and future production and release objectives were reviewed. Among the three tributaries, forty seven sites were evaluated and compared to facility requirements for water and space. Site screening was conducted to identify the sites with the most potential for facility development. Alternative sites were selected for conceptual design of each facility type. A proposed program for adult holding facilities, final rearing/acclimation, and direct release facilities was developed

  18. NNWSI project information management system concepts evaluation report. Final report

    International Nuclear Information System (INIS)

    1986-08-01

    This report is intended as a first step in developing detailed information management system specifications for the Nevada Nuclear Waste Storage Investigations (NNWSI) Project. The current state of information management at the NNWSI Project level is investigated and an information management system (IMS) is proposed. The IMS as it relates to aspects of Project and records management is discussed. Information management concepts and prospective IMS system components are investigated. Concepts and system components include: indexing, searching, retrieval, data base management system technology, computers, storage media, computer-assisted retrieval (CAR) of microfilm, electronic imaging-based systems, optical character recognition, and communications. Performance criteria and desirable system attributes applicable to the IMS are discussed. Six conceptual system approaches capable of satisfying the performance criteria are defined. System approaches include: fully centralized microfilm system based on CAR retrieval (Approach 1), partially distributed microfilm system based on CAR retrieval (Approach 2), fully distributed microfilm system based on CAR retrieval (Approach 3), fully centralized optical disk system based on electronic image and full-text retrieval (Approach 4), partially distributed optical system based on electron image and full-text retrieval (Approach 5), and fully distributed optical disk system based on electronic image and full-text retrieval (Approach 6). Technical and cost considerations associated with the six conceptual approaches are evaluated. Technical evaluation results indicate Approach 4 is the best conceptual approach, and cost evaluation results show no significant differences among approaches. On the basis of the evaluation, Approach 4 is recommended

  19. Project monitor. Final report. [Allegheny County, PA

    Energy Technology Data Exchange (ETDEWEB)

    Hammond, P.Y.; Beck, P.; Doctors, S.I.

    1979-04-27

    Results are reported of a study of consumers' energy attitudes and behavior. Household consumers and small business consumers (both retail and manufacturing) responded to the survey, but only the household results are reported. The study sought to understand energy-related behavior at the level where the various components of energy policy intersect. Attempts are made to attain this goal by determining the extent to which various properties of the individuals and firms are associated with various amounts of conservation. A representative sample of the adult population in Allegheny County, Pennsylvania was interviewed. Part I introduces the measures of household conservation to be used in the survey. Part II analyzes each of the types of energy conservation - general, winterization, heating, cooling, appliance, transportation, and electricity reductions - and relates them to demographic, situation, attitudinal, and perceptual variables in the household sample. Part III deals with the impacts of Project Pacesetter and the United Mine Workers' strike against the coal operators - particularly, the impact of the coal strike on household residents of Allegheny County. Part IV summarizes the findings and uses them for recommendations regarding energy conservation policy. Additional data are presented in 4 appendices. (MCW)

  20. 77 FR 69925 - Assessment of Hazardous Materials Incident Data Collection, Analysis, Reporting, and Use

    Science.gov (United States)

    2012-11-21

    ... for an assessment to improve the collection, analysis, reporting, and use of data related to accidents... Department to conduct an assessment to improve the collection, analysis, reporting, and use of data related... improving the collection, analysis, reporting, and use of data related to accidents and incidents involving...

  1. Final project report for NEET pulsed ion beam project

    Energy Technology Data Exchange (ETDEWEB)

    Kucheyev, S. O. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2018-01-11

    The major goal of this project was to develop and demonstrate a novel experimental approach to access the dynamic regime of radiation damage formation in nuclear materials. In particular, the project exploited a pulsed-ion-beam method in order to gain insight into defect interaction dynamics by measuring effective defect interaction time constants and defect diffusion lengths. This project had the following four major objectives: (i) the demonstration of the pulsed ion beam method for a prototypical nuclear ceramic material, SiC; (ii) the evaluation of the robustness of the pulsed beam method from studies of defect generation rate effects; (iii) the measurement of the temperature dependence of defect dynamics and thermally activated defect-interaction processes by pulsed ion beam techniques; and (iv) the demonstration of alternative characterization techniques to study defect dynamics. As we describe below, all these objectives have been met.

  2. In situ simulation: Taking reported critical incidents and adverse events back to the clinic

    DEFF Research Database (Denmark)

    Juul, Jonas; Paltved, Charlotte; Krogh, Kristian

    2014-01-01

    improve patient safety if coupled with training and organisational support2. Insight into the nature of reported critical incidents and adverse events can be used in writing in situ simulation scenarios and thus lead to interventions that enhance patient safety. The patient safety literature emphasises...... well-developed non-technical skills in preventing medical errors3. Furthermore, critical incidents and adverse events reporting systems comprise a knowledgebase to gain in-depth insights into patient safety issues. This study explores the use of critical incidents and adverse events reports to inform...... in situ simulation to improve patient safety. Design and purpose The study uses a case study design of in situ simulation training tailored to two emergency departments in the Central Denmark Region. We aim to: - Develop a model that integrates critical incidents and adverse events, a contextual needs...

  3. Web-based Project Reporting System

    Data.gov (United States)

    US Agency for International Development — Web-PRS is a web-based system that captures financial information and project status information that is sortable by geographical location, pillar, project type and...

  4. Project report - an overview of the project and experiences with project management

    DEFF Research Database (Denmark)

    Jørgensen, Michael Søgaard; Mikkelsen, Bent Egberg

    1996-01-01

    A collection of the project planning and the experiences with project management from the Catering 2000 project.As appendieces articles etc. from journals, newspapers etc. about the project.......A collection of the project planning and the experiences with project management from the Catering 2000 project.As appendieces articles etc. from journals, newspapers etc. about the project....

  5. Statistical analysis of incidents reported in the Greek Petrochemical Industry for the period 1997-2003

    International Nuclear Information System (INIS)

    Konstandinidou, Myrto; Nivolianitou, Zoe; Markatos, Nikolaos; Kiranoudis, Chris

    2006-01-01

    This paper makes an analysis of all reported accidents and incidents in the Greek Petrochemical Industry for the period spanning from 1997 to 2003. The work performed is related to the analysis of important parameters of the incidents, their inclusion in a database adequately designed for the purposes of this analysis and an importance assessment of this reporting scheme. Indeed, various stakeholders have highlighted the importance of a reporting system for industrial accidents and incidents. The European Union has established for this purpose the Major Accident Reporting System (MARS) for the reporting of major accidents in the Member States. However, major accidents are not the only measure that can characterize the safety status of an establishment; neither are the former the only events from which important lessons can be learned. Near misses, industrial incidents without major consequences, as well as occupational accidents could equally supply with important findings the interested analyst, while statistical analysis of these incidents could give significant insight in the understanding and the prevention of similar incidents or major accidents in the future. This analysis could be more significant, if each industrial sector was separately analyzed, as the authors do for the petrochemical sector in the present article

  6. Incidence du cancer au Canada : tendances et projections (1983-2032

    Directory of Open Access Journals (Sweden)

    Lin Xie

    2015-01-01

    Full Text Available Dans cette monographie, nous présentons, pour 1983 à 2032, un historique et des projections du nombre de nouveaux cas et des taux d'incidence du cancer pour le Canada, à l'exception des cancers de la peau autres que le mélanome (c.-à -d. les carcinomes basocellulaire et spinocellulaire. Ces renseignements visent à faciliter la planification stratégique et l'affectation de ressources et d'infrastructures pour assurer la prestation future de soins de santé et de mesures de lutte contre le cancer. Évolution projetée des taux d'incidence de cancer : De 2003-2007 à 2028-2032, les taux d'incidence normalisés selon l'âge (TINA pour l'ensemble des cancers devraient diminuer de 5 % pour les Canadiens, passant de 464,8 à 443,2 pour 100 000 habitants, et augmenter de 4 % pour les Canadiennes, passant de 358,3 à 371,0 pour 100 000 habitants. La diminution globale des taux de cancer chez les hommes sera le résultat de la baisse des taux de cancer du poumon chez les hommes de 65 ans et plus et des taux de cancer de la prostate chez les hommes de 75 ans et plus. L'augmentation globale des taux de cancer chez les femmes correspond à la hausse prévue des taux de cancer du poumon chez les femmes de 65 ans et plus. Elle représente également la hausse prévue des cas de cancer de l'utérus, de la thyroïde, du sein (chez les femmes de moins de 45 ans, du rein et du pancréas ainsi que des cas de leucémie et de mélanome. Parmi les changements les plus importants dans les TINA projetés sur un horizon de 25 ans, mentionnons une augmentation du nombre de cas de cancer de la thyroïde (55 % chez les hommes et 65 % chez les femmes et de cancer du foie chez les hommes (43 %, et une diminution du nombre de cas de cancer du larynx (47 % chez les hommes et 59 % chez les femmes, de cancer du poumon chez les hommes (34 % et de cancer de l'estomac (30 % chez les hommes et 24 % chez les femmes. Le taux d'incidence du cancer du poumon chez les femmes

  7. Family Reading Project, First Year Report.

    Science.gov (United States)

    Solorzano, Ronald W.

    The first program year evaluation of the Family Reading project addresses implementation issues at the national and local levels relating to the literacy intervention model designed for the project. The project is a collaborative effort between the National Council of La Raza and the Educational Testing Service to improve literacy levels of Latino…

  8. Kansas Advanced Semiconductor Project: Final Report

    International Nuclear Information System (INIS)

    Baringer, P.; Bean, A.; Bolton, T.; Horton-Smith, G.; Maravin, Y.; Ratra, B.; Stanton, N.; von Toerne, E.; Wilson, G.

    2007-01-01

    KASP (Kansas Advanced Semiconductor Project) completed the new Layer 0 upgrade for D0, assumed key electronics projects for the US CMS project, finished important new physics measurements with the D0 experiment at Fermilab, made substantial contributions to detector studies for the proposed e+e- international linear collider (ILC), and advanced key initiatives in non-accelerator-based neutrino physics.

  9. Patient safety incidents involving neuromuscular blockade: analysis of the UK National Reporting and Learning System data from 2006 to 2008.

    Science.gov (United States)

    Arnot-Smith, J; Smith, A F

    2010-11-01

    Neuromuscular blockade is a powerful anaesthetic tool that has the potential for significant adverse outcomes. We sought to explore the national picture by analysing incidents relating to neuromuscular blockade in anaesthesia from the National Reporting and Learning System from England and Wales between 2006 and 2008. We searched the database of incidents using SNOMED CT search terms and reading the free text of relevant incidents. There were 231 incidents arising from the use or reversal of neuromuscular blocking agents. The main themes identified were: non-availability of drugs (45 incidents, 19%), possible unintentional awareness under general anaesthesia (42 incidents, 18%), potential allergic reaction (31 incidents, 13%), problems with reversal of blockade (13 incidents, 6%), storage (13 incidents, 6%) and prolonged apnoea (11 incidents, 5%). We make recommendations to reduce human error in the use of neuromuscular blocking agents and on future incident reporting in anaesthesia. © 2010 The Authors. Anaesthesia © 2010 The Association of Anaesthetists of Great Britain and Ireland.

  10. Incident reporting: Its role in aviation safety and the acquisition of human error data

    Science.gov (United States)

    Reynard, W. D.

    1983-01-01

    The rationale for aviation incident reporting systems is presented and contrasted to some of the shortcomings of accident investigation procedures. The history of the United State's Aviation Safety Reporting System (ASRS) is outlined and the program's character explained. The planning elements that resulted in the ASRS program's voluntary, confidential, and non-punitive design are discussed. Immunity, from enforcement action and misuse of the volunteered data, is explained and evaluated. Report generation techniques and the ASRS data analysis process are described; in addition, examples of the ASRS program's output and accomplishments are detailed. Finally, the value of incident reporting for the acquisition of safety information, particularly human error data, is explored.

  11. TX-100 manufacturing final project report.

    Energy Technology Data Exchange (ETDEWEB)

    Ashwill, Thomas D.; Berry, Derek S. (TPI Composites, Inc., Warren, RI)

    2007-11-01

    This report details the work completed under the TX-100 blade manufacturing portion of the Carbon-Hybrid Blade Developments: Standard and Twist-Coupled Prototype project. The TX-100 blade is a 9 meter prototype blade designed with bend-twist coupling to augment the mitigation of peak loads during normal turbine operation. This structural coupling was achieved by locating off axis carbon fiber in the outboard portion of the blade skins. The report will present the tooling selection, blade production, blade instrumentation, blade shipping and adapter plate design and fabrication. The baseline blade used for this project was the ERS-100 (Revision D) wind turbine blade. The molds used for the production of the TX-100 were originally built for the production of the CX-100 blade. The same high pressure and low pressure skin molds were used to manufacture the TX-100 skins. In order to compensate for the difference in skin thickness between the CX-100 and the TX-100, however, a new TX-100 shear web plug and mold were required. Both the blade assembly fixture and the root stud insertion fixture used for the CX-100 blades could be utilized for the TX-100 blades. A production run of seven TX-100 prototype blades was undertaken at TPI Composites during the month of October, 2004. Of those seven blades, four were instrumented with strain gauges before final assembly. After production at the TPI Composites facility in Rhode Island, the blades were shipped to various test sites: two blades to the National Wind Technology Center at the National Renewable Energy Laboratory in Boulder, Colorado, two blades to Sandia National Laboratory in Albuquerque, New Mexico and three blades to the United States Department of Agriculture turbine field test facility in Bushland, Texas. An adapter plate was designed to allow the TX-100 blades to be installed on existing Micon 65/13M turbines at the USDA site. The conclusion of this program is the kick-off of the TX-100 blade testing at the three

  12. Environmental Impact Report, November 15, 1972. Indian Valley Colleges Project.

    Science.gov (United States)

    Berg, Ernest H.; Fleming, Dale A.

    A study of the environmental impact of the construction of a second community college on a site adjacent to the City of Novato in Marin County, California, is presented. The five sections of the report are as follows: I. Project Description and Purpose: A. The Proposal; B. Purpose of the Project; C. Need for the Project; D. History of the Project;…

  13. Geothermal policy project. Quarterly report, June 1-August 31, 1980

    Energy Technology Data Exchange (ETDEWEB)

    Connor, T.D.

    1980-11-01

    Efforts continued to initiate geothermal and water source heat pump study activities in newly selected project states and to carry forward policy development in existing project states. Follow-up contacts were made with several project states, and state meetings and workshops were held in nine project states. Two state-specific documents were prepared during this reporting period, for Nevada and Wyoming.

  14. Enewetak radiological support project. Final report

    International Nuclear Information System (INIS)

    Friesen, B.

    1982-09-01

    From 1972 through 1980, the Department of Energy acted in an advisory role to the Defense Nuclear Agency during planning for and execution of the cleanup of Enewetak Atoll. The Nevada Operations Office of the Department of Energy was responsible for the radiological characterization of the atoll and for certification of radiological condition of each island upon completion of the project. In-situ measurements of gamma rays emitted by americium-241 were utilized along with wet chemistry separation of plutonium from soil samples to identify and delineate surface areas requiring removal of soil. Military forces removed over 100,000 cubic yards of soil from the surface of five islands and deposited this material in a crater remaining from the nuclear testing period. Subsurface soil was excavated and removed from several locations where measurements indicated the presence of radionuclides above predetermined criteria. The methodologies of data acquisition, analysis and interpretation are described and detailed results are provided in text, figures and microfiche. The final radiological condition of each of 43 islets is reported

  15. Borehole project - Final report of phase 3

    International Nuclear Information System (INIS)

    Pusch, R.; Ramqvist, G.

    2008-03-01

    The report describes borehole plugging techniques for use in deep boreholes extending from the ground surface, and construction and placement of plugs in holes of different lengths and orientations bored from the repository rooms. The principle employed is the one proposed in earlier phases of the project, i.e. to tightly seal those parts of boreholes where the rock has few fractures and a low hydraulic conductivity, and filling of those parts that intersect water-bearing fracture zones with physically stable material that does not need to be low-permeable. Four methods for tight plugging have been identified and tested and a technique has been found for filling boreholes that are intersected by fracture zones. The upper end of boreholes extending from the ground surface needs a 'mechanical' seal for which copper metal and concrete work well. The experience from plugging of a 550 m deep borehole at Olkiluoto (OL-KR24) has been compiled and plans worked out for sampling and testing of contacting clay and concrete in this hole and in short holes in the Aespoe URL. (orig.)

  16. Progress report of THI project for 1996

    International Nuclear Information System (INIS)

    Baron, E.

    1998-01-01

    The set of tests reported in this paper has allowed to identify the actions to be undertaken in order to achieve a THI system operation stable and reliable. Still an important burden rests concerning accessories to diagnosis installation, the set up of electronics and control (on R2 inclusive), improvement of automatic operation control and beam tests. For the next year this work is evaluated at 180 man.week and the machine studies at 70 UT. In this context one is planned to provide to SISSI a beam of intensity intermediate between the current mode and THI mode, for instance 1.5 kW light ions, starting from mid 97. The presented planning summarizes the most important operation to perform in relation with the machine studies. Detailed are presented concerning the R2 regrouping system and the adaptation of the accelerator to high intensities. The following items are also discussed: source; regulating methods and the associated pickup systems; surveillance pickup systems, supply surveillance; the new ejection system of the injector; the mechanical modifications; the radiation protection and the machine studies directly related to the THI project

  17. cptnHook - Summer Student Project Report

    CERN Document Server

    Asimakopoulou, Eleni - Myrto

    2015-01-01

    The present is a report of the work that was conducted during my 8-week summer school internship at CERN. The project was centered on the development of an instrumentation tool for the usage of mathematical functions in a scientific application. More specifically, $\\textbf{cptnHook}$ addresses a current issue that arises from the the extensive use of very time-consuming mathematical functions (such as transcendental functions) that results in them accounting for a big portion of their run-time. It is believed that the problem can be addressed with ad-hoc approximations of mathematical functions, for which a clear overview of the usage of the functions in the program is required. $\\textbf{cptnHook}$ approaches this problem by providing a measurement of the use of mathematical functions in a program by hooking into the machine code and probing the arguments of the functions, without modifying the application's source code. The outputs of the tool are provided in ROOT format for further on analysis.

  18. Quality review of an adverse incident reporting system and root cause analysis of serious adverse surgical incidents in a teaching hospital of Scotland

    Directory of Open Access Journals (Sweden)

    Khorsandi Maziar

    2012-08-01

    Full Text Available Abstract Background A significant proportion of surgical patients are unintentionally harmed during their hospital stay. Root Cause Analysis (RCA aims to determine the aetiology of adverse incidents that lead to patient harm and produce a series of recommendations, which would minimise the risk of recurrence of similar events, if appropriately applied to clinical practice. A review of the quality of the adverse incident reporting system and the RCA of serious adverse incidents at the Department of Surgery of Ninewells hospital, in Dundee, United Kingdom was performed. Methods The Adverse Incident Management (AIM database of the Department of Surgery of Ninewells Hospital was retrospectively reviewed. Details of all serious (red, sentinel incidents recorded between May 2004 and December 2009, including the RCA reports and outcomes, where applicable, were reviewed. Additional related information was gathered by interviewing the involved members of staff. Results The total number of reported surgical incidents was 3142, of which 81 (2.58% cases had been reported as red or sentinel. 19 of the 81 incidents (23.4% had been inappropriately reported as red. In 31 reports (38.2% vital information with regards to the details of the adverse incidents had not been recorded. In 12 cases (14.8% the description of incidents was of poor quality. RCA was performed for 47 cases (58% and only 12 cases (15% received recommendations aiming to improve clinical practice. Conclusion The results of our study demonstrate the need for improvement in the quality of incident reporting. There are enormous benefits to be gained by this time and resource consuming process, however appropriate staff training on the use of this system is a pre-requisite. Furthermore, sufficient support and resources are required for the implementation of RCA recommendations in clinical practice.

  19. Project Familia. Final Evaluation Report, 1993-94. OER Report.

    Science.gov (United States)

    New York City Board of Education, Brooklyn, NY. Office of Educational Research.

    Project Familia was an Elementary and Secondary Education Act Title VII project in its second year in 1993-94 in New York City. Project Familia served 77 children at 3 schools who were identified as limited English proficient, special education students in prekindergarten through fifth grade and their parents. The project provided after-school…

  20. A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice

    OpenAIRE

    Carson-Stevens, Andrew; Hibbert, Peter; Avery, Anthony; Butlin, Amy; Carter, Ben; Cooper, Alison; Evans, Huw Prosser; Gibson, Russell; Luff, Donna; Makeham, Meredith; McEnhill, Paul; Panesar, Sukhmeet S; Parry, Gareth; Rees, Philippa; Shiels, Emma

    2015-01-01

    INTRODUCTION: Incident reports contain descriptions of errors and harms that occurred during clinical care delivery. Few observational studies have characterised incidents from general practice, and none of these have been from the England and Wales National Reporting and Learning System. This study aims to describe incidents reported from a general practice care setting.METHODS AND ANALYSIS: A general practice patient safety incident classification will be developed to characterise patient s...

  1. Incident reporting by acute pain service at a tertiary care university hospital

    Science.gov (United States)

    Ahmed, Aliya; Yasir, Muhammad

    2015-01-01

    Background and Aims: Provision of effective and safe postoperative pain management is the principal responsibility of acute pain services (APSs). Continuous quality assurance is essential for high-quality patient care. We initiated anonymous reporting of critical incidents by APS to ensure continuous quality improvement and here present prospectively collected data on the reported incidents. Our objective was to analyze the frequency and nature of incidents and to see if any harm was caused to patients. Material and Methods: Data were collected from January 1, 2012 to September 30, 2013. An incident related to pain management was defined as An incident that occurs in a patient receiving pain management supervised by APS, and causes or has the potential to cause harm or affects patient safety. A form was filled including incident type, personnel involved, any harm caused, and steps taken to rectify it. Frequencies and percentages were computed for categorical variables. Results: A total of 2042 patients were seen and 442 (21.64%) incidents reported during the study period, including documentation errors (136/31%), noncompliance with protocols (113/25.56%), wrong combination of drugs (56/12.66%), premature discontinuation (74/16.72%), prolonged delays in change of syringes (27/6.10%), loss to follow-up (19/4.29%), administration of contraindicated drugs (9/2.03%), catheter pull-outs (6/1.35%), and faulty equipment (2/0.45%). Steps were taken to rectify the errors accordingly. No harm was caused to any patient. Conclusion: Reporting of untoward incidents and their regular analysis by APS is recommended to ensure high-quality patient care and to provide guidance in making teaching strategies and guidelines to improve patient safety. PMID:26702208

  2. Community pharmacy incident reporting: a new tool for community pharmacies in Canada.

    Science.gov (United States)

    Ho, Certina; Hung, Patricia; Lee, Gary; Kadija, Medina

    2010-01-01

    Incident reporting offers insight into a variety of intricate processes in healthcare. However, it has been found that medication incidents are under reported in the community pharmacy setting. The Community Pharmacy Incident Reporting (CPhIR) program was created by the Institute for Safe Medication Practices Canada specifically for incident reporting in the community pharmacy setting in Canada. The initial development of key elements for CPhIR included several focus-group teleconferences with pharmacists from Ontario and Nova Scotia. Throughout the development and release of the CPhIR pilot, feedback from pharmacists and pharmacy technicians was constantly incorporated into the reporting program. After several rounds of iterative feedback, testing and consultation with community pharmacy practitioners, a final version of the CPhIR program, together with self-directed training materials, is now ready to launch. The CPhIR program provides users with a one-stop platform to report and record medication incidents, export data for customized analysis and view comparisons of individual and aggregate data. These unique functions allow for a detailed analysis of underlying contributing factors in medication incidents. A communication piece for pharmacies to share their experiences is in the process of development. To ensure the success of the CPhIR program, a patient safety culture must be established. By gaining a deeper understanding of possible causes of medication incidents, community pharmacies can implement system-based strategies for quality improvement and to prevent potential errors from occurring again in the future. This article highlights key features of the CPhIR program that will assist community pharmacies to improve their drug distribution system and, ultimately, enhance patient safety.

  3. The effect of a workflow-based response system on hospital-wide voluntary incident reporting rates.

    Science.gov (United States)

    Wang, Szu-Chang; Li, Ying-Chun; Huang, Hung-Chi

    2013-02-01

    Hospital incident reporting systems are usually evaluated on their theoretical benefit to the hospital or increase in reporting rates alone. To evaluate a workflow-based response system on staff incident reporting rates. A prospective cohort study of incident reports made by staff members before (2006-2007) and after (2008-2009) the system was implemented on 1 January 2008 at a medical center in southern Taiwan. Pre-system and post-system data were based on 713 129 and 730 176 inpatient days and 160 692 and 168 850 emergency department visits. The addition of a workflow-based response system to a reporting system processing incident reports and intra-hospital responses. Voluntary incident reporting rates and distribution of incident severities. Inpatient reports [9.9 vs. 28.8 per 10 000 patient days; rate ratio (RR): 2.9, 95% confidence interval (CI): 2.7-3.2, P reports (5.9 vs. 19.2 per 10 000 visits, RR: 3.3, 95% CI: 2.6-4.1, P system reported incidents were more evenly distributed over five severity levels than pre-sytem incidents, moving more toward the very severe level (RR: 17.6, 95% CI: 8.4-37.0, P system to the hospital incident reporting system significantly increased hospital-wide voluntary incident report rates at all incident injury levels.

  4. Ice Load Project Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, Timothy J. [DNV GL, Seattle, WA (United States); Brown, Thomas [IFC Engineering, Calgary, AB (Canada); Byrne, Alex [DNV GL, Seattle, WA (United States)

    2014-10-30

    As interest and investment in offshore wind projects increase worldwide, some turbines will be installed in locations where ice of significant thickness forms on the water surface. This ice moves under the driving forces of wind, current, and thermal effects and may result in substantial forces on bottom-fixed support structures. The North and Baltic Seas in Europe have begun to see significant wind energy development and the Great Lakes of the United States and Canada may host wind energy development in the near future. Design of the support structures for these projects is best performed through the use of an integrated tool that can calculate the cumulative effects of forces due to turbine operations, wind, waves, and floating ice. The dynamic nature of ice forces requires that these forces be included in the design simulations, rather than added as static forces to simulation results. The International Electrotechnical Commission (IEC) standard[2] for offshore wind turbine design and the International Organization for Standardization (ISO) standard[3] for offshore structures provide requirements and algorithms for the calculation of forces induced by surface ice; however, currently none of the major wind turbine dynamic simulation codes provides the ability to model ice loads. The scope of work of the project described in this report includes the development of a suite of subroutines, collectively named IceFloe, that meet the requirements of the IEC and ISO standards and couples with four of the major wind turbine dynamic simulation codes. The mechanisms by which ice forces impinge on offshore structures generally include the forces required for crushing of the ice against vertical-sided structures and the forces required to fracture the ice as it rides up on conical-sided structures. Within these two broad categories, the dynamic character of the forces with respect to time is also dependent on other factors such as the velocity and thickness of the moving ice

  5. Genomics :GTL project quarterly report April 2005.

    Energy Technology Data Exchange (ETDEWEB)

    Rintoul, Mark Daniel; Martino, Anthony A.; Palenik, Brian; Heffelfinger, Grant S.; Xu, Ying; Geist, Al; Gorin, Andrey

    2005-11-01

    This SAND report provides the technical progress through April 2005 of the Sandia-led project, ''Carbon Sequestration in Synechococcus Sp.: From Molecular Machines to Hierarchical Modeling'', funded by the DOE Office of Science GenomicsGTL Program. Understanding, predicting, and perhaps manipulating carbon fixation in the oceans has long been a major focus of biological oceanography and has more recently been of interest to a broader audience of scientists and policy makers. It is clear that the oceanic sinks and sources of CO{sub 2} are important terms in the global environmental response to anthropogenic atmospheric inputs of CO{sub 2} and that oceanic microorganisms play a key role in this response. However, the relationship between this global phenomenon and the biochemical mechanisms of carbon fixation in these microorganisms is poorly understood. In this project, we will investigate the carbon sequestration behavior of Synechococcus Sp., an abundant marine cyanobacteria known to be important to environmental responses to carbon dioxide levels, through experimental and computational methods. This project is a combined experimental and computational effort with emphasis on developing and applying new computational tools and methods. Our experimental effort will provide the biology and data to drive the computational efforts and include significant investment in developing new experimental methods for uncovering protein partners, characterizing protein complexes, identifying new binding domains. We will also develop and apply new data measurement and statistical methods for analyzing microamy experiments. Computational tools will be essential to our efforts to discover and characterize the function of the molecular machines of Synechococcus. To this end, molecular simulation methods will be coupled with knowledge discovery from diverse biological data sets for high-throughput discovery and characterization of protein-protein complexes. In

  6. LYNX community advocacy & service engagement (CASE) project final report.

    Science.gov (United States)

    2009-05-14

    This report is a final assessment of the Community Advocacy & Service Engagement (CASE) project, a LYNX-FTA research project designed : to study transit education and public engagement methods in Central Florida. In the Orlando area, as in other part...

  7. Incident reporting in dentistry: Clinical supervisor's awareness, practice and perceived barriers.

    Science.gov (United States)

    AlBlaihed, R M; AlSaeed, M I; Abuabat, A A; Ahsan, S H

    2017-12-21

    The significance of patient safety and risk management in dentistry has surfaced as dental settings bear delicate procedures carried out by teams utilising numerous devices and tools in complex environments. Our aim is to assess awareness, practice, attitude and perceived barriers of reporting incidents amongst dental clinical supervisors working at dental colleges in Riyadh, Saudi Arabia. The objectives are as follows: (i) Determine if correlations exist between socio-demographic data and supervisors' awareness, practice, attitude and perceived barriers. (ii) Identify most common perceived barriers. An online questionnaire was sent to the 450 clinical supervisors working at five dental colleges of Riyadh. The collected data included items assessing the awareness, practice and attitude of reporting students' incidents along with the perceived barriers. A response rate of (60.1% n = 264 of 450) was established. The majority of the respondents (62.9% n = 166) were aware of the incident reporting policy. Yet, only (35.4% n = 93) of them had completed an incident reporting form before. Most of the participants (90.5% n = 239) agreed on the necessity of reporting student's incidents, but only (67.0% n = 177) agreed on the necessity of reporting well-handled incidents. The possible negative relationship with students was the most agreed on barrier to reporting. This study shows that certain demographics of supervisors had significant relationship with their awareness, attitude, perceived barriers and practice. Awareness of the policy and form was linked to the increase in supervisors' practice, although they tend to report verbally rather than in writing. The possible negative relationship with students was the most common perceived barrier. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Incidence and pattern of 12 years of reported transfusion adverse events in Zimbabwe: A retrospective analysis

    NARCIS (Netherlands)

    Mafirakureva, Nyashadzaishe; Khoza, Star; Mvere, David A.; Chitiyo, McLeod E.; Postma, Maarten J.; Van Hulst, Marinus

    2014-01-01

    Background. Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. Materials and

  9. 77 FR 53779 - Reports by Air Carriers on Incidents Involving Animals During Air Transport

    Science.gov (United States)

    2012-09-04

    ... Involving Animals During Air Transport AGENCY: Office of the Secretary (OST), Department of Transportation... period of an NPRM on the reporting of incidents involving animals during air transport that was published... animal during air transport. The NPRM proposed to: (1) Expand the reporting requirement to U.S. carriers...

  10. 76 FR 72850 - Adjustment of Monetary Threshold for Reporting Rail Equipment Accidents/Incidents for Calendar...

    Science.gov (United States)

    2011-11-28

    ... increase, as keeping the 2011 threshold in place would not allow it to keep pace with the increasing dollar... (DOT). ACTION: Final rule. SUMMARY: This rule increases the rail equipment accident/incident reporting... reflect cost increases that have occurred since the reporting threshold was last published in December of...

  11. Educators' Reports on Incidence of Harassment and Advocacy toward LGBTQ Students

    Science.gov (United States)

    Dragowski, Eliza A.; McCabe, Paul C.; Rubinson, Florence

    2016-01-01

    This study is based on a national survey investigation of 968 educators, who reported the incidence of LGBTQ harassment in schools, and their advocacy efforts on behalf of this population. LGBTQ-related knowledge, attitudes, norms, and perceived ability to advocate were also assessed. Ninety percent of educators reported observing LGBTQ harassment…

  12. Longitudinal trends in organophosphate incidents reported to the National Pesticide Information Center, 1995–2007

    Directory of Open Access Journals (Sweden)

    Jenkins Jeffrey J

    2009-04-01

    Full Text Available Abstract Background Regulatory decisions to phase-out the availability and use of common organophosphate pesticides among the general public were announced in 2000 and continued through 2004. Based on revised risk assessments, chlorpyrifos and diazinon were determined to pose unacceptable risks. To determine the impact of these decisions, organophosphate (OP exposure incidents reported to the National Pesticide Information Center (NPIC were analyzed for longitudinal trends. Methods Non-occupational human exposure incidents reported to NPIC were grouped into pre- (1995–2000 and post-announcement periods (2001–2007. The number of total OP exposure incidents, as well as reports for chlorpyrifos, diazinon and malathion, were analyzed for significant differences between these two periods. The number of informational inquiries from the general public was analyzed over time as well. Results The number of average annual OP-related exposure incidents reported to NPIC decreased significantly between the pre- and post-announcement periods (p Conclusion Consistent with other findings, the number of chlorpyrifos and diazinon exposure incidents reported to NPIC significantly decreased following public announcement and targeted regulatory action.

  13. Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant.

    Science.gov (United States)

    Levtzion-Korach, Osnat; Frankel, Allan; Alcalai, Hanna; Keohane, Carol; Orav, John; Graydon-Baker, Erin; Barnes, Janet; Gordon, Kathleen; Puopulo, Anne Louise; Tomov, Elena Ivanova; Sato, Luke; Bates, David W

    2010-09-01

    A study was conducted to examine and compare information gleaned from five different reporting systems within one institution: incident reporting, patient complaints, risk management, medical malpractice claims, and executive walk rounds. These data sources vary in the timing of the reporting (retrospective or prospective), severity of the events, and profession of the reporters. A common methodology was developed for classifying incidents. Data specific to each incident were abstracted from each system and then categorized using the same framework into one of 23 categories. Overall, there was little overlap, although each reporting system identified important safety issues. Communication problems were common among patient complaints and malpractice claims; malpractice claims' leading category was clinical judgement. Walk rounds identified issues with equipment and supplies. Adverse event reporting systems highlighted identification issues, especially mislabelled specimens. The frequency of contributions of reports by provider group varied substantially by system. Physicians accounted for 50% of risk management reports, but in adverse event reporting, where nurses were the main reporters, physicians accounted for only 2.5% of reports. Complaints and malpractice claims come primarily from patients. The five reporting systems each identified different yet complementary patient safety issues. To obtain a comprehensive picture of their patient safety problems and to develop priorities for improving safety, hospitals should use a broad portfolio of approaches and then synthesize the messages from all individual approaches into a collated and cohesive whole.

  14. What Happened, and Why: Toward an Understanding of Human Error Based on Automated Analyses of Incident Reports. Volume 2

    Science.gov (United States)

    Ferryman, Thomas A.; Posse, Christian; Rosenthal, Loren J.; Srivastava, Ashok N.; Statler, Irving C.

    2006-01-01

    The objective of the Aviation System Monitoring and Modeling project of NASA's Aviation Safety and Security Program was to develop technologies to enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. Information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. In Volume I, the concept of the Scenario was introduced as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. In this Volume II, that study continues into the analyses of the free narratives to gain understanding as to why the incident occurred from the reporter s perspective. While this is just the first experiment, the results of our approach are encouraging and indicate that it will be possible to design an automated analysis process guided by the structure of the Scenario that can achieve the level of consistency and reliability of human analysis of narrative reports.

  15. The Southern Forest Futures Project: technical report

    Science.gov (United States)

    David N. Wear; John G. Greis

    2013-01-01

    Please visit the Southern Forest Futures Project website for more information.The Southern Forest Futures Project provides a science-based “futuring” analysis of the forests of the 13 States of the Southeastern United States. With findings...

  16. World Family Map Project. Prototype Report

    Science.gov (United States)

    Wilcox, W. Bradford; Lippman, Laura; Whitney, Camille

    2009-01-01

    In 2010, the "World Family Map Project" seeks to launch a research initiative that will track central indicators of family strength around the globe. The "World Family Map Project" (WFMP) would partner with Child Trends, a nonpartisan research organization in Washington, D.C., the Institute of Marriage and Family Canada, and…

  17. Final report Hanford environmental compliance project 89-D-172

    International Nuclear Information System (INIS)

    Kelly, J.R.

    1996-01-01

    The Hanford Environmental Compliance (HEC) Project is unique in that it consisted of 14 subprojects which varied in project scope and were funded from more that one program. This report describes the HEC Project from inception to completion and the scope, schedule, and cost of the individual subprojects. Also provided are the individual subproject Cost closing statements and Project completion reports accompanied by construction photographs and illustrations

  18. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.

    Science.gov (United States)

    Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

    2015-05-01

    A constructive safety culture is essential for the successful implementation of patient safety improvements. To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. © British Journal of General Practice 2015.

  19. Project Radiation protection East. Status Report, July 1997

    Energy Technology Data Exchange (ETDEWEB)

    Snihs, J.O.; Sundewall, H.; Grapengiesser, S. [STEGRA Consultants (Sweden); Bennerstedt, T. [TeknoTelje (Sweden)

    1997-12-01

    Project Radiation Protection East is a Swedish program for radiation protection work in Central and Eastern Europe. The projects are assessed, planned and performed in close cooperation with partner organizations in the East. Since 1994 radiation protection cooperation concerning the former Soviet Navy training reactors in Paldiski, Estonia, is included in the project. This report presents a summary over some 140 projects, their status, allocated funds and their distribution over countries and project areas. 12 tabs.

  20. Medication incidents related to automated dose dispensing in community pharmacies and hospitals--a reporting system study.

    Directory of Open Access Journals (Sweden)

    Ka-Chun Cheung

    Full Text Available INTRODUCTION: Automated dose dispensing (ADD is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. METHODS: The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR reporting system were selected and characterized independently by two researchers. MAIN OUTCOME MEASURES: Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. RESULTS: From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4% incidents from community pharmacies and 11,428 (75.6% incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8% were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2% were related to ADD than in hospitals (41/11,428 = 0.4%. The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. CONCLUSION: A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an

  1. Adult Perpetrator Gender Asymmetries in Child Sexual Assault Victim Selection: Results from the 2000 National Incident-Based Reporting System

    Science.gov (United States)

    McCloskey, Kathy A.; Raphael, Desreen N.

    2005-01-01

    Data from the 2000 National Incident-Based Reporting System (NIBRS) show that while males make up about nine out of every 10 adult sexual assault perpetrators, totaling about 26,878 incidents within the reporting period, females account for about one out of 10 perpetrators, totaling about 1,162 incidents. Male sexual assault perpetrators offend…

  2. Hanford Environmental Dose Reconstruction Project monthly report

    International Nuclear Information System (INIS)

    Finch, S.M.

    1990-12-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that populations could have been have received from nuclear operations at Hanford since 1944. The project is being managed and conducted by the Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (dose estimates): source terms; environmental transport; environmental monitoring data; demographics, agriculture, food habits; and environmental pathways and dose estimates. 3 figs., 3 tabs

  3. Status Report of Projects Activities at CERN

    CERN Document Server

    Missiaen, Dominique; Dobers, Tobias; Fuchs, Jean-Frederic; Gayde, Jean-Christophe; Jones, Mark; Mainaud Durand, Helene

    2014-01-01

    Besides the Long Shut-Down 1 (LS1), some projects are still progressing at CERN. Among them, it has to be mentioned LINAC4, a future essential part of the LHC injector chain, AWAKE, a project to verify the approach of using protons to drive a strong wakefield in a plasma, ELENA, a small compact ring for cooling and decelerating antiproton and HIE-Isolde, not to forget the long term studies for CLIC and FCC. This paper describes the status of these projects from the survey and alignment point of view.

  4. Hanford Environmental Dose Reconstruction Project Monthly Report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M. (comp.)

    1991-03-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that populations could have received from nuclear operations at Hanford since 1944. The project is being managed and conducted by the Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The project is divided into the technical tasks which correspond to the path radionuclides followed, from release to impact on humans (dose estimates): source terms; environmental transport; environment monitoring data; demographics, agriculture, food habits; and environmental pathways and dose estimates. 3 figs., 2 tabs.

  5. OECD-IAEA Paks Fuel Project. Final Report

    International Nuclear Information System (INIS)

    2010-05-01

    It is important for nuclear power plant designers, operators and regulators to effectively use lessons learned from events occurring at nuclear power plants since, in general, it is impossible to reproduce the event using experimental facilities. In particular, evaluation of the event using accident analysis codes is expected to contribute to improving understanding of phenomena during the events and to facilitate the validation of computer codes through simulation analyses. The information presented in this publication will be of use in future revisions of safety guides on accident analysis. During a fuel crud removal operation on the Paks-2 unit of the Paks nuclear power plant, Hungary on 10 April 2003, several fuel assemblies were severely damaged. The assemblies were being cleaned in a special tank under deep water in a service pit connected to the spent fuel storage pool. The first sign of fuel failures was the detection of some fission gases released from the cleaning tank. Later, visual inspection revealed that most of the 30 fuel assemblies suffered heavy oxidation and fragmentation. The first evaluation of the event showed that the severe fuel damage had been caused by inadequate cooling. The Paks-2 event was discussed in various committees of the OECD Nuclear Energy Agency (OECD/NEA) and of the International Atomic Energy Agency (IAEA). Recommendations were made to undertake actions to improve the understanding of the incident sequence and of the consequence this had on the fuel. It was considered that the Paks-2 event may constitute a useful case for a comparative exercise on safety codes, in particular for models devised to predict fuel damage and potential releases under abnormal cooling conditions and the analyses of the Paks-2 event may provide information which is relevant for in-reactor and spent fuel storage safety evaluations. The OECD-IAEA Paks Fuel Project was established in 2005 as a joint project between the IAEA and the OECD/NEA. The IAEA

  6. SU-F-T-223: Radiotherapy Incident Reporting and Analysis System (RIRAS):Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [National Radiation Oncology Program (10P4H), Dept. of Veterans Affairs, Richmond, VA (United States); Burkett, D; Leidholdt, E [National Health Physics Program (10P4X), Dept. of Veterans Affairs, Little Rock, AR (United States)

    2016-06-15

    Background & Purpose: RIRAS is a web-based information system deployed on the Veterans Health Administration intranet in early 2014 to collect adverse events and good catch data; analyze the causes and contributing factors; and find ways to prevent future occurrences. Material and Methods: Incident learning consists of a feedback loop which starts with reporting an event, followed by analysis of contributing factors, and culminates in the development of a patient safety work product (PSWP) to prevent recurrence. RIRAS permits both anonymous and non-anonymous reporting. Each report is analyzed by a team of medical physicists who are independent of the reporting facility. The analysts usually contact the reporting facilities for additional information. We analyzed all reports and held telephonic interviews (when necessary) with the reporters. We then generated PSWPs with corrective/preventive and learning actions. Anonymous reporting is handled in the same manner, except without the ability to further interview the reporter. Results: In a significant number of reports, the causes and recommended preventive actions were considerably altered by the independent analysis and additional information from the facility. 130 reports have been entered in RIRAS; 9 misadministrations, 83 good catches, 3 anonymous good catches, and 35 earlier reported incidents from FY2005-14. 45% of the reported incidents occurred in the treatment delivery stages, 19% in on-treatment management, and 16% in pre-treatment verification. 80% of the good catches were found in the treatment delivery workflow. Majority of these incidents were due to inconsistent patient setup instructions or documentation, nonadherence to policies and procedures, lax time-out policy, distracted RTTs, and inadequate RTT staffing. Conclusion: RIRAS has identified many areas for improvement and elevated the quality and safety of radiation treatments in the VHA. We found that the ability to learn is significantly

  7. Medicare Demonstration Projects and Evaluation Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) conducts and sponsors a number of innovative demonstration projects to test and measure the effect of potential...

  8. Hiilangaay Hydroelectric Project – Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Twitchell, Sara [HDR, Omaha, NE (United States); Stimac, Michael [HDR, Omaha, NE (United States); Lang, Lisa [Haida Corporation, Hydaburg, AK (United States); Witwer, Doreen [Haida Corporation, Hydaburg, AK (United States); Jameson, Vincent [Haida Corporation, Hydaburg, AK (United States)

    2016-06-01

    The Hiilangaay Hydroelectric Project (“Hiilangaay” or the “Project”) is a 5-megawatt hydroelectric resource currently under construction on Prince of Wales Island (POW), Alaska, approximately ten miles east of Hydaburg. The objective of the Project is to interconnect with the existing transmission grid on Prince of Wales Island, increasing the hydroelectric generation capability by 5 MW, eliminating the need for diesel generation, increasing the reliability of the electrical system, and allowing the interconnected portion of the island to have 100 percent renewable energy generation. Pre-construction activities including construction planning, permit coordination and compliance, and final design have made it possible to move forward with construction of the Hiilangaay Project. Despite repeated delays to the schedule, persistence and long-term planning will culminate in the construction of the Project, and make Prince of Wales Island independent of diesel-fueled energy

  9. The Southern Forest Futures Project: summary report

    Science.gov (United States)

    David N. Wear; John G. Greis

    2012-01-01

    The Southern Forest Futures Project provides a science-based “futuring” analysis of the forests of the 13 States of the Southeastern United States. With findings organized in a set of scenarios and using a combination of computer models and science synthesis, the authors of the Southern Forest Futures Project examine a variety of possible futures that could shape...

  10. Hanford Environmental Dose Reconstruction Project monthly report

    International Nuclear Information System (INIS)

    Finch, S.M.

    1991-10-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doeses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (dose estimates): Source terms; environmental transport; environmental monitoring data; demographics, agriculture, food habits; environmental pathways and dose estimates

  11. Hanford Environmental Dose Reconstruction Project. Monthly report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M.; McMakin, A.H. [comps.

    1992-04-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (dose estimates): Source terms, environmental transport, environmental monitoring data, demography, food consumption, and agriculture, and environmental pathways and dose estimates.

  12. Hanford Environmental Dose Reconstruction Project Monthly Report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M.; McMakin, A.H. (comps.)

    1992-03-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (dose estimates): Source Terms, Environmental Transport, Environmental Monitoring Data, Demography, Food Consumption, and Agriculture, and Environmental Pathways and Dose Estimates.

  13. Hanford Environmental Dose Reconstruction Project. Monthly report

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S.M.; McMakin, A.H. [comps.

    1992-02-01

    The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on humans (dose estimates): source terms; environmental transport; environmental monitoring data; demography, food consumption, and agriculture; environmental pathways and dose estimates.

  14. Hanford Environmental Dose Reconstruction Project. Monthly report

    Energy Technology Data Exchange (ETDEWEB)

    Cannon, S.D.; Finch, S.M. [comps.

    1992-10-01

    The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The independent Technical Steering Panel (TSP) provides technical direction. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impact on humans (dose estimates):Source Terms, Environmental Transport, Environmental Monitoring Data, Demography, Food Consumption, and Agriculture, and Environmental Pathways and Dose Estimates.

  15. The STRIPA project. Annual report 1986

    International Nuclear Information System (INIS)

    1987-08-01

    A summary of the Stripa Project phase 2 is given. The detailed informations describe crosshole techniques for the detection and characterization of fracture zones, the hydrological characterization of the Stripa site Part II, a three-dimensional migration experiment, borehole, shaft and tunnel sealing, the hydrogeochemical characterization of the Stripa groundwater and question of economy. A decision was taken in principale for an extension of the project into a third phase. (DG)

  16. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review.

    Science.gov (United States)

    Sari, Ali Baba-Akbari; Sheldon, Trevor A; Cracknell, Alison; Turnbull, Alastair

    2007-01-13

    To evaluate the performance of a routine incident reporting system in identifying patient safety incidents. Two stage retrospective review of patients' case notes and analysis of data submitted to the routine incident reporting system on the same patients. A large NHS hospital in England. 1006 hospital admissions between January and May 2004: surgery (n=311), general medicine (n=251), elderly care (n=184), orthopaedics (n=131), urology (n=61), and three other specialties (n=68). Proportion of admissions with at least one patient safety incident; proportion and type of patient safety incidents missed by routine incident reporting and case note review methods. 324 patient safety incidents were identified in 230/1006 admissions (22.9%; 95% confidence interval 20.3% to 25.5%). 270 (83%) patient safety incidents were identified by case note review only, 21 (7%) by the routine reporting system only, and 33 (10%) by both methods. 110 admissions (10.9%; 9.0% to 12.8%) had at least one patient safety incident resulting in patient harm, all of which were detected by the case note review and six (5%) by the reporting system. The routine incident reporting system may be poor at identifying patient safety incidents, particularly those resulting in harm. Structured case note review may have a useful role in surveillance of routine incident reporting and associated quality improvement programmes.

  17. Project Dribble (Salmon event). Project manager's report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1966-07-01

    The Salmon experiment detonated Oct. 22, 1964, was the first of three originally proposed underground nuclear detonations to be conducted as part of Project Dribble. The principal purpose of the Salmon experiment was to determine the seismic propagation factor out of Tatum Dome and study seismic wave propagation in the mantle of the earth from a nuclear explosion in the Southeastern United States. These measurements were then combined with a calculation of the seismic source strength from a 5-kt decoupled detonation at that site to give the amplitudes of distant seismic signals from such a decoupled detonation for comparison with detonations in other media. Other objectives of the Salmon detonation were concerned with measuring seismic waves, comparing them with signals generated from similar detonations in other media, and determining the accuracy with which the location could be determined by seismic measurements. Scientists were also interested in determining the condition of the cavity, which was created by the detonation, and assessing the feasibility of reusing the cavity for futher experiments. The administration, operational planning engineering, construction, public safety, and logistics performed by NV00 in support of the technical and scientific experiments carried out are presented. (TFD)

  18. A study of cases reported as incidents in a public hospital from 2011 to 2014.

    Science.gov (United States)

    Göttems, Leila Bernarda Donato; Santos, Maria do Livramento Gomes Dos; Carvalho, Paloma Aparecida; Amorim, Fábio Ferreira

    2016-01-01

    Analyzing incidents reported in a public hospital in the Federal District, Brasilia, according to the characteristics and outcomes involving patients. A descriptive and retrospective study of incidents reported between January 2011 and September 2014. 209 reported incidents were categorized as reportable occurrences (n = 22, 10.5%), near misses (n = 16, 7.7%); incident without injury (n = 4, 1.9%) and incident with injury (adverse events) (n = 167, 79.9%). The average age of patients was 44 years and the hospitalization time until the moment of the incident was on average 38.5 days. Nurses were the healthcare professionals who most reported the incidents (n = 55, 67%). No outcomes resulted in death. Incidents related to blood/hemoderivatives, medical devices/equipment, patient injuries and intravenous medication/fluids were the most frequent. Standardizing the reporting processes and enhancing participation by professionals in managing incidents is recommended. Analisar os incidentes notificados em um hospital público do Distrito Federal, segundo as características e os desfechos quando envolveram pacientes. Estudo descritivo e retrospectivo dos incidentes notificados entre janeiro de 2011 e setembro de 2014. Notificados 209 incidentes categorizados em ocorrência comunicável (n = 22, 10,5%), quase evento (n = 16, 7,7%), incidente sem dano (n = 4, 1,9%) e incidente com dano (eventos adversos) (n = 167, 79,9%). A idade média dos pacientes foi de 44 anos e o tempo da internação até o momento do incidente teve média de 38,5 dias. Os enfermeiros foram os que mais notificaram (n = 55, 67%). Nenhum desfecho resultou em morte. Os incidentes relacionados a sangue/hemoderivados, dispositivos/equipamento médico, acidentes do doente e medicação/fluidos endovenosos foram os mais frequentes. Recomenda-se padronizar os processos de notificação e potencializar a participação dos profissionais no manejo dos incidentes.

  19. Canadian Fusion Fuels Technology Project activities report

    International Nuclear Information System (INIS)

    1985-01-01

    The Canadian Fusion Fuels Technology Project was formally established in 1982. The project is directed toward the further development of Canadian capabilities in five major areas: tritium technology, breeder technology, materials technology, equipment development and safety and the environment. The project is funded by three partners - Government of Canada (50%), Ontario Provincial Government (25%) and Ontario Hydro (25%). The fiscal year 1984/85 represents the third year of operation of the project. In 1984/85, 108 contracts were awarded totalling $4 million. Supplementary funding by subcontractors added approximately $1.9 million to the total project value. More than 200 people participated in the technical work involved in the project. Sixteen people were on attachment to foreign facilities for terms ranging from 1 month to 2.5 years. Five patents were applied for including a tritium discrimination monitor, a new radio-chemical tritium separation method, a new variation of fuel cleanup by gas chromatography, a passive tritium permeation system using bimetallic membranes, and a new breeder process using lithium salts dissolved in heavy water

  20. Survey to identify depth of penetration of critical incident reporting systems in Austrian healthcare facilities.

    Science.gov (United States)

    Sendlhofer, Gerald; Eder, Harald; Leitgeb, Karina; Gorges, Roland; Jakse, Heidelinde; Raiger, Marianne; Türk, Silvia; Petschnig, Walter; Pregartner, Gudrun; Kamolz, Lars-Peter; Brunner, Gernot

    2018-01-01

    Incident reporting systems or so-called critical incident reporting systems (CIRS) were first recommended for use in health care more than 15 years ago. The uses of these CIRS are highly variable among countries, ranging from being used to report critical incidents, falls, or sentinel events resulting in death. In Austria, CIRS have only been introduced to the health care sector relatively recently. The goal of this work, therefore, was to determine whether and specifically how CIRS are used in Austria. A working group from the Austrian Society for Quality and Safety in Healthcare (ASQS) developed a survey on the topic of CIRS to collect information on penetration of CIRS in general and on how CIRS reports are used to increase patient safety. Three hundred seventy-one health care professionals from 274 health care facilities were contacted via e-mail. Seventy-eight respondents (21.0%) completed the online survey, thereof 66 from hospitals and 12 from other facilities (outpatient clinics, nursing homes). In all, 64.1% of the respondents indicated that CIRS were used in the entire health care facility; 20.6% had not yet introduced CIRS and 15.4% used CIRS only in particular areas. Most often, critical incidents without any harm to patients were reported (76.9%); however, some health care facilities also use their CIRS to report patient falls (16.7%), needle stick injuries (17.9%), technical problems (51.3%), or critical incidents involving health care professionals. CIRS are not yet extensively or homogeneously used in Austria. Inconsistencies exist with respect to which events are reported as well as how they are followed up and reported to health care professionals. Further recommendations for general use are needed to support the dissemination in Austrian health care environments.

  1. The non-technical skills used by anaesthetic technicians in critical incidents reported to the Australian Incident Monitoring System between 2002 and 2008.

    Science.gov (United States)

    Rutherford, J S; Flin, R; Irwin, A

    2015-07-01

    The outcome of critical incidents in the operating theatre has been shown to be influenced by the behaviour of anaesthetic technicians (ATs) assisting anaesthetists, but the specific non-technical skills involved have not been described. We performed a review of critical incidents (n=1433) reported to the Australian Incident Monitoring System between 2002 and 2008 to identify which non-technical skills were used by ATs. The reports were assessed if they mentioned anaesthetic assistance or had the boxes ticked to identify "inadequate assistance" or "absent supervision or assistance". A total of 90 critical incidents involving ATs were retrieved, 69 of which described their use of non-technical skills. In 20 reports, the ATs ameliorated the critical incident, whilst in 46 they exacerbated the critical incident, and three cases had both positive and negative non-technical skills described. Situation awareness was identified in 39 reports, task management in 23, teamwork in 21 and decision-making in two, but there were no descriptions of issues related to leadership, stress or fatigue management. Situation awareness, task management and teamwork appear to be important non-technical skills for ATs in the development or management of critical incidents in the operating theatre. This analysis has been used to support the development of a non-technical skills taxonomy for anaesthetic assistants.

  2. Properties of incident reporting systems in relation to statistical trend and pattern analysis

    International Nuclear Information System (INIS)

    Kalfsbeek, H.W.; Arsenis, S.P.

    1990-01-01

    This paper describes the properties deemed desirable for an incident reporting system in order to render it useful for extracting valid statistical trend and pattern information. The perspective under which a data collection system is seen in this paper is the following: data are essentially gathered on a set of variables describing an event or incident (the items featuring on a reporting format) in order to learn about (multiple) dependencies (called interactions) between these variables. Hence, the necessary features of the data source are highlighted and potential problem sources limiting the validity of the results to be obtained are identified. In this frame, important issues are the reporting completeness, related to the reporting criteria and reporting frequency, and of course the reporting contents and quality. The choice of the report items (the variables) and their categorization (code dictionary) may influence (bias) the insights gained from trend and pattern analyses, as may the presence or absence of a structure for correlating the reported issues within an incident. The issues addressed in this paper are brought in relation to some real world reporting systems on safety related events in Nuclear Power Plants, so that their possibilities and limitations with regard to statistical trend and pattern analysis become manifest

  3. Analysis of Incident and Accident Reports and Risk Management in Spine Surgery.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Morozumi, Masayoshi; Nishida, Yoshihiro; Nagao, Yoshimasa; Ishiguro, Naoki

    2017-08-01

    A review of accident and incident reports. To analyze prevalence, characteristics, and details of perioperative incidents and accidents in patients receiving spine surgery. In our institution, a clinical error that potentially results in an adverse event is usually submitted as an incident or accident report through a web database, to ensure anonymous and blame-free reporting. All reports are analyzed by a medical safety management group. These reports contain valuable data for management of medical safety, but there have been no studies evaluating such data for spine surgery. A total of 320 incidents and accidents that occurred perioperatively in 172 of 415 spine surgeries were included in the study. Incidents were defined as events that were "problematic, but with no damage to the patient," and accidents as events "with damage to the patient." The details of these events were analyzed. There were 278 incidents in 137 surgeries and 42 accidents in 35 surgeries, giving prevalence of 33% (137/415) and 8% (35/415), respectively. The proportion of accidents among all events was significantly higher for doctors than non-doctors [68.0% (17/25) vs. 8.5% (25/295), P < 0.01] and in the operating room compared with outside the operating room [40.5% (15/37) vs. 9.5% (27/283), P < 0.01]. There was no significant difference in years of experience among personnel involved in all events. The major types of events were medication-related, line and tube problems, and falls and slips. Accidents also occurred because of a long-term prone position, with complications such as laryngeal edema, ulnar nerve palsy, and tooth damage. Surgery and procedures in the operating room always have a risk of complications. Therefore, a particular effort is needed to establish safe management of this environment and to provide advice on risk to the doctor and medical care team. 4.

  4. SU-E-T-524: Web-Based Radiation Oncology Incident Reporting and Learning System (ROIRLS)

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, R; Palta, J; Hagan, M [Virginia Commonwealth University, Richmond, VA (United States); National Radiation Oncology Program (10P4H), Richmond, VA (United States); Grover, S; Malik, G [TSG Innovations Inc., Richmond, VA (United States)

    2014-06-01

    Purpose: Describe a Web-based Radiation Oncology Incident Reporting and Learning system that has the potential to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: The VA National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and near miss data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. Software used for this program is deployed on the VAs intranet as a Website. All data entry forms (adverse event or near miss reports, work product reports) utilize standard causal, RT process step taxonomies and data dictionaries defined in AAPM and ASTRO reports on error reporting (AAPM Work Group Report on Prevention of Errors and ASTROs safety is no accident report). All reported incidents are investigated by the radiation oncology domain experts. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The operational workflow is similar to that of the Aviation Safety Reporting System. This system is also synergistic with ROSIS and SAFRON. Results: The ROIRLS facilitates the collection of data that help in tracking adverse events and near misses and develop new interventions to prevent such incidents. The ROIRLS electronic infrastructure is fully integrated with each registered facility profile data thus minimizing key strokes and multiple entries by the event reporters. Conclusions: OIRLS is expected to improve the quality and safety of a broad spectrum of radiation therapy patients treated in the VA and fulfills our goal of Effecting Quality While Treating Safely The Radiation Oncology Incident Reporting and Learning System software used for this program has been developed, conceptualized and maintained by TSG Innovations

  5. SU-E-T-524: Web-Based Radiation Oncology Incident Reporting and Learning System (ROIRLS)

    International Nuclear Information System (INIS)

    Kapoor, R; Palta, J; Hagan, M; Grover, S; Malik, G

    2014-01-01

    Purpose: Describe a Web-based Radiation Oncology Incident Reporting and Learning system that has the potential to improve quality of care for radiation therapy patients. This system is an important facet of continuing effort by our community to maintain and improve safety of radiotherapy.Material and Methods: The VA National Radiation Oncology Program office has embarked on a program to electronically collect adverse events and near miss data of radiation treatment of over 25,000 veterans treated with radiotherapy annually. Software used for this program is deployed on the VAs intranet as a Website. All data entry forms (adverse event or near miss reports, work product reports) utilize standard causal, RT process step taxonomies and data dictionaries defined in AAPM and ASTRO reports on error reporting (AAPM Work Group Report on Prevention of Errors and ASTROs safety is no accident report). All reported incidents are investigated by the radiation oncology domain experts. This system encompasses the entire feedback loop of reporting an incident, analyzing it for salient details, and developing interventions to prevent it from happening again. The operational workflow is similar to that of the Aviation Safety Reporting System. This system is also synergistic with ROSIS and SAFRON. Results: The ROIRLS facilitates the collection of data that help in tracking adverse events and near misses and develop new interventions to prevent such incidents. The ROIRLS electronic infrastructure is fully integrated with each registered facility profile data thus minimizing key strokes and multiple entries by the event reporters. Conclusions: OIRLS is expected to improve the quality and safety of a broad spectrum of radiation therapy patients treated in the VA and fulfills our goal of Effecting Quality While Treating Safely The Radiation Oncology Incident Reporting and Learning System software used for this program has been developed, conceptualized and maintained by TSG Innovations

  6. Differences in reported sepsis incidence according to study design: a literature review

    Directory of Open Access Journals (Sweden)

    Saga Elise Mariansdatter

    2016-10-01

    Full Text Available Abstract Background Sepsis and severe sepsis are common conditions in hospital settings, and are associated with high rates of morbidity and mortality, but reported incidences vary considerably. In this literature review, we describe the variation in reported population-based incidences of sepsis and severe sepsis. We also examine methodological and demographic differences between studies that may explain this variation. Methods We carried out a literature review searching three major databases and reference lists of relevant articles, to identify all original studies reporting the incidence of sepsis or severe sepsis in the general population. Two authors independently assessed all articles, and the final decision to exclude an article was reached by consensus. We extracted data according to predetermined variables, including study country, sepsis definition, and data source. We then calculated descriptive statistics for the reported incidences of sepsis and severe sepsis. The studies were classified according to the method used to identify cases of sepsis or severe sepsis: chart-based (i.e. review of patient charts or code-based (i.e. predetermined International Classification of Diseases [ICD] codes. Results Among 482 articles initially screened, we identified 23 primary publications reporting incidence of sepsis and/or severe sepsis in the general population. The reported incidences ranged from 74 to 1180 per 100,000 person-years and 3 to 1074 per 100,000 person-years for sepsis and severe sepsis, respectively. Most chart-based studies used the Bone criteria (or a modification hereof and Protein C Worldwide Evaluation in Severe Sepsis (PROWESS study criteria to identify cases of sepsis and severe sepsis. Most code-based studies used ICD-9 codes, but the number of codes used ranged from 1 to more than 1200. We found that the incidence varied according to how sepsis was identified (chart-based vs. code-based, calendar year, data source, and

  7. Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency.

    Science.gov (United States)

    Wheway, Jayne; Agbabiaka, Taofikat B; Ernst, Edzard

    2012-01-01

    Acupuncture is frequently employed to treat chronic pain syndromes or other chronic conditions. Nevertheless, there is a growing literature on adverse events (AEs) from treatments including pneumothorax, cardiac tamponade and spinal cord injury. Acupuncture is provided in almost all NHS pain clinics and by an increasing number of GP's and physiotherapists. Considering acupuncture's popularity, its safety has become an important public health issue. To evaluate the harm caused to patients through acupuncture treatments within NHS organisations. The National Reporting and Learning System (NRLS) database was searched for incidents reported from 1st January 2009 to 31st December 2011. The free text fields of all reports received from all healthcare settings and specialties were searched for the keyword 'acupuncture'. All relevant incidents were reviewed to provide a qualitative theme of the harm to patients. 468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm. A number of AEs are recorded after acupuncture treatments in the NHS but the majority is not severe. However, miscategorisation and under-reporting may distort the overall picture. Acupuncture practitioners should be aware of, and be prepared to manage, any significant harm from treatments.

  8. Bartlesville Project Office FY 1990 Annual report

    Energy Technology Data Exchange (ETDEWEB)

    1991-04-01

    The Bartlesville Project Office (BPO) was established in 1983 to succeed the Bartlesville Energy Technology Center (BETC). Its lead mission from the Office of Fossil Energy (FE) of the US Department of energy is to plan and implement research in the Enhanced Oil Recovery (EOR) and Advanced Extraction and Process Technology (AEPT) subprograms of the Petroleum Program. As such, BPO oversees some 160 research projects falling within these two broad subprograms and support activities. These projects, form the major portion of DOE's National Petroleum Research Program. The EOR subprogram consists of two research categories: Light Oil and Heavy Oil. These two categories include research activities in: (1) geoscience and reservoir characterization, (2) chemical flooding (3) gas flooding, (4) thermal recovery, (5) novel technology, and (6) microbial EOR. The AEPT subprogram includes research activities in (1) fundamental geoscience and extraction research, (2) supporting technology and environmental research, and (3) university geoscience research. 8 figs., 5 tabs.

  9. DTU contribution to Final Report for EASYTRACK project

    DEFF Research Database (Denmark)

    Savio, Enrico; Carmignato, Simone; De Chiffre, Leonardo

    This report was made as a part of the project EASYTRAC, an EU project under the programme Competitive and Sustainable Growth: Contract No. G6RD-CT-2000-00188, coordinated by UNIMETRIK S.A. (Spain). The project is concerned with low uncertainty calibrations on coordinate measuring machines (CMMs...

  10. Collinsville solar thermal project: Yield forecasting - Draft report

    OpenAIRE

    William Paul Bell; Phil Wild; John Foster

    2014-01-01

    This report’s primary aim is to provide yield projections for the proposed Linear Fresnel Reflector (LFR) technology plant at Collinsville, Queensland, Australia. However, the techniques developed in this report to overcome inadequate datasets at Collinsville to produce the yield projections are of interest to a wider audience because inadequate datasets for renewable energy projects are commonplace.

  11. Kalispel Resident Fish Project : Annual Report, 2008.

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Todd [Kalispel Natural Resource Department

    2009-07-08

    In 2008, the Kalispel Natural Resource Department (KNRD) continued to implement its habitat enhancement projects for bull trout (Salvelinus confluentus) and westslope cutthroat trout (Oncorhynchus clarki lewisi). Baseline fish population and habitat assessments were conducted in Upper West Branch Priest River. Additional fish and habitat data were collected for the Granite Creek Watershed Assessment, a cooperative project between KNRD and the U.S. Forest Service Panhandle National Forest (FS) . The watershed assessment, funded primarily by the Salmon Recovery Funding Board of the State of Washington, will be completed in 2009.

  12. Nuclear data project evaluation activity report. October 1998 - October 2000

    International Nuclear Information System (INIS)

    Akovali, Y.; Blackmon, J.; Radford, D.; Smith, M.

    2001-01-01

    This report summarizes the activities of the ORNL Nuclear Data Project since the IAEA Advisory Group meeting in December 1998. The group's future plans are also included. The ORNL Nuclear Data Project's responsibility includes the compilation/evaluation of astrophysics data, as well as the evaluation and compilation of nuclear structure data. The Nuclear Data Project, therefore, is composed of two groups. The Nuclear Data Project staff through September 2000 is listed below. Accomplishments for the period of October 1998 through September 2000 of the nuclear structure data group and the nuclear astrophysics group are submitted in this Nuclear Data Project report

  13. Cumulative incidence of postoperative severe pain at Hospital Universitario San Jose, Popayan. Preliminar report

    Directory of Open Access Journals (Sweden)

    Ingrid Muñoz

    2013-12-01

    Full Text Available Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU at Hospital Universitario San José of Popayán (HUSJ in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10 were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients. Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients and 1.9% 60 minutes 95%CI [0-4.5] (3 patients. 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

  14. MORE: Management of Requirements in NPP Modernisation Projects, final report

    International Nuclear Information System (INIS)

    Fredriksen, R.; Katta, V.; Raspotnig, C.; Valkonen, J.

    2008-09-01

    This report documents the work and related activities of the MORE (Management of Requirements in NPP Modernisation Projects) (NKS-R project number NKS-R-2005-47) project. This report also provides a summary of the project activities and deliverables, and discusses possible application areas. The project has aimed at the industrial utilisation of the results from the TACO: (Traceability and Communication of Requirements in Digital I and C Systems Development) (NKS-R project number NKS-R-2002-16, completed June, 2005) project, and practical application of improved approaches and methods for requirements engineering and change management. Finally, the report provides a brief description of the extended industrial network and disseminations of the results in Nordic and NKS related events such as seminars and workshops. (au)

  15. MORE: Management of Requirements in NPP Modernisation Projects, final report

    Energy Technology Data Exchange (ETDEWEB)

    Fredriksen, R.; Katta, V.; Raspotnig, C. (Inst. for energiteknikk (IFE) (Norway)); Valkonen, J. (Technical Research Centre of Finland (VTT) (Finland))

    2008-09-15

    This report documents the work and related activities of the MORE (Management of Requirements in NPP Modernisation Projects) (NKS-R project number NKS-R-2005-47) project. This report also provides a summary of the project activities and deliverables, and discusses possible application areas. The project has aimed at the industrial utilisation of the results from the TACO: (Traceability and Communication of Requirements in Digital I and C Systems Development) (NKS-R project number NKS-R-2002-16, completed June, 2005) project, and practical application of improved approaches and methods for requirements engineering and change management. Finally, the report provides a brief description of the extended industrial network and disseminations of the results in Nordic and NKS related events such as seminars and workshops. (author)

  16. Incident and Trafficking Database: New Systems for Reporting and Accessing State Information

    International Nuclear Information System (INIS)

    Dimitrovski, D.; Kittley, S.

    2015-01-01

    The IAEA's Incident and Trafficking Database (ITDB) is the Agency's authoritative source for information on incidents in which nuclear and other radioactive material is out of national regulatory control. It was established in 1995 and, as of June 2014, 126 States participate in the ITDB programme. Currently, the database contains over 2500 confirmed incidents, out of which 21% involve nuclear material, 62% radioactive source and 17% radioactively contaminated material. In recent years, the system for States to report incidents to the ITDB has been evolving — moving from fax-based to secure email and most recently to secure on-line reporting. A Beta version of the on-line system was rolled out this June, offering a simple, yet secure, communication channel for member states to provide information. In addition the system serves as a central hub for information related to official communication of the IAEA with Member States so some communication that is traditionally shared by e-mail does not get lost when ITDB counterparts change. In addition the new reporting system incorporates optional features that allow multiple Member State users to collaboratively contribute toward an INF. States are also being given secure on-line access to a streamlined version of the ITDB. This improves States' capabilities to retrieve and analyze information for their own purposes. In addition, on-line access to ITDB statistical information on incidents is available to States through an ITDB Dashboard. The dashboard contains aggregate information on number and types of incidents, material involved, as well some other statistics related to the ITDB that is typically provided in the ITDB Quarterly reports. (author)

  17. Canton hydroelectric project: feasibility study. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1979-06-01

    The Canton Hydroelectric Project study was undertaken to determine the feasibility of redeveloping hydroelectric power generation facilities at the Upper and Lower Dams on the Farmington River at Collinsville, CT. The integrity of the existing dams and power plants was investigated and found to be generally adequate. The intake channels, powerhouses and tailraces will require refurbishing but no major repairs. The Lower Dam will require some repair to correct surface deterioration conditions. New flashboard installations are contemplated for both the dams. Energy production operational studies were performed on 25 generating unit alternatives for the two sites. Detailed cost estimates were prepared for seven Upper and five Lower site alternatives, and a detailed economic analysis of ten project alternatives was performed. The economic analysis included 3 power marketing options and the future escalation of the value of energy. The conclusions of this study were: the project is economically feasible on a 40-y life cycle basis; short-term financing, bond payment adjustments, or other special financial arrangements will be needed to provide for the negative cash flow during the early years of operation; and the Town of Canton should further pursue the power marketing and financing aspects of the project. (LCL)

  18. The Continuity Project, Fall 1997 Report.

    Science.gov (United States)

    Wasilko, Peter J.

    The Continuity Project is a research, development, and technology transfer initiative aimed at creating a "Library of the Future" by combining features of an online public access catalog (OPAC) and a campus wide information system (CWIS) with advanced facilities drawn from such areas as artificial intelligence (AI), knowledge…

  19. Ecological Compliance Assessment Project: 1994 Summary report

    International Nuclear Information System (INIS)

    Brandt, C.A.

    1994-11-01

    The Ecological Compliance Assessment Project (ECAP) began full operation on March 1, 1994. The project is designed around a baseline environmental data concept that includes intensive biological field surveys of key areas of the Hanford Site where the majority of Site activities occur. These surveys are conducted at biologically appropriate times of year to ensure that the data gathered are current and accurate. The data are entered into the ECAP database, which serves as a reference for the evaluation of review requests coming in to the project. This methodology provided the basis for over 90 percent of the review requests received. Field surveys conducted under ECAP are performed to document occurrence information for species of concern and to obtain habitat descriptions. There are over 200 species of concern on the Hanford Site, including plants, birds, mammals, reptiles, amphibians, fish, and invertebrates. In addition, Washington State has designated mature sagebrush-steppe habitat as a Priority Habitat meriting special protective measures. Of the projects reviewed, 17 resulted or will result in impacts to species or habitats of concern on the Hanford Site. The greatest impact has been on big sagebrush habitat. Most of the impact has been or will be within the 600 Area of the Site

  20. College Cost Containment Project. Final Report.

    Science.gov (United States)

    Lemke, Darrell

    In response to serious concerns about the dramatic increases in college and university costs, the Department of Education solicited proposals in May 1987 for innovative projects to explore means of cost reduction or containment which promise significant cost savings, whether accrued in the short- or long-term. The solicitation for cost containment…

  1. Project SEED. What Works Clearinghouse Intervention Report

    Science.gov (United States)

    What Works Clearinghouse, 2012

    2012-01-01

    "Project SEED" is a supplemental mathematics program for low-achieving students in grades 3 through 8 and is intended to prepare students to be successful in high school and college math. Based on the Socratic method, instruction is delivered through a series of questions to the class. In addition to individual responses, the instructor…

  2. Self-Correcting HVAC Controls Project Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, Nicholas; Brambley, Michael R.; Katipamula, Srinivas; Cho, Heejin; Goddard, James K.; Dinh, Liem H.

    2010-01-04

    This document represents the final project report for the Self-Correcting Heating, Ventilating and Air-Conditioning (HVAC) Controls Project jointly funded by Bonneville Power Administration (BPA) and the U.S. Department of Energy (DOE) Building Technologies Program (BTP). The project, initiated in October 2008, focused on exploratory initial development of self-correcting controls for selected HVAC components in air handlers. This report, along with the companion report documenting the algorithms developed, Self-Correcting HVAC Controls: Algorithms for Sensors and Dampers in Air-Handling Units (Fernandez et al. 2009), document the work performed and results of this project.

  3. Photovoltaic Programme Edition 2007. Summary Report, Project List, Annual Project Reports 2006 (Abstracts)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    This 2007 edition summary report for the Swiss Federal Office of Energy (SFOE), reports on the work done within the framework of the Swiss Photovoltaics Program in 2006. The document contains 46 abstracts on work done in the photovoltaics area. The subjects reported on in the thin-film photovoltaics sector include advanced processing and characterisation of thin film silicon solar cells, high-rate deposition of micro-crystalline silicon, a new large-area VHF reactor for high-rate deposition of micro-crystalline silicon, the stability of zinc oxide in encapsulated thin film silicon solar cells, spectral photocurrent measurement, roll-to-roll technology for the production of thin film silicon modules, advanced thin film technologies, ultra thin silicon wafer cutting, bifacial thin industrial multi-crystalline silicon solar cells, flexible CIGS solar cells and mini-modules, large-area CIS-based thin-film solar modules and advanced thin-film technologies. In the area of dye-sensitised modules, the following projects are reported on: Dye-sensitised nano-crystalline solar cells, voltage enhancement of dye solar cells and molecular orientation as well as low band-gap and new hybrid device concepts for the improvement of flexible organic solar cells. Other projects reported on include a new PV wave making more efficient use of the solar spectrum, photovoltaic textiles, organic photovoltaic devices, photo-electrochemical and photovoltaic conversion and storage of solar energy, PV modules with antireflex glass, improved integration of PV into existing buildings, the seventh program at the LEEE-TISO, the 'PV enlargement' and 'Performance' programs, efficiency and annual electricity production of PV modules, photovoltaics system technology 2005-2006, an update on photovoltaics in view of the 'ecoinvent' v.2.0 tool and environmental information services for solar energy industries. The contributions to four Swiss IEA PVPS tasks and the Swiss

  4. Automating the Identification of Patient Safety Incident Reports Using Multi-Label Classification.

    Science.gov (United States)

    Wang, Ying; Coiera, Enrico; Runciman, William; Magrabi, Farah

    2017-01-01

    Automated identification provides an efficient way to categorize patient safety incidents. Previous studies have focused on identifying single incident types relating to a specific patient safety problem, e.g., clinical handover. In reality, there are multiple types of incidents reflecting the breadth of patient safety problems and a single report may describe multiple problems, i.e., it can be assigned multiple type labels. This study evaluated the abilty of multi-label classification methods to identify multiple incident types in single reports. Three multi-label methods were evaluated: binary relevance, classifier chains and ensemble of classifier chains. We found that an ensemble of classifier chains was the most effective method using binary Support Vector Machines with radial basis function kernel and bag-of-words feature extraction, performing equally well on balanced and stratified datasets, (F-score: 73.7% vs. 74.7%). Classifiers were able to identify six common incident types: falls, medications, pressure injury, aggression, documentation problems and others.

  5. Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments.

    Science.gov (United States)

    Crock, Carmel; Hansen, Kim; Fogg, Toby; Cahill, Angela; Deakin, Anita; Runciman, William B

    2018-02-01

    To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing. In all, 51 problems were identified among the 36 incidents related to airway and/or breathing. Fourteen involved clinical decision-making, 11 equipment, nine communication, seven intubation, five surgical access and five pneumothorax. Eight incidents involved children and there were nine deaths within hours or days. Recommendations for improving preparedness of ED staff and facilities have been made for each of the problem areas identified with respect to clinical practice, equipment, communication and clinical process. Analysis of incidents from the Australasian Emergency Medicine Events Register allows clusters of like-events to be identified and characterised, providing the possibility of getting a better idea of how problems present and progress, with some information about contributing factors, characteristics and context. This will pave the way for earlier and better detection of life-threatening problems and the development and reinforcement of preventive and corrective strategies. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

    NARCIS (Netherlands)

    Verbakel, N.J.; Langelaan, M.; Verheij, T.J.M.; Wagner, C.; Zwart, D.L.M.

    2015-01-01

    Background: A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim: To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting: A three-arm cluster randomised trial

  7. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.

    NARCIS (Netherlands)

    Verbakel, N.J.; Langelaan, M.; Verheij, T.J.M.; Wagner, C.; Zwart, D.L.M.

    2015-01-01

    Background A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting A three-arm cluster randomised trial was

  8. Effects on incident reporting after educating residents in patient safety: a controlled trial.

    NARCIS (Netherlands)

    Jansma, J.D.; Wagner, C.; Kate, R.W. ten; Bijnen, A.B.

    2011-01-01

    Background: Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of

  9. 76 FR 34812 - Proposed Information Collection (Report of Medical, Legal, and Other Expenses Incident to...

    Science.gov (United States)

    2011-06-14

    ... report compensation awarded by another entity or government agency for personal injury or death. Such... injury or death, or incident to the collection or recovery of the compensation may be deducted from the..., Program Analyst, Enterprise Records Service. BILLING CODE 8320-01-P ...

  10. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics

    NARCIS (Netherlands)

    Maarsingh, Otto R.; Dros, Jacquelien; Schellevis, François G.; van Weert, Henk C.; Bindels, Patrick J.; Horst, Henriette E. van der

    2010-01-01

    Although dizziness in elderly patients is very common in family practice, most prevalence studies on dizziness are community-based and include a study population that is not representative of family practice. The aim of this study was to investigate the prevalence and incidence of dizziness reported

  11. Parasitic fibroid: case report and novel approach in reducing incidence of future cases

    OpenAIRE

    Sukainah S.; Nasir TK; Zulkifli K.; Roziana R.

    2016-01-01

    We report a case of parasitic fibroid which developed less than 1 year following laparoscopic myomectomy using power morcellation. Following this case, a novel approach in reducing the incidence of future parasitic fibroid is described. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000): 2836-2839

  12. Effects on incident reporting after educating residents in patient safety: a controlled study

    NARCIS (Netherlands)

    Jansma, J.D.; Wagner, C.; ten Kate, R.W.; Bijnen, A.B.

    2011-01-01

    Background: Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of

  13. Samplings performed after the incident which occurred on the Penly (76) nuclear site. Analysis report

    International Nuclear Information System (INIS)

    Bernollin, A.; Josset, M.

    2012-01-01

    This report presents and comments measurements performed on different spots around the Penly nuclear site after an incident occurred there. Measurements have been performed on grass. Several artificial and natural radio-elements have been searched. It appeared that no artificial radionuclide was present in the samples

  14. 75 FR 51953 - Notification and Reporting of Aircraft Accidents or Incidents and Overdue Aircraft, and...

    Science.gov (United States)

    2010-08-24

    ... definition of ``unmanned aircraft accident'' and requiring that operators notify the NTSB of accidents... cases, to complete NTSB Form 6120.1, ``Pilot/Operator Accident/ Incident Report,'' as described in 49... that a similar maximum weight for unmanned aircraft is logical, captures those aircraft that pose a...

  15. A report on mutual projects related to breast cancer nursing between Israel and China

    Directory of Open Access Journals (Sweden)

    Ilana Kadmon

    2015-01-01

    Full Text Available Breast cancer is a major concern in women′s health in the western world, and is now receiving more and more attention also in the East. In China, for example, where the incidence of breast cancer was very low, there has been a rapid increase of the disease since the last few years. This report describes how a collaborative nursing project between the Hadassah Medical Organization and the Tianjin Cancer Institute and Hospital was initiated, planned and implemented.

  16. Project Familia. Final Evaluation Report, 1992-93. OREA Report.

    Science.gov (United States)

    Clarke, Candice

    Project Familia was an Elementary and Secondary Education Act Title VII funded project that, in the year covered by this evaluation, served 41 special education students of limited English proficiency (LEP) from 5 schools, with the participation of 54 parents and 33 siblings. Participating students received English language enrichment and…

  17. Project Aprendizaje, 1988-89. Evaluation Section Report. OREA Report.

    Science.gov (United States)

    Berney, Tomi D.; Velasquez, Clara

    In it's first year, Project Aprendizaje served 250 students from the Dominican Republic and Puerto Rico at Seward Park High School in Manhattan (New York). Project objectives were to improve participants' language skills in Spanish and English, help participants successfully complete content area courses needed for graduation, and provide career…

  18. Canadian Fusion Fuels Technology Project annual report 93/94

    International Nuclear Information System (INIS)

    1994-01-01

    The Canadian Fusion Fuels Technology Project exists to develop fusion technologies and apply them worldwide in today's advanced fusion projects and to apply these technologies in fusion and tritium research facilities. CFFTP concentrates on developing capability in fusion fuel cycle systems, in tritium handling technologies and in remote handling. This is an annual report for CFFTP and as such also includes a financial report

  19. Systems analysis of voluntary reported anaesthetic safety incidents occurring in a university teaching hospital.

    Science.gov (United States)

    McMillan, Matthew W; Lehnus, Kristina S

    2018-01-01

    To identify factors contributing to the development of anaesthetic safety incidents. Prospective, descriptive, voluntary reporting audit of safety incidents with subsequent systems analysis. All animals anaesthetized in a multispecies veterinary teaching hospital from November 2014 to October 2016. Peri-anaesthetic incidents that risked or caused unnecessary harm to an animal were reported by anaesthetists alongside animal morbidity and mortality data. A modified systems analysis framework was used to identify contributing factors from the following categories: Animal and Owner, Task and Technology, Individual, Team, Work Environmental, and Organizational and Management. The outcome was graded using a simple descriptive scale. Data were analysed using Pearson's Chi-Square test for association and univariable and multivariable logistic regression analysis. Totally, 3379 anaesthetics were performed during the audit period. Of these, 174 incident reports were analysed, 163 of which impacted safe veterinary care and 26 incidents were considered to have had major or catastrophic outcomes. Incident outcome was believed to have been limited by anaesthetist intervention in 104 (63.8%) cases. Various factors were identified as: Individual in 123 (70.7%), Team in 108 (62.1%), Organizational and Management in 94 (54.0%), Task and Technology in 80 (46.0%), Work Environmental in 53 (30.5%) and Animal and Owner in 36 (20.7%) incidents. Individual factors were rarely seen in isolation. Significant associations were identified between Experience and Supervision, X 2 (1, n=174)=54177, p=0.001, Failure to follow a standard operating procedure and Task Management, X 2 (2, n=174)=11318, p=0.001, and Staffing and Poor Scheduling, X 2 (1, n=174)=36742, p=0.001. Animal Condition [odds ratio (OR)=16210, 95% confidence interval (CI)=5573-47147)] and anaesthetist Decision Making (OR=3437, 95% CI=1184-9974) were risk factors for catastrophic and major outcomes. Individual factors contribute

  20. Final performance report for Project JEM

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, M.J.; Jenkins, S.

    1997-12-31

    Project JEM (Jarvis Enhancement of Males) is a pre-college program directed toward stimulating disadvantaged, talented African American males in grades four, five, and six to attend college and major in mathematics, science, computer science, or related technical areas needed by the US Department of Energy. Twenty young African American male students were recruited from Gladewater Independent School District (ISD), Longview ISD, Hawkins ISD, Tyler ISD, Winona ISD and big Sandy ISD. Students enrolled in the program range from ages 10 to 13 and are in grades four, five and six. Student participants in the 1997 Project JEM Program attended Saturday Academy sessions and a four week intensive, summer residential program. The information here provides a synopsis of the activities which were conducted through each program component.

  1. EuCARD final project report

    CERN Document Server

    Koutchouk, J P

    2014-01-01

    After four years of activity, EuCARD has most of its objectives fulfilled, with some new objectives added and a few others on excellent tracks while requiring additional time. The management has been active in reinforcing the collaborative links between partners and projects, contributing to the preparation of FP7-EuCARD2, initiating FP7-HiLumi-LHC Design Study, to favour sustained collaborations beyond EuCARD. An out-of-contract network has been successfully launched on laser plasma acceleration, to combine forces between accelerator, laser and plasma communities. Communication and dissemination activities have led to two highlights: Accelerating News, an accelerator R&D newsletter initiated by EuCARD and now common to all FP7 accelerator projects (over 1000 subscribers) and a series of monographs on accelerator sciences that is progressively finding its public. The scientific networks have more than fulfilled their initial objectives: roadmaps are defined for neutrino facilities, submitted to the Europe...

  2. Alaska Wood Biomass Energy Project Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Jonathan Bolling

    2009-03-02

    The purpose of the Craig Wood Fired Boiler Project is to use waste wood from local sawmilling operations to provide heat to local public buildings, in an effort to reduce the cost of operating those buildings, and put to productive use a byproduct from the wood milling process that otherwise presents an expense to local mills. The scope of the project included the acquisition of a wood boiler and the delivery systems to feed wood fuel to it, the construction of a building to house the boiler and delivery systems, and connection of the boiler facility to three buildings that will benefit from heat generated by the boiler: the Craig Aquatic Center, the Craig Elementary School, and the Craig Middle School buildings.

  3. PROJECT INTERIM ACTIVITY REPORT FOR SEMESTER 4

    CERN Document Server

    Koutchouk, J P

    2011-01-01

    The EuCARD project gathers 37 European partners engaged in state-of the-art technologies to upgrade major research accelerators. The main components and objectives of the project are: • Networks, focused on communication and dissemination, neutrino physics facilities, performance of hadron colliders and accelerators, and RF technologies, resulting in 40 leading laboratories worldwide being associated with EuCARD. • Transnational access facilities, offering precision beams and muon cooling setup, and pulsed irradiation for material testing. • Joint research: 21 R&D tasks grouped under the following themes: o Investigating the feasibility of new superconducting magnets and electrical links using Nb3Sn and/or High Temperature Superconductors. o Investigating the gradient limits for radiofrequency (RF) accelerating structures, whether normal or superconducting, together with specific issues of linear colliders such as extreme geometrical stabilization. o Developing more robust collimators for the protec...

  4. Hanford Environmental Dose Reconstruction Project. Monthly report

    Energy Technology Data Exchange (ETDEWEB)

    McMakin, A.H.; Cannon, S.D.; Finch, S.M. [comps.

    1992-07-01

    The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed technical members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impact on humans (dose estimates): Source terms, environmental transport, environmental monitoring data, demography, food consumption, and agriculture, and environmental pathways and dose estimates. Progress is discussed.

  5. Hanford Environmental Dose Reconstruction Project monthly report

    Energy Technology Data Exchange (ETDEWEB)

    McMakin, A.H., Cannon, S.D.; Finch, S.M. (comps.)

    1992-09-01

    The objective of the Hanford Environmental Dose Reconstruction MDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in envirorunental pathways. epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering. radiation dosimetry. and cultural anthropology. Included are appointed members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impact on humans (dose estimates): Source Terms; Environmental Transport; Environmental Monitoring Data Demography, Food Consumption, and Agriculture; and Environmental Pathways and Dose Estimates.

  6. Hanford Environmental Dose Reconstruction Project monthly report

    International Nuclear Information System (INIS)

    McMakin, A.H., Cannon, S.D.; Finch, S.M.

    1992-09-01

    The objective of the Hanford Environmental Dose Reconstruction MDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in envirorunental pathways. epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering. radiation dosimetry. and cultural anthropology. Included are appointed members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impact on humans (dose estimates): Source Terms; Environmental Transport; Environmental Monitoring Data Demography, Food Consumption, and Agriculture; and Environmental Pathways and Dose Estimates

  7. The ALPHA project: a progress report

    International Nuclear Information System (INIS)

    Yadigaroglu, G.; Cachard, F. de; Coddington, P.; Dreier, J.; Smith, B.; Guentay, S.; Varadi, G.

    1995-01-01

    A review of the ALPHA project is presented, including a summary of progress and current status. The project comprises the experimental and analytical investigation of the long-term decay heat removal phenomena from the containment of the next generation of 'passive' Advanced Light Water Reactors. The effects of aerosols that may result from hypothetical severe accidents are also considered. The construction of the major ALPHA experimental facilities, PANDA, LINX-2 and AIDA, has been completed and all facilities are now in their commissioning phases. Scaling studies have guided the design of the experimental facilities. Several small-scale experiments and studies have already produced valuable results which can be used to direct the experimental work, as well as the design of the passive ALWRs. (author) 7 figs., 23 refs

  8. The Versatile Link common project: feasibility report

    International Nuclear Information System (INIS)

    Vasey, F; Soos, C; Troska, J; Hall, D; Huffman, T; Weidberg, T; Kwan, S; Prosser, A; Xiang, A; Ye, J

    2012-01-01

    The Versatile Link is a bi-directional digital optical data link operating at rates up to 4.8 Gbit/s and featuring radiation-resistant low-power and low-mass front-end components. The system is being developed in multimode or singlemode versions operating at 850 nm or 1310 nm wavelength respectively. It has serial data interfaces and is protocol-agnostic, but is targeted to operate in tandem with the GigaBit Transceiver (GBT) serializer/deserializer chip being designed at CERN. This paper gives an overview of the project status three and a half years after its launch. It describes the challenges encountered and highlights the solutions proposed at the system as well as the component level. It concludes with a positive feasibility assesment and an outlook for future project development directions.

  9. Manufacturing Methods and Technology Project Summary Reports.

    Science.gov (United States)

    1983-12-01

    to be not feasible. _ Inductoslag Remelting - The effect of the layering of the chips in the molten salt could not be overcome irrespective of long...Manufacturing ME-20 Processes for Depleted Uranium Large Caliber Armor Defeating Projectiles *_o" "-g _ "...• %...- "% "%’.-- % U W C . . C...TECHNOLOGY PROJICT SUIUARY R -PO RT (iCS DROIT-302) MMT Projects 576, 77, 78, and 79 6634 titled "Manufacturing Processes for Depleted Uranium Large

  10. The CHEMVAL 2 project - status report

    International Nuclear Information System (INIS)

    Read, D.

    1993-01-01

    This paper summarizes the progress made during the first year of CHEMVAL 2, a coordinated four year research programme for evaluating and enhancing chemical models used in radiological risk assessment. Eighteen organisations from nine countries are currently participating, several of whom are also undertaking related experimental studies within the Commission of European Communities (CEC) MIRAGE Project (Migration of Radionuclides in the geosphere) - Third Phase. 16 refs., 3 figs

  11. The ETE spherical Tokamak project. IAEA report

    Energy Technology Data Exchange (ETDEWEB)

    Ludwig, Gerson Otto; Del Bosco, E.; Berni, L.A.; Ferreira, J.G.; Oliveira, R.M.; Andrade, M.C.R.; Shibata, C.S.; Barroso, J.J.; Castro, P.J.; Patire Junior, H. [Instituto Nacional de Pesquisas Espaciais (INPE), Sao Jose dos Campos, SP (Brazil). Lab. Associado de Plasma]. E-mail: ludwig@plasma.inpe.br

    2002-07-01

    This paper describes the general characteristics of spherical tokamaks, or spherical tori, with a brief overview of work in this area already performed or in progress at several institutions worldwide. The paper presents also the historical development of the ETE (Spherical Tokamak Experiment) project, its research program, technical characteristics and operating conditions as of October, 2002 at the Associated Plasma Laboratory (LAP) of the National Space Research Institute (INPE) in Brazil. (author)

  12. Manufacturing Methods & Technology (MMT) Project Execution Report

    Science.gov (United States)

    1982-10-01

    CY82 19 PROJECTS ADDED IN IST HALF, CY82 DARCOM 0 82 5052 ARMY ENGINEERING UESIGN HANidBOCKS TEChNICAL SLILNTIFIL ANu ENGINEERING DATA IS CONTINALLY...FROM SUPER- ALLOY POWDER THE NEED TO IMPRCVE PObDER CLEANLINESS HAS BEEN RECOGNIZED. 1 82 7298 HIGH TEMPERATURE VACUUM CARBURIZING GEAR CARBURIZING IS...THE PRODUCTION ENVIRONMENT. 1 82 7389 PRODUCTION OF ALUMINUM ALiFRAME COMPONENTS CURRENT METHODS OF MACHINING ALUMINIUM FORGINGS ARE EXPENSIVE AND

  13. Manufacturing Methods and Technology Project Summary Reports.

    Science.gov (United States)

    1980-12-01

    sulfuric acid with organic modifiers were examined. Aluminum alloys which were processed included the 1100, 2024, 3003, 5052 , 6061, and 7075 series. The...and 772 3500 - Extrusion Technology for High 156 Strength Aluminum Bridge Deck Components Project E75 3552 - Improved Aluminum Alloy Welding Filler...that a 7075-type aluminum alloy which was much tougher than commercially available alloys , could be produced using a certain thermal-mechanical

  14. The Dust Management Project: Final Report

    Science.gov (United States)

    Hyatt, Mark J.; Straka, Sharon

    2011-01-01

    A return to the Moon to extend human presence, pursue scientific activities, use the Moon to prepare for future human missions to Mars, and expand Earth s economic sphere, will require investment in developing new technologies and capabilities to achieve affordable and sustainable human exploration. From the operational experience gained and lessons learned during the Apollo missions, conducting longterm operations in the lunar environment will be a particular challenge, given the difficulties presented by the unique physical properties and other characteristics of lunar regolith, including dust. The Apollo missions and other lunar explorations have identified significant lunar dust-related problems that will challenge future mission success. Comprised of regolith particles ranging in size from tens of nanometers to microns, lunar dust is a manifestation of the complex interaction of the lunar soil with multiple mechanical, electrical, and gravitational effects. The environmental and anthropogenic factors effecting the perturbation, transport, and deposition of lunar dust must be studied in order to mitigate it s potentially harmful effects on exploration systems and human explorers. The Dust Management Project (DMP) is tasked with the evaluation of lunar dust effects, assessment of the resulting risks, and development of mitigation and management strategies and technologies related to Exploration Systems architectures. To this end, the DMP supports the overall goal of the Exploration Technology Development Program (ETDP) of addressing the relevant high priority technology needs of multiple elements within the Constellation Program (CxP) and sister ETDP projects. Project scope, approach, accomplishments, summary of deliverables, and lessons learned are presented.

  15. Half Moon Cove Tidal Project. Feasibility report

    Energy Technology Data Exchange (ETDEWEB)

    1980-11-01

    The proposed Half Moon Cove Tidal Power Project would be located in a small cove in the northern part of Cobscook Bay in the vicinity of Eastport, Maine. The project would be the first tidal electric power generating plant in the United States of America. The basin impounded by the barrier when full will approximate 1.2 square miles. The average tidal range at Eastport is 18.2 feet. The maximum spring tidal range will be 26.2 feet and the neap tidal range 12.8 feet. The project will be of the single pool-type single effect in which generation takes place on the ebb tide only. Utilizing an average mean tidal range of 18.2 feet the mode of operation enables generation for approximately ten and one-half (10-1/2) hours per day or slightly in excess of five (5) hours per tide. The installed capacity will be 12 MW utilizing 2 to 6 MW units. An axial flow, or Bulb type of turbine was selected for this study.

  16. Radioactive Materials Packaging (RAMPAC) Radioactive Materials Incident Report (RMIR). RAMTEMP users manual

    International Nuclear Information System (INIS)

    Tyron-Hopko, A.K.; Driscoll, K.L.

    1985-10-01

    The purpose of this document is to familiarize the potential user with RadioActive Materials PACkaging (RAMPAC), Radioactive Materials Incident Report (RMIR), and RAMTEMP databases. RAMTEMP is a minor image of RAMPAC. This reference document will enable the user to access and obtain reports from databases while in an interactive mode. This manual will be revised as necessary to reflect enhancements made to the system

  17. MORE: Management of requirements in NPP modernisation projects. Project report 2007

    International Nuclear Information System (INIS)

    Fredriksen, R.; Katta, V.; Raspotnig, C.; Valkonen, J.

    2008-03-01

    This report documents the work and related activities of the MORE project in the period January 1 - December 31 in 2007. The focus of this report is on improvements of the former project results, to identify and apply a couple of case studies from NPP projects, and activities in order to initiate and implement the industrial take-up and utilisation of the research results in real modernisation projects. The report also provides a brief description of the extended industrial network and disseminations of the results in Nordic and NKS related events such as seminars and workshops. (au)

  18. MORE: Management of requirements in NPP modernisation projects. Project report 2007

    Energy Technology Data Exchange (ETDEWEB)

    Fredriksen, R.; Katta, V.; Raspotnig, C. [Institutt for energiteknikk (IFE) (Norway); Valkonen, J. [Technical Research Centre of Finland (VTT) (Finland)

    2008-03-15

    This report documents the work and related activities of the MORE project in the period January 1 - December 31 in 2007. The focus of this report is on improvements of the former project results, to identify and apply a couple of case studies from NPP projects, and activities in order to initiate and implement the industrial take-up and utilisation of the research results in real modernisation projects. The report also provides a brief description of the extended industrial network and disseminations of the results in Nordic and NKS related events such as seminars and workshops. (au)

  19. DOE-EPSCOR SPONSORED PROJECT FINAL REPORT

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Jianting

    2010-03-11

    Concern over the quality of environmental management and restoration has motivated the model development for predicting water and solute transport in the vadose zone. Soil hydraulic properties are required inputs to subsurface models of water flow and contaminant transport in the vadose zone. Computer models are now routinely used in research and management to predict the movement of water and solutes into and through the vadose zone of soils. Such models can be used successfully only if reliable estimates of the soil hydraulic parameters are available. The hydraulic parameters considered in this project consist of the saturated hydraulic conductivity and four parameters of the water retention curves. To quantify hydraulic parameters for heterogeneous soils is both difficult and time consuming. The overall objective of this project was to better quantify soil hydraulic parameters which are critical in predicting water flows and contaminant transport in the vadose zone through a comprehensive and quantitative study to predict heterogeneous soil hydraulic properties and the associated uncertainties. Systematic and quantitative consideration of the parametric heterogeneity and uncertainty can properly address and further reduce predictive uncertainty for contamination characterization and environmental restoration at DOE-managed sites. We conducted a comprehensive study to assess soil hydraulic parameter heterogeneity and uncertainty. We have addressed a number of important issues related to the soil hydraulic property characterizations. The main focus centered on new methods to characterize anisotropy of unsaturated hydraulic property typical of layered soil formations, uncertainty updating method, and artificial neural network base pedo-transfer functions to predict hydraulic parameters from easily available data. The work also involved upscaling of hydraulic properties applicable to large scale flow and contaminant transport modeling in the vadose zone and

  20. Enhancing Police Responses to Domestic Violence Incidents: Reports From Client Advocates in New South Wales.

    Science.gov (United States)

    Goodman-Delahunty, Jane; Crehan, Anna Corbo

    2016-07-01

    In an online survey about experiences with the police complaint system, 239 client advocates described a recent incident in which a client with grounds to lodge a complaint declined to do so. Almost one third of those incidents involved domestic violence. Thematic analysis of case descriptions revealed that many police did not take domestic violence reports seriously. A typology of problematic police conduct was developed. Many officers failed to observe current procedures and appeared to lack knowledge of relevant laws. Citizens feared retaliatory victimization by police and/or perceived that complaining was futile. Implications of these findings are reviewed in light of procedural justice theory. © The Author(s) 2015.

  1. Annual report on reactor safety research projects. Reporting period 2013. Progress report

    International Nuclear Information System (INIS)

    2013-01-01

    Within its competence for energy research the Federal Ministry of Economics and Technology (BMWi) sponsors research projects on the safety of nuclear power plants currently in operation. The objective of these projects is to provide fundamental knowledge, procedures and methods to contribute to realistic safety assessments of nuclear installations, to the further development of safety technology and to make use of the potential of innovative safety-related approaches. The Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS)mbH, by order of the BMWi, continuously issues information on the status of such research projects by publishing semi-annual and annual progress reports within the series of GRSF- Fortschrittsberichte (GRS-F-Progress Reports). Each progress report represents a compilation of individual reports about the objectives, work performed, results achieved, next steps of the work etc. The individual reports are prepared in a standard form by the research organisations themselves as documentation of their progress in work. The progress reports are published by the Project Management Agency/Authority Support Division of GRS. The reports as of the year 2000 are available in the Internet-based information system on results and data of reactor safety research (http://www.grs-fbw.de). The compilation of the reports is classified according to the classification system ''Joint Safety Research Index (JSRI)''. The reports are arranged in sequence of their project numbers. It has to be pointed out that the authors of the reports are responsible for the contents of this compilation. The BMWi does not take any responsibility for the correctness, exactness and completeness of the information nor for the observance of private claims of third parties. (orig.)

  2. Estimation and Projection of Lung Cancer Incidence and Mortality in China

    Directory of Open Access Journals (Sweden)

    Xiaonong ZOU

    2010-05-01

    Full Text Available Background and objective The aim of this study is to analyze lung cancer epidemiological trend and estimate lung cancer burden in China. Methods Lung cancer age specific mortality and incidence rate ratios in different areas and sexes were obtained from national cancer registration database in 2004 and 2005. Cancer crude mortalities were retrieved from the database of the third national death survey, 2004-2005. Age specific incidence rates of lung cancer were calculated using mortality and M/I ratios. Annual percent change (APC was estimated by log regression model using Joint Point software by analyzing pooled lung cancer incidence data from 10 cancer registries from 1988 to 2005. Results The total estimated new cases and deaths of lung cancer in 2005 were 536 407 and 475 768 which were higher in male than in female. There was 1.63% increase of lung cancer incidence per year from 1988 to 2005, however, the trend showed a slowdown by 0.55% annually after adjusted by age. Conclusion Lung cancer is one of major health issues in China and the burden is getting serious. Ageing population is main cause for increasing incidence and mortality of lung cancer. Effective cancer prevention and control is imperative. Especially, tobacco control should be carried out in statewide.

  3. Using incident reports to inform the prevention of medication administration errors.

    Science.gov (United States)

    Härkänen, Marja; Saano, Susanna; Vehviläinen-Julkunen, Katri

    2017-11-01

    To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters' perceptions of how to prevent medication administration errors have rarely been analysed. This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free-text descriptions include reporters' views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Reporters' views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines; and (5) development of the work. Health professionals should administer medication with a high moral awareness and an attempt to concentrate on the task. Nonetheless, the system should support health professionals by providing a reasonable work environment and encouraging collaboration among the providers to facilitate the safe administration of medication. Although there are numerous approaches to supporting medication safety, approaches that support the ability of individual health

  4. The Astronomy Genealogy Project: A Progress Report

    Science.gov (United States)

    Tenn, Joseph S.

    2016-01-01

    Although it is not yet visible, much progress has been made on the Astronomy Genealogy Project (AstroGen) since it was accepted as a project of the Historical Astronomy Division (HAD) three years ago. AstroGen will list the world's astronomers with information about their highest degrees and advisors. (In academic genealogy, your thesis advisor is your parent.) A small group (the AstroGen Team) has compiled a database of approximately 12,000 individuals who have earned doctorates with theses (dissertations) on topics in astronomy, astrophysics, cosmology, or planetary science. These include nearly all those submitted in Australia, Canada, the Netherlands, and New Zealand, and most of those in the United States (all through 2014 for most universities and all through 1990 for all). We are compiling more information than is maintained by the Mathematics Genealogy Project (MGP). In addition to name, degree, university, year of degree, and thesis advisor(s), all provided by MGP as well, we are including years of birth and death when available, mentors in addition to advisors, and links to the thesis when it is online and to the person's web page or obituary, when we can find it. We are still struggling with some questions, such as the boundaries of inclusion and whether or not to include subfields of astronomy. We believe that AstroGen will be a valuable resource for historians of science as well as a source of entertainment for those who like to look up their academic family trees. A dedicated researcher following links from AstroGen will be able to learn quite a lot about the careers of astronomy graduates of a particular university, country, or era. We are still seeking volunteers to enter the graduates of one or more universities.

  5. Final Report. Montpelier District Energy Project

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Jessie [City of Montpelier Vermont, Montpelier, VT (United States). Dept. of Public Works; Motyka, Kurt [City of Montpelier Vermont, Montpelier, VT (United States). Dept. of Public Works; Aja, Joe [State of Vermont, Montpelier, VT (United States). Dept. of Buildings and General Services; Garabedian, Harold T. [Energy & Environmental Analytics, Montpelier, VT (United States)

    2015-03-30

    The City of Montpelier, in collaboration with the State of Vermont, developed a central heat plant fueled with locally harvested wood-chips and a thermal energy distribution system. The project provides renewable energy to heat a complex of state buildings and a mix of commercial, private and municipal buildings in downtown Montpelier. The State of Vermont operates the central heat plant and the system to heat the connected state buildings. The City of Montpelier accepts energy from the central heat plant and operates a thermal utility to heat buildings in downtown Montpelier which elected to take heat from the system.

  6. Emergency Fish Restoration Project; Final Report 2002.

    Energy Technology Data Exchange (ETDEWEB)

    LeCaire, Richard

    2003-03-01

    Lake Roosevelt is a 151-mile impoundment created by the construction of Grand Coulee Dam during the early 1940's. The construction of the dam permanently and forever blocked the once abundant anadromous fish runs to the upper Columbia Basin. Since the construction of Grand Coulee Dam in 1943 and Chief Joseph Dam in 1956 this area is known as the blocked area. The blocked area is totally dependant upon resident fish species to provide a subsistence, recreational and sport fishery. The sport fishery of lake Roosevelt is varied but consists mostly of Rainbow trout (Oncorhynchus mykiss), Kokanee salmon (Oncorhynchus nerka), Walleye (Stizostedion vitreum) Small mouth bass (Micropterus dolomieui) and white sturgeon (Acipenser transmontanus). Currently, Bonneville Power Administration funds and administers two trout/kokanee hatcheries on Lake Roosevelt. The Spokane Tribe of Indians operates one hatchery, the Washington Department of Fish and Wildlife the other. In addition to planting fish directly into Lake Roosevelt, these two hatcheries also supply fish to a net pen operation that also plants the lake. The net pen project is administered by Bonneville Power funded personnel but is dependant upon volunteer labor for daily feeding and monitoring operations. This project has demonstrated great success and is endorsed by the Colville Confederated Tribes, the Spokane Tribe of Indians, the Washington Department of Fish and Wildlife, local sportsmen associations, and the Lake Roosevelt Forum. The Lake Roosevelt/Grand Coulee Dam area is widely known and its diverse fishery is targeted by large numbers of anglers annually to catch rainbow trout, kokanee salmon, small mouth bass and walleye. These anglers contribute a great deal to the local economy by fuel, grocery, license, tackle and motel purchases. Because such a large portion of the local economy is dependant upon the Lake Roosevelt fishery and tourism, any unusual operation of the Lake Roosevelt system may have a

  7. The MAJORANA Project: a status report

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, Steven Ray [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-06-09

    This series of slides presents the topic under the following aspects: ββ sensitivity, underground laboratory, shield, monoliths, strings, detectors, electroformed small parts, and background. Assembly and construction are proceeding at Sanford Davis Campus laboratory. Based on assays, material backgrounds are projected to meet cleanliness goals. Module 1 is complete. Electroformed copper has just been completed at SURF and PNNL. The shield is nearly complete. Successful reduction and refinement of enrGe has taken place with 98% yield. AMTEK (ORTEC) has produced 27 kg within 32 detectors from the reduced/refined enrGe; 30 of these are underground at SURF being assembled into strings.

  8. Manufacturing Methods and Technology Project Execution Report.

    Science.gov (United States)

    1984-10-01

    CY84 A,4t TA C 8’. 5052 ARMY ENGINEERING DESIGN H&NUBOIUKS TkCHNICAL SLIENTIFIC AND ENGINEERING OATA IS CONTINALLY BEING GENERk ED WITHIN THt ARMY A:A0...PRODUCTION OF ALUMINUM AIRFRAME COMPONENTS LURRENT METHODS OF MACHINING ALUMINIUM FORGINGS ARE EXPENSIVE AND REQUIRE AN EXCESSIVE NUMBER OF PARTS. 1 84...PRODUCING WEAPON COMPONENTS IS MAINLY BY MACHINING FROM WROUGHT STUCK. IHIS IS A HIGH COST METHOD WHICH PRODUCES MUCH ALLOY STEEL SCRAP. 29 0..I PROJECTS

  9. Work Project Report - Summer Internship 2013

    CERN Document Server

    Alampounti, Chantif Alexandros

    2013-01-01

    The report summarizes the work undertaken during the summer internship 2013. It involves both practical and theoretical work in the context of the ALPHA experiment, which is involved with the trapping and spectroscopic analysis of antihydrogen.

  10. RO-ILS: Radiation Oncology Incident Learning System: A report from the first year of experience.

    Science.gov (United States)

    Hoopes, David J; Dicker, Adam P; Eads, Nadine L; Ezzell, Gary A; Fraass, Benedick A; Kwiatkowski, Theresa M; Lash, Kathy; Patton, Gregory A; Piotrowski, Tom; Tomlinson, Cindy; Ford, Eric C

    2015-01-01

    Incident learning is a critical tool to improve patient safety. The Patient Safety and Quality Improvement Act of 2005 established essential legal protections to allow for the collection and analysis of medical incidents nationwide. Working with a federally listed patient safety organization (PSO), the American Society for Radiation Oncology and the American Association of Physicists in Medicine established RO-ILS: Radiation Oncology Incident Learning System (RO-ILS). This paper provides an overview of the RO-ILS background, development, structure, and workflow, as well as examples of preliminary data and lessons learned. RO-ILS is actively collecting, analyzing, and reporting patient safety events. As of February 24, 2015, 46 institutions have signed contracts with Clarity PSO, with 33 contracts pending. Of these, 27 sites have entered 739 patient safety events into local database space, with 358 events (48%) pushed to the national database. To establish an optimal safety culture, radiation oncology departments should establish formal systems for incident learning that include participation in a nationwide incident learning program such as RO-ILS. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  11. CERN SUMMER SCHOOL 2015 PROJECT REPORT

    CERN Document Server

    Jin, Zizhuo Tony

    2015-01-01

    The context of this internship is the CERN summer student program for the year 2015. As a member of the CERN summer school, I have been assigned, in addition to the classes I attended in the morning, a scientific project within the BE-ABP-HSC section. This work was done under the directions of Benoit Salvant and Nicolo Biancacci whom I thank greatly for their help, patience and teaching. The project consisted in observing the effects generated by the beam passing through various devices. We focused mainly on the electromagnetic waves generated by beams of particles travelling along two of the accelerator's devices: A wire scanner and the TDI (LHC injection beam stopper). These Simulations are of importance to estimate the effect of the beam onto the surrounding apparatus and ensuring both that the latter doesn't get damaged and that the beam doesn't lose too much energy. All the models and simulations were done using c CST STUDIO SUITE software developed by the c CST company.

  12. Biorefinery Demonstration Project Final Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, David [University of Georgia Research Foundation, Inc., Athens, GA (United States)

    2015-10-20

    In this project we focused on various aspects of biorefinery technology development including algal-biorefinery technology, thermochemical conversion of biomass to bio-oils and biochar; we tested characteristics and applications of biochars and evaluated nutrient cycling with wastewater treatment by the coupling of algal culture systems and anaerobic digestion. Key results include a method for reducing water content of bio-oil through atomized alcohol addition. The effect included increasing the pH and reducing the viscosity and cloud point of the bio-oil. Low input biochar production systems were evaluated via literature reviews and direct experimental work. Additionally, emissions were evaluated and three biochar systems were compared via a life cycle analysis. Attached growth systems for both algal cultivation and algal harvesting were found to be superior to suspended growth cultures. Nutrient requirements for algal cultivation could be obtained by the recycling of anaerobic digester effluents, thus experimentally showing that these two systems could be directly coupled. Twenty-two journal articles and six intellectual property applications resulted from the cumulative work that this project contributed to programmatically.

  13. Agile Machining and Inspection Non-Nuclear Report (NNR) Project

    Energy Technology Data Exchange (ETDEWEB)

    Lazarus, Lloyd

    2009-02-19

    This report is a high level summary of the eight major projects funded by the Agile Machining and Inspection Non-Nuclear Readiness (NNR) project (FY06.0422.3.04.R1). The largest project of the group is the Rapid Response project in which the six major sub categories are summarized. This project focused on the operations of the machining departments that will comprise Special Applications Machining (SAM) in the Kansas City Responsive Infrastructure Manufacturing & Sourcing (KCRIMS) project. This project was aimed at upgrading older machine tools, developing new inspection tools, eliminating Classified Removable Electronic Media (CREM) in the handling of classified Numerical Control (NC) programs by installing the CRONOS network, and developing methods to automatically load Coordinated-Measuring Machine (CMM) inspection data into bomb books and product score cards. Finally, the project personnel leaned perations of some of the machine tool cells, and now have the model to continue this activity.

  14. National critical incident reporting systems relevant to anaesthesia: a European survey.

    Science.gov (United States)

    Reed, S; Arnal, D; Frank, O; Gomez-Arnau, J I; Hansen, J; Lester, O; Mikkelsen, K L; Rhaiem, T; Rosenberg, P H; St Pierre, M; Schleppers, A; Staender, S; Smith, A F

    2014-03-01

    Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

  15. SDC Supplier Obligation project : household energy from 2011 : final report

    OpenAIRE

    Sustainable Development Commission

    2008-01-01

    This report is based on 'SDC Supplier Obligation engagement project : process plan'. Evaluation of the engagement process used in this report can be found in 'SDC Supplier Obligation project : an evaluation of the Sustainable Development Commission's stakeholder and public engagement process'. This report presents the findings of the Sustainable Development Commission’s stakeholder and public engagement process and informs the development of Department for Environment, Food and Rural Af...

  16. The Greenland Analogue Project, Yearly Report 2009

    International Nuclear Information System (INIS)

    2011-08-01

    To advance the understanding of processes associated with glaciation and their impact on the long-term performance of a deep geological repository, the Greenland Analogue Project (GAP), a four-year field and modelling study of the Greenland ice sheet and sub-surface conditions, has been initiated collaboratively by SKB, Posiva and NWMO. The study site encompasses a land terminus portion of the Greenland ice sheet east of Kangerlussuaq and is in many ways considered to be an appropriate analogue of the conditions that are expected to prevail in much of Canada and Fennoscandia during future glacial cycles. The project is planned to run from 2009 until 2012. The GAP will conduct the first in situ investigations of some of the parameters and processes needed to achieve a realistic understanding of how an ice sheet may impact a deep repository, and will provide measurements, observations and data that may significantly improve our safety assessments and risk analyses of glaciation scenarios. The project includes three sub-projects (A-C) with specific individual objectives, which collectively aim at contributing knowledge and input to the overall project aim. Three field campaigns were carried out in SPA during 2009. These campaigns focused on: (1) deployment and maintenance of AWS and GPS stations and to test the deep-look radar equipment; (2) investigating the hydrological processes and feedbacks and testing of passive seismic equipment; (3) downloading of weather station data and GPS data and winterizing the equipment. An extensive archive of real-time satellite remote sensing datasets has been obtained to be able to better constraint the surface elevation and dynamics of basal hydrological mechanisms. From this archive it has been possible to obtain Russell Glacier Cachment (RGC)-wide constraints on annual, seasonal and specific temporal snapshots of surface speed, initial lake and moulin distribution, drainage and network connections along with the temporal

  17. Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

    Directory of Open Access Journals (Sweden)

    Marília Berlofa Visacri

    2014-04-01

    Full Text Available The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs.

  18. Application examples of the reports of the NEA Incident Reporting System of the OECD and evolution of the system

    International Nuclear Information System (INIS)

    Libmann, J.

    1989-06-01

    Some reports of the work group no. 1 of the Nuclear Installations Security Committee of NEA, are summarized. An example of the report coding system concerning human factors, is given. The aim of the study is to improve the report contents as well as the coding system. In this case, a fast data selection is possible, and allows an efficient analysis of a particular situation. Moreover, the corrective procedures of the nuclear installation conception or operation can be easily modified, by the national organisations. Due to the improvements in quality, the opinion of the member countries on the incident reporting systems efficiency was enhanced [fr

  19. The association between patient-reported incidents in hospitals and estimated rates of patient harm.

    Science.gov (United States)

    Bjertnaes, Oyvind; Deilkås, Ellen Tveter; Skudal, Kjersti Eeg; Iversen, Hilde Hestad; Bjerkan, Anne Mette

    2015-02-01

    The aim of this study was to test the association between the rates of patient-reported incidents and patient harm documented in the patient record. The study was a secondary analysis of two national hospital assessments conducted in 2011. Hospital services in Norway. The patient survey was a standard national patient-experience survey conducted at the hospital level for all 63 hospitals in Norway. The medical record review was performed by 47 Global Trigger Tools (GTTs) in all 19 hospital trusts and 4 private hospitals. The two data sets were matched at the unit level, yielding comparable patient experiences and GTT data for 7 departments, 16 hospitals and 11 hospital trusts. No intervention. The correlation at the unit level between the patient-reported incident in hospital instrument (PRIH-I) and estimated rates of patient harm from the GTT. The PRIH-I index was significantly correlated with all patient-reported experience indicators at the individual level, with estimates for all patient harm events (Categories E-I) at the unit level (r = 0.62, P < 0.01), and with estimates of more serious harm events in Categories F-I (r = 0.42, P < 0.05). Patient-reported incidents in hospitals, as measured by the PRIH-I, are strongly correlated with patient harm rates based on the GTT. This indicates that patient-reported incidents are related to patient safety, but more research is needed to confirm the usefulness of patient reporting in the evaluation of patient safety. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  20. TRUE Block Scale Continuation Project. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Peter; Byegaard, Johan [Geosigma AB (Sweden); Billaux, Daniel [Itasca Consultants SA (France); Cvetkovic, Vladimir [Royal Inst. of Technology, Stockholm (Sweden); Dershowitz, William; Doe, Thomas [Golder Associates Inc. (United States); Hermanson, Jan [Golder Associates AB (Sweden); Poteri, Antti [VTT (Finland); Tullborg, Eva-Lena [Terralogica AB (Sweden); Winberg, Anders [Conterra AB (SE)] (ed.)

    2007-03-15

    The TRUE Block Scale project was carried out during 1996-2002. This project focused on site characterisation and building of hydrostructural and microstructural models, sorbing tracer experiments in single structures and networks of structures over distances ranging between 1 and 100 m and also involved a unified application of various model approaches for modelling the in situ experiments. In 2002, ANDRA, Posiva, JNC and SKB decided to pursue some remaining issues in the so-called TRUE Block Scale Continuation project (TRUE BS2). The specific objectives of BS2 can be summarised as: 'Improve understanding of transport pathways at the block scale, including assessment of effects of geology and geometry, macrostructure and microstructure'. In order to cater to addressing the stated objective a series of hypotheses were formulated which explored the importance of geological information for predicting transport and retention and the possible differences between transport and retention between transport paths dominated by faults and those dominated by non-fault fractures (background fractures). In the process, prospects for carrying out experiments in fracture networks over longer distances (c 20-100 m) were explored. It was identified that experiments with sorbing tracers over these distances were prohibitive because of the time frames involved and the projected low mass recoveries. Instead the experimental locus was shifted to a geological structure previously not investigated by tracer tests in the TRUE Block Scale experiments. The lower immobile zone retention material properties assigned to background fractures compared to those assigned to the fault-type Structure 19 have been verified by means of back-calculations. The evaluated Type 1 flow path (Structure 19, Flow path I) retention material properties, as expressed by {kappa} parameter, are one order of magnitude higher than for the background fracture flow path. This finding is consistent with the

  1. Advanced Blade Manufacturing Project - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    POORE, ROBERT Z.

    1999-08-01

    The original scope of the project was to research improvements to the processes and materials used in the manufacture of wood-epoxy blades, conduct tests to qualify any new material or processes for use in blade design and subsequently build and test six blades using the improved processes and materials. In particular, ABM was interested in reducing blade cost and improving quality. In addition, ABM needed to find a replacement material for the mature Douglas fir used in the manufacturing process. The use of mature Douglas fir is commercially unacceptable because of its limited supply and environmental concerns associated with the use of mature timber. Unfortunately, the bankruptcy of FloWind in June 1997 and a dramatic reduction in AWT sales made it impossible for ABM to complete the full scope of work. However, sufficient research and testing were completed to identify several promising changes in the blade manufacturing process and develop a preliminary design incorporating these changes.

  2. The Greenland Analogue Project. Yearly Report 2010

    International Nuclear Information System (INIS)

    Harper, J.; Hubbard, A.; Ruskeeniemi, T.

    2011-12-01

    Sub-project A, (SPA), Ice sheet hydrology and subglacial groundwater formation. SPA aims to improve the understanding of ice sheet hydrology (i.e. to assess how an ice sheet impacts groundwater circulation and chemistry in crystalline bedrock) up to, including, and beyond proposed repository depths. The data collected in SPA will be utilized in numerical ice sheet flow and hydrological modelling. SPA focuses on indirect observations of the properties of the basal hydrological system, and on what parts of the ice sheet that contribute water for groundwater infiltration. The latter includes quantification of ice sheet surface water production and how that water is routed from the ice sheet surface to its basal interface. This is achieved through remote-sensing, as well as direct measurements of vertical ice displacement and horizontal velocity fluctuation, and the determination of how these parameters vary in space and time under variable surface meltwater production and routing. Main activities within SPA involve (1) the installation and monitoring of GPS receivers and automatic weather stations on the ice sheet, and (2) air borne- and ground-based radar studies. Sub-project B, (SPB), Subglacial ice sheet hydrology. SPB, like SPA, aims at improving the understanding of ice sheet hydrology. SPB aims at collecting direct observations and measurements of the characteristics of the hydrological system at the base of the ice sheet. The data collected in SPB will be utilized in numerical ice sheet flow and hydrological modelling. The main activity for SPB is drilling through the ice sheet at a number of locations where the ice sheet has been found to be wet-based from the radar surveys in SPA. The purpose of the drilling and borehole monitoring installations is to observe water pressures at the interface between the ice and bedrock. In addition to the ice drilling, collection of remote sensing data of ice-sheet surface conditions are to be carried out. SPB is the core of

  3. The Greenland Analogue Project. Yearly Report 2010

    Energy Technology Data Exchange (ETDEWEB)

    Harper, J. (Univ. of Montana (United States)); Hubbard, A. (Aberystwyth Univ. (United Kingdom)); Ruskeeniemi, T. (Geological Survey of Finland (Finland)) (and others)

    2011-12-15

    Sub-project A, (SPA), Ice sheet hydrology and subglacial groundwater formation. SPA aims to improve the understanding of ice sheet hydrology (i.e. to assess how an ice sheet impacts groundwater circulation and chemistry in crystalline bedrock) up to, including, and beyond proposed repository depths. The data collected in SPA will be utilized in numerical ice sheet flow and hydrological modelling. SPA focuses on indirect observations of the properties of the basal hydrological system, and on what parts of the ice sheet that contribute water for groundwater infiltration. The latter includes quantification of ice sheet surface water production and how that water is routed from the ice sheet surface to its basal interface. This is achieved through remote-sensing, as well as direct measurements of vertical ice displacement and horizontal velocity fluctuation, and the determination of how these parameters vary in space and time under variable surface meltwater production and routing. Main activities within SPA involve (1) the installation and monitoring of GPS receivers and automatic weather stations on the ice sheet, and (2) air borne- and ground-based radar studies. Sub-project B, (SPB), Subglacial ice sheet hydrology. SPB, like SPA, aims at improving the understanding of ice sheet hydrology. SPB aims at collecting direct observations and measurements of the characteristics of the hydrological system at the base of the ice sheet. The data collected in SPB will be utilized in numerical ice sheet flow and hydrological modelling. The main activity for SPB is drilling through the ice sheet at a number of locations where the ice sheet has been found to be wet-based from the radar surveys in SPA. The purpose of the drilling and borehole monitoring installations is to observe water pressures at the interface between the ice and bedrock. In addition to the ice drilling, collection of remote sensing data of ice-sheet surface conditions are to be carried out. SPB is the core of

  4. Ambient air pollution and primary liver cancer incidence in four European cohorts within the ESCAPE project

    NARCIS (Netherlands)

    Pedersen, Marie; Andersen, Zorana J; Stafoggia, Massimo; Weinmayr, Gudrun; Galassi, Claudia; Sørensen, Mette; Eriksen, Kirsten T; Tjønneland, Anne; Loft, Steffen; Jaensch, Andrea; Nagel, Gabriele; Concin, Hans; Tsai, Ming-Yi; Grioni, Sara; Marcon, Alessandro; Krogh, Vittorio; Ricceri, Fulvio; Sacerdote, Carlotta; Ranzi, Andrea; Sokhi, Ranjeet; Vermeulen, Roel|info:eu-repo/dai/nl/216532620; Hoogh, Kees de; Wang, Meng; Beelen, Rob|info:eu-repo/dai/nl/30483100X; Vineis, Paolo; Brunekreef, Bert|info:eu-repo/dai/nl/067548180; Hoek, Gerard|info:eu-repo/dai/nl/069553475; Raaschou-Nielsen, Ole

    2017-01-01

    BACKGROUND: Tobacco smoke exposure increases the risk of cancer in the liver, but little is known about the possible risk associated with exposure to ambient air pollution. OBJECTIVES: We evaluated the association between residential exposure to air pollution and primary liver cancer incidence.

  5. Medical students' perceptions of a novel institutional incident reporting system : A thematic analysis.

    Science.gov (United States)

    Gordon, Morris; Parakh, Dillan

    2017-10-01

    Errors in healthcare are a major patient safety issue, with incident reporting a key solution. The incident reporting system has been integrated within a new medical curriculum, encouraging medical students to take part in this key safety process. The aim of this study was to describe the system and assess how students perceived the reporting system with regards to its role in enhancing safety. Employing a thematic analysis, this study used interviews with medical students at the end of the first year. Thematic indices were developed according to the information emerging from the data. Through open, axial and then selective stages of coding, an understanding of how the system was perceived was established. Analysis of the interview specified five core themes: (1) Aims of the incident reporting system; (2) internalized cognition of the system; (3) the impact of the reporting system; (4) threshold for reporting; (5) feedback on the systems operation. Selective analysis revealed three overriding findings: lack of error awareness and error wisdom as underpinned by key theoretical constructs, student support of the principle of safety, and perceptions of a blame culture. Students did not interpret reporting as a manner to support institutional learning and safety, rather many perceived it as a tool for a blame culture. The impact reporting had on students was unexpected and may give insight into how other undergraduates and early graduates interpret such a system. Future studies should aim to produce interventions that can support a reporting culture.

  6. Physics Computer Development Project (PCDP), Progress Report.

    Science.gov (United States)

    Bork, Alfred M.

    This report discusses the development and implementation of computer-related teaching materials for undergraduate physics courses. A list of the computer dialogs developed, with a short description of each, is included. The types of dialog are: (1) development of an interactive proof, (2) assistance in problem solving, (3) diagnosing and filling…

  7. Fast Breeder Project. Second quarterly report, 1974

    International Nuclear Information System (INIS)

    Hueper, R.

    Research progress is reported on fuel pin development, material studies and development, corrosion tests and coolant analysis, fuel cycle studies, physics experiments, fast reactor safety, instrumentation development, environmental studies, and sodium technology tests. Much of the work had SNR-300 design applications. (U.S.)

  8. Rand Project AIR FORCE Annual Report 2010

    Science.gov (United States)

    2010-01-01

    engen - dering an increasingly raucous debate. Pointing to modern- day reliance on computers and the Internet—communications, financial networks, power...Airman Albert is an electrical power produc- tion journeyman with the 10th Intelligence Squadron. Annual Report 2010 43 will possess...RAND Corporation Robert C. Wright, Former Vice Chairman, General Electric ; Former Chairman and Chief Executive Officer, NBC Universal; Chairman and

  9. SAT-WIND project. Final report

    DEFF Research Database (Denmark)

    Hasager, Charlotte Bay; Astrup, Poul; Nielsen, Niels Morten

    microwave, altimeter, scatterometer and imaging Synthetic Aperture Radar (SAR) technologies for wind energy tools for wind resources and wind-indexing. The study area was the Danish Seas including the North Sea, interior seas and the Baltic Sea. The report describes technical details on the satellite data...

  10. Criteria for classification and reporting of fire incidences in nuclear power plants of India

    International Nuclear Information System (INIS)

    Kapoor, R.K.

    1998-01-01

    Is is important that all fires in and around fire effective neighbourhood of Nuclear Power Plant (NPP) should be promptly reported (Reportable fires) and investigated. However, the depth of investigation and the range of authorities to whom the individual fire incidence need to be reported depends upon the severity of fire. In case of conventional non-chemical industries, the severity of fire depends mainly on the extent of loss caused by fire on property and the burn injury to persons. In case of NPP, two additional losses viz, release of radioactivity to working/public environment and the risk to safety related systems of NPP due to fire assume greater importance. This paper describes the criteria used in NPPs of India for classification of reportable fire incidences into four categories, viz. Insignificant, small, medium and large fires. It also gives the level of investigation depending upon the severity of fire. The fire classification scheme is explained in this paper with the help of worked out examples and two incidences of fire in Indian NPPs. (author)

  11. WSF Biodiesel Demonstration Project Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Washington State University; University of Idaho; The Glosten Associates, Inc.; Imperium Renewables, Inc.

    2009-04-30

    In 2004, WSF canceled a biodiesel fuel test because of “product quality issues” that caused the fuel purifiers to clog. The cancelation of this test and the poor results negatively impacted the use of biodiesel in marine application in the Pacific Northwest. In 2006, The U.S. Department of Energy awarded the Puget Sound Clean Air Agency a grant to manage a scientific study investigating appropriate fuel specifications for biodiesel, fuel handling procedures and to conduct a fuel test using biodiesel fuels in WSF operations. The Agency put together a project team comprised of experts in fields of biodiesel research and analysis, biodiesel production, marine engineering and WSF personnel. The team reviewed biodiesel technical papers, reviewed the 2004 fuel test results, designed a fuel test plan and provided technical assistance during the test. The research reviewed the available information on the 2004 fuel test and conducted mock laboratory experiments, but was not able to determine why the fuel filters clogged. The team then conducted a literature review and designed a fuel test plan. The team implemented a controlled introduction of biodiesel fuels to the test vessels while monitoring the environmental conditions on the vessels and checking fuel quality throughout the fuel distribution system. The fuel test was conducted on the same three vessels that participated in the canceled 2004 test using the same ferry routes. Each vessel used biodiesel produced from a different feedstock (i.e. soy, canola and yellow grease). The vessels all ran on ultra low sulfur diesel blended with biodiesel. The percentage of biodiesel was incrementally raised form from 5 to 20 percent. Once the vessels reached the 20 percent level, they continued at this blend ratio for the remainder of the test. Fuel samples were taken from the fuel manufacturer, during fueling operations and at several points onboard each vessel. WSF Engineers monitored the performance of the fuel systems and

  12. LLNL NESHAPs project. 1992 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Surano, K.A.; Failor, R.A.; Biermann, A.H.; Berger, R.L.; Harrach, R.J.

    1993-05-01

    This report summarizes work conducted during FY 1992 for the Environmental Monitoring and Analysis Division of the Environmental Protection Department at Lawrence Livermore National Laboratory (LLNL). This document contains information regarding environmental monitoring of a wide variety of radioisotopes which are emitted to the atmosphere. These radioisotopes include transuranics, biomedical tracers, tritium, mixed fission products, and other radioisotopes used for general research and nuclear weapons research. Information regarding radionuclide air emissions for each of the 56 buildings at LLNL where radionuclides are used or activation products occur is given. Detailed information is included for all point source emissions from 43 LLNL site buildings. In addition, dose equivalents and dose assessment are evaluated. Reported annual releases are based on inventory data and unabated EPA potential release fractions for unmonitored sources, and on actual emission measurements for continuously monitored facilities.

  13. Numerical analyses of an ex-core fuel incident: Results of the OECD-IAEA Paks Fuel Project

    Energy Technology Data Exchange (ETDEWEB)

    Hozer, Z., E-mail: hozer@aeki.kfki.h [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary); Aszodi, A. [BME NTI Budapest (Hungary); Barnak, M. [IVS, Trnava (Slovakia); Boros, I. [BME NTI Budapest (Hungary); Fogel, M. [VUJE, Trnava (Slovakia); Guillard, V. [IRSN, Cadarache (France); Gyori, Cs. [ITU, EU, Karlsruhe (Germany); Hegyi, G. [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary); Horvath, G.L. [VEIKI, Budapest (Hungary); Nagy, I. [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary); Junninen, P. [VTT, Espoo (Finland); Kobzar, V. [KI, Moscow (Russian Federation); Legradi, G. [BME NTI Budapest (Hungary); Molnar, A. [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary); Pietarinen, K. [VTT, Espoo (Finland); Perneczky, L. [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary); Makihara, Y. [ATMEA, Paris (France); Matejovic, P. [IVS, Trnava (Slovakia); Perez-Fero, E.; Slonszki, E. [Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, H-1525 Budapest, P.O. Box 49 (Hungary)

    2010-03-15

    The OECD-IAEA Paks Fuel Project was developed to support the understanding of fuel behaviour in accident conditions on the basis of analyses of the Paks-2 incident. Numerical simulation of the most relevant aspects of the event and comparison of the calculation results with the available data from the incident was carried out between 2006 and 2007. A database was compiled to provide input for the code calculations. The activities covered the following three areas: (a) Thermal hydraulic calculations described the cooling conditions possibly established during the incident. (b) Simulation of fuel behaviour described the oxidation and degradation mechanisms of the fuel assemblies. (c) The release of fission products from the failed fuel rods was estimated and compared to available measured data. The applied used codes captured the most important events of the Paks-2 incident and the calculated results improved the understanding of the causes and mechanisms of fuel failure. The numerical analyses showed that the by-pass flow leading to insufficient cooling amounted to 75-90% of the inlet flow rate, the maximum temperature in the tank was between 1200 and 1400 deg. C, the degree of zirconium oxidation reached 4-12% and the mass of produced hydrogen was between 3 and 13 kg.

  14. Learning From Incident Reporting? Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care.

    Science.gov (United States)

    Ahlberg, Eva-Lena; Elfström, Johan; Borgstedt, Madeleine Risberg; Öhrn, Annica; Andersson, Christer; Sjödahl, Rune; Nilsen, Per

    2017-11-04

    Incident reporting (IR) systems have the potential to improve patient safety if they enable learning from the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council. The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence. Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline. The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

  15. Environmental Report Utah State Prison Geothermal Project

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-03-01

    This environmental report assesses the potential impact of developing a geothermal resource for space heating at the Utah State Prison. Wells will be drilled on prison property for production and for injection to minimize reservoir depletion and provide for convenient disposal of cooled fluid. The most significant environmental concerns are the proper handling of drilling muds during well drilling and the disposal of produced water during well testing. These problems will be handled by following currently accepted practices to reduce the potential risks.

  16. Advanced Neutron Source (ANS) Project progress report

    International Nuclear Information System (INIS)

    McBee, M.R.; Chance, C.M.

    1990-04-01

    This report discusses the following topics on the advanced neutron source: quality assurance (QA) program; reactor core development; fuel element specification; corrosion loop tests and analyses; thermal-hydraulic loop tests; reactor control concepts; critical and subcritical experiments; material data, structural tests, and analysis; cold source development; beam tube, guide, and instrument development; hot source development; neutron transport and shielding; I ampersand C research and development; facility concepts; design; and safety

  17. Brown Grease to Biodiesel Demonstration Project Report

    Energy Technology Data Exchange (ETDEWEB)

    San Francisco Public Utilities Commission; URS Corporation; Biofuels, Blackgold; Carollo Engineers

    2013-01-30

    Municipal wastewater treatment facilities have typically been limited to the role of accepting wastewater, treating it to required levels, and disposing of its treatment residuals. However, a new view is emerging which includes wastewater treatment facilities as regional resource recovery centers. This view is a direct result of increasingly stringent regulations, concerns over energy use, carbon footprint, and worldwide depletion of fossil fuel resources. Resources in wastewater include chemical and thermal energy, as well as nutrients, and water. A waste stream such as residual grease, which concentrates in the drainage from restaurants (referred to as Trap Waste), is a good example of a resource with an energy content that can be recovered for beneficial reuse. If left in wastewater, grease accumulates inside of the wastewater collection system and can lead to increased corrosion and pipe blockages that can cause wastewater overflows. Also, grease in wastewater that arrives at the treatment facility can impair the operation of preliminary treatment equipment and is only partly removed in the primary treatment process. In addition, residual grease increases the demand in treatment materials such as oxygen in the secondary treatment process. When disposed of in landfills, grease is likely to undergo anaerobic decay prior to landfill capping, resulting in the atmospheric release of methane, a greenhouse gas (GHG). This research project was therefore conceptualized and implemented by the San Francisco Public Utilities Commission (SFPUC) to test the feasibility of energy recovery from Trap Waste in the form of Biodiesel or Methane gas. The research goals are given below: To validate technology performance; To determine the costs and benefits [including economic, socioeconomic, and GHG emissions reduction] associated with co-locating this type of operation at a municipal wastewater treatment plant (WWTP); To develop a business case or model for replication of the

  18. Kalispel Resident Fish Project : Annual Report, 1995.

    Energy Technology Data Exchange (ETDEWEB)

    Maroney, Joseph; Donley, Christopher; Scott, Jason; Lockwood, Jr., Neil

    1997-06-01

    In 1995 the Kalispel Natural Resource Department (KNRD) in conjunction with the Washington Department of Fish and Wildlife (WDFW) initiated the implementation of a habitat and population enhancement project for bull trout (Salvelinus confluentus), westslope cutthroat trout (Oncorhynchus clarki lewisi) and largemouth bass (Micropterus salmoides). Habitat and population assessments were conducted in seven tributaries of the Box Canyon reach of the Pend Oreille River. Assessments were used to determine the types and quality of habitat that were limiting to native bull trout and cutthroat trout populations. Assessments were also used to determine the effects of interspecific competition within these streams. A bull trout and brook trout (Salvelinus fontinalis) hybridization assessment was conducted to determine the degree of hybridization between these two species. Analysis of the habitat data indicated high rates of sediment and lack of wintering habitat. The factors that contribute to these conditions have the greatest impact on habitat quality for the tributaries of concern. Population data suggested that brook trout have less stringent habitat requirements; therefore, they have the potential to outcompete the native salmonids in areas of lower quality habitat. No hybrids were found among the samples, which is most likely attributable to the limited number of bull trout. Data collected from these assessments were compiled to develop recommendations for enhancement measures. Recommendations for restoration include riparian planting and fencing, instream structures, as well as, removal of non-native brook trout to reduce interspecific competition with native salmonids in an isolated reach of Cee Cee Ah Creek.

  19. Helical Screw Expander Evaluation Project. Final report

    Energy Technology Data Exchange (ETDEWEB)

    McKay, R.

    1982-03-01

    A functional 1-MW geothermal electric power plant that featured a helical screw expander was produced and then tested in Utah in 1978 to 1979 with a demonstrated average performance of approximately 45% machine efficiency over a wide range of test conditions in noncondensing operation on two-phase geothermal fluids. The Project also produced a computer-equipped data system, an instrumentation and control van, and a 1000-kW variable load bank, all integrated into a test array designed for operation at a variety of remote test sites. Additional testing was performed in Mexico in 1980 under a cooperative test program using the same test array, and machine efficiency was measured at 62% maximum with the rotors partially coated with scale, compared with approximately 54% maximum in Utah with uncoated rotors, confirming the importance of scale deposits within the machine on performance. Data are presented for the Utah testing and for the noncondensing phases of the testing in Mexico. Test time logged was 437 hours during the Utah tests and 1101 hours during the Mexico tests.

  20. Project Report: Undergraduate Student Research Program (USRP)

    Science.gov (United States)

    Gavin, Patricia

    2011-01-01

    To better understand geochemical processes occurring on Europa's seafloor, we investigated the effects of varying Fe?content in the seafloor rock and varying temperature. Iron is important in such geochemical processes as the production of methane through serpentinization (e.g. Allen and Seyfried, 2003) and can be a nutrient for microbes (Russell and Hall, 2006; Park and Kim, 2001). It can also offer clues as to the state of differentiation of Europa's core/mantle. If Europa is fully differentiated and contains an iron core, we would expect there to be little iron in the mantle and ocean floor whereas a homogeneous Europa would have iron evenly dispersed throughout the ocean floor. Furthermore, the composition of the ocean is a result of water?rock interactions at the seafloor. This project investigated the effects of temperature on geochemical processes, comparing high temperature (> 250oC) hydrothermal vents (Kelley et al., 2001) to lower temperature (20oC) cold seeps (e.g. Orphan et al., 2002).

  1. Final Report for NMBSA Project, Monika Kaden, 2016

    Energy Technology Data Exchange (ETDEWEB)

    Ward, William Carl [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-12-13

    The following pages define the objectives and results for Project 022, requested by Monika Kaden, a sculptor who maintains studios in Santa Fe. This effort was first approved in February 2016, and was completed during several different time segments spread over the year, depending on Monika’s availability. The project deliverables that are of primary use to the customer are digital data files that are to be delivered electronically. This report is a summary overview of how the project was conducted.

  2. Research Projects, Technical Reports and Publications

    Science.gov (United States)

    Oliger, Joseph

    1996-01-01

    The Research Institute for Advanced Computer Science (RIACS) was established by the Universities Space Research Association (USRA) at the NASA Ames Research Center (ARC) on June 6, 1983. RIACS is privately operated by USRA, a consortium of universities with research programs in the aerospace sciences, under contract with NASA. The primary mission of RIACS is to provide research and expertise in computer science and scientific computing to support the scientific missions of NASA ARC. The research carried out at RIACS must change its emphasis from year to year in response to NASA ARC's changing needs and technological opportunities. A flexible scientific staff is provided through a university faculty visitor program, a post doctoral program, and a student visitor program. Not only does this provide appropriate expertise but it also introduces scientists outside of NASA to NASA problems. A small group of core RIACS staff provides continuity and interacts with an ARC technical monitor and scientific advisory group to determine the RIACS mission. RIACS activities are reviewed and monitored by a USRA advisory council and ARC technical monitor. Research at RIACS is currently being done in the following areas: Advanced Methods for Scientific Computing High Performance Networks During this report pefiod Professor Antony Jameson of Princeton University, Professor Wei-Pai Tang of the University of Waterloo, Professor Marsha Berger of New York University, Professor Tony Chan of UCLA, Associate Professor David Zingg of University of Toronto, Canada and Assistant Professor Andrew Sohn of New Jersey Institute of Technology have been visiting RIACS. January 1, 1996 through September 30, 1996 RIACS had three staff scientists, four visiting scientists, one post-doctoral scientist, three consultants, two research associates and one research assistant. RIACS held a joint workshop with Code 1 29-30 July 1996. The workshop was held to discuss needs and opportunities in basic research in

  3. PLATO IV: First Year Report, Computerized Training System, Project ABACUS.

    Science.gov (United States)

    Hinkle, Lawrence R.

    This report covers the PLATO IV activities during calendar year 1973 at the Computerized Training System. The work reported herein is supported by a program sponsored by the Advanced Research Projects Agency (ARPA) to evaluate the PLATO IV system for use in training, oriented to the needs of the Armed Services. The report presents a synopsis of…

  4. LIEKKI 2 - Annual Review 1995. Project reports

    International Nuclear Information System (INIS)

    Hupa, M.; Matinlinna, J.

    1995-01-01

    The yearbook is the second research in progress report of the research program in combustion and gasification technology named LIEKKI 2. LIEKKI 2 program is planned to cover the research work to be performed in the period beginning in 1993 and ending in 1998. LIEKKI 2 is largely to continue that combustion and gasification research which earlier was included in the national research program LIEKKI and JALO. The key areas in the research programme are: Mathematical modelling of furnace processes, Chemistry of gaseous pollutants; Particle behavior, Ash aerosols, New combustion and gasification and gasification technologies, Black liquor, Conventional technologies and Waste incineration

  5. FY 2014 LDRD Annual Report Project Summaries

    Energy Technology Data Exchange (ETDEWEB)

    Tomchak, Dena [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-02-01

    The FY 2014 Laboratory Directed Research and Development (LDRD) Annual Report is a compendium of the diverse research performed to develop and ensure the INL's technical capabilities can support future DOE missions and national research priorities. LDRD is essential to INL - it provides a means for the laboratory to pursue novel scientific and engineering research in areas that are deemed too basic or risky for programmatic investments. This research enahnces technical capabilities at the laboratory, providing scientific and engineering staff with opportunities for skill building and partnership development.

  6. No-Tack Inlay on Milled Surface: Project Report

    Science.gov (United States)

    1999-02-01

    This report documents observation of a construction project west of Nashville, Tennessee that did not use a tack coat during the placement of the hot mix asphalt (HMA). This observation took place on June 23, 1998. For this project, the existing pave...

  7. Video-Based Reporting of Evaluation Results in Project SUCCESS

    Science.gov (United States)

    Macy, Daniel J.; Wallace, Karla

    2007-01-01

    Project SUCCESS sought to recruit, train, and support paraprofessionals and mid-career adults in high-need teaching fields (math, science, special education, bilingual) in transitioning to teach in high-need schools. A 27-minute video was produced to supplement reporting of project evaluation outcomes. This paper highlights procedures and…

  8. Project Aprendizaje. Final Evaluation Report 1992-93.

    Science.gov (United States)

    Clark, Andrew

    This report provides evaluative information regarding the effectiveness of Project Aprendizaje, a New York City program that served 269 Spanish-speaking students of limited English proficiency (LEP). The project promoted parent and community involvement by sponsoring cultural events, such as a large Latin American festival. Students developed…

  9. Basalt Waste Isolation Project. Annual report, fiscal year 1979

    Energy Technology Data Exchange (ETDEWEB)

    1979-11-01

    This project is aimed at examining the feasibility and providing the technology to design and construct a radwaste repository in basalt formations beneath and within the Hanford Site. The project is divided into seven areas: systems integration, geosciences, hydrologic studies, engineered barriers, near-surface test facility, engineering testing, and repository engineering. This annual report summarizes key investigations in these seven areas. (DLC)

  10. Basalt Waste Isolation Project. Annual report, fiscal year 1979

    International Nuclear Information System (INIS)

    1979-11-01

    This project is aimed at examining the feasibility and providing the technology to design and construct a radwaste repository in basalt formations beneath and within the Hanford Site. The project is divided into seven areas: systems integration, geosciences, hydrologic studies, engineered barriers, near-surface test facility, engineering testing, and repository engineering. This annual report summarizes key investigations in these seven areas

  11. Project W-049H disposal facility test report

    International Nuclear Information System (INIS)

    Buckles, D.I.

    1995-01-01

    The purpose of this Acceptance Test Report (ATR) for the Project W-049H, Treated Effluent Disposal Facility, is to verify that the equipment installed in the Disposal Facility has been installed in accordance with the design documents and function as required by the project criteria

  12. The Indiana Deaf-Blind Services Project. Final Performance Report.

    Science.gov (United States)

    Goehl, Karen S.

    This final report describes activities and accomplishments of the Indiana Deaf-Blind Services Project, a 3-year federally funded project to enhance and further develop coordinated direct services to children and youth, birth through age 2 and ages 18 through 21. It also was designed to provide technical assistance to public and private agencies…

  13. Quality and Use of Rolling Project Completion Reports | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-11-09

    Nov 9, 2016 ... In 2005, IDRC adopted the rolling Project Completion Report (rPCR), creating a cross-organization interactive process to elicit staff reflection, deepen learning about projects, and fulfill an accountability function for the organization. Five years after its implementation, we commissioned an assessment of the ...

  14. Colorado Better Buildings Project. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Strife, Susie [Boulder County, Boulder, CO (United States); Yancey, Lea [Boulder County, Boulder, CO (United States)

    2013-12-30

    The Colorado Better Buildings project intended to bring new and existing energy efficiency model programs to market with regional collaboration and funding partnerships. The goals for Boulder County and its program partners were to advance energy efficiency investments, stimulate economic growth in Colorado and advance the state’s energy independence. Collectively, three counties set out to complete 9,025 energy efficiency upgrades in 2.5 years and they succeeded in doing so. Energy efficiency upgrades have been completed in more than 11,000 homes and businesses in these communities. Boulder County and its partners received a $25 million BetterBuildings grant from the U.S. Department of Energy under the American Recovery and Reinvestment Act in the summer of 2010. This was also known as the Energy Efficiency and Conservation Block Grants program. With this funding, Boulder County, the City and County of Denver, and Garfield County set out to design programs for the residential and commercial sectors to overcome key barriers in the energy upgrade process. Since January 2011, these communities have paired homeowners and business owners with an Energy Advisor – an expert to help move from assessment to upgrade with minimal hassle. Pairing this step-by-step assistance with financing incentives has effectively addressed many key barriers, resulting in energy efficiency improvements and happy customers. An expert energy advisor guides the building owner through every step of the process, coordinating the energy assessment, interpreting results for a customized action plan, providing a list of contractors, and finding and applying for all available rebates and low-interest loans. In addition to the expert advising and financial incentives, the programs also included elements of social marketing, technical assistance, workforce development and contractor trainings, project monitoring and verification, and a cloud-based customer data system to coordinate among field

  15. Nuclear power plant operating experiences from the IAEA / Nea incident reporting system 2002-2005

    International Nuclear Information System (INIS)

    2006-01-01

    The Incident Reporting System (IRS) is an essential element of the international operating experience feedback system for nuclear power plants. The IRS is jointly operated and managed by the Nuclear Energy Agency (NEA), a semi-autonomous body within the Organisation for Economic Co-operation and Development (OECD), and the International Atomic Energy Agency (IAEA), a specialized agency within the United Nations System. (author)

  16. FINAL PROJECT REPORT - EVALUATION AND TESTING OF HTGR REACTOR BUILDING RESPONSE TO DEPRESSURIZATION ACCIDENTS

    Energy Technology Data Exchange (ETDEWEB)

    ALLIANCE LIMITED, NGNP INDUSTRY

    2017-07-25

    This report provides a description of the project, summarizes each phase of the project, and ends with project conclusions. In addition, the report contains a descriptive index of the technical reports generated during the course of the project.

  17. ICPP water inventory study project summary report

    International Nuclear Information System (INIS)

    Richards, B.T.

    1994-01-01

    The Idaho Chemical Processing Plant (ICPP) Water inventory Study was initiated in September 1993 with the formation of a joint working group consisting of representatives from DOE-ID, State of Idaho INEL Oversight Program, US Geological Survey, and INEL employees to investigate three issues that had been identified by the INEL Oversight Program at ICPP: (1) the water inventory imbalance at ICPP, (2) the source of water infiltrating into the Tank Farm vault sumps, and (3) the source of water providing potential recharge to perched water bodies underlying ICPP. These issues suggested that water was being lost from the ICPP distribution system. The INEL Oversight Program was concerned that the unaccounted for water at ICPP could be spreading contaminants that have been released over the past 40 years of operations of ICPP, possibly to the Snake River Plain Aquifer. This report summarizes the findings of each of the component investigations that were undertaken to resolve each of the three issues. Concerns about the risk of spreading contaminants will be resolved as part of the Remedial Investigation/Feasibility Study being undertaken at ICPP in compliance with the Federal Facility Agreement and Consent Order between DOE-H), EPA, and the State of Idaho. This report will be a key input to that study

  18. American fuel cell bus project : first analysis report.

    Science.gov (United States)

    2013-06-01

    This report summarizes the experience and early results from the American Fuel Cell Bus Project, a fuel cell electric bus demonstration : funded by the Federal Transit Administration (FTA) under the National Fuel Cell Bus Program. A team led by CALST...

  19. Final Project Report for "Interfacial Thermal Resistance of Carbon Nanotubes”

    Energy Technology Data Exchange (ETDEWEB)

    Cumings, John [Univ. of Maryland, College Park, MD (United States)

    2016-04-15

    This report describes an ongoing project to comprehensively study the interfacial thermal boundary resistance (Kapitza resistance) of carbon nanotubes. It includes a list of publications, personnel supported, the overall approach, accomplishments and future plans.

  20. Self-reported physical work exposures and incident carpal tunnel syndrome

    Science.gov (United States)

    Dale, Ann Marie; Gardner, Bethany T.; Zeringue, Angelique; Strickland, Jaime; Descatha, Alexis; Franzblau, Alfred; Evanoff, Bradley

    2015-01-01

    Background To prospectively evaluate associations between self-reported physical work exposures and incident carpal tunnel syndrome (CTS). Methods Newly employed workers (n=1,107) underwent repeated nerve conduction studies (NCS), and periodic surveys on hand symptoms and physical work exposures including average daily duration of wrist bending, forearm rotation, finger pinching, using vibrating tools, finger/thumb pressing, forceful gripping, and lifting >2 pounds. Multiple logistic regression models examined relationships between peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index. Results 710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTS occurred over 3 year follow-up. All models describing lifting or forceful gripping exposures predicted future CTS. Vibrating tool use was predictive in some models. Conclusions Self-reported exposures showed consistent risks across different exposure models in this prospective study. Workers’ self-reported job demands can provide useful information for targeting work interventions. PMID:25223617

  1. NREL Energy Storage Projects: FY2013 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Pesaran, A.; Ban, C.; Brooker, A.; Gonder, J.; Ireland, J.; Keyser, M.; Kim, G. H.; Long, D.; Neubauer, J.; Santhanagopalan, S.; Smith, K.; Tenent, R.; Wood, E.; Han, T.; Hartridge, S.; Shaffer, C. E.

    2014-07-01

    In FY13, DOE funded NREL to make technical contributions to various R&D activities. This report summarizes NREL's R&D projects in FY13 in support of the USABC; Battery Testing, Analysis, and Design; ABR; and BATT program elements. The FY13 projects under NREL's Energy Storage R&D program are discussed in depth in this report.

  2. Whitestone Poncelet RISEC Project Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Hasz Consulting, LLC; Whitestone Power and Communications; CE2 Engineers

    2011-09-23

    This report covers the development of the Poncelet Kinetics RHK100 Prototype. The work was completed by Hasz Consulting, LLC; CE2 Engineers, LLC; Energetic Drives, LLC; and Applied Power and Control all operating as subcontractors to Whitestone Power and Communications during the year from October 1, 2010 to September 23, 2011. As designed, the prototype is run-of-river instream energy conversion (RISEC) system. The design is principally a three-stage undershot water wheel arranged according to the method of General Poncelet. The power train consists of an epicyclic transmission coupled to a permanent magnet generator. The electronic controls system governs the speed of the wheel and rectifies the power signal to enable the system to be integrated with infinite grid infrastructures, to operate in parallel in finite grid applications with other small power productions sources or to operate in stand-alone mode on demand.

  3. Final Project Report Load Modeling Transmission Research

    Energy Technology Data Exchange (ETDEWEB)

    Lesieutre, Bernard [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bravo, Richard [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Yinger, Robert [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Chassin, Dave [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Huang, Henry [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Lu, Ning [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hiskens, Ian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Venkataramanan, Giri [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-03-31

    The research presented in this report primarily focuses on improving power system load models to better represent their impact on system behavior. The previous standard load model fails to capture the delayed voltage recovery events that are observed in the Southwest and elsewhere. These events are attributed to stalled air conditioner units after a fault. To gain a better understanding of their role in these events and to guide modeling efforts, typical air conditioner units were testing in laboratories. Using data obtained from these extensive tests, new load models were developed to match air conditioner behavior. An air conditioner model is incorporated in the new WECC composite load model. These models are used in dynamic studies of the West and can impact power transfer limits for California. Unit-level and systemlevel solutions are proposed as potential solutions to the delayed voltage recovery problem.

  4. Imperial Valley Environmental Project: progress report

    Energy Technology Data Exchange (ETDEWEB)

    Phelps, P.L.; Anspaugh, L.R. (eds.)

    1977-10-19

    Progress is reported in six areas of research: air quality, water quality, ecosystem quality, subsidence and seismicity, socioeconomic effects, and integrated assessment. A major goal of the air quality element is to evaluate the rate of emission of H/sub 2/S, CO/sub 2/, H/sub 2/, N/sub 2/, CH/sub 4/, and C/sub 2/H/sub 6/ from the operation of the geothermal loop experimental facility at Niland. Concentrations of H/sub 2/S were found to vary between 1500 to 4900 ppM by volume at the Niland facility. To distinguish between geothermal fluids and other waters, extensive sampling networks were established. A major accomplishment was the installation of a high-resolution subsidence-detection network in the Salton Sea geothermal field area, centered on the test facility at Niland. A major effort went into establishing a background of data needed for subsequent impact assessments related to socioeconomic issues raised by geothermal developments. Underway are a set of geothermal energy scenarios that include power development schedules, technology characterizations, and considerations of power-plant-siting criteria. A Gaussian air-pollution model was modified for use in preliminary air-quality assessments. A crop-growth model was developed to evaluate impacts of gases released from geothermal operations on various agricultural crops. Work is also reported on the legal analysis of geothermal legislation and the legal aspects of water-supply utilization. Remote sensing was directed primarily at the Salton Sea, Heber, Brawley, and East Mesa KGRAs. However, large-format photography of the entire Salton Trough was completed. Thermal and multispectral imaging was done for several selected sites in the Salton Sea KGRA. (JGB)

  5. Final Report on Atomic Database Project

    International Nuclear Information System (INIS)

    Yuan, J.; Gui, Z.; Moses, G.A.

    2006-01-01

    Atomic physics in hot dense plasmas is essential for understanding the radiative properties of plasmas either produced terrestrially such as in fusion energy research or in space such as the study of the core of the sun. Various kinds of atomic data are needed for spectrum analysis or for radiation hydrodynamics simulations. There are many atomic databases accessible publicly through the web, such as CHIANTI (an atomic database for spectroscopic diagnostics for astrophysical plasmas) from Naval Research Laboratory [1], collaborative development of TOPbase (The Opacity Project for astrophysically abundant elements) [2], NIST atomic spectra database from NIST [3], TOPS Opacities from Los Alamos National Laboratory [4], etc. Most of these databases are specific to astrophysics, which provide energy levels, oscillator strength f and photoionization cross sections for astrophysical elements ( Z=1-26). There are abundant spectrum data sources for spectral analysis of low Z elements. For opacities used for radiation transport, TOPS Opacities from LANL is the most valuable source. The database provides mixed opacities from element for H (Z=1) to Zn (Z=30) The data in TOPS Opacities is calculated by the code LEDCOP. In the Fusion Technology Institute, we also have developed several different models to calculate atomic data and opacities, such as the detailed term accounting model (DTA) and the unresolved transition array (UTA) model. We use the DTA model for low-Z materials since an enormous number of transitions need to be computed for medium or high-Z materials. For medium and high Z materials, we use the UTA model which simulates the enormous number of transitions by using a single line profile to represent a collection of transition arrays. These models have been implemented in our computing code JATBASE and RSSUTA. For plasma populations, two models are used in JATBASE, one is the local thermodynamic equilibrium (LTE) model and the second is the non-LTE model. For the

  6. An analysis of critical incidents relevant to pediatric anesthesia reported to the UK National Reporting and Learning System, 2006-2008.

    Science.gov (United States)

    MacLennan, Andrew I; Smith, Andrew F

    2011-08-01

    We aimed to identify and analyze critical incidents relating to pediatric anesthesia from the National Reporting and Learning System (NRLS) in England and Wales. Critical incident reporting plays a key role in learning from problems and so enhancing patient safety. There has been no previous analysis of pediatric anesthetic incidents in the NRLS. We obtained potentially relevant records from the UK National Patient Safety Agency. Eligible incidents were classified according to patient age, degree of harm sustained, and clinical category. A total of 606 incidents met the inclusion criteria. Six deaths were reported and 48 incidents resulted in severe harm. In many reports, sufficient detail was lacking for a full understanding of what had happened. However, the broad focus of the NRLS revealed a wide spectrum of clinical and organizational incidents relating to pediatric anesthesia. Medication issues predominated (35.6%), notably inadvertent duplication of dosing in operating theater and ward. Airway/ventilation incidents formed 18.8% of the total, cardiovascular incidents 5.9%, and equipment-related incidents (failure or unavailability) 15.7%. Communication and organizational problems made up 8.6% of reports. We make a number of recommendations for practice. In addition, anesthetists should be encouraged to take ownership and contribute high-quality descriptions of incidents to national systems. © 2010 Blackwell Publishing Ltd.

  7. Reporting Crime Victimizations to the Police and the Incidence of Future Victimizations: A Longitudinal Study.

    Science.gov (United States)

    Ranapurwala, Shabbar I; Berg, Mark T; Casteel, Carri

    2016-01-01

    Law enforcement depends on cooperation from the public and crime victims to protect citizens and maintain public safety; however, many crimes are not reported to police because of fear of repercussions or because the crime is considered trivial. It is unclear how police reporting affects the incidence of future victimization. To evaluate the association between reporting victimization to police and incident future victimization. We conducted a retrospective cohort study using National Crime Victimization Survey 2008-2012 data. Participants were 12+ years old household members who may or may not be victimized, were followed biannually for 3 years, and who completed at least one follow-up survey after their first reported victimization between 2008 and 2012. Crude and adjusted generalized linear mixed regression for survey data with Poisson link were used to compare rates of future victimization. Out of 18,657 eligible participants, 41% participants reported to their initial victimization to police and had a future victimization rate of 42.8/100 person-years (PY) (95% CI: 40.7, 44.8). The future victimization rate of those who did not report to the police (59%) was 55.0/100 PY (95% CI: 53.0, 57.0). The adjusted rate ratio comparing police reporting to not reporting was 0.78 (95%CI: 0.72, 0.84) for all future victimizations, 0.80 (95% CI: 0.72, 0.90) for interpersonal violence, 0.73 (95% CI: 0.68, 0.78) for thefts, and 0.95 (95% CI: 0.84, 1.07) for burglaries. Reporting victimization to police is associated with fewer future victimization, underscoring the importance of police reporting in crime prevention. This association may be attributed to police action and victim services provisions resulting from reporting.

  8. FINAL REPORT FOR THE DIII-D RADIATIVE DIVERTOR PROJECT

    International Nuclear Information System (INIS)

    O'NEIL, RC; STAMBAUGH, RD

    2002-01-01

    OAK A271 FINAL REPORT FOR THE DIII-D RADIATIVE DIVERTOR PROJECT. The Radiative Divertor Project originated in 1993 when the DIII-D Five Year Plan for the period 1994--1998 was prepared. The Project Information Sheet described the objective of the project as ''to demonstrate dispersal of divertor power by a factor of then with sufficient diagnostics and modeling to extend the results to ITER and TPX''. Key divertor components identified were: (1) Carbon-carbon and graphite armor tiles; (2) The divertor structure providing a gas baffle and cooling; and (3) The divertor cryopumps to pump fuel and impurities

  9. Pilot Training Project. Community-Based Criminal Justice Staff Development Project, Final Report.

    Science.gov (United States)

    Massachusetts Residential Programs, Inc., Cambridge.

    This report on the pilot training phase of the Community-Based Criminal Justice Staff Development Project represents an attempt to describe and document project efforts during the months between October, 1975 and June, 1976 with a view toward providing a detailed guide for future implementation of staff development activities for community-based…

  10. Final Project Report; Final Internal Evaluation: PROJECT DESIGN. Interagency Planning for Urban Educational Needs.

    Science.gov (United States)

    Fresno City Unified School District, CA.

    This document contains the final progress report and final internal evaluation for PROJECT DESIGN, funded under ESEA Title III. The first section describes the project's major activities leading to development of a master plan for education in Fresno, California. Significant modifications of operational plans are described and supplementary…

  11. Tritium research laboratory cleanup and transition project final report

    International Nuclear Information System (INIS)

    Johnson, A.J.

    1997-02-01

    This Tritium Research Laboratory Cleanup and Transition Project Final Report provides a high-level summary of this project's multidimensional accomplishments. Throughout this report references are provided for in-depth information concerning the various topical areas. Project related records also offer solutions to many of the technical and or administrative challenges that such a cleanup effort requires. These documents and the experience obtained during this effort are valuable resources to the DOE, which has more than 1200 other process contaminated facilities awaiting cleanup and reapplication or demolition

  12. Reclamation report, Basalt Waste Isolation Project, boreholes 1990

    Energy Technology Data Exchange (ETDEWEB)

    Brandt, C.A.; Rickard, W.H. Jr.; Cadoret, N.A.

    1991-01-01

    The restoration of areas disturbed activities of the Basalt Waste Isolation Project (BWIP) has been undertaken by the US Department of Energy (DOE) in fulfillment of obligations and commitments made under the National Environmental Policy Act and the Nuclear Waste Policy Act. This restoration program comprises three separate projects: borehole reclamation, Near Surface Test Facility reclamation, and Exploratory Shaft Facility reclamation. Detailed descriptions of these reclamation projects may be found in a number of previous reports. This report describes the second phase of the reclamation program for the BWIP boreholes and analyzes its success relative to the reclamation objective. 6 refs., 14 figs., 13 tabs.

  13. Change in Reported Lyme Disease Incidence in the Northeast and Upper Midwest, 1991-2014

    Science.gov (United States)

    This indicator shows how reported Lyme disease incidence has changed by state since 1991, based on the number of new cases per 100,000 people. The total change has been estimated from the average annual rate of change in each state. This map is limited to the 14 states where Lyme disease is most common, where annual rates are consistently above 10 cases per 100,000. Connecticut, New York, and Rhode Island had too much year-to-year variation in reporting practices to allow trend calculation. For more information: www.epa.gov/climatechange/science/indicators

  14. Uranium Mill Tailings Remedial Action Project 1993 Environmental Report

    Energy Technology Data Exchange (ETDEWEB)

    1994-10-01

    This annual report documents the Uranium Mill Tailing Remedial Action (UMTRA) Project environmental monitoring and protection program. The UMTRA Project routinely monitors radiation, radioactive residual materials, and hazardous constituents at associated former uranium tailings processing sites and disposal sites. At the end of 1993, surface remedial action was complete at 10 of the 24 designated UMTRA Project processing sites. In 1993 the UMTRA Project office revised the UMTRA Project Environmental Protection Implementation Plan, as required by the US DOE. Because the UMTRA Project sites are in different stages of remedial action, the breadth of the UMTRA environmental protection program differs from site to site. In general, sites actively undergoing surface remedial action have the most comprehensive environmental programs for sampling media. At sites where surface remedial action is complete and at sites where remedial action has not yet begun, the environmental program consists primarily of surface water and ground water monitoring to support site characterization, baseline risk assessments, or disposal site performance assessments.

  15. Uranium Mill Tailings Remedial Action Project 1993 Environmental Report

    International Nuclear Information System (INIS)

    1994-10-01

    This annual report documents the Uranium Mill Tailing Remedial Action (UMTRA) Project environmental monitoring and protection program. The UMTRA Project routinely monitors radiation, radioactive residual materials, and hazardous constituents at associated former uranium tailings processing sites and disposal sites. At the end of 1993, surface remedial action was complete at 10 of the 24 designated UMTRA Project processing sites. In 1993 the UMTRA Project office revised the UMTRA Project Environmental Protection Implementation Plan, as required by the US DOE. Because the UMTRA Project sites are in different stages of remedial action, the breadth of the UMTRA environmental protection program differs from site to site. In general, sites actively undergoing surface remedial action have the most comprehensive environmental programs for sampling media. At sites where surface remedial action is complete and at sites where remedial action has not yet begun, the environmental program consists primarily of surface water and ground water monitoring to support site characterization, baseline risk assessments, or disposal site performance assessments

  16. Nuclear power plant operating experiences from the IAEA/NEA Incident Reporting System 1999-2002

    International Nuclear Information System (INIS)

    2003-01-01

    Incident reporting has become an increasingly important aspect of the operation and regulation of all public health and safety-related industries. Diverse industries such as aeronautics, chemicals, pharmaceuticals and explosives all depend on operating experience feedback to provide lessons learned about safety. The Incident Reporting System (IRS) is an essential element of the system for feeding back international operating experience for nuclear power plants. IRS reports contain information on events of Safety significance with important lessons learned. These experiences assist in reducing or eliminating recurrence of events at other plants. The IRS is jointly operated and managed by the Nuclear Energy Agency (NEA), a semi-autonomous body within the Organisation for Economic Co-operation and Development (OECD), and the International Atomic Energy Agency (IAEA). It is important that sufficient national resources be allocated to enable timely and high quality reporting of events important to safety, and to share these events in the IRS database. The first report, which covered the period July 1996 - June 1999, was widely acclaimed and encouraged both agencies to prepare this second report in order to highlight important lessons learned from around 300 events reported to the IRS for the period July 1999 - December 2002. Several areas were selected in this report to show the range of important topics available in the IRS. These include different types of failure in a variety of plant systems, as well as human performance considerations. This report is primarily aimed at senior officials in industry and government who have decision-making roles in the nuclear power industry

  17. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Directory of Open Access Journals (Sweden)

    Tariq Amina

    2012-11-01

    Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

  18. Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)

    Energy Technology Data Exchange (ETDEWEB)

    Kwoen, Young Teck; Han, Sung Il; Chung, Soo Kyo; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

    1988-10-15

    Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

  19. Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)

    International Nuclear Information System (INIS)

    Kwoen, Young Teck; Han, Sung Il; Chung, Soo Kyo; Bahk, Yong Whee

    1988-01-01

    Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

  20. Nuclear medicine incident reporting in Australia: control charts and notification rates inform quality improvement.

    Science.gov (United States)

    Larcos, G; Collins, L T; Georgiou, A; Westbrook, J I

    2015-06-01

    Australia has a statutory incident reporting system for radiopharmaceutical maladministrations, but additional research into registry data is required for the purpose of quality improvement in nuclear medicine. We (i) used control charts to identify factors contributing to special cause variation (indicating higher than expected rates) in maladministrations and (ii) evaluated the impact of heterogeneous notification criteria and extent of underreporting among jurisdictions and individual facilities, respectively. Anonymised summaries of Australian Radiation Incident Register reports permitted calculation of national monthly maladministration notification rates for 2007-2012 and preparation of control charts. Multivariate logistic regression assessed the association of population, insurance and regulatory characteristics with maladministration notifications in each Australian State and Territory. Maladministration notification rates from two facilities with familiarity of notification processes and commitment to radiation protection were compared with those elsewhere. Special cause variation occurred in only 3 months, but contributed to 21% of all incidents (42 of 197 patients), mainly because of 'clusters' of maladministrations (n = 24) arising from errors in bulk radiopharmaceutical dispensing. Maladministration notification rates varied significantly between jurisdictions (0 to 12.2 maladministrations per 100 000 procedures (P < 0.05)) and individual facilities (31.7 vs 5.8 per 100 000; χ(2) = 40; 1 degree of freedom, P < 0.001). Unexpected increases in maladministration notifications predominantly relate to incident 'clusters' affecting multiple patients. The bulk preparation of radiopharmaceuticals is a vulnerable process and merits additional safeguards. Maladministration notification rates in Australia are heterogeneous. Adopting uniform maladministration notification criteria among States and Territories and methods to overcome underreporting are

  1. A Country Report Project for an International Economics Class.

    Science.gov (United States)

    Abdalla, Adil E. A.

    1993-01-01

    Asserts that international economics textbooks pay too little attention to the complexity of issues and problems facing individual nations. Describes a country report project included as part of a college-level international or development economics course. Provides two student instruction sheets and a sample country report. (CFR)

  2. Recommendations for Nuclear Medicine Technologists Drawn from an Analysis of Errors Reported in Australian Radiation Incident Registers.

    Science.gov (United States)

    Kearney, Nicole; Denham, Gary

    2016-12-01

    When a radiation incident occurs in nuclear medicine in Australia, the incident is reported to the relevant state or territory authority, which performs an investigation and sends its findings to the Australian Radiation Protection and Nuclear Safety Agency. The agency then includes these data in its Australian Radiation Incident Register and makes them available to the public as an annual summary report on its website. The aim of this study was to analyze the radiation incidents included in these annual reports and in the publically available state and territory registers, identify any recurring themes, and make recommendations to minimize future incidents. A multidisciplinary team comprising a nuclear medicine technologist, a radiation therapist, and a diagnostic radiographer analyzed all nuclear medicine technology-, radiation therapy-, and diagnostic radiography-related incidents recorded in the Australian Radiation Incident Register and in the registers of New South Wales, Western Australia, Victoria, South Australia, and Tasmania between 2003 and 2015. Each incident was placed into 1 of 18 categories, and each category was examined to determine any recurring causes of the incidents. We analyzed 209 nuclear medicine incidents. Their primary cause was failure to comply with time-out protocols (85.6%). By analyzing both the causes and the rates of radiation incidents, we were able to recommend ways to help prevent them from being repeated. Information drawn from the Australian Radiation Incident Register and 5 state registers has revealed steps that can be taken by any nuclear medicine department to prevent repetition of the incidents that have already occurred. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  3. The New Mexico Technology Deployment Pilot Project: A technology reinvestment project. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The New Mexico Technology Deployment Project (NMTDP) has been in operation for slightly more than two years. As one of the original TRP projects, NMTDP had the charter to develop and validate a new model for technology extraction which emphasized focused technology collaboration, early industry involvement, and a strong dual use commercialization and productization emphasis. Taken in total, the first two years of the NMTDP have been exceptionally successful, surpassing the goals of the project. This report describes the accomplishments and evolution of the NMTDP to date and discusses the future potential of the project. Despite the end of federal funding, and a subsequent reduction in level of effort, the project partners are committed to continuation of the project.

  4. Uranium Mill Tailings Remedial Action Project. 1995 Environmental Report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-01

    In accordance with U.S. Department of Energy (DOE) Order 23 1. 1, Environment, Safety and Health Reporting, the DOE prepares an annual report to document the activities of the Uranium Mill Tailings Remedial Action (UMTRA) Project environmental monitoring program. This monitoring must comply with appropriate laws, regulations, and standards, and it must identify apparent and meaningful trends in monitoring results. The results of all monitoring activities must be communicated to the public. The UMTRA Project has prepared annual environmental reports to the public since 1989.

  5. Uranium Mill Tailings Remedial Action Project. 1995 Environmental Report

    International Nuclear Information System (INIS)

    1996-06-01

    In accordance with U.S. Department of Energy (DOE) Order 23 1. 1, Environment, Safety and Health Reporting, the DOE prepares an annual report to document the activities of the Uranium Mill Tailings Remedial Action (UMTRA) Project environmental monitoring program. This monitoring must comply with appropriate laws, regulations, and standards, and it must identify apparent and meaningful trends in monitoring results. The results of all monitoring activities must be communicated to the public. The UMTRA Project has prepared annual environmental reports to the public since 1989

  6. EUB post-incident report : Celtic Exploration Ltd. well servicing incident : blowout and fire, August 9, 2005

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-02-06

    A blowout and fire occurred on August 9, 2005 at a sour oil well during a routine well completion operation. The Alberta Energy and Utilities Board (EUB) was notified by Celtic Exploration Ltd., the well operator which implemented the emergency response plan (ERP). The 21 residents in the area were evacuated along with 100 campers from a nearby provincial park. The release concentration of hydrogen sulphide from the well was 4.5 moles/kilomole. The well was brought under control the next day by pumping calcium chloride water down the well. The evacuees were allowed to return. One fatality and 2 injuries were sustained by workers at the site and the service rig was destroyed by fire. Celtic assessed the incident as an uncontrollable event. The EUB conducted an investigation that focused on the cause of the incident, the risk to public safety, environmental impacts, and the conservation of the resource. The worker fatalities and injuries are being investigated by the Alberta Human Resources and Employment, Workplace Health and Safety. It was determined that the blowout was caused by an explosion within the swab tree assembly at the top of the well. An explosive situation was created when a mix of hydrocarbons and air was ignited. However, the source of ignition could not be definitively determined. The EUB also assessed the implementation of Celtic's ERP and the actions taken to manage the incident. The EUB determined that while several ERP measures were managed appropriately, some specific elements were deficient, particularly communication during the incident. About 228 cubic metres of contaminated soil was removed from the well lease to a waste site. The total production loss is estimated at 4 m{sup 3} of oil and 12,000 m{sup 3} of raw solution gas. Four follow-up actions that Celtic has committed to were described along with the EUB's directive 033 regarding well servicing and completions operations and requirements regarding the potential for explosive

  7. Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study.

    Science.gov (United States)

    Ahmadi-Abhari, Sara; Guzman-Castillo, Maria; Bandosz, Piotr; Shipley, Martin J; Muniz-Terrera, Graciela; Singh-Manoux, Archana; Kivimäki, Mika; Steptoe, Andrew; Capewell, Simon; O'Flaherty, Martin; Brunner, Eric J

    2017-07-05

    interval 735 000 to 797 000) people with dementia in England and Wales in 2016. Despite the decrease in incidence and age specific prevalence, the number of people with dementia is projected to increase to 872 000, 1 092 000, and 1 205 000 in 2020, 2030, and 2040, respectively. A sensitivity analysis without the incidence decline gave a much larger projected growth, of more than 1.9 million people with dementia in 2040. Conclusions  Age specific dementia incidence is declining. The number of people with dementia in England and Wales is likely to increase by 57% from 2016 to 2040. This increase is mainly driven by improved life expectancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS: relevance and structure

    Directory of Open Access Journals (Sweden)

    Wangler Martin

    2011-04-01

    Full Text Available Abstract Background In 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU and the European Academy of Chiropractic (EAC involved in the European Committee for Standardization (CEN process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations. Objective To introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems. Discussion Providing health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care. Conclusions Before a reporting and learning system can be established it has to be clear

  9. Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: The SUN project.

    Science.gov (United States)

    Pimenta, Adriano M; Toledo, Estefanía; Rodriguez-Diez, Maria C; Gea, Alfredo; Lopez-Iracheta, Roberto; Shivappa, Nitin; Hébert, James R; Martinez-Gonzalez, Miguel A

    2015-06-01

    We prospectively assessed the association between adherence to several a priori defined healthy food patterns and risk of metabolic syndrome (MetS). We assessed 6851 participants of a Spanish dynamic prospective cohort of university graduates, initially free of any MetS-specific definition criteria, and followed-up for a median of 8.3 years. We calculated the adherence to thirteen different a priori defined food patterns or dietary indexes. MetS was classified according to the updated harmonizing criteria. We estimated multivariable-adjusted Incidence Rate Ratios (IRR) of metabolic syndrome and their 95% Confidence Intervals (95% CI), using Poisson regression models. The cumulative incidence of MetS was 5.0%. Moderate adherence to the Pro-Vegetarian Diet (PVEG) was significantly associated with a lower risk for developing MetS (IRR = 0.75, 95% CI = 0.59-0.97). Among women, an inverse association with the PVEG was significant not only for a moderate adherence (IRR = 0.54, 95% CI = 0.36-0.82), but also for higher adherence (IRR = 0.63, 95% CI = 0.43-0.93). A higher adherence to the Dietary Approaches to Stop Hypertension (DASH) diet showed an inverse association with the MetS among participants, but only if they had low alcohol intake (RR = 0.41, 95% CI = 0.20-0.85). Our findings support the adoption of a PVEG dietary pattern for the reduction of MetS risk. The same statement can be applied in relation to the DASH diet, insofar a limited consumption of alcoholic beverages is also maintained. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project.

    Science.gov (United States)

    Noguchi, Naomi; Chan, Lewis; Cumming, Robert G; Blyth, Fiona M; Handelsman, David J; Seibel, Markus J; Waite, Louise M; Le Couteur, David G; Naganathan, Vasi

    2016-12-01

    We sought to determine which lower urinary tract symptoms are associated with incident falls in community dwelling older men. The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS subscores were calculated for storage and voiding symptoms. Incident falls in 1 year were determined by telephone followup every 4 months. I-PSS storage and voiding subscores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage subscores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, trials to treat lower urinary tract symptoms in older men should include falls as an end point. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010-2012.

    Science.gov (United States)

    Donaldson, Liam J; Panesar, Sukhmeet S; Darzi, Ara

    2014-06-01

    Hospital mortality is increasingly being regarded as a key indicator of patient safety, yet methodologies for assessing mortality are frequently contested and seldom point directly to areas of risk and solutions. The aim of our study was to classify reports of deaths due to unsafe care into broad areas of systemic failure capable of being addressed by stronger policies, procedures, and practices. The deaths were reported to a patient safety incident reporting system after mandatory reporting of such incidents was introduced. The UK National Health Service database was searched for incidents resulting in a reported death of an adult over the period of the study. The study population comprised 2,010 incidents involving patients aged 16 y and over in acute hospital settings. Each incident report was reviewed by two of the authors, and, by scrutinising the structured information together with the free text, a main reason for the harm was identified and recorded as one of 18 incident types. These incident types were then aggregated into six areas of apparent systemic failure: mismanagement of deterioration (35%), failure of prevention (26%), deficient checking and oversight (11%), dysfunctional patient flow (10%), equipment-related errors (6%), and other (12%). The most common incident types were failure to act on or recognise deterioration (23%), inpatient falls (10%), healthcare-associated infections (10%), unexpected per-operative death (6%), and poor or inadequate handover (5%). Analysis of these 2,010 fatal incidents reveals patterns of issues that point to actionable areas for improvement. Our approach demonstrates the potential utility of patient safety incident reports in identifying areas of service failure and highlights opportunities for corrective action to save lives.

  12. Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010-2012.

    Directory of Open Access Journals (Sweden)

    Liam J Donaldson

    2014-06-01

    Full Text Available BACKGROUND: Hospital mortality is increasingly being regarded as a key indicator of patient safety, yet methodologies for assessing mortality are frequently contested and seldom point directly to areas of risk and solutions. The aim of our study was to classify reports of deaths due to unsafe care into broad areas of systemic failure capable of being addressed by stronger policies, procedures, and practices. The deaths were reported to a patient safety incident reporting system after mandatory reporting of such incidents was introduced. METHODS AND FINDINGS: The UK National Health Service database was searched for incidents resulting in a reported death of an adult over the period of the study. The study population comprised 2,010 incidents involving patients aged 16 y and over in acute hospital settings. Each incident report was reviewed by two of the authors, and, by scrutinising the structured information together with the free text, a main reason for the harm was identified and recorded as one of 18 incident types. These incident types were then aggregated into six areas of apparent systemic failure: mismanagement of deterioration (35%, failure of prevention (26%, deficient checking and oversight (11%, dysfunctional patient flow (10%, equipment-related errors (6%, and other (12%. The most common incident types were failure to act on or recognise deterioration (23%, inpatient falls (10%, healthcare-associated infections (10%, unexpected per-operative death (6%, and poor or inadequate handover (5%. Analysis of these 2,010 fatal incidents reveals patterns of issues that point to actionable areas for improvement. CONCLUSIONS: Our approach demonstrates the potential utility of patient safety incident reports in identifying areas of service failure and highlights opportunities for corrective action to save lives.

  13. Crystalline Repository Project. Technical progress report, October 1982-March 1983

    International Nuclear Information System (INIS)

    1985-01-01

    This document reports the progress being made periodically on the development of a geologic repository in crystalline rock for the permanent disposal of high-level nuclear waste. The reporting elements are arranged by the work breakdown structure so that related studies are presented together. The studies are reported by the Office of Crystalline Respository Development (OCRD), a prime contractor of the US Department of Energy Repository Project Office. The studies include work by other prime contractors and by subcontractors to OCRD

  14. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

    2017-02-01

    Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Pesticide exposure and self-reported incident depression among wives in the Agricultural Health Study.

    Science.gov (United States)

    Beard, John D; Hoppin, Jane A; Richards, Marie; Alavanja, Michael C R; Blair, Aaron; Sandler, Dale P; Kamel, Freya

    2013-10-01

    Depression in women is a public health problem. Studies have reported positive associations between pesticides and depression, but few studies were prospective or presented results for women separately. We evaluated associations between pesticide exposure and incident depression among farmers' wives in the Agricultural Health Study, a prospective cohort study in Iowa and North Carolina. We used data on 16,893 wives who did not report physician-diagnosed depression at enrollment (1993-1997) and who completed a follow-up telephone interview (2005-2010). Among these wives, 1054 reported physician diagnoses of depression at follow-up. We collected information on potential confounders and on ever use of any pesticide, 11 functional and chemical classes of pesticides, and 50 specific pesticides by wives and their husbands via self-administered questionnaires at enrollment. We used inverse probability weighting to adjust for potential confounders and to account for possible selection bias induced by the death or loss of 10,639 wives during follow-up. We used log-binomial regression models to estimate risk ratios and 95% confidence intervals. After weighting for age at enrollment, state of residence, education level, diabetes diagnosis, and drop out, wives' incident depression was positively associated with diagnosed pesticide poisoning, but was not associated with ever using any pesticide. Use of individual pesticides or functional or chemical classes of pesticides was generally not associated with wives' depression. Among wives who never used pesticides, husbands' ever use of individual pesticides or functional or chemical classes of pesticides was generally not associated with wives' incident depression. Our study adds further evidence that high level pesticide exposure, such as pesticide poisoning, is associated with increased risk of depression and sets a lower bound on the level of exposure related to depression, thereby providing reassurance that the moderate levels

  16. Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data.

    Directory of Open Access Journals (Sweden)

    Ann-Marie Howell

    Full Text Available The National Reporting and Learning System (NRLS collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems.This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure.5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27, p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55, p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80 p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23, p = 0.03]. Litigation claims per bed were

  17. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

  18. Austin Children`s Museum ``Go Power`` project. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1993-10-01

    Go Power, was conceived as an interactive exhibit and related set of activities designed to promote in children and families an understanding and appreciation of energy concepts. Planned in 1990, the project culminated its first phase of activities with colorful, interactive exhibit about the pathways and transformations of energy, on display at the Austin Children`s Museum between February 5th and June 6th, 1993. The project was supported by the US Department of Energy, the National Science Foundation, the Lower Colorado River Authority and various local foundations and businesses. This report describes the process, product and outcomes of this project.

  19. Iowa Hill Pumped Storage Project Investigations - Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, David [Sacramento Municipal Unitlity District, Sacramento, CA (United States)

    2016-07-01

    This Final Technical Report is a summary of the activities and outcome of the Department of Energy (DOE) Assistance Agreement DE-EE0005414 with the Sacramento Municipal Utility District (SMUD). The Assistance Agreement was created in 2012 to support investigations into the Iowa Hill Pumped-storage Project (Project), a new development that would add an additional 400 MW of capacity to SMUD’s existing 688MW Upper American River Hydroelectric Project (UARP) in the Sierra Nevada mountains east of Sacramento, California.

  20. Report of the State of Nevada Commission on Nuclear Projects

    International Nuclear Information System (INIS)

    1990-12-01

    This third biennial Report of the Nevada Commission on Nuclear Projects has been prepared in fulfillment of the requirements of NRS 459.0092, which stipulates that the Commission shall report to the Governor and Legislature on any matter relating to radioactive waste disposal the Commission deems appropriate and advise and make recommendations on the policy of the State concerning nuclear waste disposal projects. Chapter One of the Report presents a brief overview of the Commission's functions and statutory charges. It also contains a summary of developments which have affected the overall nuclear waste disposl issue since the last Commission Report was published in November, 1988. Chapter Two contains a synthesis of Commission activities and reports on the findings of the Commission relative to the geotechnical, environmental, socioeconomic, transportation, intergovernmental and legal aspects of federal and State nuclear waste program efforts

  1. Report of the State of Nevada Commission on Nuclear Projects

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1990-12-01

    This third biennial Report of the Nevada Commission on Nuclear Projects has been prepared in fulfillment of the requirements of NRS 459.0092, which stipulates that the Commission shall report to the Governor and Legislature on any matter relating to radioactive waste disposal the Commission deems appropriate and advise and make recommendations on the policy of the State concerning nuclear waste disposal projects. Chapter One of the Report presents a brief overview of the Commission`s functions and statutory charges. It also contains a summary of developments which have affected the overall nuclear waste disposl issue since the last Commission Report was published in November, 1988. Chapter Two contains a synthesis of Commission activities and reports on the findings of the Commission relative to the geotechnical, environmental, socioeconomic, transportation, intergovernmental and legal aspects of federal and State nuclear waste program efforts.

  2. Aquatic Species Project report, FY 1989--1990

    Energy Technology Data Exchange (ETDEWEB)

    Brown, L.M.; Sprague, S.

    1992-01-01

    This report summarizes the progress and research accomplishments of the Aquatic Species Project. The four articles included are summaries of individual research projects and are entered into the EDB as such. The goal of the Aquatic Species Project is to develop the technology base for large-scale production of oil-rich microalgae. The project is also developing methods to convert the microalgal lipids into liquid fuels needed for industry and transportation. Researchers in the Aquatics Species Project focus on the use of microalgae as a feedstock for producing renewable, high-energy liquid fuels such as diesel. It is important for the United States to develop alternative renewable oil sources because 42% of the current energy market in the United States is for liquid fuels, and 38% of these fuels are imported. In 1979, the US Department of Energy (DOE) and the National Renewable Energy Laboratory (NREL) initiated the Aquatic Species Project as part of the overall effort in biofuels. The project began to focus exclusively on fuels from microalgae in 1982. Estimates show that the technology being developed by the project can provide as much as 7% of the total current energy demand. The program`s basic premise is that microalgae, which have been called the most productive biochemical factories in the world, can produce up to 30 times more oil per unit of growth area than land plants. Selected papers were processed separately for inclusion in the Energy Science and Technology Database.

  3. Marine radioecology. Annual report 1996. Project plan 1997

    International Nuclear Information System (INIS)

    1997-06-01

    The project plan for the EKO-1 project states that 'the main aim of the EKO-1 project is to enable faster and better assessments to be made of the effects of releases of radionuclides into the marine environment'. To meet this goal the main parts of the project were defined as follows: Model work - Identifying parameters of main interest including estimating and validating the values of these parameters; Research - Field studies, environments typical for various Nordic regions, environments with special physical or chemical characteristics. Laboratory studies; Dissemination of information - Seminars, reports, articles. During the project period emphasis has also been put on quality issues concerning sampling and analysis. The project work has progressed in accordance with project plans in 1996 and within the set budget. In modelling a parameter sensitivity analysis was carried out for a radiological assessment model used for the prediction of doses to man from dumping of radioactive waste in the Kara Sea. Doses to man were found to be generally dominated by contributions from long-lived transuranic radionuclides (plutonium and americium) which associate readily with sediments. Sediment related processes and parameters show therefore high sensitivities, especially at long distances (e.g. Barents Sea). Within the EKO-1 project there has been emphasis on encouraging the Nordic aspect of sediment research in spite of the limitations set by nationally run sampling projects. The EKO-1 project has managed this by e.g.: Organizing exchange of samples for analysis links with the EKO-2.3 project ('Limnic systems'). (EG) 52 refs

  4. [Preliminary results of an anonymous internet-based reporting system for critical incidents in ambulatory primary care].

    Science.gov (United States)

    Brun, A

    2005-03-01

    To learn from errors is not always easy, especially if they happened to others! This paper describes the organization and management of a critical incident reporting system for primary care physicians in Switzerland and reports about the difficulties and experiences during the first 18 months since the start of the program. It seems to be particularly difficult to enhance the attentiveness of physicians for apparently harmless daily critical incidents and to motivate them to report it even in an anonymous reporting system. As incentives for more intensive participation there are the hope for comments on reported cases by other participants and the expectation that reported errors will be avoided by the readers.

  5. Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Bouras, George; Donaldson, Liam J; Athanasiou, Thanos; Darzi, Ara

    2015-01-01

    The National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems. This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure. 5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), preport death than other staff [OR 3.04(95%CI: 2.43 to 3.80) preported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were significantly negatively associated with incident reports. Patient satisfaction and mortality outcomes were not significantly associated with reporting rates. Staff survey responses revealed that keeping reports confidential, keeping staff informed about

  6. Final Reclamation Report: Basalt Waste Isolation Project exploratory shaft site

    Energy Technology Data Exchange (ETDEWEB)

    Brandt, C.A.; Rickard, W.H. Jr.

    1990-06-01

    The restoration of areas disturbed by activities of the Basalt Waste Isolation Project (BWIP) constitutes a unique operation at the US Department of Energy's (DOE) Hanford Site, both from the standpoint of restoration objectives and the time frame for accomplishing these objectives. The BWIP reclamation program comprises three separate projects: borehole reclamation, Near Surface Test Facility (NSTF) reclamation, and Exploratory Shaft Facility (ESF) reclamation. The main focus of this report is on determining the success of the revegetation effort 1 year after work was completed. This report also provides a brief overview of the ESF reclamation program. 21 refs., 7 figs., 14 tabs.

  7. Budget Period 1 Summary Report: Hywind Maine Project

    Energy Technology Data Exchange (ETDEWEB)

    Keiser, Meagan [Statoil, Stavanger (Norway)

    2014-02-28

    In accordance with the Statement of Project Objectives (SOPO) agreed to between the Department of Energy (“DOE”) and Statoil for the Hywind Maine project, Statoil hereby submits a Budget Period 1 Summary Report which includes accomplishments for the project. The report includes summaries of the other submitted reports (see Section 1.2-2) and progress regarding innovations leading to potential reductions in the Cost of Energy (see Section 3). The Hywind Demo project, the world’s first full-scale 2.3 megawatts (MW) floating wind turbine, installed at a water depth of 200 meter (m), 10 kilometer (km) off the coast of Norway, has proven that the Hywind floating substructure is a suitable platform for conventional multi- MW turbines. A principal goal of the Hywind Maine Project was to leverage that experience, both to demonstrate the commercial feasibility of the technology and to further develop and optimize the technology all in order to bring the costs down in a larger scale development. With the Hywind Maine Project, Statoil planned to deploy four turbines of 3 MW in approximately 140 meters water depth. Although the project in Maine will not move forward, much value was gained through the BP1 work package. Advanced modeling related to the design basis, which will have applicability beyond the Maine project, was completed. In addition, initial supply chain analyses were conducted, which will help assist with development of updated cost of energy models. Geophysical and various environmental surveys were also conducted, the results of which Statoil has committed to share publicly, and which will help build a database of information that future developers may be able to access. Finally, Statoil gained a greater understanding of the US offshore wind industry and related markets, which will assist the company as it looks for full-scale, commercial opportunities.

  8. Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports.

    Science.gov (United States)

    Magrabi, Farah; Liaw, Siaw Teng; Arachi, Diana; Runciman, William; Coiera, Enrico; Kidd, Michael R

    2016-11-01

    To identify the categories of problems with information technology (IT), which affect patient safety in general practice. General practitioners (GPs) reported incidents online or by telephone between May 2012 and November 2013. Incidents were reviewed against an existing classification for problems associated with IT and the clinical process impacted. 87 GPs across Australia. Types of problems, consequences and clinical processes. GPs reported 90 incidents involving IT which had an observable impact on the delivery of care, including actual patient harm as well as near miss events. Practice systems and medications were the most affected clinical processes. Problems with IT disrupted clinical workflow, wasted time and caused frustration. Issues with user interfaces, routine updates to software packages and drug databases, and the migration of records from one package to another generated clinical errors that were unique to IT; some could affect many patients at once. Human factors issues gave rise to some errors that have always existed with paper records but are more likely to occur and cause harm with IT. Such errors were linked to slips in concentration, multitasking, distractions and interruptions. Problems with patient identification and hybrid records generated errors that were in principle no different to paper records. Problems associated with IT include perennial risks with paper records, but additional disruptions in workflow and hazards for patients unique to IT, occasionally affecting multiple patients. Surveillance for such hazards may have general utility, but particularly in the context of migrating historical records to new systems and software updates to existing systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Ceramic Technology Project data base: September 1992 summary report

    Energy Technology Data Exchange (ETDEWEB)

    Keyes, B.L.P.

    1993-06-01

    Data presented in this report represent an intense effort to improve processing methods, testing methods, and general mechanical properties (rupture modulus, tensile, creep, stress-rupture, dynamic and cyclic fatigue, fracture toughness) of candidate ceramics for use in advanced heat engines. This work was performed by many facilities and represents only a small part of the data generated by the Ceramic Technology Project (CTP) since 1986. Materials discussed include GTE PY6, GN-10, NT-154, NT-164, SN-260, SN-251, SN-252, AY6, silicon nitride combined with rare-earth oxides, Y-TZP, ZTA, NC-433, NT-230, Hexoloy SA, MgO-PSZ-to-MgO-PSZ joints, MgO-PSZ-to-cast iron, and a few whisker/fiber-reinforced ceramics. Information in this report was taken from the project`s semiannual and bimonthly progress reports and from final reports summarizing the results of individual studies. Test results are presented in tabular form and in graphs. All data, including test rig descriptions and material characterizations, are stored in the CTP data base and are available to all project participants on request. The objective of this report is to make available the test results from these studies but not to draw conclusions from those data.

  10. Trustworthy information sharing for biosecurity incident management - The AU2EU project

    Science.gov (United States)

    Zic, John

    2013-10-01

    Managing sensitive information between partners collaborating to address an exotic disease outbreak is crucial in preserving the medical, economic and social well-being of the affected population (whether it is human, animal or plant). Further, the ability to respond quickly to the outbreak by providing real-time, interactive access to shared (collaborative) information will minimise the impact of an outbreak. The sharing of information must be done carefully, with agreement between the partners and enforced by specific protocols. This paper presents an overview of a new joint project between EU partners and AU partners, total value of around €8.64 million, which is examining the issue of authentication and authorisation required to ensure that collaborative information in such situations is kept within the control of the collaborating partners and that accidental (or deliberate) release to unauthorised partners can be mitigated.

  11. The United States Department of Energy (DOE) Computerized Accident/Incident Reporting System (CAIRS)

    International Nuclear Information System (INIS)

    Briscoe, G.J.

    1993-01-01

    The Department of Energy's (DOE) Computerized Accident/Incident Reporting System (CAIRS) is a comprehensive data base containing more than 50,000 investigation reports of injury/illness, property damage and vehicle accident cases representing safety data from 1975 to the present for more than 150 DOE contractor organizations. A special feature is that the text of each accident report is translated using a controlled dictionary and rigid sentence structure called Factor Relationship and Sequence of Events (FRASE) that enhances the ability to retrieve specific types of information and to perform detailed analyses. DOE summary and individual contractor reports are prepared quarterly and annually. In addition, ''Safety Performance Profile'' reports for individual organizations are prepared to provide advance information to appraisal teams, and special topical reports are prepared for areas of concern such as an increase in the number of security injuries or environmental releases. The data base is open to all DOE and Contractor registered users with no access restrictions other than that required by the Privacy Act

  12. Prevalence and Incidence of Epilepsy Associated with Convulsive Seizures in Rural Bolivia. A Global Campaign against Epilepsy Project

    Science.gov (United States)

    Crespo Gómes, Elizabeth Blanca; Sofia, Vito; Padilla, Sandra; Camargo, Mario; Zappia, Mario; Bartoloni, Alessandro; Nicoletti, Alessandra

    2015-01-01

    Objective we performed a three-stages door-to-door survey to estimate incidence and prevalence of epilepsy associated with convulsive seizures (EACS) in a rural area of Bolivia. Methods the study was carried out in the Cordillera Province, southern-eastern Bolivia. One hundred fourteen rural communities with a total population of 18,907 inhabitants were included in the survey. In order to identify subjects with EACS, trained fieldworkers administered a validated single screening question to the householders (stage I). A second face-to-face questionnaire was administered to each positive subject (stage II) that, in case of positive answer, underwent a complete neurological examination to confirm the diagnosis (stage III). We estimated age and sex specific life-time and active EACS prevalence at the prevalence day (30th June 2010). Incidence risk was evaluated for the 10-year period between January 2000 and December 2010. Results on prevalence day we identified 136 subjects with EACS, 124 of whom had active epilepsy. The life-time prevalence of EACS was 7.2/1,000 (7.6/1,000 age-adjusted to the world standard population) while the prevalence of active EACS was 6.6/1,000 (6.7/1,000 age-adjusted to the world standard population). Both life-time and active prevalence showed a peak (10.3/1,000) in the 15–24 years age group and, overall, were higher among women. During the incidence study period, 105 patients living in the study area had the onset of EACS. The crude incidence risk was 55.4/100,000 (49.5/100,000 age-adjusted to the world standard population). Incidence was slightly but not significantly higher among women (58.9/100,000 versus 51.9/100,000). Conclusions the present study demonstrated a considerable burden of EACS in the Bolivian Chaco, showing prevalence and incidence estimates close to those reported for low and middle- income countries and underlying the need of treatment programs. PMID:26427017

  13. Prevalence and Incidence of Epilepsy Associated with Convulsive Seizures in Rural Bolivia. A Global Campaign against Epilepsy Project.

    Science.gov (United States)

    Bruno, Elisa; Quattrocchi, Graziella; Crespo Gómes, Elizabeth Blanca; Sofia, Vito; Padilla, Sandra; Camargo, Mario; Zappia, Mario; Bartoloni, Alessandro; Nicoletti, Alessandra

    2015-01-01

    we performed a three-stages door-to-door survey to estimate incidence and prevalence of epilepsy associated with convulsive seizures (EACS) in a rural area of Bolivia. the study was carried out in the Cordillera Province, southern-eastern Bolivia. One hundred fourteen rural communities with a total population of 18,907 inhabitants were included in the survey. In order to identify subjects with EACS, trained fieldworkers administered a validated single screening question to the householders (stage I). A second face-to-face questionnaire was administered to each positive subject (stage II) that, in case of positive answer, underwent a complete neurological examination to confirm the diagnosis (stage III). We estimated age and sex specific life-time and active EACS prevalence at the prevalence day (30th June 2010). Incidence risk was evaluated for the 10-year period between January 2000 and December 2010. on prevalence day we identified 136 subjects with EACS, 124 of whom had active epilepsy. The life-time prevalence of EACS was 7.2/1,000 (7.6/1,000 age-adjusted to the world standard population) while the prevalence of active EACS was 6.6/1,000 (6.7/1,000 age-adjusted to the world standard population). Both life-time and active prevalence showed a peak (10.3/1,000) in the 15-24 years age group and, overall, were higher among women. During the incidence study period, 105 patients living in the study area had the onset of EACS. The crude incidence risk was 55.4/100,000 (49.5/100,000 age-adjusted to the world standard population). Incidence was slightly but not significantly higher among women (58.9/100,000 versus 51.9/100,000). the present study demonstrated a considerable burden of EACS in the Bolivian Chaco, showing prevalence and incidence estimates close to those reported for low and middle- income countries and underlying the need of treatment programs.

  14. Investigation and evaluation of cracking incidents in piping in pressurized water reactors. Technical report

    International Nuclear Information System (INIS)

    1980-09-01

    This report summarizes an investigation of known cracking incidents in pressurized water reactor plants. Several instances of cracking in feedwater piping in 1979, together with reported cases of stress corrosion cracking at Three Mile Island Unit 1, led to the establishment of the third Pipe Crack Study Group. Major differences between the scope of the third PCSG and the previous two are: (1) the emphasis given to systems safety implications of cracking, and (2) the consideration given all cracking mechanisms known to affect PWR piping, including the failure of small lines in secondary safety systems. The present PCSG reviewed existing information on cracking of PWR pipe systems, either contained in written records of collected from meetings in the United States, and made recommendations in response to the PCSG charter questions and to othe major items that may be considered to either reduce the potential for cracking or to improve licensing bases

  15. Proposed OPEG Namakan River hydro development project draft environmental report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    The Ojibway Power and Energy Group (OPEG) is planning on installing a hydroelectric generating facility along the Namakan River at High Falls in Canada. In order the meet the different requirements in terms of environmental assessment for such a project, the group prepared an environmental report. The aim of this paper is to present the comments of the Quetico Foundation, a charity whose aim is to protect wilderness class parks. The foundation found both general and discipline-by-discipline deficiencies in OPEG's environmental report. All the deficiencies the Foundation observed are listed in this report, general deficiencies, and specific deficiencies concerning fisheries, terrestrial ecology, hydrology and socio-economic impacts. The Quetico Foundation demonstrated that a significant number of deficiencies are found in the OPEG environmental report, suggesting that they did not fully understand the potential long term impacts of their project and that further study should be undertaken.

  16. Risk factors and short-term projections for serotype-1 poliomyelitis incidence in Pakistan: A spatiotemporal analysis.

    Directory of Open Access Journals (Sweden)

    Natalie A Molodecky

    2017-06-01

    Full Text Available Pakistan currently provides a substantial challenge to global polio eradication, having contributed to 73% of reported poliomyelitis in 2015 and 54% in 2016. A better understanding of the risk factors and movement patterns that contribute to poliovirus transmission across Pakistan would support evidence-based planning for mass vaccination campaigns.We fit mixed-effects logistic regression models to routine surveillance data recording the presence of poliomyelitis associated with wild-type 1 poliovirus in districts of Pakistan over 6-month intervals between 2010 to 2016. To accurately capture the force of infection (FOI between districts, we compared 6 models of population movement (adjacency, gravity, radiation, radiation based on population density, radiation based on travel times, and mobile-phone based. We used the best-fitting model (based on the Akaike Information Criterion [AIC] to produce 6-month forecasts of poliomyelitis incidence. The odds of observing poliomyelitis decreased with improved routine or supplementary (campaign immunisation coverage (multivariable odds ratio [OR] = 0.75, 95% confidence interval [CI] 0.67-0.84; and OR = 0.75, 95% CI 0.66-0.85, respectively, for each 10% increase in coverage and increased with a higher rate of reporting non-polio acute flaccid paralysis (AFP (OR = 1.13, 95% CI 1.02-1.26 for a 1-unit increase in non-polio AFP per 100,000 persons aged <15 years. Estimated movement of poliovirus-infected individuals was associated with the incidence of poliomyelitis, with the radiation model of movement providing the best fit to the data. Six-month forecasts of poliomyelitis incidence by district for 2013-2016 showed good predictive ability (area under the curve range: 0.76-0.98. However, although the best-fitting movement model (radiation was a significant determinant of poliomyelitis incidence, it did not improve the predictive ability of the multivariable model. Overall, in Pakistan the risk of polio cases

  17. Legacy sample disposition project. Volume 2: Final report

    International Nuclear Information System (INIS)

    Gurley, R.N.; Shifty, K.L.

    1998-02-01

    This report describes the legacy sample disposition project at the Idaho Engineering and Environmental Laboratory (INEEL), which assessed Site-wide facilities/areas to locate legacy samples and owner organizations and then characterized and dispositioned these samples. This project resulted from an Idaho Department of Environmental Quality inspection of selected areas of the INEEL in January 1996, which identified some samples at the Test Reactor Area and Idaho Chemical Processing Plant that had not been characterized and dispositioned according to Resource Conservation and Recovery Act (RCRA) requirements. The objective of the project was to manage legacy samples in accordance with all applicable environmental and safety requirements. A systems engineering approach was used throughout the project, which included collecting the legacy sample information and developing a system for amending and retrieving the information. All legacy samples were dispositioned by the end of 1997. Closure of the legacy sample issue was achieved through these actions

  18. Wind River Watershed Project; 1998 Annual Report; Volume II

    International Nuclear Information System (INIS)

    Connolly, Patrick J.

    1999-01-01

    The authors report here their on-ground restoration actions. Part 1 describes work conducted by the Underwood Conservation District (UCD) on private lands. This work involves the Stabler Cut-Bank project. Part 2 describes work conducted by the U.S. Forest Service. The Stabler Cut-Bank Project is a cooperative stream restoration effort between Bonneville Power Administration (BPA), the UCD, private landowners, the U.S. Forest Service (USFS), and the U.S. Fish and Wildlife Service (USFWS). The Stabler site was identified by UCD during stream surveys conducted in 1996 as part of a USFWS funded project aimed at initiating water quality and habitat restoration efforts on private lands in the basin. In 1997 the Wind River Watershed Council selected the project as a top priority demonstration project. The landowners were approached by the UCD and a partnership developed. Due to their expertise in channel rehabilitation, the Forest Service was consulted for the design and assisted with the implementation of the project. A portion of the initial phase of the project was funded by USFWS. However, the majority of funding (approximately 80%) has been provided by BPA and it is anticipated that additional work that is planned for the site will be conducted with BPA funds

  19. Risk Factors for Sexual Violence in the Military: An Analysis of Sexual Assault and Sexual Harassment Incidents and Reporting

    Science.gov (United States)

    2017-03-01

    harassment and sexual assault. 17 III. DATA AND METHODOLOGY In this chapter, I describe the data used for the empirical analysis and the construction...THE MILITARY: AN ANALYSIS OF SEXUAL ASSAULT AND SEXUAL HARASSMENT INCIDENTS AND REPORTING by William C. Souder, III March 2017 Thesis Advisor...ASSAULT AND SEXUAL HARASSMENT INCIDENTS AND REPORTING 5. FUNDING NUMBERS 6. AUTHOR(S) William C. Souder, III 7. PERFORMING ORGANIZATION NAME(S) AND

  20. Insulin, hospitals and harm: a review of patient safety incidents reported to the National Patient Safety Agency.

    Science.gov (United States)

    Cousins, David; Rosario, Catherine; Scarpello, John

    2011-02-01

    Patient safety incidents involving insulin are frequent and cause considerable distress to people with diabetes and anxieties to their families and carers. This article describes an analysis of the National Reporting and Learning System database of patient safety incidents concerning insulin reported from NHS providers in England and Wales over six years. The main causes are discussed and the ongoing developments by the National Patient Safety Agency and partner organisations to reduce insulin errors are described.