WorldWideScience

Sample records for inpatient facilities risk

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

    Science.gov (United States)

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

    2016-09-01

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

  2. Inpatient Psychiatric Facility PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  3. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Science.gov (United States)

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... Services of Inpatient Psychiatric Facilities § 412.405 Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. The prospective payment system...

  4. Inpatient Psychiatric Facility Quality Measure Data – by State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  5. 42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

    Science.gov (United States)

    2010-10-01

    ... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

  6. Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital

    Directory of Open Access Journals (Sweden)

    Christoffel Grobler

    2015-08-01

    Full Text Available About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way. Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor. When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.

  7. 75 FR 70013 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2010-11-16

    ... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...

  8. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete

    2017-01-01

    trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during......People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time...... admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors...

  9. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete

    2017-01-01

    People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time...... trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during...... is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment...

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. 76 FR 59256 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2011-09-26

    ...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...

  13. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... facility prospective payment system. 412.432 Section 412.432 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient...

  14. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

    Science.gov (United States)

    Hou, Wen-Hsuan; Kang, Chun-Mei; Ho, Mu-Hsing; Kuo, Jessie Ming-Chuan; Chen, Hsiao-Lien; Chang, Wen-Yin

    2017-03-01

    To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Secondary data analysis. A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely

  15. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – by Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  16. 76 FR 32085 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

    Science.gov (United States)

    2011-06-03

    ..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...

  17. Contracting between public agencies and private psychiatric inpatient facilities.

    Science.gov (United States)

    Fisher, W H; Dorwart, R A; Schlesinger, M; Davidson, H

    1991-08-01

    Purchasing human services through contracts with private providers has become an increasingly common practice over the past 20 years. Using data from a national survey of psychiatric inpatient facilities, this paper examines the extent to which psychiatric units in privately controlled general hospitals and private psychiatric specialty hospitals (N = 611) participate in contractual arrangements to provide services to governmental bodies. It also examines how the likelihood of such a practice is affected by hospital characteristics (general or specialty, for profit or nonprofit) and features of hospitals' environments, including the competitiveness of the market for psychiatric inpatient care and the population's need for services in the hospital's county. The findings indicate that nonprofit psychiatric specialty hospitals were more likely than other types of hospitals to enter into such contracts, and that forces such as local competition and need for services were not predictors of such involvement. Contracting was shown to have a significant impact on the level of referrals a hospital accepted, but these levels were also affected by competition and need. Among hospitals with public contracts, referral acceptance from public agencies was unaffected by these factors, but they did have a significant effect on referral acceptance by hospitals without public contracts. These data suggest that public agencies contracting for services with private hospitals may represent a means by which "public sector" patients may gain access to private providers. Further, this mechanism may impose sufficient structure and regulation on the acceptance of such patients that many concerns of hospital administrators regarding patients who are costly and difficult to treat and discharge can be allayed.

  18. 42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

    Science.gov (United States)

    2010-10-01

    ... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

  19. Risk factors of coercion among psychiatric inpatients

    DEFF Research Database (Denmark)

    Thomsen, Christoffer; Starkopf, Liis; Hastrup, Lene Halling

    2017-01-01

    PURPOSE: Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do...... and having children, reduced the risk of being subjected to coercive measure (all p risk factors associated with coercive measures. Our findings can assist researchers in identifying patients at risk of coercion and thereby help...... measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased...

  20. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

    Science.gov (United States)

    Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

    2012-01-01

    There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

  1. Risk of obstructive sleep apnoea syndrome among in-patients at a ...

    African Journals Online (AJOL)

    We screened for risk of OSA among in-patients with severe mental illness to determine its prevalence ... Keywords: obstructive sleep apnoea; severe mental illness; Nigeria, in-patients .... a physical co-morbidity which was hypertension, none.

  2. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – by State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  3. Inpatient Psychiatric Facility Follow-Up After Hospitalization for Mental Illness (FUH) Quality Measure Data – National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  4. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... rehabilitation facility receives payment under this subpart for inpatient operating costs and capital-related... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... and for costs of an approved education program and other costs paid outside the prospective payment...

  5. 78 FR 26879 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2013-05-08

    ... Prospective Payment System for Federal Fiscal Year 2014; Proposed Rule #0;#0;Federal Register / Vol. 78, No... Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 AGENCY... IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data...

  6. Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States.

    Science.gov (United States)

    Daras, Laura Coots; Ingber, Melvin J; Deutsch, Anne; Hefele, Jennifer Gaudet; Perloff, Jennifer

    2017-12-22

    To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions. Observational study. IRFs. Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs). Not applicable. We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state). IRFs' mean risk-standardized hospital readmission rate was 13.00%±0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (Preadmission rates than did IRFs in New England that had the lowest rates. Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Postoperative mortality after inpatient surgery: Incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2008-09-01

    Full Text Available Karamarie Fecho1, Anne T Lunney1, Philip G Boysen1, Peter Rock2, Edward A Norfleet11Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 2Department of Anesthesiology, University of Maryland, Baltimore, MD, USAPurpose: This study determined the incidence of and identified risk factors for 48 hour (h and 30 day (d postoperative mortality after inpatient operations.Methods: A retrospective cohort study was conducted using Anesthesiology’s Quality Indicator database as the main data source. The database was queried for data related to the surgical procedure, anesthetic care, perioperative adverse events, and birth/death/operation dates. The 48 h and 30 d cumulative incidence of postoperative mortality was calculated and data were analyzed using Chi-square or Fisher’s exact test and generalized estimating equations.Results: The 48 h and 30 d incidence of postoperative mortality was 0.57% and 2.1%, respectively. Higher American Society of Anesthesiologists physical status scores, extremes of age, emergencies, perioperative adverse events and postoperative Intensive Care Unit admission were identified as risk factors. The use of monitored anesthesia care or general anesthesia versus regional or combined anesthesia was a risk factor for 30 d postoperative mortality only. Time under anesthesia care, perioperative hypothermia, trauma, deliberate hypotension and invasive monitoring via arterial, pulmonary artery or cardiovascular catheters were not identified as risk factors.Conclusions: Our findings can be used to track postoperative mortality rates and to test preventative interventions at our institution and elsewhere.Keywords: postoperative mortality, risk factors, operations, anesthesia, inpatient surgery

  8. Analysis of rehabilitation activities within skilled nursing and inpatient rehabilitation facilities after hip replacement for acute hip fracture.

    Science.gov (United States)

    Munin, Michael C; Putman, Koen; Hsieh, Ching-Hui; Smout, Randall J; Tian, Wenqiang; DeJong, Gerben; Horn, Susan D

    2010-07-01

    To characterize rehabilitation services in two types of postacute facilities in patients who underwent hip replacement following a hip fracture. Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission. Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers. Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.

  9. Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups

    OpenAIRE

    Marschollek, Michael; Gövercin, Mehmet; Rust, Stefan; Gietzelt, Matthias; Schulze, Mareike; Wolf, Klaus-Hendrik; Steinhagen-Thiessen, Elisabeth

    2012-01-01

    Abstract Background Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). Methods A ...

  10. Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment

    Directory of Open Access Journals (Sweden)

    Preuss UW

    2012-05-01

    married but live separated.Conclusion: Rates of treatment noncompletion in inpatient and outpatient rehabilitation programs correspond to results from previous research. Noncompletion is a significant correlate of relapse 1 year after treatment, and noncompleters show an elevated level of psychopathology. These findings may help rehabilitation treatment facilities to tailor specific therapies for these individuals to reduce risk for treatment noncompletion.Keywords: alcohol dependence, rehabilitation treatment, noncompletion, inpatient, outpatient

  11. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

    Science.gov (United States)

    2017-08-03

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

  12. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

    Directory of Open Access Journals (Sweden)

    Trine Madsen

    2017-03-01

    Full Text Available People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.

  13. HealthSouth's inpatient rehabilitation facilities: how does their performance compare with other for-profit and nonprofit inpatient rehabilitation facilities?

    Science.gov (United States)

    McCue, Michael J; Thompson, Jon M

    2010-05-01

    To assess the financial and operational differences in freestanding inpatient rehabilitation facilities (IRFs) that are operated by HealthSouth Corporation relative to other for-profit and nonprofit system-affiliated ownership groups. Since 2003, when it faced fraud charges and financial penalties, HealthSouth has experienced new management and refocused its business strategy. Because HealthSouth is the largest provider of freestanding IRF services, it is important to understand how their performance may differ relative to other ownership groups. We used the Mann-Whitney U test to assess differences in median values for financial and operational variables of HealthSouth-owned IRFs compared with other for-profit system IRFs and nonprofit system IRFs. System-affiliated freestanding IRFs in the United States. Sixty-four HealthSouth IRFs, 18 nonprofit system-affiliated IRFs, and 18 for-profit system-affiliated IRFs. Not applicable. Net patient revenue per adjusted discharge, operating expense per adjusted discharge, salary expense per full-time equivalent, and cash flow margin. HealthSouth IRFs had significantly lower net patient revenue per adjusted discharge and operating expense per adjusted discharge; however, its cash flow margin was significantly higher than other comparison groups. HealthSouth IRFs treated a higher case mix of patients relative to these comparison groups. The financial and operating performance of HealthSouth IRFs is stronger than other ownership groups. Strong cash flow will enable HealthSouth to pay down long-term debt.

  14. Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

    Science.gov (United States)

    Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B; Meurer, William J; Adelman, Eric E; Kerber, Kevin A; Callaghan, Brian C; Lisabeth, Lynda D

    2014-08-01

    Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), Pstroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted. © 2014 American Heart Association, Inc.

  15. Do mental health consumers want to improve their long-term disease risk behaviours? A survey of over 2000 psychiatric inpatients.

    Science.gov (United States)

    Bartlem, Kate; Bailey, Jacqueline; Metse, Alexandra; Asara, Ashley; Wye, Paula; Clancy, Richard; Wiggers, John; Bowman, Jenny

    2017-12-02

    Policies and clinical guidelines acknowledge the role mental health services have in addressing the physical health of individuals with a mental illness; however, little research has explored interest in reducing health risk behaviours or the acceptability of receiving support to reduce such risks among psychiatric inpatients. This study estimated the prevalence of four long-term disease risk behaviours (tobacco smoking, hazardous alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity); patient interest in reducing these risks; and acceptability of being provided care to do so during a psychiatric inpatient stay. A cross-sectional survey was undertaken with 2075 inpatients from four inpatient psychiatric facilities in one health district in Australia (October 2012-April 2014). Prevalence of risk behaviours ranged from 50.2% (inadequate physical activity) to 94.8% (inadequate fruit and/or vegetable consumption). The majority of respondents (88.4%) had more than one risk behaviour, and most were seriously considering improving their risk behaviours (47.6% to 65.3%). The majority (80.4%) agreed that it would be acceptable to be provided support and advice to change such behaviours during their psychiatric inpatient stay. Some diagnoses were associated with smoking and hazardous alcohol consumption, interest in reducing alcohol consumption and increasing fruit and/or vegetable consumption, and acceptability of receiving advice and support. The findings reinforce the need and opportunity for psychiatric inpatient facilities to address the long-term disease risk behaviours of their patients. © 2017 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.

  16. Risk factors and precautions of inpatient suicide from the perspective of nurses: A qualitative study.

    Science.gov (United States)

    Hu, De-ying; Huang, Di; Xiong, Yu; Lu, Cai-hong; Han, Yan-hong; Ding, Xiao-ping; Wang, Shu-jie; Liu, Yi-lan

    2015-04-01

    The risk factors and precautions of inpatient suicide were explored. Thirty suicide victims were drawn from the adverse event reports of suicidal act during hospitalization in a general hospital from 2008 to 2014. Data were gathered from the focus group interviews of twelve nurses who had experienced inpatient suicide. The data were analyzed by using analytical technique based on grounded theory, and software QSR NVIVO8 was used to aid the collation of data. Three main themes of risk factors about inpatient suicide emerged from the analysis: individual value, social factors and environmental factors. The individual value was categorized into different groups such as sense of guilt, hopelessness and low self-esteem. Social factors included two aspects of negative life events and social support. Three themes of precautions about inpatient suicide appeared in this study: evaluation, nursing and information exchange. Evaluation was elaborated from both physical and psychological assessments. This finding extends existing work of risk factors and precautions about inpatient suicide and brings new knowledge about the reasons why inpatients commit suicide.

  17. Relocation consequences on an ophthalmology consultation service from an inpatient to outpatient facility

    Directory of Open Access Journals (Sweden)

    Singh JS

    2015-10-01

    Full Text Available Jorawer S Singh,1 Vincent M Imbrogno,2 Mary K Howard,3 Amandip S Cheema,3 Ausra D Selvadurai,4 Surbhi Bansal5 1Department of Ophthalmology, George Washington University, Washington, DC, 2Contemporary Ophthalmology of Erie, Erie, PA, 3Department of Ophthalmology, University at Buffalo, Buffalo, NY, 4OcuSight Eye Care Center, Rochester, NY, 5Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Importance: This study shows that relocation of an academic ophthalmology residency program from an inpatient to an outpatient setting in western New York does not affect the consult volume but affects management patterns and follow-up rates.Objective: To investigate the effects on the ophthalmology consultation service of an academic program with relocation from a Regional Level-1 Trauma center to an outpatient facility.Design: Consultation notes from 3 years before and 3 years after the University at Buffalo’s (UB Department of Ophthalmology relocation from a Regional Level-1 Trauma center (Erie County Medical Center to an outpatient facility (Ross Eye Institute were obtained from hospital electronic medical records and analyzed.Setting: Hospitalized care and institutional practice.Participants: All inpatient or Emergency Room Ophthalmology consultation patients from the Department of Ophthalmology at UB from 2004 to 2010 (1,379 patients.Exposures: None, this was a retrospective chart review.Main outcome measures: Patient demographics, reason for consult, diagnoses, and ophthalmic procedures performed by the UB Department of Ophthalmology before and after its relocation.Results: Relocation to the outpatient facility did not affect consult volume (P=0.15. The number of consults focusing on ophthalmic conditions, as a percentage of the yearly total, rose 460% (P=0.0001, while systemic condition consults with ocular manifestations fell 83% (P=0.0001. Consults for ocular trauma decreased 65% (P=0.0034. Consults ending with a

  18. Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure.

    Science.gov (United States)

    Pardasaney, Poonam K; Deutsch, Anne; Iriondo-Perez, Jeniffer; Ingber, Melvin J; McMullen, Tara

    2018-06-01

    To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016. Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability. IRFs. Medicare FFS patients aged ≥21 years (N=4769). Not applicable. Facility-level discharge self-care quality measure performance score. A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged quality measure showed strong reliability, with intraclass correlation coefficients of .91. The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs. Published by Elsevier Inc.

  19. Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy.

    Science.gov (United States)

    Preti, A; Rucci, P; Santone, G; Picardi, A; Miglio, R; Bracco, R; Norcio, B; de Girolamo, G

    2009-03-01

    A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy. Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales. Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions. In a mixed, public-private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.

  20. Pediatric malignant hyperthermia: risk factors, morbidity, and mortality identified from the Nationwide Inpatient Sample and Kids' Inpatient Database.

    Science.gov (United States)

    Salazar, Jose H; Yang, Jingyan; Shen, Liang; Abdullah, Fizan; Kim, Tae W

    2014-12-01

    Malignant Hyperthermia (MH) is a potentially fatal metabolic disorder. Due to its rarity, limited evidence exists about risk factors, morbidity, and mortality especially in children. Using the Nationwide Inpatient Sample and the Kid's Inpatient Database (KID), admissions with the ICD-9 code for MH (995.86) were extracted for patients 0-17 years of age. Demographic characteristics were analyzed. Logistic regression was performed to identify patient and hospital characteristics associated with mortality. A subset of patients with a surgical ICD-9 code in the KID was studied to calculate the prevalence of MH in the dataset. A total of 310 pediatric admissions were seen in 13 nonoverlapping years of data. Patients had a mortality of 2.9%. Male sex was predominant (64.8%), and 40.5% of the admissions were treated at centers not identified as children's hospitals. The most common associated diagnosis was rhabdomyolysis, which was present in 26 cases. Regression with the outcome of mortality did not yield significant differences between demographic factors, age, sex race, or hospital type, pediatric vs nonpediatric. Within a surgical subset of 530,449 admissions, MH was coded in 55, giving a rate of 1.04 cases per 10,000 cases. This study is the first to combine two large databases to study MH in the pediatric population. The analysis provides an insight into the risk factors, comorbidities, mortality, and prevalence of MH in the United States population. Until more methodologically rigorous, large-scale studies are done, the use of databases will continue to be the optimal method to study rare diseases. © 2014 John Wiley & Sons Ltd.

  1. Perceived Relapse Risk and Desire for Medication Assisted Treatment among Persons Seeking Inpatient Opiate Detoxification

    Science.gov (United States)

    Bailey, Genie L; Herman, Debra S.; Stein, Michael D.

    2016-01-01

    Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p detox abstinence. PMID:23786852

  2. Rates of adult acute inpatients documented as at risk of refeeding syndrome by dietitians.

    Science.gov (United States)

    Owers, Emma L; Reeves, Anneli I; Ko, Susan Y; Ellis, Aleshia K; Huxtable, Shannon L; Noble, Sally A; Porteous, Helen E; Newman, Eli J; Josephson, Christine A; Roth, Rachel A; Byrne, Clare E; Palmer, Michelle A

    2015-02-01

    Identification of Refeeding Syndrome (RFS) is vital for prevention and treatment of metabolic disturbances, yet no information exists that describes identification rates by dietitians in acute care. We aimed to describe rates and demographics of inpatients identified by dietitians as at-risk of RFS and factors associated with electrolyte levels post-dietetic assessment. Eligible participants were adult (≥ 18 yrs) acute care inpatients reviewed by dietitians between March 2012-February 2013 and not admitted to intensive care prior to first dietetic assessment. Patient information was sourced from medical charts. Chi-squared, t-tests and linear regression analyses were conducted. Of 1661 eligible inpatients (55%F, 65 ± 18 yrs), 9% (n = 151) were documented as at-risk of RFS in the first dietetic medical chart entry. On average, patients identified with RFS-risk had four days greater hospital stay, were 13 kg lighter, more likely classified SGA C (36% vs. 7%), and on a modified diet (52% vs. 35%) than non-RFS patients (p < 0.05). Very low and low electrolyte values occurred within seven days post-dietetic assessment in 7% and 52%, respectively, of inpatients with RFS-risk. Regression analysis showed that electrolyte supplementation was positively associated (β = 0.145-0.594), and number of RFS-related risk factors negatively associated (β = -0.044-0.122), with potassium, magnesium and phosphate levels within seven days post-dietetic assessment (p < 0.05). Nine percent of adult inpatients were documented as at-risk of RFS by dietitians. Identification of at-risk patients was in accordance with RFS guidelines. Electrolyte supplementation was positively associated with electrolyte levels post-assessment. Consistency of RFS-risk identification between dietitians requires determination. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  3. Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

    Science.gov (United States)

    Hunderfund, Andrea N. Leep; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, LeAnn M.; Britton, Jeffrey W.

    2011-01-01

    OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls. PMID:21193651

  4. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

    Science.gov (United States)

    Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

    2014-12-01

    To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Not applicable. Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. © The Author(s) 2014.

  5. Risk Factors for Coronary Heart Disease Among Inpatients Who Have Mild Intellectual Disability and Mental Illness

    Science.gov (United States)

    Merriman, S.; Haw, C.; Kirk, J.; Stubbs, J.

    2005-01-01

    Coronary heart disease (CHD) is a major cause of morbidity and mortality in the UK. The aim of this study was to screen inpatients with mild or borderline intellectual disability, many of whom also have mental illness, for risk factors for CHD. Participants were interviewed, measured and had blood samples taken. Of the 53 participants, 20 (37.7%)…

  6. Admissions to inpatient care facilities in the last year of life of community-dwelling older people in Europe.

    Science.gov (United States)

    Overbeek, Anouk; Van den Block, Lieve; Korfage, Ida J; Penders, Yolanda W H; van der Heide, Agnes; Rietjens, Judith A C

    2017-10-01

    In the last year of life, many older people rather avoid admissions to inpatient care facilities. We describe and compare such admissions in the last year of life of 5092 community-dwelling older people in 15 European countries (+Israel). Proxy-respondents of the older people, who participated in the longitudinal SHARE study, reported on admissions to inpatient care facilities (hospital, nursing home or hospice) during the last year of their life. Multivariable regression analyses assessed associations between hospitalizations and personal/contextual characteristics. The proportion of people who had been admitted at least once to an inpatient care facility in the last year of life ranged from 54% (France) to 76% (Austria, Israel, Slovenia). Admissions mostly concerned hospitalizations. Multivariable analyses showed that especially Austrians, Israelis and Poles had higher chances of being hospitalized. Further, hospitalizations were more likely for those being ill for 6 months or more (OR:1.67, CI:1.39-2.01), and less likely for persons aged 80+ (OR:0.54, CI:0.39-0.74; compared with 48-65 years), females (OR:0.74, CI:0.63-0.89) and those dying of cardiovascular diseases (OR:0.66, CI:0.51-0.86; compared with those dying of cancer). Although healthcare policies increasingly stress the importance that people reside at home as long as possible, admissions to inpatient care facilities in the last year of life are relatively common across all countries. Furthermore, we found a striking variation concerning the proportion of admissions across countries which cannot only be explained by patient needs. It suggests that such admissions are at least partly driven by system-level or cultural factors. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  7. 42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... maintain the appropriate outlier percentage. (e) Describe the ICD-9-CM coding changes and DRG classification changes discussed in the annual update to the hospital inpatient prospective payment system...

  8. Staffing Levels and Inpatient Outcomes at Military Health Care Facilities: A Resource-Based View

    National Research Council Canada - National Science Library

    Yap, Glenn

    2004-01-01

    Using a Resource-Based Theory/View of the firm, this study examined if increased inpatient staffing levels at military hospitals can generate a competitive advantage based on better patient quality outcomes...

  9. Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke.

    Science.gov (United States)

    Goljar, Nika; Globokar, Daniel; Puzić, Nataša; Kopitar, Natalija; Vrabič, Maja; Ivanovski, Matic; Vidmar, Gaj

    2016-09-01

    To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.

  10. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation

    Science.gov (United States)

    Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

    2014-01-01

    Objective To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Design and setting Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Participants Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Interventions Not applicable. Main outcome measure(s) Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales’ classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. Results A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. PMID:24849795

  11. Psychometric validation of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool for older Chinese inpatients.

    Science.gov (United States)

    Zhang, Junhong; Wang, Min; Liu, Yu

    2016-10-01

    To culturally adapt and evaluate the reliability and validity of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool among older inpatients in the mainland of China. Patient falls are an important safety consideration within hospitals among older inpatients. Nurses need specific risk assessment tools for older inpatients to reliably identify at-risk populations and guide interventions that highlight fixable risk factors for falls and consequent injuries. In China, a few tools have been developed to measure fall risk. However, they lack the solid psychometric development necessary to establish their validity and reliability, and they are not widely used for elderly inpatients. A cross-sectional study. A convenient sampling was used to recruit 201 older inpatients from two tertiary-level hospitals in Beijing and Xiamen, China. The Johns Hopkins Fall Risk Assessment Tool was translated using forward and backward translation procedures and was administered to these 201 older inpatients. Reliability of the tool was calculated by inter-rater reliability and Cronbach's alpha. Validity was analysed through content validity index and construct validity. The Inter-rater reliability of Chinese version of Johns Hopkins Fall Risk Assessment Tool was 97·14% agreement with Cohen's Kappa of 0·903. Cronbach's α was 0·703. Content of Validity Index was 0·833. Two factors represented intrinsic and extrinsic risk factors were explored that together explained 58·89% of the variance. This study provided evidence that Johns Hopkins Fall Risk Assessment Tool is an acceptable, valid and reliable tool to identify older inpatients at risk of falls and falls with injury. Further psychometric testing on criterion validity and evaluation of its advanced utility in geriatric clinical settings are warranted. The Chinese version of Johns Hopkins Fall Risk Assessment Tool may be useful for health care personnel to identify older Chinese inpatients at risk of falls and falls

  12. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers.

    Science.gov (United States)

    Dunn, Adam G; Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-05-01

    To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols.

  13. Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups.

    Science.gov (United States)

    Marschollek, Michael; Gövercin, Mehmet; Rust, Stefan; Gietzelt, Matthias; Schulze, Mareike; Wolf, Klaus-Hendrik; Steinhagen-Thiessen, Elisabeth

    2012-03-14

    Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493). A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances. The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity. Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity) reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified

  14. Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups

    Directory of Open Access Journals (Sweden)

    Marschollek Michael

    2012-03-01

    Full Text Available Abstract Background Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1, and to identify high-risk subgroups from the data (aim#2. Methods A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493. A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances. Results The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity. Conclusions Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack

  15. Health-based risk adjustment: is inpatient and outpatient diagnostic information sufficient?

    Science.gov (United States)

    Lamers, L M

    Adequate risk adjustment is critical to the success of market-oriented health care reforms in many countries. Currently used risk adjusters based on demographic and diagnostic cost groups (DCGs) do not reflect expected costs accurately. This study examines the simultaneous predictive accuracy of inpatient and outpatient morbidity measures and prior costs. DCGs, pharmacy cost groups (PCGs), and prior year's costs improve the predictive accuracy of the demographic model substantially. DCGs and PCGs seem complementary in their ability to predict future costs. However, this study shows that the combination of DCGs and PCGs still leaves room for cream skimming.

  16. Estimating Fire Risks at Industrial Nuclear Facilities

    International Nuclear Information System (INIS)

    Coutts, D.A.

    1999-01-01

    The Savannah River Site (SRS) has a wide variety of nuclear production facilities that include chemical processing facilities, machine shops, production reactors, and laboratories. Current safety documentation must be maintained for the nuclear facilities at SRS. Fire Risk Analyses (FRAs) are used to support the safety documentation basis. These FRAs present the frequency that specified radiological and chemical consequences will be exceeded. The consequence values are based on mechanistic models assuming specific fire protection features fail to function as designed

  17. Uncertainties in risk assessment at USDOE facilities

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, L.D.; Holtzman, S.; Meinhold, A.F.; Morris, S.C.; Rowe, M.D.

    1994-01-01

    The United States Department of Energy (USDOE) has embarked on an ambitious program to remediate environmental contamination at its facilities. Decisions concerning cleanup goals, choices among cleanup technologies, and funding prioritization should be largely risk-based. Risk assessments will be used more extensively by the USDOE in the future. USDOE needs to develop and refine risk assessment methods and fund research to reduce major sources of uncertainty in risk assessments at USDOE facilities. The terms{open_quote} risk assessment{close_quote} and{open_quote} risk management{close_quote} are frequently confused. The National Research Council (1983) and the United States Environmental Protection Agency (USEPA, 1991a) described risk assessment as a scientific process that contributes to risk management. Risk assessment is the process of collecting, analyzing and integrating data and information to identify hazards, assess exposures and dose responses, and characterize risks. Risk characterization must include a clear presentation of {open_quotes}... the most significant data and uncertainties...{close_quotes} in an assessment. Significant data and uncertainties are {open_quotes}...those that define and explain the main risk conclusions{close_quotes}. Risk management integrates risk assessment information with other considerations, such as risk perceptions, socioeconomic and political factors, and statutes, to make and justify decisions. Risk assessments, as scientific processes, should be made independently of the other aspects of risk management (USEPA, 1991a), but current methods for assessing health risks are based on conservative regulatory principles, causing unnecessary public concern and misallocation of funds for remediation.

  18. Uncertainties in risk assessment at USDOE facilities

    International Nuclear Information System (INIS)

    Hamilton, L.D.; Holtzman, S.; Meinhold, A.F.; Morris, S.C.; Rowe, M.D.

    1994-01-01

    The United States Department of Energy (USDOE) has embarked on an ambitious program to remediate environmental contamination at its facilities. Decisions concerning cleanup goals, choices among cleanup technologies, and funding prioritization should be largely risk-based. Risk assessments will be used more extensively by the USDOE in the future. USDOE needs to develop and refine risk assessment methods and fund research to reduce major sources of uncertainty in risk assessments at USDOE facilities. The terms open-quote risk assessment close-quote and open-quote risk management close-quote are frequently confused. The National Research Council (1983) and the United States Environmental Protection Agency (USEPA, 1991a) described risk assessment as a scientific process that contributes to risk management. Risk assessment is the process of collecting, analyzing and integrating data and information to identify hazards, assess exposures and dose responses, and characterize risks. Risk characterization must include a clear presentation of open-quotes... the most significant data and uncertainties...close quotes in an assessment. Significant data and uncertainties are open-quotes...those that define and explain the main risk conclusionsclose quotes. Risk management integrates risk assessment information with other considerations, such as risk perceptions, socioeconomic and political factors, and statutes, to make and justify decisions. Risk assessments, as scientific processes, should be made independently of the other aspects of risk management (USEPA, 1991a), but current methods for assessing health risks are based on conservative regulatory principles, causing unnecessary public concern and misallocation of funds for remediation

  19. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

    Science.gov (United States)

    Slemon, Allie; Jenkins, Emily; Bungay, Vicky

    2017-10-01

    The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

  20. Communication in reducing facility siting risk

    International Nuclear Information System (INIS)

    Bisconti, A.S.

    1992-01-01

    Today, social considerations are as important as technical ones in siting new nuclear facilities. Siting any industrial facility has become extremely difficult in this era of not in my backyard (NIMBY). Even if NIMBY does not arise locally, well-organized national opposition groups can be counted on to step in to fan the flames, especially when the industrial facility has to do with anything nuclear. It is now generally recognized that the greatest risk of failure for new nuclear facilities is not technical but social. Applying lessons gained from past experience and social science research can help reduce that risk. From these lessons, six principles for public interaction and communication stand out: (1) create goodwill now; (2) involve the community early; (3) establish the need; (4) communicate controls, not risk; (5) avoid jargon; (6) understand your public

  1. Risk factors of coercion among psychiatric inpatients: a nationwide register-based cohort study.

    Science.gov (United States)

    Thomsen, Christoffer; Starkopf, Liis; Hastrup, Lene Halling; Andersen, Per Kragh; Nordentoft, Merete; Benros, Michael Eriksen

    2017-08-01

    Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do in this first large-scale study. A cohort study was conducted among all psychiatric inpatients in Denmark, following 112,233 individuals during 1999-2014. Data from Danish registers were analysed using logistic regression for repeated measures. 24,594 inpatients were exposed to a coercive measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased with the number of admissions (all p < 0.001). The following socioeconomic variables were associated with an increased risk of coercion: male sex, unemployment, lower social class and immigrants from low and middle income countries (all p < 0.001). Early retirement and social relations, such as being married and having children, reduced the risk of being subjected to coercive measure (all p < 0.05). From our nationwide data, we identified a broad range of risk factors associated with coercive measures. Our findings can assist researchers in identifying patients at risk of coercion and thereby help targeting new coercion reduction programs.

  2. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers

    Science.gov (United States)

    Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-01-01

    Objective To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. Design An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. Results The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. Conclusions The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols. PMID:21486883

  3. Risk of acute gout among active smokers: data from nationwide inpatient sample.

    Science.gov (United States)

    Poudel, Dilli Ram; Karmacharya, Paras; Donato, Anthony

    2016-12-01

    Smoking has been found to be negatively correlated with serum uric acid levels by virtue of reduced production and increased consumption of endogenous antioxidant uric acid among smokers and has been reported to decrease incidence of gout. To shed further light on the question of association between active smoking and acute gout by examining this association using a large inpatient US database, using the Nationwide Inpatient Sample data from 2009 to 2011, we identified current smokers based on the International Classification of Diseases, Ninth Revision (ICD-9) code 305.1 and were assumed to have ceased smoking during hospital stay. Patients who developed acute gout inhospital were identified based on ICD-9 code 274.01 at secondary diagnosis position. Univariate and multivariate logistic regressions were used to derive odds ratio for measures of association. Statistical analysis was done using STATA version 13.0 (College Station, TX). A total of 17,847,045 discharge records were used which included 13,932 (0.08 %) inhospital acute gouty arthritis and 2,615,944 (14.66 %) active smokers. Both univariate (OR 0.59, CI 0.54-0.63, p gout among hospitalized patients who were current smokers but were assumed to have ceased smoking during hospital stay. Active tobacco use was associated with a lower risk of acute inpatient gouty arthritis, even when controlling for conventional risk factors. More study is needed to correlate this finding with uric acid levels, and a better understanding of the mechanisms that explain this finding are necessary.

  4. High-risk facilities. Emergency management in nuclear, chemical and hazardous waste facilities

    International Nuclear Information System (INIS)

    Kloepfer, Michael

    2012-01-01

    The book on emergency management in high-risk facilities covers the following topics: Change in the nuclear policy, risk management of high-risk facilities as a constitutional problem - emergency management in nuclear facilities, operational mechanisms of risk control in nuclear facilities, regulatory surveillance responsibilities for nuclear facilities, operational mechanism of the risk control in chemical plants, regulatory surveillance responsibilities for chemical facilities, operational mechanisms of the risk control in hazardous waste facilities, regulatory surveillance responsibilities for hazardous waste facilities, civil law consequences in case of accidents in high-risk facilities, criminal prosecution in case of accidents in high-risk facilities, safety margins as site risk for emission protection facilities, national emergency management - strategic emergency management structures, warning and self-protection of the public in case of CBRN hazards including aspects of the psych-social emergency management.

  5. Methodology for analyzing risk at nuclear facilities

    International Nuclear Information System (INIS)

    Yoo, Hosik; Lee, Nayoung; Ham, Taekyu; Seo, Janghoon

    2015-01-01

    Highlights: • A new methodology for evaluating the risk at nuclear facilities was developed. • Five measures reflecting all factors that should be concerned to assess risk were developed. • The attributes on NMAC and nuclear security culture are included as attributes for analyzing. • The newly developed methodology can be used to evaluate risk of both existing facility and future nuclear system. - Abstract: A methodology for evaluating risks at nuclear facilities is developed in this work. A series of measures is drawn from the analysis of factors that determine risks. Five measures are created to evaluate risks at nuclear facilities. These include the legal and institutional framework, material control, physical protection system effectiveness, human resources, and consequences. Evaluation attributes are developed for each measure and specific values are given in order to calculate the risk value quantitatively. Questionnaires are drawn up on whether or not a state has properly established a legal and regulatory framework (based on international standards). These questionnaires can be a useful measure for comparing the status of the physical protection regime between two countries. Analyzing an insider threat is not an easy task and no methodology has been developed for this purpose. In this study, attributes that could quantitatively evaluate an insider threat, in the case of an unauthorized removal of nuclear materials, are developed by adopting the Nuclear Material Accounting & Control (NMAC) system. The effectiveness of a physical protection system, P(E), could be analyzed by calculating the probability of interruption, P(I), and the probability of neutralization, P(N). In this study, the Tool for Evaluating Security System (TESS) code developed by KINAC is used to calculate P(I) and P(N). Consequence is an important measure used to analyze risks at nuclear facilities. This measure comprises radiological, economic, and social damage. Social and

  6. Risk assessment of LPG automotive refuelling facilities

    Energy Technology Data Exchange (ETDEWEB)

    Melchers, R.E. [University of Newcastle, Newcastle (Australia). Dept. of Civil, Surveying and Enviromental Engineering; Feutrill, W.R. [Wesfarmers Kleenheat Gas Pty. Ltd., Perth (Australia)

    2001-12-01

    Quantified risk analysis (QRA) was used for the revision of regulatory separation distances associated with medium size liquefied petroleum gas (LPG) refuelling facilities used in automotive service (gas) stations. Typically these facilities consist of a 7.5 kl pressure vessel, pump, pipework, dispensing equipment and safety equipment. Multi-tank installations are relatively uncommon. This paper describes the hazard scenarios considered, the risk analysis procedure and the selection and application of data for initiating events and for rates of failure of mechanical components and of the pressure vessel. Human errors and intervention possibilities were also considered. Because of the inapplicability of established consequence models and the relatively small scale of the facilities, a number of tests were performed to estimate flame length, flame impingement effects, ignition probabilities and the effectiveness of screening devices. (author)

  7. Health at risk in immigration detention facilities

    Directory of Open Access Journals (Sweden)

    Ioanna Kotsioni

    2013-09-01

    Full Text Available Since 2004 Médecins Sans Frontières (MSF has provided medical and psychosocial support for asylum seekers and migrants held in different immigration detention facilities across Europe (in Greece, Malta, Italy and Belgium where the life, health and human dignity of vulnerable people are being put at risk.

  8. A retrospective review of fall risk factors in the bone marrow transplant inpatient service.

    Science.gov (United States)

    Vela, Cory M; Grate, Lisa M; McBride, Ali; Devine, Steven; Andritsos, Leslie A

    2018-06-01

    Purpose The purpose of this study was to compare medications and potential risk factors between patients who experienced a fall during hospitalization compared to those who did not fall while admitted to the Blood and Marrow Transplant inpatient setting at The James Cancer Hospital. Secondary objectives included evaluation of transplant-related disease states and medications in the post-transplant setting that may lead to an increased risk of falls, post-fall variables, and number of tests ordered after a fall. Methods This retrospective, case-control study matched patients in a 2:1 ratio of nonfallers to fallers. Data from The Ohio State University Wexner Medical Center (OSUWMC) reported fall events and patient electronic medical records were utilized. A total of 168 adult Blood and Marrow Transplant inpatients with a hematological malignancy diagnosis were evaluated from 1 January 2010 to 30 September 2012. Results Univariable and multivariable conditional logistic regression models were used to assess the relationship between potential predictor variables of interest and falls. Variables that were found to be significant predictors of falls from the univariable models include age group, incontinence, benzodiazepines, corticosteroids, anticonvulsants and antidepressants, and number of days status-post transplant. When considered for a multivariable model age group, corticosteroids, and a cancer diagnosis of leukemia were significant in the final model. Conclusion Recent medication utilization such as benzodiazepines, anticonvulsants, corticosteroids, and antidepressants placed patients at a higher risk of experiencing a fall. Other significant factors identified from a multivariable analysis found were patients older than age 65, patients with recent corticosteroid administration and a cancer diagnosis of leukemia.

  9. An investigation of factors increasing the risk of aggressive behaviour among schizophrenic inpatients

    Directory of Open Access Journals (Sweden)

    Michel eLejoyeux

    2013-09-01

    Full Text Available Aim of the studyThis study tried to identify risk factors of aggressive behavior in a population of schizophrenic inpatients. We tested the association between aggressive behavior and socio-demographic characteristics, addictive disorders, history of suicide attempt and sexual violence, impulsivity and sensation seeking.MethodsAll consecutive schizophrenic inpatients (100 were assessed during six months. Aggressive behavior was quantified with a standardized scale, the Overt Aggression Scale (OAS. We studied socio-demographic characteristics and the history of suicide attempt and sexual violence with a specific standardized questionnaire. Addictive disorders were identified with the Fagerström and CAGE questionnaires and with the DSM-IV-R diagnostic criteria for nicotine, alcohol, cannabis opiates, and cocaine abuse and dependence disorders. Lastly, we studied sensation-seeking with the Zuckerman scale and impulsivity with the Barratt scale. ResultsLinear regression identified four factors associated with aggressive behaviour: male gender (odd ratio =12.8, history of sexual violence (odd ratio = 3.6, Fagerström score (odd ratio= 1.3, number of cigarettes smoked each day (odd ratio=1.16. Patients with nicotine use or dependence had significantly higher levels of OAS scores. This difference was not observed between patients with or without alcohol dependence. OAS scores were correlated to the number of cigarettes smoked each day and to Fagerström scores. Patients with a higher level of sensation seeking and impulsivity also had higher OAS scores. ConclusionA Typical schizophrenic patient at risk of showing aggressive behavior is a man, who smokes and presents a history of sexual violence.

  10. Opinions of Nurses About the Evaluation of Risk of Falling Among Inpatients.

    Science.gov (United States)

    Atay, Selma; Vurur, Sevda; Erdugan, Necla

    Patient falls and fall-related injuries are an important problem for patients, relatives, caregivers, and the health system at large. This study aims to identify opinions of nurses about the risk of falling among patients staying in hospitals. This study uses a qualitative descriptive design and employs a semistructured interview method to identify the opinions and experiences of nurses about patient falls. This study evaluated the opinions of a total of 12 staff nurses. It was found that nurses consider patients in the postoperative period to be most prone to falls. They think that most falls take place during transfers and that the medical diagnosis of the patient plays a crucial role in fall incidents. The most important problem associated with patient falls was symptoms of traumatic brain injury. According to the participating nurses, the risk of fall for every patient should be evaluated upon admission. Measures that the nurses take against patient falls include raising the bed's side rails and securing the bed brakes. The findings of this research suggest that in-service training programs about the evaluation of the risk of falling should be organized for nurses. Guidelines should be developed for patients with different levels of risk of falling. It is suggested that nurses should be in charge of training patients who are conscious, their relatives, and caregiver personnel. The training of nurses and caregivers helps to prevent the falls of inpatients.

  11. Impact of obesity on the risk of venous thromboembolism in an inpatient pediatric population.

    Science.gov (United States)

    Stokes, Sean; Breheny, Patrick; Radulescu, Aurelia; Radulescu, Vlad Calin

    2014-08-01

    The incidence of venous thromboembolism in children has increased significantly over the past 20 years. Over the same period of time, there was an increase in the prevalence of obesity in the pediatric population. Obesity is a known risk factor for VTE in adults, but little information is available in children. This study evaluates the relation between obesity and VTE using a retrospective, case-control design, comparing the body mass index (BMI) of patients admitted with a diagnosis of VTE versus patients admitted with other diagnoses, at a single institution, between 2007 and 2011. We studied 48 inpatients diagnosed with deep venous thrombosis or pulmonary embolism and a control group of 274 age and gender matched patients admitted with other diagnoses. We found obese patients (BMI > 95th percentile) to have significantly higher risk of VTE (odds ratio 2.1, with 95% CI 1.1-4.2) than patients of normal weight (BMI obesity and VTE in a group of hospitalized children, showing a risk for VTE in obese children similar to the one described in much larger adult cohorts.

  12. Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample.

    Science.gov (United States)

    Kalla, Aditi; Krishnamoorthy, Parasuram M; Gopalakrishnan, Akshaya; Figueredo, Vincent M

    2018-06-06

    Cannabis for medicinal and/or recreational purposes has been decriminalized in 28 states as of the 2016 election. In the remaining states, cannabis remains the most commonly used illicit drug. Cardiovascular effects of cannabis use are not well established due to a limited number of studies. We therefore utilized a large national database to examine the prevalence of cardiovascular risk factors and events amongst patients with cannabis use. Patients aged 18-55 years with cannabis use were identified in the National Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Disease code 304.3. Demographics, risk factors, and cardiovascular event rates were collected on these patients and compared with general population data. Prevalence of heart failure, cerebrovascular accident (CVA), coronary artery disease, sudden cardiac death, and hypertension were significantly higher in patients with cannabis use. After multivariate regression adjusting for age, sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, tobacco use, and alcohol use, cannabis use remained an independent predictor of both heart failure (odds ratio = 1.1, 1.03-1.18, P < 0.01) and CVA (odds ratio = 1.24, 1.14-1.34, P < 0.001). Cannabis use independently predicted the risks of heart failure and CVA in individuals 18-55 years old. With continued legalization of cannabis, potential cardiovascular effects and their underlying mechanisms need to be further investigated.

  13. Interdisciplinary Approach to Fall Prevention in a High-Risk Inpatient Pediatric Population: Quality Improvement Project.

    Science.gov (United States)

    Stubbs, Kendra E; Sikes, Lindsay

    2017-01-01

    Within a tertiary care pediatric medical center, the largest number of inpatient falls (8.84 falls per 1,000 patient days) occurred within a 14-bed rehabilitation/transitional care unit between February and September 2009. An interdisciplinary fall prevention program, called "Red Light, Green Light," was developed to better educate all staff and family members to ensure safety of transfers and ambulation of children with neurological impairments. The purpose of this study was to develop and implement an interdisciplinary pediatric fall prevention program to reduce total falls and falls with family members present in this population. Preintervention 2009 data and longitudinal data from 2010-2014 were obtained from retrospective review of event/incident reports. This quality improvement project was based on inpatient pediatric admissions to a rehabilitation care unit accommodating children with neurological impairments. Data extraction included: total falls, falls with caregiver (alone versus staff versus family), type of falls, and falls by diagnosis. Descriptive statistics were obtained on outcome measures; chi-square statistics were calculated on preintervention and postintervention comparisons. Total falls decreased steadily from 8.84 falls per 1,000 patient days in 2009 to 1.79 falls per 1,000 patient days in 2014 (χ12=3.901, P=.048). Falls with family members present decreased 50% postintervention. (χ12=6.26, P=.012). Limitations included unit size nearly doubled postintervention, event reporting changed to both uncontrolled and controlled therapy falls (safely lowering patient to bed, chair, or floor), and enhanced reporting increased numbers of postintervention falls. The Red Light, Green Light program has resulted in reductions in overall fall rates, falls with family members present, increased staff collaboration, heightened staff and family safety awareness, and a safer environment for patients at high risk for neurological or musculoskeletal impairments

  14. Risk assessment of tailings facility dam failure

    OpenAIRE

    Hadzi-Nikolova, Marija; Mirakovski, Dejan; Stefanova, Violeta

    2011-01-01

    This paper presents the consequences of tailings facility dam failure and therefore the needs for its risk assessment. Tailings are fine-grained wastes of the mining industry, output as slurries, due to mixing with water during mineral processing. Tailings dams vary a lot as it is affected by: tailings characteristics and mill output, site characteristics as: topography, hydrology, geology, groundwater, seismicity and available material and disposal methods. The talings which accumulat...

  15. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

    Science.gov (United States)

    Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

    2017-10-01

    Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

  16. Weekend hospitalization and additional risk of death: an analysis of inpatient data.

    Science.gov (United States)

    Freemantle, N; Richardson, M; Wood, J; Ray, D; Khosla, S; Shahian, D; Roche, W R; Stephens, I; Keogh, B; Pagano, D

    2012-02-01

    To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk. Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death. National Health Service Hospitals in England. 30 day mortality (in or out of hospital). There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set. Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day.

  17. In-patient suicide: selection of people at risk, failure of protection and the possibility of causation

    OpenAIRE

    Large, Matthew Michael; Chung, Daniel Thomas; Davidson, Michael; Weiser, Mark; Ryan, Christopher James

    2017-01-01

    Background Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units ...

  18. The validity of three fall risk screening tools in an acute geriatric inpatient population.

    Science.gov (United States)

    Latt, Mark Dominic; Loh, K Florence; Ge, Ludi; Hepworth, Annie

    2016-09-01

    We examined the validity of the Ontario Modified STRATIFY (OM) (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients), The Northern Hospital Modified STRATIFY (TNH) and STRATIFY in predicting falls in an acute aged care unit. Data were collected prospectively from 217 people presenting consecutively and falls identified during hospitalisation. Sensitivities of OM (80.0, 95% confidence interval (CI) 58.4 to 91.9%), TNH (85, CI 64.0 to 94.8%) and STRATIFY (80.0, CI 58.4 to 91.0%) were similar. The STRATIFY had higher specificity (61.4, CI 54.5 to 67.9%) than OM (37.1, CI 30.6 to 44.0%) and TNH (51.3, CI 44.3 to 58.2%). Accuracy (percentage of patients correctly classified as 'faller' or 'non-faller') was higher using STRATIFY (63.1, CI 56.5 to 69.3%) and TNH (54.4, CI 47.8 to 61.0%) than with OM (41.0, CI 34.7 to 47.7%, P patients at high risk of falls. © 2016 AJA Inc.

  19. [Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities].

    Science.gov (United States)

    Horikoshi, Naoko; Kuwahara, Yuki; Taguchi, Atsuko; Nagata, Tomoko; Murashima, Sachiyo

    2013-07-01

    The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care. The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home. The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff. It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.

  20. The Prevalence and Investigation of Risk Factors of Oral Mucositis in a Pediatric Oncology Inpatient Population; a Prospective Study.

    Science.gov (United States)

    Allen, Gabrielle; Logan, Richard; Revesz, Tom; Keefe, Dorothy; Gue, Sam

    2018-01-01

    Oral mucositis can be a frequent and severe complication of chemotherapy in children. It can result in pain, infection, depression, prolonged admission, treatment delays, increase in patient morbidity, and increased costs. To record the prevalence and severity of oral mucositis among inpatients and explore the relationship of risks factors and the development of oral mucositis. During an 18-month period 643 clinical inpatient assessments were completed on 73 children who were admitted and had received chemotherapy in the last 14 days. There were 43 episodes of oral mucositis in 31 children; 42.5% of the inpatient population. World Health Organization assessment identified 32.6% of episodes were grade 1, 34.9% grade 2, 14.0% grade 3, and 18.6% grade 4. Analysis revealed significant associations between patient diagnosis (P<0.0001), chemotherapy cycles (P<0.0001), day 8 and 9 of the chemotherapy cycle (P<0.05), and neutropenia (P<0.0001) and oral mucositis. Children had increased length of admission with increasing severity of oral mucositis (P=0.0005). The prevalence of oral mucositis was 42.5% among inpatients and admission length was increased with increasing severity. Patient diagnosis, chemotherapy treatment block, day of chemotherapy cycle, and neutropenic status were shown to influence the risk of developing oral mucositis.

  1. Microalbuminuria indicates long-term vascular risk in patients after acute stroke undergoing in-patient rehabilitation

    Directory of Open Access Journals (Sweden)

    Sander Dirk

    2012-09-01

    Full Text Available Abstract Background Patients in neurologic in-patient rehabilitation are at risk of cardio- and cerebrovascular events. Microalbuminuria (MAU is frequent and an important risk predictor but has not been validated in in-patient rehabilitation. We therefore aimed to examine MAU as an indicator of risk and predictor of vascular events in a prospective study. Methods The INSIGHT (INvestigation of patients with ischemic Stroke In neuroloGic reHabiliTation registry is the first to provide large scale data on 1,167 patients with acute stroke (χ2 or Mann–Whitney-U Test. Relative risks (RR with 95% confidence intervals (CI were estimated using log-binominal models. To evaluate the association between MAU and new vascular events as well as mortality, we calculated hazard ratios (HR using Cox proportional hazard regression. Results A substantial proportion of patients was MAU positive at baseline (33.1%. Upon univariate analysis these patients were about 4 years older (69 vs. 65 years; p 2; p = 0.03 and increased waist circumference (79.5 vs. 50.4% for women [p  Conclusions INSIGHT demonstrated a significant association between MAU and polyvascular disease and further supports previous findings that MAU predicts cardio-/cerebrovascular events in patients recovering from ischemic stroke. This biomarker may also be used in patients during neurologic in-patient rehabilitation, opening a window of opportunity for early intervention in this patient group at increased risk for recurrent events.

  2. Risk factors for adverse drug reactions in pediatric inpatients: A cohort study.

    Science.gov (United States)

    Andrade, Paulo Henrique Santos; Lobo, Iza Maria Fraga; da Silva, Wellington Barros

    2017-01-01

    The present study aims to identify the risk factors for adverse drug reactions (ADR) in pediatric inpatients. A prospective cohort study in one general pediatric ward in a hospital in Northeast Brazil was conducted in two stages: the first stage was conducted between August 17th and November 6th, 2015, and the second one between March 1st and August 25th, 2016. We included children aged 0-14 years 11 months hospitalized with a minimum stay of 48 hours. Observed outcomes were the ADR occurrence and the time until the first ADR observed. In the univariate analysis, the time to the first ADR was compared among groups using a log-rank test. For the multivariate analysis, the Cox regression model was used. A total of 173 children (208 admissions) and 66 ADR classified as "definite" and "probable" were identified. The incidence rate was 3/100 patient days. The gastro-intestinal system disorders were the main ADR observed (28.8%). In addition, 22.7% of the ADR were related to antibacterials for systemic use and 15.2% to general anesthesia. Prior history of ADR of the child [hazard ratio (HR) 2.44; 95% confidence interval (CI) 1.19-5.00], the use of meglumine antimonate (HR 4.98; 95% CI 1.21-20.54), antibacterial for systemic use (HR 2.75; 95% CI 1.08-6.98) and antiepileptic drugs (HR 3.84; 95% CI 1.40-10.56) were identified risk factors for ADR. We identified as risk factors the prior history of ADR of the child and the use of meglumine antimonate, antibacterial for systemic use and antiepileptic drugs.

  3. Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa.

    Science.gov (United States)

    Kameoka, Naomi; Iga, Jun-ichi; Tamaru, Mai; Tominaga, Takeo; Kubo, Hiroko; Watanabe, Shin-Ya; Sumitani, Satsuki; Tomotake, Masahito; Ohmori, Tetsuro

    2016-04-01

    Refeeding in patients with anorexia nervosa (AN) is associated with a risk of refeeding syndrome, which is a disruption in metabolism with a variety of features including hypophosphatemia. We evaluated the risk factors for refeeding hypophosphatemia (RH) during nutritional replenishment in Japanese patients with AN. We retrospectively examined clinical data for 99 female inpatients (mean age 30.9 ± 10.7 years; range, 9 - 56 years). RH (phosphate < 2.3 mg/dL) occurred within 4.8 ± 3.7 days of hospital admission and was still observed at 28 days after admission in 21 of the 99 cases (21.2%). Oral or intravenous phosphate was given to some patients to treat or prevent RH. Patients with RH had a significantly lower body mass index, were older, and had higher blood urea nitrogen than those without RH. Severe complications associated with RH were recorded in only one patient who showed convulsions and disturbed consciousness at Day 3 when her serum phosphate level was 1.6 mg/dL. The significant risk factors for RH that we identified were lower body mass index, older age, and higher blood urea nitrogen at admission. No significant difference in total energy intake was seen between the RH and no RH groups, suggesting that RH may not be entirely correlated with energy intake. Precisely predicting and preventing RH is difficult, even in patients with AN who are given phosphate for prophylaxis. Thus, serum phosphate levels should be monitored for more than 5 days after admission. © 2015 Wiley Periodicals, Inc.

  4. Risk factors for adverse drug reactions in pediatric inpatients: A cohort study.

    Directory of Open Access Journals (Sweden)

    Paulo Henrique Santos Andrade

    Full Text Available The present study aims to identify the risk factors for adverse drug reactions (ADR in pediatric inpatients.A prospective cohort study in one general pediatric ward in a hospital in Northeast Brazil was conducted in two stages: the first stage was conducted between August 17th and November 6th, 2015, and the second one between March 1st and August 25th, 2016. We included children aged 0-14 years 11 months hospitalized with a minimum stay of 48 hours. Observed outcomes were the ADR occurrence and the time until the first ADR observed. In the univariate analysis, the time to the first ADR was compared among groups using a log-rank test. For the multivariate analysis, the Cox regression model was used.A total of 173 children (208 admissions and 66 ADR classified as "definite" and "probable" were identified. The incidence rate was 3/100 patient days. The gastro-intestinal system disorders were the main ADR observed (28.8%. In addition, 22.7% of the ADR were related to antibacterials for systemic use and 15.2% to general anesthesia. Prior history of ADR of the child [hazard ratio (HR 2.44; 95% confidence interval (CI 1.19-5.00], the use of meglumine antimonate (HR 4.98; 95% CI 1.21-20.54, antibacterial for systemic use (HR 2.75; 95% CI 1.08-6.98 and antiepileptic drugs (HR 3.84; 95% CI 1.40-10.56 were identified risk factors for ADR.We identified as risk factors the prior history of ADR of the child and the use of meglumine antimonate, antibacterial for systemic use and antiepileptic drugs.

  5. Risk management activities at the DOE Class A reactor facilities

    International Nuclear Information System (INIS)

    Sharp, D.A.; Hill, D.J.; Linn, M.A.; Atkinson, S.A.; Hu, J.P.

    1993-01-01

    The probabilistic risk assessment (PRA) and risk management group of the Association for Excellence in Reactor Operation (AERO) develops risk management initiatives and standards to improve operation and increase safety of the DOE Class A reactor facilities. Principal risk management applications that have been implemented at each facility are reviewed. The status of a program to develop guidelines for risk management programs at reactor facilities is presented

  6. Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: a national one-day snapshot.

    Science.gov (United States)

    White, Melinda; Dennis, Nicole; Ramsey, Rebecca; Barwick, Katie; Graham, Christie; Kane, Sarah; Kepreotes, Helen; Queit, Leah; Sweeney, Annabel; Winderlich, Jacinta; Wong See, Denise; Littlewood, Robyn

    2015-03-01

    Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia. Malnutrition, obesity and nutritional risk prevalence were investigated in 832 and 570 paediatric inpatients, respectively, in eight tertiary paediatric hospitals and eight regional hospitals across Australia on a single day. Malnutrition and obesity prevalence was determined using z-scores and body mass index (BMI) percentiles. High nutritional risk was determined as a Paediatric Yorkhill Malnutrition Score of 2 or more. The prevalence rates of malnourished, wasted, stunted, overweight and obese paediatric patients were 15%, 13.8%, 11.9%, 8.8% and 9.9%, respectively. Patients who identified as Aboriginal and Torres Strait Islander were more likely to have lower height-for-age z-scores (P malnutrition and nutritional risk of Australian paediatric inpatients on a given day was much higher when compared with the healthy population. In contrast, the proportion of overweight and obese patients was less. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  7. Inpatient Rehabilitation Facility PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Section 4421 of the Balanced Budget Act of 1997 (Public Law 105-33), as amended by section 125 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of...

  8. [Evaluating the activity of the Italian Mental Health Services inpatient and residential facilities: the PRISM (Process Indicator System for Mental health) indicators].

    Science.gov (United States)

    Picardi, Angelo; Tarolla, Emanuele; de Girolamo, Giovanni; Gigantesco, Antonella; Neri, Giovanni; Rossi, Elisabetta; Biondi, Massimo

    2014-01-01

    This article describes the activities of a project aimed at developing a system of process and process/outcome indicators suitable to monitor over time the quality of psychiatric care of Italian inpatient and residential psychiatric facilities. This system, named PRISM (Process Indicator System for Mental health), was developed by means of a standardized evaluation made by a panel of experts and a consecutive pilot study in 17 inpatient and 13 residential psychiatric facilities. A total of 28 indicators were selected from a set of 251 candidate indicators developed by the most relevant and qualified Italian and international authorities. These indicators are derived by data from medical records and information about characteristics of facilities, and they cover processes of care, operational equipment of facilities, staff training and working, relationships with external agencies, and sentinel events. The procedure followed for the development of the indicator system was reliable and innovative. The data collected from the pilot study suggested a favourable benefit-cost ratio between the workload associated with regular use of the indicators into the context of daily clinical activities and the advantages related to the information gathered through regular use of the indicators. CONCLUSIONS.:The PRISM system provides additional information about the healthcare processes with respect to the information gathered via routine information systems, and it might prove useful for both continuous quality improvement programs and health services research.

  9. Prevalence of vision loss among hospital in-patients; a risk factor for falls?

    Science.gov (United States)

    Leat, Susan J; Zecevic, Aleksandra A; Keeling, Alexis; Hileeto, Denise; Labreche, Tammy; Brymer, Christopher

    2018-01-01

    Despite poor vision being a risk factor for falls, current hospital policies and practices often do not include a vision assessment at patient admission or in the hospital's incident reporting system when a fall occurs. Our purpose was to document the prevalence of vision loss in hospital general medicine units to increase awareness of poor vision as a potential risk factor for falls that occur within the hospital, and inform future preventative practice. This cross-sectional study took place in medicine units of an acute care hospital. Participants were adult in-patients. Visual acuity (VA), contrast sensitivity and stereoacuity were measured, and patients were screened for field loss, extinction and neglect. 115 participants took part (average age 67 ± 17, 48% female). Overall, 89% had a visual impairment defined as being outside the age-norms for one or more vision measure, 62% had low vision, and 36% had vision loss equivalent to legal blindness [VA equal to or poorer than 1.0 logMAR (6/60, 20/200) or ≥10x below age-norms]. There was a considerable discrepancy between the prevalence of low vision and the percentage of patients who reported an ocular diagnosis that would result in visual loss (30%). Ten patients fell during the study period, and of these 100% had visual impairment, 90% had low vision and 60% had vision loss equivalent to legal blindness, which compares to 58%, 22% and 9% for non-fallers. Similar high prevalences were found in those whose reason for admission to the hospital was a fall (92%, 63% and 33% respectively). Vision loss has a high prevalence among patients in hospital medicine units, and is higher still among those who fall. Since vision loss may be a contributing factor to falls that occur in hospitals, implementing an assessment of vision at hospital admission would be useful to alert staff to those patients who are at risk for falls due to poor vision, so that preventative measures can be applied. © 2017 The Authors Ophthalmic

  10. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.

    Science.gov (United States)

    Launay, Cyrille P; de Decker, Laure; Kabeshova, Anastasiia; Annweiler, Cédric; Beauchet, Olivier

    2014-01-01

    The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (PLHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

  11. Screening for Older Emergency Department Inpatients at Risk of Prolonged Hospital Stay: The Brief Geriatric Assessment Tool

    Science.gov (United States)

    Launay, Cyrille P.; de Decker, Laure; Kabeshova, Anastasiia; Annweiler, Cédric; Beauchet, Olivier

    2014-01-01

    Background The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Methods Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Results Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (Prisk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients. PMID:25333271

  12. Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial.

    Science.gov (United States)

    Wye, Paula M; Stockings, Emily A; Bowman, Jenny A; Oldmeadow, Chris; Wiggers, John H

    2017-02-07

    Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods. The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25

  13. Suicide mortality and risk factors in the 12 months after discharge from psychiatric inpatient care in Korea: 1989-2006.

    Science.gov (United States)

    Park, Subin; Choi, Jae Won; Kyoung Yi, Ki; Hong, Jin Pyo

    2013-07-30

    This study aimed to determine the suicide mortality within 1 year after discharge from psychiatric inpatient care and identify the risk factors for suicide completion during this period. A total of 8403 patients were admitted to general hospitals in Seoul, Korea, for psychiatric disorders from January 1989 to December 2006. The suicide mortality risk of these patients within 1 year of discharge was compared with that of gender- and age-matched subjects from the general population of Korea. The standardized mortality ratios (SMR) for suicide in the year following discharge were 49.7 for males and 45.5 for females. Patients aged 15-24 years had the highest risk for suicide. Among the different diagnostic groups, patients with personality disorders, schizophrenia, or affective disorders had the highest risk for suicide completion. Suicidal ideation at admission and inpatient stay more than 1 month were also associated with increased risk of suicide. In Korean psychiatric patients, the SMR is much higher in young female patients, a high percentage of patients commit suicide by jumping, and there is a stronger association of long duration of hospitalization and suicide. These factors should be considered in the development and implementation of suicide prevention strategies for Korean psychiatric patients. Copyright © 2013. Published by Elsevier Ireland Ltd.

  14. Mitigating risks related to facilities management.

    Science.gov (United States)

    O'Neill, Daniel P; Scarborough, Sydney

    2013-07-01

    By looking at metrics focusing on the functionality, age, capital investment, transparency, and sustainability (FACTS) of their organizations' facilities, facilities management teams can build potential business cases to justify upgrading the facilities. A FACTS analysis can ensure that capital spent on facilities will produce a higher or more certain ROI than alternatives. A consistent process for managing spending helps to avoid unexpected spikes that cost the enterprise more in the long run.

  15. Protection of Facilities and Risk Assessment Application

    OpenAIRE

    Nađ, Ivan; Mihaljević, Branko; Mihalinčić, Martina

    2014-01-01

    The state of security on a specific area imposes the necessity for constant analysis of the existing system of protection of key state facilities, especially facilities of special significance for the defence. The facilities of special significance for the defence are an important part of the daily life, and enable smooth functioning of the economy and all other state activities. The protection of facilities of special significance for the defence is considered to be a system of obligatory me...

  16. The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for PUs.

    Science.gov (United States)

    Motamedi, S M; de Grood, J; Harman, S; Sargious, P; Baylis, B; Flemons, W; Ghali, W A

    2012-11-01

    To assess the impact of continuous pressure imaging technology on strategic turning of patients by health professionals. This pilot study of a newly-developed continuous pressure imaging technology (XSENSOR ForeSite PatientTurn System) involved two phases of videotaped observation of medical inpatients, with each patient serving as his/her own control: a control phase in which continuous pressure imaging was not available to health-care providers and an intervention phase where it was. The primary outcome was to determine whether access to the technology influenced the rate of patient turns/shifts by nursing staff. Secondary outcomes included a comparison of the rates of other care provider shifts, patient self-shifts, and family assisted shifts. Qualitative data regarding nurse and patient/family perspectives were also obtained. Complete control/intervention data were available for nine patients.The mean rate of two-person assisted turns was 0.274 +/- 0.087 turns per hour in the control phase versus 0.413 +/- 0.091 turns per hour in the intervention phase (p = 0.08). For the combined endpoint of two-person assisted turns or patient transfers off the bed into a wheelchair/chair, there was a statistically significant difference in the mean number of turns per hour: mean of 0.491 +/- 0.271 turns per hour for the intervention group versus 0.327 +/- 0.235 turns per hour for the control group (p = 0.04). Provider interviews confirmed that nurses used information from the technology to inform their patient shifting strategies and behaviours. This pilot study provides some initial data supporting the hypothesis that continuous pressure imaging technology could positively impact the frequency of patient turns by care providers, as well as provide impetus to inspect specific skin locations,thereby providing a potential targeted risk mitigation strategy for the development of pressure ulcers. Funding for the study was obtained from PreCarn Inc., an independent, nonprofit

  17. Suicide attempts among depressed inpatients with depressive disorder in a Malaysian sample. Psychosocial and clinical risk factors.

    Science.gov (United States)

    Chan, L F; Maniam, T; Shamsul, A S

    2011-01-01

    Depressed inpatients constitute a high-risk population for suicide attempts. To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck's Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

  18. CSF 5-HIAA and DST non-suppression--orthogonal biologic risk factors for suicide in male mood disorder inpatients.

    Science.gov (United States)

    Jokinen, Jussi; Nordström, Anna-Lena; Nordström, Peter

    2009-01-30

    Two biomarkers of suicide risk; non-suppression in the dexamethasone suppression test (DST) and low 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been reported to be predictors of suicide in mood disorders. The interrelation of the two systems seems to be different in suicide attempters compared with depressed inpatients who have not made a suicide attempt, indicating that the two biomarkers may be seen as independent. This investigation examined the interrelation of low CSF 5-HIAA and DST non-suppression in suicide victims with mood disorder. Fifty-eight mood disorder inpatients not receiving any treatment with antidepressants underwent lumbar puncture and the DST. Plasma cortisol levels at 8:00 a.m., 4:00 p.m. and 11:00 p.m. were analysed in relation to CSF 5-HIAA. All patients were followed up for causes of death and suicides were verified with death certificates. During follow-up (mean 21 years), 11 (19%) patients had committed suicide. In male suicide victims (n=6), the serum cortisol level at 4:00 p.m. showed a significant positive correlation with CSF 5-HIAA. Low CSF 5-HIAA predicted all early suicides (within 1 year), whereas all males who committed suicide after 1 year were DST non-suppressors. In female suicide victims (n=5), the post-DST serum cortisol did not correlate with CSF 5-HIAA. Low CSF 5-HIAA and DST non-suppression are orthogonal biologic risk factors for suicide in male mood disorder inpatients. CSF 5-HIAA is associated with short-term suicide risk; dysregulation of the hypothalamic-pituitary-adrenal axis seems to be a long-term suicide predictor.

  19. Assessing the reliability, predictive and construct validity of historical, clinical and risk management-20 (HCR-20) in Mexican psychiatric inpatients.

    Science.gov (United States)

    Sada, Andrea; Robles-García, Rebeca; Martínez-López, Nicolás; Hernández-Ramírez, Rafael; Tovilla-Zarate, Carlos-Alfonso; López-Munguía, Fernando; Suárez-Alvarez, Enrique; Ayala, Xochitl; Fresán, Ana

    2016-08-01

    Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.

  20. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Claudiu Avram

    2010-12-01

    Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

  1. Risk management study for the retired Hanford Site facilities

    International Nuclear Information System (INIS)

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

    1993-04-01

    Risk from retired surplus facilities has always been assumed to be low at the Hanford Site as the facilities are inactive and have few potentials for causing an offsite hazardous material release. However,the fatal accident that occurred in the spring of 1992 in which an employee fell through a deteriorated roof at the 105-F Reactor Building has raised the possibility that retired facilities represent a greater risk than was originally assumed. Therefore, Westinghouse Hanford Company and the US Department of Energy management have determined that facility risk management strategies and programmatic plans should be reevaluated to assure risks are identified and appropriate corrective action plans are developed. To evaluate risk management strategies, accurate risk information about the current and projected condition of the facilities must be developed. This work procedure has been created to address the development of accurate and timely risk information. By using the evaluation results in this procedure, it will be possible to create a prioritized baseline for managing facility risk until all retired surplus facilities are demolished

  2. Risk evaluation system for facility safeguards and security planning

    International Nuclear Information System (INIS)

    Udell, C.J.; Carlson, R.L.

    1987-01-01

    The Risk Evaluation System (RES) is an integrated approach to determining safeguards and security effectiveness and risk. RES combines the planning and technical analysis into a format that promotes an orderly development of protection strategies, planing assumptions, facility targets, vulnerability and risk determination, enhancement planning, and implementation. In addition, the RES computer database program enhances the capability of the analyst to perform a risk evaluation of the facility. The computer database is menu driven using data input screens and contains an algorithm for determining the probability of adversary defeat and risk. Also, base case and adjusted risk data records can be maintained and accessed easily

  3. Risk evaluation system for facility safeguards and security planning

    International Nuclear Information System (INIS)

    Udell, C.J.; Carlson, R.L.

    1987-01-01

    The Risk Evaluation System (RES) is an integrated approach to determining safeguards and security effectiveness and risk. RES combines the planning and technical analysis into a format that promotes an orderly development of protection strategies, planning assumptions, facility targets, vulnerability and risk determination, enhancement planning, and implementation. In addition, the RES computer database program enhances the capability of the analyst to perform a risk evaluation of the facility. The computer database is menu driven using data input screens and contains an algorithm for determining the probability of adversary defeat and risk. Also, base case and adjusted risk data records can be maintained and accessed easily

  4. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.

    Directory of Open Access Journals (Sweden)

    Cyrille P Launay

    Full Text Available The aims of this study were 1 to confirm that combinations of brief geriatric assessment (BGA items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED; and 2 to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS.Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day, use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year. The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry.Area under receiver operating characteristic (ROC curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010. Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003. Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4 and a low likelihood ratio of positive test under 5.6.Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients.

  5. Construction and evaluation of FiND, a fall risk prediction model of inpatients from nursing data.

    Science.gov (United States)

    Yokota, Shinichiroh; Ohe, Kazuhiko

    2016-04-01

    To construct and evaluate an easy-to-use fall risk prediction model based on the daily condition of inpatients from secondary use electronic medical record system data. The present authors scrutinized electronic medical record system data and created a dataset for analysis by including inpatient fall report data and Intensity of Nursing Care Needs data. The authors divided the analysis dataset into training data and testing data, then constructed the fall risk prediction model FiND from the training data, and tested the model using the testing data. The dataset for analysis contained 1,230,604 records from 46,241 patients. The sensitivity of the model constructed from the training data was 71.3% and the specificity was 66.0%. The verification result from the testing dataset was almost equivalent to the theoretical value. Although the model's accuracy did not surpass that of models developed in previous research, the authors believe FiND will be useful in medical institutions all over Japan because it is composed of few variables (only age, sex, and the Intensity of Nursing Care Needs items), and the accuracy for unknown data was clear. © 2016 Japan Academy of Nursing Science.

  6. Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities

    International Nuclear Information System (INIS)

    Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

    1994-02-01

    This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km 2 Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included

  7. Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities. Volume 4

    Energy Technology Data Exchange (ETDEWEB)

    Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

    1994-02-01

    This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km{sup 2} Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included.

  8. Use of risk information to safety regulation. Reprocessing facilities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-15

    A procedure of probabilistic risk assessment (PRA) for a reprocessing facility has been under the development aiming to utilize risk information for safety regulations in this project. Activities in the fiscal year 2012 are summarized in the paper. A major activity is a fundamental study on a concept of serious accidents, requirements of serious accident management, and a policy of utilizing risk information for fabrication and reprocessing facilities. Other than the activity a study on release and transport of aerial radioactive materials at a serious accident in a reprocessing facility has been conducted. The outline and results are provided in the chapter 1 and 2 respectively. (author)

  9. Westinghouse Hanford Company risk management strategy for retired surplus facilities

    International Nuclear Information System (INIS)

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

    1993-09-01

    This paper describes an approach that facilitates management of personnel safety and environmental release risk from retired, surplus Westinghouse Hanford Company-managed facilities during the predemolition time frame. These facilities are located in the 100 and 200 Areas of the 1,450-km 2 (570-mi 2 ) Hanford Site in Richland, Washington. The production reactors are located in the 100 Area and the chemical separation facilities are located in the 200 Area. This paper also includes a description of the risk evaluation process, shows applicable results, and includes a description of comparison costs for different risk reduction options

  10. Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups.

    Science.gov (United States)

    Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

    2009-04-30

    The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to

  11. 29 CFR 825.114 - Inpatient care.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  12. Prevalence of pressure ulcer and associated risk factors in middle- and older-aged medical inpatients in Norway.

    Science.gov (United States)

    Børsting, Tove E; Tvedt, Christine R; Skogestad, Ingrid J; Granheim, Tove I; Gay, Caryl L; Lerdal, Anners

    2018-02-01

    To describe the prevalence of pressure ulcers among middle- and older-aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses' clinical judgements combined with risk assessment tools are effective to detect pressure ulcer risk. Cross-sectional study. The study was performed as part of a research project conducted between September 2012-May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students' clinical practice studies. The Braden scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient's self-report. This analysis focused on the 255 inpatients at the medical wards ≥52 years of age, most of whom had more than one comorbidity. The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Adding age, weight and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. Knowledge about strengths and limitations of risk assessment tools is important for clinical practice. Age, weight and diabetes status should be considered for inclusion in risk assessment tools for pressure ulcers in medical wards. © 2017 John Wiley & Sons Ltd.

  13. Engineering risk assessment for hydro facilities

    International Nuclear Information System (INIS)

    Laurence, K.G.

    1991-01-01

    Faced with escalating property insurance premiums, the Alaska Energy Authority decided to evaluate what losses may realistically be expected due to catastrophic events at their hydroelectric generation and transmission facilities. Ideally insurance rates are established using historic loss statistics. Where these statistics are non-existent, other means must be employed to estimate expected losses so that appropriate steps may be taken to protect investments in facilities. The natural perils of earthquake, flood, tidal wave (tsunami), wind, snow and internal failure potentially can cause catastrophic damage, but due to their infrequency in the higher magnitudes, meaningful statistics are as yet insufficient to be of value in estimating losses from these events. In order to overcome this deficiency a quasi-engineering approach can be adopted as distinct from the actuarial approach preferred and most often used by the insurance industry. This paper describes the quasi-engineering approach used for this assessment with a specific example worked through for earthquake peril

  14. Radiation risk management at DOE accelerator facilities

    International Nuclear Information System (INIS)

    Dyck, O.B. van.

    1997-01-01

    The DOE accelerator contractors have been discussing among themselves and with the Department how to improve radiation safety risk management. This activity-how to assure prevention of unplanned high exposures-is separate from normal exposure management, which historically has been quite successful. The ad-hoc Committee on the Accelerator Safety Order and Guidance [CASOG], formed by the Accelerator Section of the HPS, has proposed a risk- based approach, which will be discussed. Concepts involved are risk quantification and comparison (including with non-radiation risk), passive and active (reacting) protection systems, and probabilistic analysis. Different models of risk management will be presented, and the changing regulatory environment will also be discussed

  15. Noxious facility impact projection: Incorporating the effects of risk aversion

    International Nuclear Information System (INIS)

    Nieves, L.A.

    1993-01-01

    Developing new sites for noxious facilities has become a complex process with many potential pitfalls. In addition to the need to negotiate conditions acceptable to the host community, siting success may depend on the facility proposer's ability to identify a candidate site that not only meets technical requirements, but that is located in a community or region whose population is not highly averse to the risks associated with the type of facility being proposed. Success may also depend on the proposer accurately assessing potential impacts of the facility and offering an equitable compensation package to the people affected by it. Facility impact assessments, as typically performed, include only the effects of changes in population, employment and economic activity associated with facility construction and operation. Because of their scope, such assessments usually show a short-run, net economic benefit for the host region, making the intensely negative public reaction to some types and locations of facilities seem unreasonable. The impact component excluded from these assessments is the long-run economic effect of public perceptions of facility risk and nuisance characteristics. Recent developments in psychological and economic measurement techniques have opened the possibility of correcting this flaw by incorporating public perceptions in projections of economic impacts from noxious facilities

  16. [Inpatient psychotherapy].

    Science.gov (United States)

    Spitzer, C; Rullkötter, N; Dally, A

    2016-01-01

    In German-speaking countries inpatient psychotherapy plays a major role in the mental healthcare system. Due to its characteristic features, i. e. multiprofessionalism, multimodality and method integration, the inpatient approach represents a unique and independent type of psychotherapy. In order to be helpful, the manifold verbal and non-verbal methods need to be embedded into an overall treatment plan. Additionally, the therapeutic milieu of the hospital represents an important effective factor and its organization requires a more active construction. The indications for inpatient psychotherapy are not only based on the mental disorder but also on illness, setting and healthcare system-related criteria. In integrative concepts, the multiprofessional team is a key component with many functions. The effectiveness of psychotherapeutic hospital treatment has been proven by meta-analysis studies; however, 20-30% of patients do not benefit from inpatient psychotherapy and almost 13% drop-out prematurely.

  17. Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour.

    Science.gov (United States)

    Maguire, Tessa; Daffern, Michael; Bowe, Steven J; McKenna, Brian

    2018-03-01

    To examine associations between risk of aggression and nursing interventions designed to prevent aggression. There is scarce empirical research exploring the nature and effectiveness of interventions designed to prevent inpatient aggression. Some strategies may be effective when patients are escalating, whereas others may be effective when aggression is imminent. Research examining level of risk for aggression and selection and effectiveness of interventions and impact on aggression is necessary. Archival case file. Data from clinical files of 30 male and 30 female patients across three forensic acute units for the first 60 days of hospitalisation were collected. Risk for imminent aggression as measured by the Dynamic Appraisal of Situational Aggression, documented nursing interventions following each assessment, and acts of aggression within the 24-hours following assessment were collected. Generalised estimating equations were used to investigate whether intervention strategies were associated with reduction in aggression. When a Dynamic Appraisal of Situational Aggression assessment was completed, nurses intervened more frequently compared to days when no Dynamic Appraisal of Situational Aggression assessment was completed. Higher Dynamic Appraisal of Situational Aggression assessments were associated with a greater number of interventions. The percentage of interventions selected for males differed from females; males received more pro re nata medication and observation, and females received more limit setting, one-to-one nursing and reassurance. Pro re nata medication was the most commonly documented intervention (35.9%) in this study. Pro re nata medication, limit setting and reassurance were associated with an increased likelihood of aggression in some risk bands. Structured risk assessment prompts intervention, and higher risk ratings result in more interventions. Patient gender influences the type of interventions. Some interventions are associated with

  18. Inpatient Suicide in a Chinese Psychiatric Hospital

    Science.gov (United States)

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

    2008-01-01

    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

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

    International Nuclear Information System (INIS)

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

    1993-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-09-01

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

  1. Risk factors of falls in inpatients and their practical use in identifying high-risk persons at admission: Fukushima Medical University Hospital cohort study.

    Science.gov (United States)

    Hayakawa, Takehito; Hashimoto, Shigeatsu; Kanda, Hideyuki; Hirano, Noriko; Kurihara, Yumi; Kawashima, Takako; Fukushima, Tetsuhito

    2014-01-01

    To clarify the risk factors for falls in hospital settings and to propose the use of such factors to identify high-risk persons at admission. Prospective cohort study. Fukushima Medical University Hospital, Japan, from August 2008 and September 2009. 9957 adult consecutive inpatients admitted to our hospital. Information was collected at admission from clinical records obtained from a structured questionnaire conducted in face-to-face interviews with subjects by nurses and doctors and fall events were collected from clinical records. The proportion of patients who fell during follow-up was 2.5% and the incidence of falls was 3.28 per 100 person-days. There were significant differences in age, history of falling, cognitive dysfunction, planned surgery, wheelchair use, need for help to move, use of a remote caring system, rehabilitation, use of laxative, hypnotic or psychotropic medications and need for help with activities of daily living (ADL) between patients who did and did not fall. Multivariable adjusted ORs for falls showed that age, history of falls and need for help with ADL were common risk factors in both men and women. Using psychotropic medication also increased the risk of falling in men while cognitive dysfunction and use of hypnotic medication increased the risk of falling in women. Planned surgery was associated with a low risk of falls in women. To prevent falls in inpatients it is important to identify high-risk persons. Age, history of falling and the need for help with ADL are the most important pieces of information to be obtained at admission. Care plans for patients including fall prevention should be clear and considered.

  2. Risk factors for violence among long-term psychiatric in-patients: a ...

    African Journals Online (AJOL)

    Previous research has linked aggressive behaviour to certain genetic conditions ... defects – such as impaired social information processing, socio-. Risk factors for ... The complex influence of diagnosis on psychiatric patients' risk of violence ...

  3. Need for realistic risk assessments at DOE facilities

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1993-01-01

    Widespread environmental contamination has been documented at U.S. Department of Energy (DOE) facilities. Human health risk assessments are increasingly being used to support decisions concerning remediation at these sites. Current methods for assessing risk at DOE facilities are generally excessively conservative or simplistic. Generic models, conservative parameter default values, and assumptions are often used, and unrealistic exposure and land-use scenarios are embedded in the analyses. These approaches are appropriate only as first-level screening analyses and identify contaminants or pathways that are not important in terms of risk to human health

  4. Evaluating health services with point of service feedback: perspectives and experiences of patients, staff and community volunteers in an inpatient rehabilitation facility.

    Science.gov (United States)

    Gill, Stephen D; Dolley, Pamela J; Dunning, Trisha L; Hughes, Andrew J

    2015-01-01

    To determine patient, staff and community volunteer opinions and experiences of point of service feedback (POSF) in an inpatient rehabilitation facility. Participants were recruited by purposeful sampling. Two researchers conducted in-depth semi-scripted interviews with patients, staff or volunteers until no new issues emerged. Manually transcribed interview data underwent thematic analysis that grouped information into categories of related information. Twenty patients, 26 staff from 10 different professional groups, and 2 community volunteers were interviewed. Patient and volunteer data were grouped into five main categories: patients wanted their voice heard and acted on; patients could be positively and negatively affected by POSF; patients could be reluctant to evaluate staff; patients preferred POSF to post-discharge mailed questionnaires; and patients' feedback was influenced by the data collector. Staff wanted: feedback to help them improve the patient experience; and feedback that was trustworthy, usable and used. Staff believed that the feedback-collector influenced patients' feedback and affected how feedback could be used. Patients, staff and community volunteers identified issues that determine the appropriateness and usefulness of POSF. Policy and practise should address the preferences, needs and experiences of health service users and providers so that POSF produces maximum benefits for both patients and health services. Implications for Rehabilitation POSF can enhance patients' experiences of inpatient rehabilitation by providing a mechanism to be heard and communicating that patients are valued; care must be exercised with patients who find giving feedback stressful. Collecting POSF is most beneficial when coupled with methods to efficiently and effectively respond to feedback. POSF requires interpretation in light of its limitations including patients' ability to accurately and unreservedly communicate their experiences. Who collects POSF

  5. The impact of a "search and destroy" strategy for the prevention of methicillin-resistant Staphylococcus aureus infections in an inpatient rehabilitation facility.

    Science.gov (United States)

    Widner, Aimee; Nobles, Delores L; Faulk, Clinton; Vos, Paul; Ramsey, Keith M

    2014-02-01

    To determine how the implementation of a methicillin-resistant Staphylococcus aureus (MRSA) control program in an inpatient rehabilitation facility (IRF) affects MRSA health care-associated infections (MRSA-HAIs). A retrospective chart review. IRF affiliated with Vidant Medical Center, an 861-bed, acute-care teaching hospital for The Brody School of Medicine at East Carolina University. Seventy-nine adult patients in the IRF who developed a MRSA-HAI from February 2005 through January 2011. Both the acute care hospital and the affiliated inpatient rehabilitation unit began screening 100% of admissions for MRSA nasal carriage, with decolonization of positive carriers, starting in February 2007. Yearly rates of MRSA-HAI per 1000 patient-days were compared in the IRF before and after the intervention. The weighted mean monthly infection rate before the intervention (February 2005 through January 2007) was 1.0714 per 1000 patient days compared with 0.6557 per 1000 patient days after the intervention (February 2007 through January 2011). The decreased infection rates after the intervention were statistically significant (P = .0315). The implementation of an all-admissions MRSA screening program with decolonization of positive carriers in an IRF affiliated with an acute care hospital resulted in decreased MRSA-HAI rates in the IRF. When developing surveillance guidelines for MRSA, IRFs should be cognizant of infection rate trends and of the affiliated hospital's scope of policies and practices for infection prevention and control. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  6. Suicide attempt history, self-esteem, and suicide risk in a sample of 116 depressed voluntary inpatients.

    Science.gov (United States)

    Palmer, Charles James

    2004-12-01

    116 consecutively admitted depressed inpatients were divided into three groups based on self-reported history of suicidal ideation and history of suicide attempt. Participants in Group 1 (M age 34.0, SD= 14.0), 13 men and 24 women, reported no history of suicidal ideation or history of suicide attempt. Group 2 (M age 34.0, SD= 8.6), 14 men and 25 women, reported having a history of suicidal ideation but no history of suicide attempt. Group 3 (M age 34.0 yr., SD=6.3), 14 men and 26 women, reported a history of suicidal ideation and at least one suicide attempt. Each participant completed the Suicide Risk Scale and the Self-esteem Scale. Analysis of variance with Tukey post hoc comparisons yielded a significant difference between Groups 1 and 2, between Groups 1 and 3, and between Groups 2 and 3 on the Suicide Risk Scale. There was a significant difference between Group 1 and Group 2 and between Group 1 and Group 3 on the Self-esteem Scale. These data indicated that suicide ideation and suicide attempt history significantly elevated suicide risk. Self-esteem was significantly decreased by suicide ideation and suicide attempt history.

  7. Radiation risk and its estimation for nuclear facilities

    International Nuclear Information System (INIS)

    Krueger, F.W.

    1979-01-01

    The level of knowledge achieved in estimating risks due to the operation of nuclear facilities is discussed. In this connection it is analyzed to what extent risk estimates may be used for establishing requirements for facilities and measures of radiation protection and accident prevention. At present, estimates of risks are subject to great uncertainties. However, the results attainable already permit to discern the causes of possible accidents and to develop effective measures for preventing such accidents. For the time being (and maybe in principle) risk estimation is possible only with more or less arbitrary premises. Within the foreseeable future, cost-benefit comparisons cannot compensate for discretionary decisions in establishing requirements for measures of radiation protection and accident prevention. In preparing such decisions based on experience, expert opinions, political and socio-economic reflections and views, comparison of the risk of novel technologies with existing ones or accepted risks may be a useful means. (author)

  8. Assessment of inpatient psychiatric readmission risk among patients discharged on an antipsychotic polypharmacy regimen: A retrospective cohort study.

    Science.gov (United States)

    Boskailo, Esad; Malkoc, Aldin; McCurry, Dustin B; Venter, Jacob; Drachman, David; Ramos, Gilbert M

    2017-11-01

    Patients are frequently prescribed multiple antipsychotic medications, leading to higher healthcare costs and increased risk for side effects. The efficacy of multiple versus single antipsychotics to prevent acute relapse, measured by incidence of inpatient readmission, is investigated in Arizona, USA. A retrospective chart review compared socio-demographic and clinical data from 1,010 patients discharged on a single and 377 discharged on multiple antipsychotic medications. Case management records were reviewed for readmission within one year of discharge. Younger age, diagnosis of Schizophrenia or Schizoaffective Disorder, prescription of mood stabilizer, shorter length of stay, and discharge to residential treatment or crisis recovery unit were associated with multiple antipsychotics at discharge. Readmission rates of the single (13.7%) versus multiple (15.9%) antipsychotic groups were not statistically different (p=0.286). Logistic regression analysis established that only age (younger) and the prescription of a mood stabilizer at discharge were significant predictors for increased risk for readmission (p=0.010 and p=0.049, respectively). A Cox survival analysis supported these findings. Concomitant antipsychotic polypharmacy at discharge did not reduce readmission risk over a one-year period. Given the increased risk of side effects and financial costs of polypharmacy, this study did not provide evidence to support this practice. Strikingly, only two variables predicted readmission risk, younger age and prescription of mood stabilizer. Although practitioners should follow practice guidelines more closely to prevent unnecessary exposure to potentially lethal side effects of antipsychotic polypharmacy, further studies are needed to better identify patients at high risk for readmission. Copyright © 2017 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  9. Profile of atrial fibrillation inpatients: Cardiovascular risk factors and cardiac rehabilitation programme delivery and referral patterns.

    Science.gov (United States)

    Gallagher, Robyn; Zhang, Ling; Roach, Kellie; Sadler, Leonie; Belshaw, Julie; Kirkness, Ann; Proctor, Ross; Neubeck, Lis

    2015-12-01

    Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes. © 2014 Wiley Publishing Asia Pty Ltd.

  10. The profile of risk factors and in-patient outcomes of stroke in ...

    African Journals Online (AJOL)

    We therefore conducted this study to evaluate the frequencies of the traditional risk factors and outcomes of stroke at the main tertiary referral centre in the middle belt of Ghana in a prospective observational study. Methods and results: Patients with a clinical diagnosis of stroke were consecutively recruited and vascular risk ...

  11. Perceived risk impacts from siting hazardous waste facilities

    International Nuclear Information System (INIS)

    Hemphill, R.C.; Edwards, B.K.; Bassett, G.W. Jr.

    1992-01-01

    This paper describes methods for evaluating perception-based economic impacts resulting from siting hazardous waste facilities. Socioeconomic impact analysis has devoted increasing attention to the potential implications of changed public perceptions of risk due to an activity or situation. This contrasts with traditional socioecconomic impact analysis, which has been limited to measuring direct and indirect consequences of activities, e.g., the employment effects of placing a military base in a specified location. Approaches to estimating economic impacts due to changes in public perceptions are ex ante or ex post. The former predict impacts prior to the construction and operation of a facility, while the later is based on impacts that become evident only when the facility is up and running. The theoretical foundations and practical requirements for demonstrating impacts, resulting from the siting of a hazardous facility are described. The theoretical rationale supporting the study of perceived risk research is presented along with discussion of problems that arise in demonstrating the existence and measuring the quantitative importance of economic impacts due to changes in perceived risk. The high-level nuclear waste facility being considered in Nevada is presented as an example in which there is potential for impacts, but where the link between perceived risk and economic conditions has not yet been developed

  12. Perceived risk impacts from siting hazardous waste facilities

    International Nuclear Information System (INIS)

    Hemphill, R.C.; Edwards, B.K.; Bassett, G.W. Jr.

    1992-01-01

    This paper describes methods for evaluating perception-based economic impacts resulting from siting hazardous waste facilities. Socioeconomic impact analysis has devoted increasing attention to the potential implications of changed public perceptions of risk due to an activity or situation. This contrasts with traditional socioeconomic impact analysis, which has been limited to measuring direct and indirect consequences of activities, e.g., the employment effects of placing a military base in a specified location. Approaches to estimating economic impacts due to changes in public perceptions are ex ante or ex post. The former predict impacts prior to the construction and operation of a facility, while the later is based on impacts that become evident only when the facility is up and running. The theoretical foundations and practical requirements for demonstrating impacts resulting from the siting of a hazardous facility are described. The theoretical rationale supporting the study of perceived risk research is presented along with discussion of problems that arise in demonstrating the existence and measuring the quantitative importance of economic impacts due to changes in perceived risk. The high-level nuclear waste facility being considered in Nevada is presented as an example in which there is potential for impacts, but where the link between perceived risk and economic conditions has not yet been developed

  13. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    OpenAIRE

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore; Matheny, Michael E

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention.

  14. A survey of ecological risk assessment at DOE facilities

    International Nuclear Information System (INIS)

    Barnthouse, L.W.; Bascietto, J.; Joseph, T.; Bilyard, G.

    1992-01-01

    The US Department of Energy (DOE) Risk-Based Standards Working Group is studying standard-setting and remedial action based on realistic estimates of human health and ecological risks. Federal and state regulations require DOE to assess ecological risks due to present and past operation of DOE facilities and ecological damage caused by remedial actions. Unfortunately, little technical guidance has been provided by regulatory agencies about how these assessments should be performed or what constitutes an adequate assessment. Active ecological research, environmental characterization, and ecological risk assessment programs are already underway at many locations. Some of these programs were established more than 30 years ago. Because of the strength of its existing programs and the depth of expertise available within the DOE complex, the agency is in a position to lead in developing ecological risk assessment procedures that are fully consistent with the general principles defined by EPA and that will ensure environmentally sound and cost-effective restoration of its sites. As a prelude to guidance development, the working group conducted a survey of ecological risk assessment activities at a subset of major DOE facilities. The survey was intended to (1) identify approaches now being used in ecological risk assessments performed by DOE staff and contractors at each site, (2) record successes and failures of these approaches, (3) identify new technical developments with potential for general application to many DOE facilities, and (4) identify major data needs, data resources, and methodological deficiencies

  15. [Incidence and risk factors for mental abnormalities in children of psychiatric inpatients].

    Science.gov (United States)

    Stelzig-Schöler, Renate; Hasselbring, Laura; Yazdi, Kurosch; Thun-Hohenstein, Leonhard; Stuppäck, Christoph; Aichhorn, Wolfgang

    2011-01-01

    Children of mentally ill parents are exposed to a variety of stress- and harmful life events. To which extent the mental illness of one or both parents affects their children's mental development is barely studied. Therefore, over a period of 6 months 142 patients with children below the age of 18 (n=237 children), who were admitted to the Dept. for Psychiatry and Psychotherapy 1 of the Paracelsus Medical University Salzburg, were questioned for abnormalities in their children's mental development. Additionally all these patients were assessed for their family situation, demographic data and psychiatric disorder. 38.4% (n=91) of the children showed mental abnormalities. The most common one were emotional (n=41), social (n=41) and learning (n=34) disabilities. Parental duration of the illness (p=0.001), age of the children (p=0.044), illness of both parents (p=0.008), longlasting family conflicts (p=0.003) and living with only one parent (p=0.012) were correlated significantly with mental abnormalities in children. The results confirm an increase risk for mental abnormalities in children of psychiatric patients. This risk varies with existing risk and protective factors, which can be partially influenced. Therefore children of mentally ill parents with problems in their mental development should be detected early. Even if genetic risk factors cannot be changed reducing known psychosocial risk factors and promotion protective factors can significantly influence a healthy development of these vulnerable children.

  16. A simple risk scoring system for prediction of relapse after inpatient alcohol treatment.

    Science.gov (United States)

    Pedersen, Mads Uffe; Hesse, Morten

    2009-01-01

    Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist. Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment. The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment. The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment.

  17. Suicide among older psychiatric inpatients: an evidence-based study of a high risk group

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Zarit, Steven H; Tu, Xin

    2006-01-01

    .1-0.3). In combination with other types of disorder, affective disorders were found to modify an increased risk of suicide. First versus later admission for depression was a better predictor for suicide than age at first hospitalization for depression (before or after age 60 years). More than half of suicides occurred......OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted...... to a psychiatric hospital. METHOD: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient...

  18. Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults.

    Science.gov (United States)

    Liu, Stephen K; Montgomery, Justin; Yan, Yu; Mecchella, John N; Bartels, Stephen J; Masutani, Rebecca; Batsis, John A

    2016-10-01

    To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Retrospective cohort study. Inpatient unit of a rural academic medical center. Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  19. Risk factors for violence among long-term psychiatric in-patients: a ...

    African Journals Online (AJOL)

    This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term ...

  20. Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks?

    LENUS (Irish Health Repository)

    Kitchen, J

    2012-02-01

    AIM: To determine non-steroidal anti-inflammatory drug (NSAID) prescribing practices in a tertiary referral hospital. METHODS: A single time-point audit of drug kardexes and clinical notes of n = 388 patients on 2 July 2008 was carried out assessing demographics, gastrointestinal and coronary heart disease risk factors, renal function and co-prescribed medications. RESULTS: Fifty-seven of 388 (14.7%) hospital patients were on NSAIDs. Forty-nine were prescribed NSAID after admission. Nineteen (32.2%) were on regular NSAID (11\\/19 on PPI) and 38 patients were on PRN NSAID (12\\/38 on PPI). Seventeen of 49 patients were on other medications associated with gastrointestinal bleeding (10\\/17 were on PPI). Nineteen patients (33.3%) were >60 years. Eight patients had three or four risk factors for gastrointestinal bleeding; six were on PPI. Thirteen patients had two risks; 7 were on PPI. Six of 19 patients with one risk factor were on PPI. 40.3% had stage 2\\/3 chronic kidney disease. 35.1% had ischaemic heart disease. CONCLUSIONS: NSAIDs and PPIs are often prescribed inappropriately.

  1. [Risk factors of venous thromboembolism recurrence and the predictive value of simplified pulmonary embolism severity index in medical inpatients].

    Science.gov (United States)

    Shi, C L; Zhou, H X; Tang, Y J; Wang, L; Yi, Q; Liang, Z A

    2016-04-12

    To explore the risk factors of venous thromboembolism (VTE) recurrence and the predictive value of simplified pulmonary embolism severity index (sPESI) in medical inpatients. A total of 149 consecutive patients with first diagnosed VTE from the medical departments of West China Hospital of Sichuan University from January 2011 and December 2012 were enrolled and followed-up for 24 months. The VTE recurrence rate was calculated and univariate and multivariate cox proportional hazards regression analysis were performed to identify the risk factors associated with VTE recurrence. All the patients were evaluated by sPESI, and survival analysis was used to explore its value in predicting VTE recurrence in these medical patients. Out of the included 149 patients, 23(15.4%) patients had VTE recurrence during the 2 years' follow-up and median recurrence time was 167 days. The univariate analysis showed bed rest, severe lung disease, nephrotic syndrome, inappropriate anticoagulant therapy, smoking, diabetes, and malignant neoplasm might be associated with VTE recurrence (P=0.043, 0.006, 0.009, 0.032, 0.098, 0.048, 0.021). Among these risk factors, the multivariate analysis revealed severe lung disease, nephrotic syndrome, and malignant neoplasm were the independent risk factors (HR=3.45, 5.67, 3.60; P=0.020, 0.020, 0.047); while for inappropriate anticoagulant therapy, the P value was marginal (HR=3.94, 95% CI: 0.99-15.63, P=0.051). The median sPESI scores of the patients with VTE recurrence was higher than that of the patients without VTE recurrence[1(1, 2) vs 0(0, 1), P=0.001], and patients with sPESI≥1 were associated with 5.57-fold increased risk of VTE recurrence compared with patients with sPESI=0 (95%CI: 1.79-17.30, P=0.001). Survival analysis also showed that the 2-year cumulative VTE recurrence rate of patients with sPESI≥1 was significant higher than that of patients with sPESI=0 (38.4% vs 5.7%, P=0.001). The medical VTE patients have high VTE recurrence risk

  2. Risk communication on the siting of radioactive waste management facility

    International Nuclear Information System (INIS)

    Okoshi, Minoru; Torii, Hiroyuki; Fujii, Yasuhiko

    2007-01-01

    Siting of radioactive waste management facilities frequently raise arguments among stakeholders such as a municipal government and the residents. Risk communication is one of the useful methods of promoting mutual understanding on related risks among stakeholders. In Finland and Sweden, siting selection procedures of repositories for spent nuclear fuels have been carried out successfully with risk communication. The success reasons are analyzed based on the interviews with those who belong to the regulatory authorities and nuclear industries in both countries. Also, in this paper, risk communication among the Japan Radioisotope Association (JRIA), a local government and the general public, which was carried out during the establishment process of additional radioactive waste treatment facilities in Takizawa Village, Iwate Prefecture, is analyzed based on articles in newspapers and interviews with persons concerned. The analysis results showed that good risk communication was not carried out because of the lack of confidence on the JRIA, decision making rules, enough communication chances and economic benefits. In order to make good use of these experiences for the future establishment of radioactive waste management facilities, the lessons learned from these cases are summarized and proposals for good risk communication (establishment of exploratory committee and technical support system for decision making, and measurements to increase familiarity of radioactive waste) are discussed. (author)

  3. Trial of risk assessment of a hypothetical nuclear facility

    International Nuclear Information System (INIS)

    Terao, Norichika; Suzuki, Mitsutoshi

    2013-01-01

    An equation for risk assessment in physical protection is shown by a probability of an adversary attack during a period time, P A , a probability of system effectiveness, P E , and consequence value, C. In addition, P E is shown as the multiplication of a probability of interruption of the facility, P I , by a probability of neutralization by response force, P N . In this study, it is assumed that an adversary assaults a hypothetical nuclear facility. The new quantification method about P A and P I in risk evaluation formula is devised, and risk assessment is attempted. In case of P A , the possibility of assaults against a nuclear facility is discussed by using terrorism data written in the open source database of terrorism, Global Terrorism Database (GTD), summarized by University of Maryland. In addition, it is discussed about P I by using the way of thinking of a risk assessment tool, EASI, developed by the Sandia National Laboratories (SNL). In the hypothetical nuclear facility, the performance of response force, sensors, and communication is expressed quantitatively by probability distribution based on some assumptions. (author)

  4. Seismic risk analysis for General Electric Plutonium Facility, Pleasanton, California

    International Nuclear Information System (INIS)

    1978-01-01

    This report presents the results of a seismic risk analysis that focuses on all possible sources of seismic activity, with the exception of the postulated Verona Fault. The best estimate curve indicates that the Vallecitos facility will experience 30% g with a return period of roughly 130 years and 60% g with a return period of roughly 700 years

  5. Eating Disorder Psychopathology as a Marker of Psychosocial Distress and Suicide Risk in Female and Male Adolescent Psychiatric Inpatients

    Science.gov (United States)

    Zaitsoff, Shannon L.; Grilo, Carlos M.

    2009-01-01

    Objective To examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (i.e., dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically-hospitalized adolescent girls and boys. Method Four hundred and ninety-two psychiatric inpatients (286 girls and 206 boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores. Results Among boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity). Conclusion In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys although the nature of the specific associations differs by sex. PMID:20152294

  6. A four-year cardiovascular risk score for type 2 diabetic inpatients

    Directory of Open Access Journals (Sweden)

    Dolores Ramírez-Prado

    2015-06-01

    Full Text Available As cardiovascular risk tables currently in use were constructed using data from the general population, the cardiovascular risk of patients admitted via the hospital emergency department may be underestimated. Accordingly, we constructed a predictive model for the appearance of cardiovascular diseases in patients with type 2 diabetes admitted via the emergency department. We undertook a four-year follow-up of a cohort of 112 adult patients with type 2 diabetes admitted via the emergency department for any cause except patients admitted with acute myocardial infarction, stroke, cancer, or a palliative status. The sample was selected randomly between 2010 and 2012. The primary outcome was time to cardiovascular disease. Other variables (at baseline were gender, age, heart failure, renal failure, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidaemia, insulin, smoking, admission for cardiovascular causes, pills per day, walking habit, fasting blood glucose and creatinine. A cardiovascular risk table was constructed based on the score to estimate the likelihood of cardiovascular disease. Risk groups were established and the c-statistic was calculated. Over a mean follow-up of 2.31 years, 39 patients had cardiovascular disease (34.8%, 95% CI [26.0–43.6%]. Predictive factors were gender, age, hypertension, renal failure, insulin, admission due to cardiovascular reasons and walking habit. The c-statistic was 0.734 (standard error: 0.049. After validation, this study will provide a tool for the primary health care services to enable the short-term prediction of cardiovascular disease after hospital discharge in patients with type 2 diabetes admitted via the emergency department.

  7. Prior inpatient admission increases the risk of post-operative infection in hepatobiliary and pancreatic surgery.

    Science.gov (United States)

    Dong, Zachary M; Chidi, Alexis P; Goswami, Julie; Han, Katrina; Simmons, Richard L; Rosengart, Matthew R; Tsung, Allan

    2015-12-01

    Hepatobiliary and pancreatic (HPB) operations have a high incidence of post-operative nosocomial infections. The aim of the present study was to determine whether hospitalization up to 1 year before HPB surgery is associated with an increased risk of post-operative infection, surgical-site infection (SSI) and infection resistant to surgical chemoprophylaxis. A retrospective cohort study of patients undergoing HPB surgeries between January 2008 and June 2013 was conducted. A multivariable logistic regression model was used for controlling for potential confounders to determine the association between pre-operative admission and post-operative infection. Of the 1384 patients who met eligibility criteria, 127 (9.18%) experienced a post-operative infection. Pre-operative hospitalization was independently associated with an increased risk of a post-operative infection [adjusted odds ratio (aOR): 1.61, 95% confidence interval [CI]: 1.06-2.46] and SSI (aOR: 1.79, 95% CI: 1.07-2.97). Pre-operative hospitalization was also associated with an increased risk of post-operative infections resistant to standard pre-operative antibiotics (OR: 2.64, 95% CI: 1.06-6.59) and an increased risk of resistant SSIs (OR: 3.99, 95% CI: 1.25-12.73). Pre-operative hospitalization is associated with an increased incidence of post-operative infections, often with organisms that are resistant to surgical chemoprophylaxis. Patients hospitalized up to 1 year before HPB surgery may benefit from extended spectrum chemoprophylaxis. © 2015 International Hepato-Pancreato-Biliary Association.

  8. Relationship of Prescribed Drugs with the Risk of Fall in Inpatients.

    Science.gov (United States)

    Kozono, Aki; Isami, Keisuke; Shiota, Kimiko; Tsumagari, Kyouichi; Nagano, Masahisa; Inoue, Daisuke; Adachi, Rui; Hiraki, Yoichi; Nakagawa, Yoshihiro; Kamimura, Hidetoshi; Yamamichi, Ken

    2016-01-01

    Falls are common in elderly patients and are often serious. Several drugs have been associated with an increased risk of fall. Older adults often take multiple drugs for chronic diseases, and thus may be at increased risk from drugs associated with fall. We investigated the association between drug use and falling in hospitalized older people, with the goal of identifying medications that may increase the risk of a fall. A retrospective case control study was performed at the National Hospital Organization Kumamoto Saishunso Hospital in Japan. Medications taken by patients who fell (n=57) were compared with those taken by patients who did not fall (n=63). The median age (interquartile range; IQR) of the fall and non-fall groups were 75.0 (67.0-83.0) and 80.0 (70.3-84.5) years, respectively. The characteristics of the two groups were similar, with no significant differences in age, sex, or body weight. The probability of falling increased when the patients used zolpidem [odds ratio (OR)=2.47; 95%CI: 1.09-5.63; pfall due to sleepiness, and blood pressure control may be important to prevent orthostatic high blood pressure. In the treatment of elderly people, medical staff should try to choose drugs that prevent fall or are not associated with falling.

  9. Risk management study for the retired Hanford Site facilities: Risk management executive summary

    International Nuclear Information System (INIS)

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

    1994-02-01

    This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km 2 Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This document is the first in a four volume series that comprise the risk management study for the retired, surplus facilities. Volume 2 is the risk evaluation work procedure; volume 3 provides the results for the risk evaluation; and volume 4 is the risk-reduction cost comparison

  10. Risk communication on the construction of radioactive waste treatment facility

    International Nuclear Information System (INIS)

    Okoshi, Minoru

    2005-01-01

    In this paper, risk communications among the Japan Radioisotope Association (JRIA), a local government and the general public which were carried out during the development process of a radioactive waste treatment facility in Takizawa Village, Iwate Prefecture are analyzed based on the articles of newspapers and the interviews with the concerned people. The analysis results show good risk communications were not carried out because of the absence of the confidence to the JRIA, decision making rules and the merits. In order to make good use of this experience for the future development of radioactive waste management facilities, the lessons learned from this case are summarized and the check lists for good risk communication are proposed. (author)

  11. Assessment of risk of potential exposures on facilities industries

    International Nuclear Information System (INIS)

    Leocadio, Joao Carlos

    2007-03-01

    This work develops a model to evaluate potential exposures on open facilities of industrial radiography in Brazil. This model will decisively contribute to optimize operational, radiological protection and safety procedures, to prevent radiation accidents and to reduce human errors in industrial radiography. The probabilistic safety assessment (PSA) methodology was very useful to assess potential exposures. The open facilities of industrial radiography were identified as the scenario to be analyzed in what concerns the evaluation of potential exposures, due to their high accidents indices. The results of the assessment of potential exposures confirm that the industrial radiography in Brazil is a high-risk practice as classified by the IAEA. The risk of potential exposure was estimated to be 40,5 x 10 -2 per year in Brazil, having as main consequences injuries to the workers' hands and arms. In the world scene, the consequences are worst, leading to fatalities of people, thus emphasizing the high risk of industrial radiography. (author)

  12. Screening Level Risk Assessment for the New Waste Calcining Facility

    Energy Technology Data Exchange (ETDEWEB)

    M. L. Abbott; K. N. Keck; R. E. Schindler; R. L. VanHorn; N. L. Hampton; M. B. Heiser

    1999-05-01

    This screening level risk assessment evaluates potential adverse human health and ecological impacts resulting from continued operations of the calciner at the New Waste Calcining Facility (NWCF) at the Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Engineering and Environmental Laboratory (INEEL). The assessment was conducted in accordance with the Environmental Protection Agency (EPA) report, Guidance for Performing Screening Level Risk Analyses at Combustion Facilities Burning Hazardous Waste. This screening guidance is intended to give a conservative estimate of the potential risks to determine whether a more refined assessment is warranted. The NWCF uses a fluidized-bed combustor to solidify (calcine) liquid radioactive mixed waste from the INTEC Tank Farm facility. Calciner off volatilized metal species, trace organic compounds, and low-levels of radionuclides. Conservative stack emission rates were calculated based on maximum waste solution feed samples, conservative assumptions for off gas partitioning of metals and organics, stack gas sampling for mercury, and conservative measurements of contaminant removal (decontamination factors) in the off gas treatment system. Stack emissions were modeled using the ISC3 air dispersion model to predict maximum particulate and vapor air concentrations and ground deposition rates. Results demonstrate that NWCF emissions calculated from best-available process knowledge would result in maximum onsite and offsite health and ecological impacts that are less then EPA-established criteria for operation of a combustion facility.

  13. Risk factors for death in children during inpatient treatment of severe acute malnutrition

    DEFF Research Database (Denmark)

    Rytter, Maren Johanne Heilskov; Babirekere-Iriso, Esther; Namusoke, Hanifa

    2017-01-01

    BACKGROUND: Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. OBJECTIVE: We assessed risk factors for death in children who were treated for malnutrition in a hospital. DESIGN: In a prospective...... observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasma markers of refeeding syndrome (electrolytes and phosphate), and acute phase reactants......% CI: 1.9, 13.3), which was an association that remained after adjustment for potential confounders (HR: 69.5; 95% CI: 7.0, 694.6). CONCLUSIONS: Refeeding syndrome may occur in children who are treated for malnutrition, even with moderately low plasma phosphate, and, in particular, in children...

  14. Radiological risks of transports to central waste management facilities

    International Nuclear Information System (INIS)

    Lange, F.

    1997-01-01

    Transports of radioactive waste from nuclear facilities have been a matter of frequent public concern in the recent past. News reports, protests and questions concerning the radiological risk tended to concentrate on transports to and from central waste management facilities, e.g. transports of spent fuel elements to reprocessing plants abroad (France, England), transports to intermediate storage sites (Ahaus, Gorleben), transports to operative (Morsleben) and projected (Konrad) final storage sites, and transports of vitrified high-activity waste from reprocessing plants to the intermediate storage site (Gorleben). (orig.) [de

  15. Managing risks during the construction of a power generation facility

    International Nuclear Information System (INIS)

    Loulakis, M.C.

    1992-01-01

    The construction of a power generation facility is a substantial undertaking that involves considerable risks to all parties involved. While contractors are accustomed to dealing with risks, construction owners are typically more naive about not only the risks they are assuming in the construction of a project, but also about the role they play on the project itself. Owners and developers of power facilities must understand at the outset that their role during the construction of a project is as integral to the success of the project as that of the designer and contractor. In addition, owners should also understand that there are virtually no risks on a construction project that cannot be shifted among the contracting parties as part of the business deal. Consequently, an owner may contractually be assuming the risks of (1) unusually severe weather, (2) unexpected subsurface conditions, (3) strikes at the turbine supplier's plant or (4) changes in law - as well as the increases in price and delays to project completion associated with such risks. In light of this, a prudent owner will evaluate more than just whether there is sufficient financing to complete the construction of a contemplated project. Prudent owners will conduct a risk management review of the project structure and the contracting terms, with the primary focus being (1) the identification and analysis of the most significant risks faced, (2) a determination of how such risks can be either mitigated or eliminated, and (3) the assessment of the financial exposure to the owner should the potential risk become a reality. This paper will present the framework that owners and developers of power generation projects can use in undertaking such a risk management review

  16. Falls Risk Prediction for Older Inpatients in Acute Care Medical Wards: Is There an Interest to Combine an Early Nurse Assessment and the Artificial Neural Network Analysis?

    Science.gov (United States)

    Beauchet, O; Noublanche, F; Simon, R; Sekhon, H; Chabot, J; Levinoff, E J; Kabeshova, A; Launay, C P

    2018-01-01

    Identification of the risk of falls is important among older inpatients. This study aims to examine performance criteria (i.e.; sensitivity, specificity, positive predictive value, negative predictive value and accuracy) for fall prediction resulting from a nurse assessment and an artificial neural networks (ANNs) analysis in older inpatients hospitalized in acute care medical wards. A total of 848 older inpatients (mean age, 83.0±7.2 years; 41.8% female) admitted to acute care medical wards in Angers University hospital (France) were included in this study using an observational prospective cohort design. Within 24 hours after admission of older inpatients, nurses performed a bedside clinical assessment. Participants were separated into non-fallers and fallers (i.e.; ≥1 fall during hospitalization stay). The analysis was conducted using three feed forward ANNs (multilayer perceptron [MLP], averaged neural network, and neuroevolution of augmenting topologies [NEAT]). Seventy-three (8.6%) participants fell at least once during their hospital stay. ANNs showed a high specificity, regardless of which ANN was used, and the highest value reported was with MLP (99.8%). In contrast, sensitivity was lower, with values ranging between 98.4 to 14.8%. MLP had the highest accuracy (99.7). Performance criteria for fall prediction resulting from a bedside nursing assessment and an ANNs analysis was associated with a high specificity but a low sensitivity, suggesting that this combined approach should be used more as a diagnostic test than a screening test when considering older inpatients in acute care medical ward.

  17. Use of probabilistic risk assessment in fuel cycle facilities

    International Nuclear Information System (INIS)

    Gonzalez, Felix; Gonzalez, Michelle; Wagner, Brian

    2013-01-01

    As expressed in its Policy Statement on the Use of Probabilistic Risk Assessment (PRA) Methods in Nuclear Regulatory Activities, the U.S Nuclear Regulatory Commission has been working for decades to increase the use of PRA technology in its regulatory activities. Since the policy statement was issued in 1995, PRA has become a core component of the nuclear power plant (NPP) licensing and oversight processes. In the last several years, interest has increased in PRA technologies and their possible application to other areas including, but not limited to, spent fuel handling, fuel cycle facilities, reprocessing facilities, and advanced reactors. This paper describes the application of PRA technology currently used in NPPs and its application in other areas such as fuel cycle facilities and advanced reactors. It describes major challenges that are being faced in the application of PRA into new technical areas and possible ways to resolve them. (authors)

  18. Risk management program for the 283-W water treatment facility

    International Nuclear Information System (INIS)

    Green, W.E.

    1999-01-01

    This Risk Management (RM) Program covers the 283-W Water Treatment Facility (283W Facility), located in the 200 West Area of the Hanford Site. A RM Program is necessary for this facility because it stores chlorine, a listed substance, in excess of or has the potential to exceed the threshold quantities defined in Title 40 of the Code of Federal Regulations (CFR) Part 68 (EPA, 1998). The RM Program contains data that will be used to prepare a RM Plan, which is required by 40 CFR 68. The RM Plan is a summary of the RM Program information, contained within this document, and will be submitted to the U.S. Environmental Protection Agency (EPA) ultimately for distribution to the public. The RM Plan will be prepared and submitted separately from this document

  19. Combining the audit questionnaire and biochemical markers to assess alcohol use and risk of alcohol withdrawal in medical inpatients.

    Science.gov (United States)

    Dolman, Jonathan M; Hawkes, Neil D

    2005-01-01

    Alcohol consumption is often under-reported in patients admitted to general hospitals with acute illness. For alcohol-dependent individuals hospital admission results in an enforced period of abstinence with potential alcohol withdrawal symptoms, and possible life threatening complications. Early detection of alcohol use is therefore beneficial to patients and health services. The purpose of this study was to investigate the performance of the alcohol use disorders identification test (AUDIT) questionnaire in the acute medical setting, and the effect of combining routine biological markers-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, and mean corpuscular volume (MCV) on its performance in the early identification of in-patients with alcohol use disorders and at risk of developing symptoms of alcohol withdrawal. Prospective study in consecutive patients admitted to an acute medical admissions ward. All patients were screened using the AUDIT questionnaire and routine blood tests. Patients were then monitored for symptoms of withdrawal using clinical institute withdrawal assessment for alcohol (CIWA-Ar). Of the 874 patients screened using the AUDIT, 98 (11%) screened positive of whom 17 (2% of the 874) experienced clinically significant alcohol withdrawal symptoms, when using serial CIWA-Ar. The AUDIT and serial CIWA-Ar detected all patients who went on to manifest acute withdrawal symptoms. There was no loss of sensitivity at an AUDIT cut-off of 13 or more compared with the lower cut-off of 8 or more. A positive predictive value of 17.3% for an AUDIT score of 8 or more in the detection of withdrawal, increased to 47.1% when found in combination with at least two abnormal biological markers whilst maintaining a sensitivity of 94.1% and specificity of 97.9%. These findings confirm that AUDIT is a useful alcohol screen in general medical settings and that its ability to correctly predict which patients will experience alcohol withdrawal is

  20. Risk management plan for the National Ignition Facility

    International Nuclear Information System (INIS)

    Brereton, S.; Lane, M.; Smith, C.; Yatabe, J.

    1998-01-01

    The National Ignition Facility (NIF) is a U.S. Department of Energy inertial confinement laser fusion facility, currently under construction at the Lawrence Livermore National Laboratory (LLNL). NIF is a critical tool for the Department of Energy (DOE) science- based Stockpile Stewardship and Management Program. In addition, it represents a major step towards realizing inertial confinement fusion as a source of energy. The NIF will focus 192 laser beams onto spherical targets containing a mixture of deuterium and tritium, causing them to implode. This will create the high temperatures and pressures necessary for these targets to undergo fusion. The plan is for NIF to achieve ignition (i.e., self-heating of the fuel) and energy gain (i.e., more fusion energy produced than laser energy deposited) in the laboratory for the first time. A Risk Management Plan was prepared for the NIF design and construction Project. The plan was prepared in accordance with the DOE Life Cycle Asset Management Good Practice Guide. The objectives of the plan were to: (1) identify the risks to the completion of the Project in terms of meeting technical and regulatory requirements, cost, and schedule, (2) assess the risks in terms of likelihood of occurrence and their impact potential relative to technical performance, ES ampersand H (environment, safety and health), costs, and schedule, and (3) address each risk in terms of suitable risk management measures. Major risk elements were identified for the NIF Project. A risk assessment methodology was developed, which was utilized to rank the Project risks with respect to one another. Those elements presenting greater risk were readily identified by this process. This paper describes that methodology and the results

  1. Quality assurance system for sitting high risk facilities

    International Nuclear Information System (INIS)

    Rodriguez, Aymee; Peralta, Jose L.; Fernandez, Manuel

    1999-01-01

    The paper shows how we have conceived and designed the quality assurance system for the site selection process of an area for sitting the facility of high risk in correspondence with the approved methodology. The results obtained in the implementation of the system have permitted the satisfactory performance of each one the expected stage, defining the most favorable sectors in order to continue the studies of the repository site for the disposal of low and intermedium. (author)

  2. Use of risk information to safety regulation. Fabrication facilities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-15

    A procedure of ISA (Integrated Safety Analysis) for uranium fuel fabrication/enrichment facilities has been under the development aiming to utilize risk information for safety regulations in this project. Activities in the fiscal year 2012 are summarized in the paper. There are two major activities in the year. First one is a study on ISA procedure for external events such as earthquakes. Second one is that for chemical consequences such as UF6 and HF. Other than the activities a fundamental study on a policy of utilizing risk information was conducted. The outline and results are provided in the chapter 1 and 2 respectively. (author)

  3. Ischemic Optic Neuropathy in Cardiac Surgery: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013.

    Science.gov (United States)

    Rubin, Daniel S; Matsumoto, Monica M; Moss, Heather E; Joslin, Charlotte E; Tung, Avery; Roth, Steven

    2017-05-01

    Ischemic optic neuropathy is the most common form of perioperative visual loss, with highest incidence in cardiac and spinal fusion surgery. To date, potential risk factors have been identified in cardiac surgery by only small, single-institution studies. To determine the preoperative risk factors for ischemic optic neuropathy, the authors used the National Inpatient Sample, a database of inpatient discharges for nonfederal hospitals in the United States. Adults aged 18 yr or older admitted for coronary artery bypass grafting, heart valve repair or replacement surgery, or left ventricular assist device insertion in National Inpatient Sample from 1998 to 2013 were included. Risk of ischemic optic neuropathy was evaluated by multivariable logistic regression. A total of 5,559,395 discharges met inclusion criteria with 794 (0.014%) cases of ischemic optic neuropathy. The average yearly incidence was 1.43 of 10,000 cardiac procedures, with no change during the study period (P = 0.57). Conditions increasing risk were carotid artery stenosis (odds ratio, 2.70), stroke (odds ratio, 3.43), diabetic retinopathy (odds ratio, 3.83), hypertensive retinopathy (odds ratio, 30.09), macular degeneration (odds ratio, 4.50), glaucoma (odds ratio, 2.68), and cataract (odds ratio, 5.62). Female sex (odds ratio, 0.59) and uncomplicated diabetes mellitus type 2 (odds ratio, 0.51) decreased risk. The incidence of ischemic optic neuropathy in cardiac surgery did not change during the study period. Development of ischemic optic neuropathy after cardiac surgery is associated with carotid artery stenosis, stroke, and degenerative eye conditions.

  4. 6 CFR 27.200 - Information regarding security risk for a chemical facility.

    Science.gov (United States)

    2010-01-01

    ... chemical facility. 27.200 Section 27.200 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.200 Information regarding security risk for a chemical facility. (a) Information to determine security risk. In order to...

  5. National Ignition Facility risk management plan, rev. 1

    International Nuclear Information System (INIS)

    Brereton, S J; Lane, M A

    1998-01-01

    The initial release of the National Ignition Facility (AUF) Risk Management Plan (LLNL, 1997a) was prepared in accordance with the DOE Life Cycle Asset Management Good Practice Guide (DOE, 1996a) and supported Critical Decision 3 (CD3), Approval to Initiate Construction (DOE, 1997a). The objectives of the plan were to: (1) Identify the risks to the completion of the Project in terms of meeting technical and regulatory requirements, cost, and schedule. (2) Assess the risks in terms of likelihood of occurrence and their impact potential relative to technical performance, ES and H (environmental, safety and health), costs, and schedule. (3) Address suitable risk mitigation measures for each identified risk. This revision of the Risk Management Plan considers project risks and vulnerabilities after CD3 (DOE, 1997a) was approved by the Secretary of Energy. During the one-year period since the initial release, the vulnerabilities of greatest concern have been the litigation of the Programmatic Environmental Impact Statement (PEIS) (DOE, 1996b) by a group of environmental organizations led by the Natural Resources Defense Council; the finding and successful clean-up of polychlorinated biphenyl (PCB)-filled electrical capacitors at the NIF site excavation; the FY98 congressional budget authorization and request for the FY99 budget authorization; funding for Inertial Confinement Fusion (ICF)/NIF programmatic activities (including French and other sources of funding); and finally, progress in the core science and technology, and optics program that form the basis for the NIF design

  6. Safety analysis and risk assessment of the National Ignition Facility

    International Nuclear Information System (INIS)

    Brereton, S.; McLouth, L.; Odell, B.

    1996-01-01

    The National Ignition Facility (NIF) is a proposed U.S. Department of Energy inertial confinement laser fusion facility. The candidate sites for locating the NIF are: Los Alamos National Laboratory, Sandia National Laboratory, the Nevada Test Site, and Lawrence Livermore National Laboratory (LLNL), the preferred site. The NIF will operate by focusing 192 laser beams onto a tiny deuterium-tritium target located at the center of a spherical target chamber. The NIF mission is to achieve inertial confinement fusion (ICF) ignition, access physical conditions in matter of interest to nuclear weapons physics, provide an above ground simulation capability for nuclear weapons effects testing, and contribute to the development of inertial fusion for electrical power production. The NIF has been classified as a radiological, low hazard facility on the basis of a preliminary hazards analysis and according to the DOE methodology for facility classification. This requires that a safety analysis be prepared under DOE Order 5481.1B, Safety Analysis and Review System. A draft Preliminary Safety Analysis Report (PSAR) has been written, and this will be finalized later in 1996. This paper summarizes the safety issues associated with the operation of the NIF and the methodology used to study them. It provides a summary of the methodology, an overview of the hazards, estimates maximum routine and accidental exposures for the preferred site of LLNL, and concludes that the risks from NIF operations are low

  7. Evaluating health risks in communities near nuclear facilities

    International Nuclear Information System (INIS)

    Ruttenber, A.J.

    1992-01-01

    Over the past 10 years, epidemiologic studies have been the most popular approach to examining health risks to populations near nuclear facilities. A review of these studies has identified a number of methodologic problems, particularly with regard to establishing causal relations between radiation exposure and disease. Recently, in the United States, dose reconstruction and risk assessment projects have been conducted as alternatives to epidemiologic studies. This paper reviews the problems associated with epidemiologic studies and discusses how dose reconstruction and risk assessment can serve as alternatives to epidemiologic studies. Examples are also provided to demonstrate how these techniques can be used to explore the feasibility of epidemiologic studies, and how dose reconstruction data can improve the quality of epidemiologic studies

  8. Association between dopaminergic polymorphisms and borderline personality traits among at-risk young adults and psychiatric inpatients

    Directory of Open Access Journals (Sweden)

    Faludi Gabor

    2010-01-01

    Full Text Available Abstract Background In the development of borderline personality disorder (BPD both genetic and environmental factors have important roles. The characteristic affective disturbance and impulsive aggression are linked to imbalances in the central serotonin system, and most of the genetic association studies focused on serotonergic candidate genes. However, the efficacy of dopamine D2 receptor (DRD2 blocking antipsychotic drugs in BPD treatment also suggests involvement of the dopamine system in the neurobiology of BPD. Methods In the present study we tested the dopamine dysfunction hypothesis of impulsive self- and other-damaging behaviors: borderline and antisocial traits were assessed by Structured Clinical Interview for Diagnosis (SCID for DSM-IV in a community-based US sample of 99 young adults from low-to-moderate income families. For the BPD trait analyses a second, independent group was used consisting of 136 Hungarian patients with bipolar or major depressive disorder filling out self-report SCID-II Screen questionnaire. In the genetic association analyses the previously indicated polymorphisms of the catechol-O-methyl-transferase (COMT Val158Met and dopamine transporter (DAT1 40 bp VNTR were studied. In addition, candidate polymorphisms of the DRD2 and DRD4 dopamine receptor genes were selected from the impulsive behavior literature. Results The DRD2 TaqI B1-allele and A1-allele were associated with borderline traits in the young adult sample (p = 0.001, and p = 0.005, respectively. Also, the DRD4 -616 CC genotype appeared as a risk factor (p = 0.02. With severity of abuse accounted for in the model, genetic effects of the DRD2 and DRD4 polymorphisms were still significant (DRD2 TaqIB: p = 0.001, DRD2 TaqIA: p = 0.008, DRD4 -616 C/G: p = 0.002. Only the DRD4 promoter finding was replicated in the independent sample of psychiatric inpatients (p = 0.007. No association was found with the COMT and DAT1 polymorphisms. Conclusions Our results

  9. Seismic risk analysis for the Westinghouse Electric facility, Cheswick, Pennsylvania

    International Nuclear Information System (INIS)

    1977-01-01

    This report presents the results of a detailed seismic risk analysis of the Westinghouse Electric plutonium fuel development facility at Cheswick, Pennsylvania. This report focuses on earthquakes. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases. Because of the aseismicity of the region around the site, an analysis different from the conventional closest approach in a tectonic province was adapted. Earthquakes as far from the site as 1,000 km were included, as were the possibility of earthquakes at the site. In addition, various uncertainties in the input were explicitly considered in the analysis. For example, allowance was made for both the uncertainty in predicting maximum possible earthquakes in the region and the effect of the dispersion of data about the best fit attenuation relation. The attenuation relationship is derived from two of the most recent, advanced studies relating earthquake intensity reports and acceleration. Results of the risk analysis, which include a Bayesian estimate of the uncertainties, are presented as return period accelerations. The best estimate curve indicates that the Westinghouse facility will experience 0.05 g every 220 years and 0.10 g every 1400 years. The accelerations are very insensitive to the details of the source region geometries or the historical earthquake statistics in each region and each of the source regions contributes almost equally to the cumulative risk at the site

  10. Probabilistic aspects of risk analyses for hazardous facilities

    International Nuclear Information System (INIS)

    Morici, A.; Valeri, A.; Zaffiro, C.

    1989-01-01

    The work described in the paper discusses the aspects of the risk analysis concerned with the use of the probabilistic methodology, in order to see how this approach may affect the risk management of industrial hazardous facilities. To this purpose reference is done to the Probabilistic Risk Assessment (PRA) of nuclear power plants. The paper points out that even though the public aversion towards nuclear risks is still far from being removed, the probabilistic approach may provide a sound support to the decision making and authorization process for any industrial activity implying risk for the environment and the public health. It is opinion of the authors that the probabilistic techniques have been developed to a great level of sophistication in the nuclear industry and provided much more experience in this field than in others. For some particular areas of the nuclear applications, such as the plant reliability and the plant response to the accidents, these techniques have reached a sufficient level of maturity and so some results have been usefully taken as a measure of the safety level of the plant itself. The use of some limited safety goals is regarded as a relevant item of the nuclear licensing process. The paper claims that it is time now that these methods would be applied with equal success to other hazardous facilities, and makes some comparative consideration on the differences of these plants with nuclear power plants in order to understand the effect of these differences on the PRA results and on the use one intends to make with them. (author)

  11. Unanticipated potential cancer risk near metal recycling facilities

    Energy Technology Data Exchange (ETDEWEB)

    Raun, Loren, E-mail: raun@rice.edu [Department of Statistics, MS 138, Rice University, P.O. Box 1892, Houston, TX 77251-1892 (United States); Pepple, Karl, E-mail: pepple.karl@epa.gov [State and Local Programs Group, Air Quality Policy Division, Office of Air Quality Planning and Standards, Policy, Analysis, and Communications Staff, Mail Drop C404-03, U.S. EPA, Research Triangle Park, NC 27711 (United States); Hoyt, Daniel, E-mail: hoyt.daniel@epa.gov [Air Surveillance Section, US EPA, Region 6, 6EN-AS, 1445 Ross Avenue, Dallas, TX 75202-2733 (United States); Richner, Donald, E-mail: Donald.Richner@houstontx.gov [Houston Department of Health and Human Services, Bureau of Pollution Control and Prevention, 7411 Park Place Blvd., Houston, TX 77087 (United States); Blanco, Arturo, E-mail: arturo.blanco@houstontx.gov [Pollution Control and Prevention, Environmental Health Division, Houston Department of Health and Human Services, 7411 Park Place Blvd., Houston, TX 77087 (United States); Li, Jiao, E-mail: jiao.li@rice.edu [Wiess School of Natural Science, Rice University, 6100 Main St., Houston, TX 77005 (United States)

    2013-07-15

    Metal recycling is an important growing industry. Prior to this study, area sources consisting of metal recycling facilities fell in a category of limited regulatory scrutiny because of assumed low levels of annual emissions. Initiating with community complaints of nuisance from smoke, dust and odor, the Houston Department of Health and Human Services (HDHHS) began a monitoring program outside metal recycler facilities and found metal particulates in outdoor ambient air at levels which could pose a carcinogenic human health risk. In a study of five similar metal recycler facilities which used a torch cutting process, air downwind and outside the facility was sampled for eight hours between 6 and 10 times each over 18 months using a mobile laboratory. Ten background locations were also sampled. Iron, manganese, copper, chromium, nickel, lead, cobalt, cadmium and mercury were detected downwind of the metal recyclers at frequencies ranging from 100% of the time for iron to 2% of the time for mercury. Of these metals, chromium, nickel, lead, cobalt, cadmium and mercury were not detected in any sample in the background. Two pairs of samples were analyzed for total chromium and hexavalent chromium to establish a ratio of the fraction of hexavalent chromium in total chromium. This fraction was used to estimate hexavalent chromium at all locations. The carcinogenic risk posed to a residential receptor from metal particulate matter concentrations in the ambient air attributed to the metal recyclers was estimated from each of the five facilities in an effort to rank the importance of this source and inform the need for further investigation. The total risk from these area sources ranged from an increased cancer risk of 1 in 1,000,000 to 6 in 10,000 using the 95th upper confidence limit of the mean of the carcinogenic metal particulate matter concentration, assuming the point of the exposure is the sample location for a residential receptor after accounting for wind direction

  12. Unanticipated potential cancer risk near metal recycling facilities

    International Nuclear Information System (INIS)

    Raun, Loren; Pepple, Karl; Hoyt, Daniel; Richner, Donald; Blanco, Arturo; Li, Jiao

    2013-01-01

    Metal recycling is an important growing industry. Prior to this study, area sources consisting of metal recycling facilities fell in a category of limited regulatory scrutiny because of assumed low levels of annual emissions. Initiating with community complaints of nuisance from smoke, dust and odor, the Houston Department of Health and Human Services (HDHHS) began a monitoring program outside metal recycler facilities and found metal particulates in outdoor ambient air at levels which could pose a carcinogenic human health risk. In a study of five similar metal recycler facilities which used a torch cutting process, air downwind and outside the facility was sampled for eight hours between 6 and 10 times each over 18 months using a mobile laboratory. Ten background locations were also sampled. Iron, manganese, copper, chromium, nickel, lead, cobalt, cadmium and mercury were detected downwind of the metal recyclers at frequencies ranging from 100% of the time for iron to 2% of the time for mercury. Of these metals, chromium, nickel, lead, cobalt, cadmium and mercury were not detected in any sample in the background. Two pairs of samples were analyzed for total chromium and hexavalent chromium to establish a ratio of the fraction of hexavalent chromium in total chromium. This fraction was used to estimate hexavalent chromium at all locations. The carcinogenic risk posed to a residential receptor from metal particulate matter concentrations in the ambient air attributed to the metal recyclers was estimated from each of the five facilities in an effort to rank the importance of this source and inform the need for further investigation. The total risk from these area sources ranged from an increased cancer risk of 1 in 1,000,000 to 6 in 10,000 using the 95th upper confidence limit of the mean of the carcinogenic metal particulate matter concentration, assuming the point of the exposure is the sample location for a residential receptor after accounting for wind direction

  13. Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.

    Science.gov (United States)

    Hu, Gwo-Chi; Hsu, Chia-Yu; Yu, Hui-Kung; Chen, Jiann-Perng; Chang, Yu-Ju; Chien, Kuo-Liong

    2014-02-01

    To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity. A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009. Referral medical center. Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital. Not applicable. Stroke-related mortality. During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30-.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31-.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively). The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Risk assessment of 30 MeV cyclotron facilities

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Gyo Seong; Lee, Jin Woo [Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup (Korea, Republic of); Kim, Chong Yeal [Dept. of Radiation Science and Technology, Chonbuk National University, Jeonju (Korea, Republic of)

    2017-03-15

    A cyclotron is a kind of particle accelerator that produces a beam of charged particles for the production of medical, industrial, and research radioisotopes. More than 30 cyclotrons are operated in Korea to produce 18F, an FDG synthesis at hospitals. A 30-MeV cyclotron was installed at ARTI (Advanced Radiation Technology Institute, KAERI) mainly for research regarding isotope production. In this study, we analyze and estimate the items of risk such as the problems in the main components of the cyclotron, the loss of radioactive materials, the leakage of coolant, and the malfunction of utilities, fres and earthquakes. To estimate the occurrence frequency in an accident risk assessment, five levels, i.e., Almost certain, Likely, Possible, Unlikely, and Rare, are applied. The accident consequence level is classified under four grades based on the annual permissible dose for radiation workers and the public in the nuclear safety law. The analysis of the accident effect is focused on the radioactive contamination caused by radioisotope leakage and radioactive material leakage of a ventilation filter due to a free. To analyze the risks, Occupation Safety and Health Acts is applied. In addition, action plans against an accident were prepared after a deep discussion among relevant researchers. In this acts, we will search for hazard and introduce the risk assessment for the research 30-MeV cyclotron facilities of ARTI.

  15. Risk assessment of 30 MeV cyclotron facilities

    International Nuclear Information System (INIS)

    Jeong, Gyo Seong; Lee, Jin Woo; Kim, Chong Yeal

    2017-01-01

    A cyclotron is a kind of particle accelerator that produces a beam of charged particles for the production of medical, industrial, and research radioisotopes. More than 30 cyclotrons are operated in Korea to produce 18F, an FDG synthesis at hospitals. A 30-MeV cyclotron was installed at ARTI (Advanced Radiation Technology Institute, KAERI) mainly for research regarding isotope production. In this study, we analyze and estimate the items of risk such as the problems in the main components of the cyclotron, the loss of radioactive materials, the leakage of coolant, and the malfunction of utilities, fres and earthquakes. To estimate the occurrence frequency in an accident risk assessment, five levels, i.e., Almost certain, Likely, Possible, Unlikely, and Rare, are applied. The accident consequence level is classified under four grades based on the annual permissible dose for radiation workers and the public in the nuclear safety law. The analysis of the accident effect is focused on the radioactive contamination caused by radioisotope leakage and radioactive material leakage of a ventilation filter due to a free. To analyze the risks, Occupation Safety and Health Acts is applied. In addition, action plans against an accident were prepared after a deep discussion among relevant researchers. In this acts, we will search for hazard and introduce the risk assessment for the research 30-MeV cyclotron facilities of ARTI

  16. Risk assessment of mitigated domino scenarios in process facilities

    International Nuclear Information System (INIS)

    Landucci, Gabriele; Necci, Amos; Antonioni, Giacomo; Argenti, Francesca; Cozzani, Valerio

    2017-01-01

    The propagation of accidents among process units may lead to severe cascading events or domino effects with catastrophic consequences. Prevention, mitigation and management of domino scenarios is of utmost importance and may be achieved in industrial facilities through the adoption of multiple safety layers. The present study was aimed at developing an innovative methodology to address the quantitative risk assessment (QRA) of domino scenarios accounting for the presence and role of safety barriers. Based on the expected performance of safety barriers, a dedicated event tree analysis allowed the identification and the assessment of the frequencies of the different end-point events deriving from unmitigated and partially mitigated domino chains. Specific criteria were introduced in consequence analysis to consider the mitigation effects of end-point scenarios deriving from safety barriers. Individual and societal risk indexes were calculated accounting for safety barriers and the mitigated scenarios that may result from their actions. The application of the methodology to case-studies of industrial interest proved the importance of introducing a specific systematic and quantitative analysis of safety barrier performance when addressing escalation leading to domino effect. - Highlights: • A methodology was developed to account for safety barrier performance in escalation prevention. • The methodology allows quantitative assessment accounting for safety barrier performance. • A detailed analysis of transient mitigated scenarios is allowed by the developed procedure. • The procedure allows accounting for safety barrier performance in QRA of domino scenarios. • An important reduction in the risk due to domino scenarios is evidenced when considering safety barriers.

  17. Managing highly flexible facilities: an essential complementary asset at risk

    NARCIS (Netherlands)

    Tierney, Robert; Tierney, R.; Groen, Arend J.; Harms, Rainer; Luizink, M.; Hetherington, D.; Steward, H.; Walsh, Steven Thomas; Linton, Jonathan; Linton, J.D.

    2012-01-01

    Purpose: Twenty first century problems are increasingly being addressed by multi technology solutions developed by regional entrepreneurial and intreprepreneurial innovators. However, they require an expensive new type of fabrication facility. Multiple technology production facilities (MTPF) have

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

    Science.gov (United States)

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

  19. Environmental risk assessment for start-up of a new consolidated maintenance facility

    Energy Technology Data Exchange (ETDEWEB)

    Heubach, J.G.; Wise, J.A.

    1992-10-01

    This paper summarizes a case study of a risk assessment for a consolidated maintenance facility (CMF). An interdisciplinary team was formed to identify and evaluate showstopper'' risks which could delay or prevent ontime, safe, and economical operation of a CMF and to recommend ways to mitigate the risks. The risk assessment was constrained by time, information, incomplete plans and facilities, and a concomitant major transition in manufacturing process, organization, and technology. Working within these constraints, the team integrated convergent findings into estimates of high, medium, and low risks based on the subjective likelihood of occurrence and predicted consequences of potential hazard events. The team also made risk-reduction recommendations for facility detail design and production start-up. The findings and recommendations reported in this study focus on risks related to environmental design and workstation ergonomics. Findings from the risk assessment effort should aid other constrained risk assessments and applied research on similar facilities.

  20. Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder.

    Science.gov (United States)

    Zeng, Ruifan; Cohen, Lisa J; Tanis, Thachell; Qizilbash, Azra; Lopatyuk, Yana; Yaseen, Zimri S; Galynker, Igor

    2015-03-30

    Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Supplementing the Braden scale for pressure ulcer risk among medical inpatients: the contribution of self-reported symptoms and standard laboratory tests.

    Science.gov (United States)

    Skogestad, Ingrid Johansen; Martinsen, Liv; Børsting, Tove Elisabet; Granheim, Tove Irene; Ludvigsen, Eirin Sigurdssøn; Gay, Caryl L; Lerdal, Anners

    2017-01-01

    To evaluate medical inpatients' symptom experience and selected laboratory blood results as indicators of their pressure ulcer risk as measured by the Braden scale. Pressure ulcers reduce quality of life and increase treatment costs. The prevalence of pressure ulcers is 6-23% in hospital populations, but literature suggests that most pressure ulcers are avoidable. Prospective, cross-sectional survey. Three hundred and twenty-eight patients admitted to medical wards in an acute hospital in Oslo, Norway consented to participate. Data were collected on 10 days between 2012-2014 by registered nurses and nursing students. Pressure ulcer risk was assessed using the Braden scale, and scores indicated pressure ulcer risk. Skin examinations were categorised as normal or stages I-IV using established definitions. Comorbidities were collected by self-report. Self-reported symptom occurrence and distress were measured with 15 items from the Memorial Symptom Assessment Scale, and pain was assessed using two numeric rating scales. Admission laboratory data were collected from medical records. Prevalence of pressure ulcers was 11·9, and 20·4% of patients were identified as being at risk for developing pressure ulcers. Multivariable analysis showed that pressure ulcer risk was positively associated with age ≥80 years, vomiting, severe pain at rest, urination problems, shortness of breath and low albumin and was negatively associated with nervousness. Our study indicates that using patient-reported symptoms and standard laboratory results as supplemental indicators of pressure ulcer risk may improve identification of vulnerable patients, but replication of these findings in other study samples is needed. Nurses play a key role in preventing pressure ulcers during hospitalisation. A better understanding of the underlying mechanisms may improve the quality of care. Knowledge about symptoms associated with pressure ulcer risk may contribute to a faster clinical judgment of

  2. Accident risks in nuclear facilities (a bibliography with abstracts). Report for 1964-Sep 77

    International Nuclear Information System (INIS)

    Grooms, D.W.

    1977-10-01

    The bibliography presents risk analysis and hazards evaluation of the design, construction and operation of nuclear facilities, including the risk and hazards of transporting radioactive materials to and from these facilities. Radiological calculations for environmental effects of nuclear accidents are also included

  3. Accident risks in nuclear facilities (a bibliography with abstracts). Report for 1964-Sep 76

    International Nuclear Information System (INIS)

    Grooms, D.W.

    1976-10-01

    The bibliography presents risk analysis and hazards evaluation of the design, construction and operation of nuclear facilities including the risk and hazards of transporting radioactive materials to and from these facilities. Radiological calculations for environmental effects of nuclear accidents are included. (This updated bibliography contains 195 abstracts, 64 of which are new entries to the previous edition.)

  4. Analysis of the formation, expression, and economic impacts of risk perceptions associated with nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Allison, T.; Hunter, S.; Calzonetti, F.J.

    1992-10-01

    This report investigates how communities hosting nuclear facilities form and express perceptions of risk and how these risk perceptions affect local economic development. Information was collected from site visits and interviews with plant personnel, officials of local and state agencies, and community activists in the hosting communities. Six commercial nuclear fuel production facilities and five nuclear facilities operated for the US Department of Energy by private contractors were chosen for analysis. The results presented in the report indicate that the nature of risk perceptions depends on a number of factors. These factors are (1) level of communication by plant officials within the local community, (2) track record of the facility. operator, (3) process through which community and state officials receive information and form opinions, (4) level of economic links each plant has with the local community, and (15) physical characteristics of the facility itself. This report finds that in the communities studied, adverse ask perceptions have not affected business location decisions, employment levels in the local community, tourism, or agricultural development. On the basis of case-study findings, this report recommends that nuclear facility siting programs take the following observations into account when addressing perceptions of risk. First, the quality of a facility`s participation with community activists, interest groups, and state agencies helps to determine the level of perceived risk within a community. Second, the development of strong economic links between nuclear facilities and their host communities will produce a higher level of acceptance of the nuclear facilities.

  5. Risk management for operations of the LANL Critical Experiments Facility

    International Nuclear Information System (INIS)

    Paternoster, R.; Butterfield, K.

    1998-01-01

    The Los Alamos Critical Experiments Facility (LACEF) currently operates two burst reactors (Godiva-IV and Skua), one solution assembly [the Solution High-Energy Burst Assembly (SHEBA)], two fast-spectrum benchmark assemblies (Flattop and Big Ten), and five general-purpose remote assembly machines that may be configured with nuclear materials and assembled by remote control. Special nuclear materials storage vaults support these and other operations at the site. With this diverse set of operations, several approaches are possible in the analysis and management of risk. The most conservative approach would be to write a safety analysis report (SAR) for each assembly and experiment. A more cost-effective approach is to analyze the probability and consequences of several classes of operations representative of operations on each critical assembly machine and envelope the bounding case accidents. Although the neutron physics of these machines varies widely, the operations performed at LACEF fall into four operational modes: steady-state mode, approach-to-critical mode, prompt burst mode, and nuclear material operations, which can include critical assembly fuel loading. The operational sequences of each mode are very nearly identical, whether operated on one assembly machine or another. The use of an envelope approach to accident analysis is facilitated by the use of classes of operations and the use of bounding case consequence analysis. A simple fault tree analysis of operational modes helps resolve which operations are sensitive to human error and which are initiated by hardware of software failures. Where possible, these errors and failures are blocked by TSR LCOs. Future work will determine the probability of accidents with various initiators

  6. Frequency and risk factors of blood transfusion in abdominoplasty in post-bariatric surgery patients: data from the nationwide inpatient sample.

    Science.gov (United States)

    Masoomi, Hossein; Rimler, Jonathan; Wirth, Garrett A; Lee, Christine; Paydar, Keyianoosh Z; Evans, Gregory R D

    2015-05-01

    There are limited data regarding blood transfusion following abdominoplasty, especially in post-bariatric surgery patients. The purpose of this study was to evaluate (1) the frequency and outcomes of blood transfusion in post-bariatric surgery patients undergoing abdominoplasty and (2) the predictive risk factors of blood transfusion in this patient population. Using the Nationwide Inpatient Sample database, the authors examined the clinical data of patients with a history of bariatric surgery who underwent abdominoplasty from 2007 to 2011 in the United States. A total of 20,130 post-bariatric surgery patients underwent abdominoplasty during this period. Overall, 1871 patients (9.3 percent) received blood transfusion. Chronic anemia patients had the highest rate of blood transfusion (25.6 percent). Post-bariatric surgery patients who received blood transfusion experienced a significantly higher complication rate (10.1 percent versus 4.8 percent; p blood transfusion. The blood transfusion rate in post-bariatric surgery abdominoplasty patients is not insignificant. Chronic anemia and congestive heart failure are the two major predictors of transfusion. Modifying risk factors such as anemia before abdominoplasty might significantly decrease the possibility of blood transfusion. Risk, III.

  7. Bioaerosol releases from compost facilities: Evaluating passive and active source terms at a green waste facility for improved risk assessments

    Science.gov (United States)

    Taha, M. P. M.; Drew, G. H.; Longhurst, P. J.; Smith, R.; Pollard, S. J. T.

    The passive and active release of bioaerosols during green waste composting, measured at source is reported for a commercial composting facility in South East (SE) England as part of a research programme focused on improving risk assessments at composting facilities. Aspergillus fumigatus and actinomycetes concentrations of 9.8-36.8×10 6 and 18.9-36.0×10 6 cfu m -3, respectively, measured during the active turning of green waste compost, were typically 3-log higher than previously reported concentrations from static compost windrows. Source depletion curves constructed for A. fumigatus during compost turning and modelled using SCREEN3 suggest that bioaerosol concentrations could reduce to background concentrations of 10 3 cfu m -3 within 100 m of this site. Authentic source term data produced from this study will help to refine the risk assessment methodologies that support improved permitting of compost facilities.

  8. Analysis of the formation, expression, and economic impacts of risk perceptions associated with nuclear facilities

    International Nuclear Information System (INIS)

    Allison, T.; Hunter, S.; Calzonetti, F.J.

    1992-10-01

    This report investigates how communities hosting nuclear facilities form and express perceptions of risk and how these risk perceptions affect local economic development. Information was collected from site visits and interviews with plant personnel, officials of local and state agencies, and community activists in the hosting communities. Six commercial nuclear fuel production facilities and five nuclear facilities operated for the US Department of Energy by private contractors were chosen for analysis. The results presented in the report indicate that the nature of risk perceptions depends on a number of factors. These factors are (1) level of communication by plant officials within the local community, (2) track record of the facility. operator, (3) process through which community and state officials receive information and form opinions, (4) level of economic links each plant has with the local community, and (15) physical characteristics of the facility itself. This report finds that in the communities studied, adverse ask perceptions have not affected business location decisions, employment levels in the local community, tourism, or agricultural development. On the basis of case-study findings, this report recommends that nuclear facility siting programs take the following observations into account when addressing perceptions of risk. First, the quality of a facility's participation with community activists, interest groups, and state agencies helps to determine the level of perceived risk within a community. Second, the development of strong economic links between nuclear facilities and their host communities will produce a higher level of acceptance of the nuclear facilities

  9. Predictive validity of the Suicide Trigger Scale (STS-3 for post-discharge suicide attempt in high-risk psychiatric inpatients.

    Directory of Open Access Journals (Sweden)

    Zimri S Yaseen

    Full Text Available BACKGROUND: The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3, was designed to measure the construct of an affective 'suicide trigger state' hypothesized to precede a suicide attempt (SA. This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample. METHODS: The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization. RESULTS: STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731, and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814. Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90(th percentile STS-3 scores differed significantly from ultra-low (10(th percentile scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security. CONCLUSION: STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw

  10. Accident risks in nuclear facilities. (Latest citations from the NTIS Bibliographic database). Published Search

    International Nuclear Information System (INIS)

    1994-02-01

    The bibliography contains citations concerning risk analysis and hazards evaluation of the design, construction, and operation of nuclear facilities. The citations also explore the risk and hazards of transporting radioactive materials to and from these facilities. Radiological calculations for environmental effects of nuclear accidents and the use of computer models in risk analysis are also included. (Contains 250 citations and includes a subject term index and title list.)

  11. Risk management technique for liquefied natural gas facilities

    Science.gov (United States)

    Fedor, O. H.; Parsons, W. N.

    1975-01-01

    Checklists have been compiled for planning, design, construction, startup and debugging, and operation of liquefied natural gas facilities. Lists include references to pertinent safety regulations. Methods described are applicable to handling of other hazardous materials.

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

    Energy Technology Data Exchange (ETDEWEB)

    Ekoto, Isaac W.; Blaylock, Myra L.; LaFleur, Angela Christine; LaChance, Jeffrey L.; Horne, Douglas B.

    2014-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Palmer, E. [Westinghouse Savannah River Company, AIKEN, SC (United States)

    1997-04-01

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

  14. Designing a Physical Security System for Risk Reduction in a Hypothetical Nuclear Facility

    International Nuclear Information System (INIS)

    Saleh, A.A.; Abd Elaziz, M.

    2017-01-01

    Physical security in a nuclear facility means detection, prevention and response to threat, the ft, sabotage, unauthorized access and illegal transfer involving radioactive and nuclear material. This paper proposes a physical security system designing concepts to reduce the risk associated with variant threats to a nuclear facility. This paper presents a study of the unauthorized removal and sabotage in a hypothetical nuclear facility considering deter, delay and response layers. More over, the study involves performing any required upgrading to the security system by investigating the nuclear facility layout and considering all physical security layers design to enhance the weakness for risk reduction

  15. Does public health system provide adequate financial risk protection to its clients? Out of pocket expenditure on inpatient care at secondary level public health institutions: Causes and determinants in an eastern Indian state.

    Science.gov (United States)

    Rout, Sarit Kumar; Choudhury, Sarmistha

    2018-02-09

    This study is undertaken to estimate the out of pocket expenditure (OOPE) for various diseases and its determinants at secondary level public health facilities in Odisha. A cross-sectional survey was conducted among the inpatients utilising secondary level public health facilities in the 2 districts of Odisha. More than 80% of the inpatients were selected conveniently, and data on OOPE and socioeconomic status of patients were collected. The OOPE was estimated separately on surgery, nonsurgery, and child birth conditions. Ordinary least square regression models were developed to explain the factors determining OOPE. The mean OOPE for the secondary care facility was Indian National Rupee 3136.14, (95% CI: 2869.08-3403.19), of which, Indian National Rupee 1622.79 (95% CI: 1462.70-1782.89) was on medicine constituting 79% of total medical expenditure. The mean OOPE on surgery was highest followed by nonsurgery and child birth conditions. The OOPE is mainly influenced by caste and educational status of patients as revealed by the regression results. With increase in social status, the OOPE increases and the results are statistically significant. This evidence should be used to design financial strategies to reduce OOPE at secondary care public health facilities, which is largely due to medicine, diagnostic services, and transport expenditure. Efforts should be made to protect the interest of the poor, who utilise public health facility in a low resource setting in India. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation.

    Science.gov (United States)

    Daras, Laura Coots; Ingber, Melvin J; Carichner, Jessica; Barch, Daniel; Deutsch, Anne; Smith, Laura M; Levitt, Alan; Andress, Joel

    2017-08-09

    To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Observational design. Inpatient rehabilitation facilities. Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Not applicable. The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. Published by Elsevier Inc.

  17. [Screening of the risk of functional decline performed by an inpatient geriatric consultation team in a general hospital].

    Science.gov (United States)

    Benoît, F; Bertiaux, M; Schouterden, R; Huard, E; Segers, K; Decorte, L; Robberecht, J; Simonetti, C; Surquin, M

    2013-01-01

    The Mobile Geriatric Team (MGT) is part of the Geriatric Care Program and aims to provide interdisciplinary geriatric expertise to other professionals for old patients hospitalized outside geriatric department. Our hospital has a MGT since 2008. Our objective is to retrospectively describe the population of patients of 75 years and older hospitalized outside the geriatric ward and screened for the risk of functional decline by the MGT between 1 October 2009 and 30 September 2011. We recorded the risk of functional decline, as indicated by the Identification of Senior At Risk score (ISAR) performed within 48 h after admission, place of living, discharge destination, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores. In two years, 1.568 patients > or = 75 Y were screened with the ISAR score (mean age 82.5 Y, 60.7% of women). We identified 833 patients with a high-risk of functional decline (ISAR > or = 3). The majority of high-risk subjects (78%) were living at home before hospitalization and 58.7% returned home after discharge. Depression and cognitive impairment were identified among respectively 41% and 59% of high-risk subjects. Only 128 patients were admitted for fall. Most of the faller patients were living at home prior hospitalization and had an ISAR score > or = 3. The MGT allowed identifying many patients > or = 75 Y living at home and presenting with high-risk of functional decline and geriatric syndromes, confirming that good screening procedures are necessary to optimize management of hospitalized olders. Most of faller patients have an ISAR score > or = 3 and should benefit a comprehensive geriatric assessment.

  18. The formation and economic impact of perceptions of risk surrounding nuclear facilities

    International Nuclear Information System (INIS)

    Allison, T.; Calzonetti, F.; Hunter, S.

    1993-01-01

    This paper summarizes the results of an investigation of factors determining the nature of risk perceptions associated with eleven nuclear facilities and their impact on local economic development. The paper indicates that the nature of risk perceptions depends primarily on the level of communication by plant officials within the local community, the track record of the facility operator, the process through which community and state officials receive information and form opinions, and the level of economic links each facility has with the local community. The research indicates that adverse risk perceptions have not affected economic development

  19. Incremental Risks of Transporting NARM to the LLW Disposal Facility at Hanford

    International Nuclear Information System (INIS)

    Weiner, R.F.

    1999-01-01

    This study models the incremental radiological risk of transporting NARM to the Hanford commercial LLW facility, both for incident-free transportation and for possible transportation accidents, compared with the radiological risk of transporting LLW to that facility. Transportation routes are modeled using HIGHWAY 3.1 and risks are modeled using RADTRAN 4. Both annual population doses and risks, and annual average individual doses and risks are reported. Three routes to the Hanford site were modeled from Albany, OR, from Coeur d'Alene, ID (called the Spokane route), and from Seattle, WA. Conservative estimates are used in the RADTRAN inputs, and RADTRAN itself is conservative

  20. Motivation to change risky drinking and motivation to seek help for alcohol risk drinking among general hospital inpatients with problem drinking and alcohol-related diseases.

    Science.gov (United States)

    Lau, Katharina; Freyer-Adam, Jennis; Gaertner, Beate; Rumpf, Hans-Jürgen; John, Ulrich; Hapke, Ulfert

    2010-01-01

    The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases. The sample consisted of 294 general hospital inpatients aged 18-64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAFmotivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated. During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, PMotivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAFmotivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups. Data suggest that hospital stay seems to be a "teachable moment." Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention. Copyright 2010 Elsevier Inc. All rights reserved.

  1. Risk assessment for civil engineering facilities: critical overview and discussion

    International Nuclear Information System (INIS)

    Faber, M.H.; Stewart, M.G.

    2003-01-01

    The present paper should be seen as a basis for discussion of important aspects of risk analysis and assessment, as well as attempting to describe risk assessment in accordance with the present state of the art. Risk assessment is thus presented in an overview form from the viewpoint of being a means for decision-making and thus within the formal framework of decision theory. First the motivation for risk analysis is given and the theoretical basis together with the practical aspects, methodologies and techniques for the implementation of risk assessment in civil engineering applications are explained and discussed. The paper furthermore addresses the problems associated with risk acceptance criteria, risk aversion and value of human life and attempts to provide suggestions for the rational treatment of these aspects. Finally a number of problem areas are highlighted and the needs for further education, research and dissemination are stressed

  2. The Impact of Exercise on Suicide Risk: Examining Pathways through Depression, PTSD, and Sleep in an Inpatient Sample of Veterans

    Science.gov (United States)

    Davidson, Collin L.; Babson, Kimberly A.; Bonn-Miller, Marcel O.; Souter, Tasha; Vannoy, Steven

    2013-01-01

    Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to…

  3. A probabilistic risk assessment of the LLNL Plutonium facility's evaluation basis fire operational accident

    International Nuclear Information System (INIS)

    Brumburgh, G.

    1994-01-01

    The Lawrence Livermore National Laboratory (LLNL) Plutonium Facility conducts numerous involving plutonium to include device fabrication, development of fabrication techniques, metallurgy research, and laser isotope separation. A Safety Analysis Report (SAR) for the building 332 Plutonium Facility was completed rational safety and acceptable risk to employees, the public, government property, and the environment. This paper outlines the PRA analysis of the Evaluation Basis Fire (EDF) operational accident. The EBF postulates the worst-case programmatic impact event for the Plutonium Facility

  4. Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study.

    Science.gov (United States)

    Rytter, Maren Jh; Babirekere-Iriso, Esther; Namusoke, Hanifa; Christensen, Vibeke B; Michaelsen, Kim F; Ritz, Christian; Mortensen, Charlotte G; Mupere, Ezekiel; Friis, Henrik

    2017-02-01

    Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. We assessed risk factors for death in children who were treated for malnutrition in a hospital. In a prospective observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasma markers of refeeding syndrome (electrolytes and phosphate), and acute phase reactants, and recorded the nutritional therapy given in hospital. Seventeen children (14%) died. Clinical risk factors for death were the presence of oral thrush (HR: 5.0; 95% CI: 1.6, 15.2), a caretaker-reported severity of illness on a visual analog scale (HR: 1.7; 95% CI: 1.1, 2.6), impaired consciousness (HR: 16.7; 95% CI: 3.1, 90.4), and a capillary refill time >2 s (HR: 3.9; 95% CI: 1.4, 11.3). HIV infection was not associated with mortality (HR: 3.0; 95% CI: 0.7, 12.4), which was most likely due to low power. Biochemical risk factors were a plasma C-reactive protein concentration >15 mg/L on admission and low plasma phosphate that was measured on day 2 (HR: 8.7; 95% CI: 2.5, 30.1), particularly in edematous children. The replacement of F-75 with unfortified rice porridge to ameliorate diarrhea was associated with a higher risk of death, particularly if given during the first 2 d (HR: 5.0; 95% CI: 1.9, 13.3), which was an association that remained after adjustment for potential confounders (HR: 69.5; 95% CI: 7.0, 694.6). Refeeding syndrome may occur in children who are treated for malnutrition, even with moderately low plasma phosphate, and, in particular, in children with edematous malnutrition. The replacement of F-75 with unfortified rice porridge is associated with increased risk of death, which is possibly mediated by lowering plasma phosphate. The identified clinical risk factors may potentially improve the

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

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset delineates the distribution of estimate risk from the TRI facilities for 1999 - 2011 throughout the census blockgroup of the region using Office of...

  6. Interpersonal amplification of risk? Citizen discussions and their impact on perceptions of risks and benefits of a biological research facility.

    Science.gov (United States)

    Binder, Andrew R; Scheufele, Dietram A; Brossard, Dominique; Gunther, Albert C

    2011-02-01

    Much risk communication research has demonstrated how mass media can influence individual risk perceptions, but lacks a comprehensive conceptual understanding of another key channel of communication: interpersonal discussion. Using the social amplification of risk as a theoretical framework, we consider the potential for discussions to function as amplification stations. We explore this possibility using data from a public opinion survey of residents living in potential locations for a new biological research facility in the United States. Controlling for a variety of key information variables, our results show that two dimensions of discussion-frequency and valence-have impacts on residents' perceptions of the facility's benefits and its risks. We also explore the possibility that an individual's overall attitude moderates the effect of discussion on their perceptions of risks and benefits. Our results demonstrate the potential for discussions to operate as amplifiers or attenuators of perceptions of both risks and benefits. © 2010 Society for Risk Analysis.

  7. Comparative analysis of risk characteristics of nuclear waste repositories and other disposal facilities

    International Nuclear Information System (INIS)

    Lindell, M.K.; Earle, T.C.; Nealey, S.M.

    1981-06-01

    Three fundamental questions concerning public perception of the measurement of radioactive wastes were addressed in this report. The first question centered on the perceived importance of nuclear waste management as a public issue: how important is nuclear waste management relative to other technological and scientific issues; do different segments of the public disagree on its importance; the second question concerned public attitudes toward a nuclear waste disposal facility: how great a risk to health and safety is a nuclear waste disposal facility relative to other industrial facilities; is there disagreement on its riskiness among various public groups; the third question pertained to the aspects of risks that affect overall risk perception: what are the qualitative aspects of a nuclear waste disposal facility that contribute to overall perceptions of risk; do different segments of the population associate different risk characteristics with hazardous facilities. The questions follow from one another: is the issue important; given the importance of the issue, is the facility designed to deal with it considered risky; given the riskiness of the facility, why is it considered risky. Also addressed in this report, and a main focus of its findings, were the patterns of differences among respondent groups on each of these questions

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

    Science.gov (United States)

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

    2017-09-01

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

  9. On fire risk/methodology for the next generation of reactors and nuclear facilities

    International Nuclear Information System (INIS)

    Majumdar, K.C.; Alesso, H.P.; Altenbach, T.J.

    1992-01-01

    Methodologies for including fire in probabilistic risk assessments (PRAs) have been evolving during the last ten years. Many of these studies show that fire risk constitutes a significant percentage of external events, as well as the total core damage frequency. This paper summarizes the methodologies used in the fire risk analysis of the next generation of reactors and existing DOE nuclear facilities. Methodologies used in other industries, as well as existing nuclear power plants, are also discussed. Results of fire risk studies for various nuclear plants and facilities are shown and compared

  10. Seismic risk and heavy industrial facilities conference: proceedings

    International Nuclear Information System (INIS)

    1983-01-01

    Summaries of over 50 papers related to seismic risk analysis were presented. The papers cover areas such as seismic input description, response of components and structures, assessment of risk and reliability including human factors, and results of integrated studies. Papers have been individually abstracted for the Energy Data Base

  11. Risk assessment of several incidents in nuclear waste management facilities

    International Nuclear Information System (INIS)

    Buetow, E.; Memmert, G.; Storck, R.; Weymann, J.; Matthies, M.; Vogt, K.J.

    1981-01-01

    Regarding surface facilities two incidents of MAVA (failure of the filter in the exhaust gas system, fire in the bituminization system) and one incident in the Krypton storage and regarding underground systems the water inlet in the pit building have been evaluated. According to the calculations only the two nuclides Tc-99 and J-129 can involve a considerable exposure. The barrier system of overlying rocks and the pit system as a whole is largely redundant and diverse. (DG) [de

  12. Interim guidance risk assessment of the device assembly facility at the Nevada test site

    International Nuclear Information System (INIS)

    Altenbach, T.J.

    1996-05-01

    The risks of plutonium dispersal and/or high explosive detonation from nuclear explosive operations at the Device Assembly Facility were examined in accordance with DOE Order 5610.11 and the Interim Guidance. The assessment consisted of a qualitative task and hazards analysis, and a quantitative risk screening. Results are displayed on risk matrices for the major types of operations. Most accident scenarios were considered to have Low risk; a few scenarios have Moderate risk; and none have High risk. The highest risk scenarios (Moderate category) consist of a high explosive detonation during assembly operations in a cell, with bare conventional high explosive surrounding the pit

  13. Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006

    Directory of Open Access Journals (Sweden)

    Katz Jeffrey N

    2010-09-01

    Full Text Available Abstract Background Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR, but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment. Methods Using the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF, chronic obstructive pulmonary disease (COPD, diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates. Results CHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65 and TKR cohort (OR = 2.47 95% CI 1.95-3.14. COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70. The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence. Conclusions Older adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis.

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

    Science.gov (United States)

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

    2013-06-01

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

  15. Analysis of Blade Fragment Risk at a Wind Energy Facility

    Energy Technology Data Exchange (ETDEWEB)

    Simms, David A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Larwood, Scott [University of the Pacific

    2018-04-06

    An analysis was performed to determine the risk posed by wind turbine fragments on roads and buildings at the National Wind Technology Center at the National Renewable Energy Laboratory. The authors used a previously developed model of fragment trajectory and took into account the wind speed/direction distribution at the site and the probability of rotor failure. The risk was assessed by determining the likelihood of impact and related consequences. For both the roads and buildings, the risk varied from low to routine, which was considered acceptable. The analysis was compared with previous recommendations on wind turbine setback distances. The results showed that a setback to property lines of 2 times the overall turbine height would be acceptable. However, the setback to dwellings should probably be increased from 3 to 3.5 times the overall turbine height for an acceptable risk.

  16. Social factors and readmission after inpatient detoxification in older alcohol-dependent patients

    NARCIS (Netherlands)

    van den Berg, Julia F.; van den Brink, Wim; Kist, Nicolien; Hermes, Jolanda S. J.; Kok, Rob M.

    2015-01-01

    Alcohol dependence is often a chronic relapsing disorder with frequent admissions to inpatient facilities. This study in older alcohol-dependent inpatients investigates the role of social factors in readmissions after inpatient detoxification. In a prospective study, 132 older alcohol-dependent

  17. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

    Science.gov (United States)

    2012-11-15

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

  18. Risk factors for fatality among confirmed adult dengue inpatients in Singapore: a matched case-control study.

    Directory of Open Access Journals (Sweden)

    Tun-Linn Thein

    Full Text Available OBJECTIVES: To identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore. METHODS: Multi-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with fatal cases. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF, warning signs and severe dengue. Statistical significance was assessed by conditional logistic regression modeling. RESULTS: Significantly more fatal cases than matched controls had pre-existing co-morbid conditions, and presented with abdominal pain/tenderness. Median pulse rates were significantly higher while myalgia was significantly less frequent in cases. . Fatal cases also had higher leucocyte counts, platelet counts, serum sodium, potassium, urea, creatine and bilirubin levels on admission compared to controls. There was no statistical significant difference between the prevalence of DHF and hematocrit level among cases and controls. Multivariate analysis showed myalgia and leucocyte count at presentation were independent predictors of fatality (adjusted odds ratios 0.09 and 2.94 respectively. None of the controls was admitted to intensive care unit (ICU or given blood transfusion, while 71.4% and 28.6% of fatal cases received ICU admission and blood transfusion. CONCLUSIONS: Absence of myalgia and leucocytosis on admission were independently associated with fatality in our matched case-control study. Fatalities were also commonly associated with co-morbidities and clinicians should be alarmed if dengue patients fulfilled severe dengue case definition on admission.

  19. Improvement of the cogeneration facilities, considering the aspects of financial risks

    International Nuclear Information System (INIS)

    Santos, A.H.M.; Nogueira, L.A.H.; Costa Bortoni, E. da

    1992-01-01

    This paper proposes a methodology to include the tools of the Portfolio Theory in the design of the cogeneration facilities. So, the effects of the risk on the return can be take in account. A computer program was developed to simulate the impacts of the thermal and mechanical (or electrical) loads on energy surplus and the potential risk. (C.M.)

  20. Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals.

    Science.gov (United States)

    Ashcroft, Darren M; Lewis, Penny J; Tully, Mary P; Farragher, Tracey M; Taylor, David; Wass, Valerie; Williams, Steven D; Dornan, Tim

    2015-09-01

    It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors. This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors. Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors. Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders. The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence

  1. Risk management for existing energy facilities. A global approach to numerical safety goals

    International Nuclear Information System (INIS)

    Pate-Cornell, M.E.

    1993-01-01

    This paper presents a structured set of numerical safety goals for risk management of existing energy facilities. The rationale behind these safety goals is based on principles of equity and economic efficiency. Some of the issues involved when using probabilistic risk analyses results for safety decisions are discussed. A brief review of existing safety targets and open-quotes floating numbersclose quotes is presented, and a set of safety goals for industrial risk management is proposed. Relaxation of these standards for existing facilities, the relevance of the lifetime of the plant, the treatment of uncertainties, and problems of failure dependencies are discussed briefly. 17 refs., 1 fig

  2. [Radon risk in healthcare facilities: environmental monitoring and effective dose].

    Science.gov (United States)

    Cammarota, B; Cascone, Maria Teresa; De Paola, L; Schillirò, F; Del Prete, U

    2009-01-01

    Radon, the second cause of lung cancer after smoking (WHO- IARC), is a natural, radioactive gas, which originates from the soil and pollutes indoor air, especially in closed or underground spaces. The purpose of this study was to determine the concentration of radon gas, its effective dose, and the measurement of microclimatic degrees C; U.R. % and air velocity in non-academic intensive care units of public hospitals in the Naples area. The annual average concentrations of radon gas were detected with EIC type ionization electret chambers, type LLT with exposure over four 3-month periods. The concentrations varied for all health facilities between 186 and 1191 Bq/m3. Overall, the effective dose of exposure to radon gas of 3mSv/a recommended by Italian legislation was never exceeded. The concentration of radon gas showed a decreasing trend starting from the areas below ground level to those on higher floors; such concentrations were also influenced by natural and artificial ventilation of the rooms, building materials used for walls, and by the state of maintenance and improvements of the building (insulation of floors and walls). The data obtained confirmed the increased concentration of radionuclides in the yellow tuff of volcanic origin in the Campania Region and the resulting rate of release of radon gas, whereas the reinforced concrete structure (a hospital located on the hillside), which had the lowest values, proved to provide good insulation against penetration and accumulation of radon gas.

  3. Radiological risk guidelines for nonreactor nuclear facilities at the Pacific Northwest Laboratory

    International Nuclear Information System (INIS)

    Lucas, D.E.; Ikenberry, T.A.

    1993-09-01

    Radiological risk evaluation guidelines for the public and workers have been developed at the Pacific Northwest Laboratory (PNL) based upon the Nuclear Safety Policy of the US Department of Energy (DOE) established in Secretary of Energy Notice SEN-35-91. The DOE nuclear safety policy states that the general public shall be protected such that no individual bears significant additional risk to health and safety from the operation of a DOE nuclear facility above the risks to which members of the general population are normally exposed. The radiological risk evaluation guidelines developed at PNL are unique in that they are (1) based upon quantitative risk goals and (2) provide a consistent level of risk management. These guidelines are used to evaluate the risk from radiological accidents that may occur during research and development activities at PNL, and are not intended for evaluation of routine exposures. A safety analyst uses the,frequency of the potential accident and the radiological dose to a given receptor to determine if the accident consequences meet the objectives of the Nuclear Safety Policy. The radiological risk evaluation guidelines are an effective tool for assisting in the management of risk at DOE nonreactor nuclear facilities. These guidelines (1) meet the nuclear safety policy of DOE, (2) establish a tool for managing risk at a consistent level within the defined constraints, and (3) set risk at an appropriate level, as compared with other risks encountered by the public and worker. Table S.1 summarizes the guidelines developed in this report

  4. Suicide risk among inpatients at a university general hospital Risco de suicídio em pacientes internados em um hospital geral universitário

    Directory of Open Access Journals (Sweden)

    Marianne Herrera Falceti Ferreira

    2007-03-01

    Full Text Available OBJECTIVE: To estimate the proportion of inpatients at a university general hospital who are at risk of committing suicide. METHOD: A random sample of 253 patients (57% males aged 18 years old or older, admitted to surgical and clinical wards, was assessed using the the Mini International Neuropsychiatric Interview, which has a section that evaluates the risk for suicide. Uni- and multivariate analyses were performed. RESULTS: There were 58 (23% patients with a risk for suicide, 13 (5% of total of whom presented a high risk. The prevalence of suicide risk was greater in young adult patients, those with no matrimonial relationship and those diagnosed with major depression (univariate analysis, Chi-squared test; p = 0.01, 0.03 and 0.0001, respectively. The multivariate analysis revealed that the risk for suicide in individuals younger than 30 years old was two fold higher than in those individuals between the ages of 30 and 59 years (OR = 0.45, 95% CI = 0.22-0.93; p = 0.03 and four fold greater than in those who were 60 years old or older (OR = 0.25, 95% CI = 0.1-0.64; p = 0.004. CONCLUSION: When young adults are admitted to general hospitals they should receive special attention due to their suicidal potential.OBJETIVO: Estimar a proporção de pacientes internados em um hospital geral universitário que têm risco de suicídio. MÉTODO: Uma amostra aleatória de 253 pacientes (57% do sexo masculino com 18 anos ou mais, internados em enfermarias clínicas e cirúrgicas, foi avaliada por meio do Mini International Neuropsychiatric Interview, o qual possui uma seção que avalia risco de suicídio. Foram realizadas analises uni e multivariadas. RESULTADOS: Cinqüenta e oito (23% pacientes tinham risco de suicídio, 13 dos quais (5% do total risco elevado. A prevalência de risco de suicídio foi maior em adultos jovens, nos que não tinham vínculo matrimonial e nos que tiveram um diagnóstico de depressão maior (análise univariada, teste do Qui

  5. Reducing the potential for conflict between proponents and the public regarding the risks entailed by radioactive waste management facilities

    International Nuclear Information System (INIS)

    Rogers, B.G.

    1984-01-01

    Sources of potential conflict between proponents and the public regarding the risks entailed by radioactive waste management facilities are identified and analyzed. Programs and policies are suggested that could reduce conflict over the siting and operation of such facilities

  6. A probabilistic risk assessment of the LLNL Plutonium Facility's evaluation basis fire operational accident. Revision 1

    International Nuclear Information System (INIS)

    Brumburgh, G.P.

    1995-01-01

    The Lawrence Livermore National Laboratory (LLNL) Plutonium Facility conducts numerous programmatic activities involving plutonium to include device fabrication, development of improved and/or unique fabrication techniques, metallurgy research, and laser isotope separation. A Safety Analysis Report (SAR) for the building 332 Plutonium Facility was completed in July 1994 to address operational safety and acceptable risk to employees, the public, government property, and the environmental. This paper outlines the PRA analysis of the Evaluation Basis Fire (EBF) operational accident. The EBF postulates the worst-case programmatic impact event for the Plutonium Facility

  7. Probabilistic risk analysis for Test Area North Hot Shop Storage Pool Facility

    International Nuclear Information System (INIS)

    Meale, B.M.; Satterwhite, D.G.

    1990-01-01

    A storage pool facility used for storing spent fuel and radioactive debris from the Three Mile Island (TMI) accident was evaluated to determine the risk associated with its normal operations. Several hazards were identified and examined to determine if any any credible accident scenarios existed. Expected annual occurrence frequencies were calculated for hazards for which accident scenarios were identified through use of fault trees modeling techniques. Fault tree models were developed for two hazards: (1) increased radiation field and (2) spread of contamination. The models incorporated facets of the operations within the facility as well as the facility itself. 6 refs

  8. Relative risk measure suitable for comparison of design alternatives of interim spent nuclear fuel storage facility

    International Nuclear Information System (INIS)

    Ferjencik, M.

    1997-01-01

    Accessible reports on risk assessment of interim spent nuclear fuel storage facilities presume that only releases of radioactive substances represent undesired consequences. However, only certain part of the undesired consequences is represented by them. Many other events are connected with safety and are able to cause losses to the operating company. The following two presumptions are pronounced based on this. 1. Any event causing a disturbance of a safety function of the storage facility is an incident event. 2. Any disturbance of a safety function is an undesired consequence. If the facility safety functions are identified and if the severity of their disturbances is quantified, then it is possible to combine consequence severity quantifications and event frequencies into a risk measure. Construction and application of such a risk measure is described in this paper. The measure is shown to be a tool suitable for comparison of interim storage technology design alternatives. (author)

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

    Science.gov (United States)

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

    2013-07-01

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

  10. 137Cs Radiological risk estimation of NSD facility at Karawang site by using RESRAD onsite application: effect of cover thickness

    Science.gov (United States)

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

    2018-02-01

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

  11. Use of reliability engineering tools in safety and risk assessment of nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Raso, Amanda Laureano; Vasconcelos, Vanderley de; Marques, Raíssa Oliveira; Soares, Wellington Antonio; Mesquita, Amir Zacarias, E-mail: amandaraso@hotmail.com, E-mail: vasconv@cdtn.br, E-mail: raissaomarques@gmail.com, E-mail: soaresw@cdtn.br, E-mail: amir@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Serviço de Tecnologia de Reatores

    2017-07-01

    Safety, reliability and availability are fundamental criteria in design, construction and operation of nuclear facilities, as nuclear power plants. Deterministic and probabilistic risk assessments of such facilities are required by regulatory authorities in order to meet licensing regulations, contributing to assure safety, as well as reduce costs and environmental impacts. Probabilistic Risk Assessment has become an important part of licensing requirements of the nuclear power plants in Brazil and in the world. Risk can be defined as a qualitative and/or quantitative assessment of accident sequence frequencies (or probabilities) and their consequences. Risk management is a systematic application of management policies, procedures and practices to identify, analyze, plan, implement, control, communicate and document risks. Several tools and computer codes must be combined, in order to estimate both probabilities and consequences of accidents. Event Tree Analysis (ETA), Fault Tree Analysis (FTA), Reliability Block Diagrams (RBD), and Markov models are examples of evaluation tools that can support the safety and risk assessment for analyzing process systems, identifying potential accidents, and estimating consequences. Because of complexity of such analyzes, specialized computer codes are required, such as the reliability engineering software develop by Reliasoft® Corporation. BlockSim (FTA, RBD and Markov models), RENO (ETA and consequence assessment), Weibull++ (life data and uncertainty analysis), and Xfmea (qualitative risk assessment) are some codes that can be highlighted. This work describes an integrated approach using these tools and software to carry out reliability, safety, and risk assessment of nuclear facilities, as well as, and application example. (author)

  12. Use of reliability engineering tools in safety and risk assessment of nuclear facilities

    International Nuclear Information System (INIS)

    Raso, Amanda Laureano; Vasconcelos, Vanderley de; Marques, Raíssa Oliveira; Soares, Wellington Antonio; Mesquita, Amir Zacarias

    2017-01-01

    Safety, reliability and availability are fundamental criteria in design, construction and operation of nuclear facilities, as nuclear power plants. Deterministic and probabilistic risk assessments of such facilities are required by regulatory authorities in order to meet licensing regulations, contributing to assure safety, as well as reduce costs and environmental impacts. Probabilistic Risk Assessment has become an important part of licensing requirements of the nuclear power plants in Brazil and in the world. Risk can be defined as a qualitative and/or quantitative assessment of accident sequence frequencies (or probabilities) and their consequences. Risk management is a systematic application of management policies, procedures and practices to identify, analyze, plan, implement, control, communicate and document risks. Several tools and computer codes must be combined, in order to estimate both probabilities and consequences of accidents. Event Tree Analysis (ETA), Fault Tree Analysis (FTA), Reliability Block Diagrams (RBD), and Markov models are examples of evaluation tools that can support the safety and risk assessment for analyzing process systems, identifying potential accidents, and estimating consequences. Because of complexity of such analyzes, specialized computer codes are required, such as the reliability engineering software develop by Reliasoft® Corporation. BlockSim (FTA, RBD and Markov models), RENO (ETA and consequence assessment), Weibull++ (life data and uncertainty analysis), and Xfmea (qualitative risk assessment) are some codes that can be highlighted. This work describes an integrated approach using these tools and software to carry out reliability, safety, and risk assessment of nuclear facilities, as well as, and application example. (author)

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

    Science.gov (United States)

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

    2011-04-01

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

  14. Imaging the risks - risking the image: Social impact assessment of the final disposal facility

    International Nuclear Information System (INIS)

    Avolahti, J.; Vira, J.

    1999-01-01

    Preparations for the final disposal of spent nuclear fuel in Finland started about twenty years ago. At present the work is carried out by Posiva Oy, which in 1996 took over the programme managed earlier by Teollisuuden Voima Oy, one of the country's nuclear power companies. From 1996 on the preparations have been made for all the spent fuel from Finnish nuclear power stations. The site for the final disposal facility will be selected among four alternatives by the end of 2000 and - assuming that the technical approach proposed by Posiva is accepted by the Government and the Parliament - the construction of the repository will start in the 2010s. The disposal operations are planned to be started in 2020. The alternative four sites have gone through a systematic site selection process based on geologic siting criteria and on environmental and cultural considerations. One of the objectives of the process was to avoid inhabited areas, agricultural fields, valuable groundwater or preservation areas as well as areas which might draw interest as regards the potential for ore deposits. The idea was that the field investigations and later the possible disposal facility should not cause any harm to local people. Two of the candidate sites are at present nuclear power plant sites situated at the coast, the two other candidates are inland sites with no nuclear activities. The geologic siting investigations were started in 1987. Interim assessments of the results so far have been made in 1992 and 1996 and a final report of all the investigations will be published before the end of 2000. The present view is that all four candidates are geologically suitable for siting the repository. Posiva's EIA for the final disposal of spent fuel in Finland is nearing completion. A considerable effort was made to involve local groups and individuals in the assessment process. Yet the participation remained limited and consisted mainly of active opponents of the project and of those who were

  15. Imaging the risks - risking the image: Social impact assessment of the final disposal facility

    Energy Technology Data Exchange (ETDEWEB)

    Avolahti, J.; Vira, J. [Posiva Oy, Helsinki (Finland)

    1999-12-01

    Preparations for the final disposal of spent nuclear fuel in Finland started about twenty years ago. At present the work is carried out by Posiva Oy, which in 1996 took over the programme managed earlier by Teollisuuden Voima Oy, one of the country's nuclear power companies. From 1996 on the preparations have been made for all the spent fuel from Finnish nuclear power stations. The site for the final disposal facility will be selected among four alternatives by the end of 2000 and - assuming that the technical approach proposed by Posiva is accepted by the Government and the Parliament - the construction of the repository will start in the 2010s. The disposal operations are planned to be started in 2020. The alternative four sites have gone through a systematic site selection process based on geologic siting criteria and on environmental and cultural considerations. One of the objectives of the process was to avoid inhabited areas, agricultural fields, valuable groundwater or preservation areas as well as areas which might draw interest as regards the potential for ore deposits. The idea was that the field investigations and later the possible disposal facility should not cause any harm to local people. Two of the candidate sites are at present nuclear power plant sites situated at the coast, the two other candidates are inland sites with no nuclear activities. The geologic siting investigations were started in 1987. Interim assessments of the results so far have been made in 1992 and 1996 and a final report of all the investigations will be published before the end of 2000. The present view is that all four candidates are geologically suitable for siting the repository. Posiva's EIA for the final disposal of spent fuel in Finland is nearing completion. A considerable effort was made to involve local groups and individuals in the assessment process. Yet the participation remained limited and consisted mainly of active opponents of the project and of those

  16. Reductions in Average Lengths of Stays for Surgical Procedures Between the 2008 and 2014 United States National Inpatient Samples Were Not Associated With Greater Incidences of Use of Postacute Care Facilities.

    Science.gov (United States)

    Dexter, Franklin; Epstein, Richard H

    2018-03-01

    Diagnosis-related group (DRG) based reimbursement creates incentives for reduction in hospital length of stay (LOS). Such reductions might be accomplished by lesser incidences of discharges to home. However, we previously reported that, while controlling for DRG, each 1-day decrease in hospital median LOS was associated with lesser odds of transfer to a postacute care facility (P = .0008). The result, though, was limited to elective admissions, 15 common surgical DRGs, and the 2013 US National Readmission Database. We studied the same potential relationship between decreased LOS and postacute care using different methodology and over 2 different years. The observational study was performed using summary measures from the 2008 and 2014 US National Inpatient Sample, with 3 types of categories (strata): (1) Clinical Classifications Software's classes of procedures (CCS), (2) DRGs including a major operating room procedure during hospitalization, or (3) CCS limiting patients to those with US Medicare as the primary payer. Greater reductions in the mean LOS were associated with smaller percentages of patients with disposition to postacute care. Analyzed using 72 different CCSs, 174 DRGs, or 70 CCSs limited to Medicare patients, each pairwise reduction in the mean LOS by 1 day was associated with an estimated 2.6% ± 0.4%, 2.3% ± 0.3%, or 2.4% ± 0.3% (absolute) pairwise reduction in the mean incidence of use of postacute care, respectively. These 3 results obtained using bivariate weighted least squares linear regression were all P < .0001, as were the corresponding results obtained using unweighted linear regression or the Spearman rank correlation. In the United States, reductions in hospital LOS, averaged over many surgical procedures, are not accomplished through a greater incidence of use of postacute care.

  17. Risk Management Technique for design and operation of facilities and equipment

    Science.gov (United States)

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

    1975-01-01

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

  18. A new framework to assess risk for a spent fuel dry storage facility

    International Nuclear Information System (INIS)

    Ryu, J. H.; Jae, M. S.; Jung, C. W.

    2004-01-01

    A spent fuel dry storage facility is a dry cooling storage facility for storing irradiated nuclear fuel and associated radioactive materials. It has very small possibilities to release radiation materials. It means a safety analysis for a spent fuel dry storage facility is required before construction. In this study, a new framework for assessing risk associated with a spent fuel dry storage facility is represented. A safety assessment framework includes 3 modules such as assessment of basket/cylinder failure rates, that of overall storage system, and site modeling. A reliability physics model for failure rates, event tree analysis(ETA)/fault tree analysis for system analysis, Bayesian analysis for initial events data, and MACCS code for consequence analysis have been used in this study

  19. Risk classification for nuclear facilities in connection with the illegal use of nuclear materials

    International Nuclear Information System (INIS)

    Bahm, W.; Naegele, G.; Sellinschegg, D.

    1976-01-01

    It is shown, and illustrated by an example, that specific conditions at a nuclear facility to a large extent determine the probability of a successful illegal attack against that facility. Therefore, a categorization of nuclear materials according to the associated hazards alone, as practised currently, does not appear to be sufficient for the establishment of a balanced national physical protection system. In this paper a possible way of categorizing nuclear facilities according to the associated risks, determined as objectively as possible, is discussed. It is felt that initially the analysis should be restricted to the determination of the conditional risks, associated with illegal acquisition and use of radioactive materials by a postulated hostile or similar group. (author)

  20. EIF onshore discharges : a quantitative environmental risk assessment tool for onshore facilities

    Energy Technology Data Exchange (ETDEWEB)

    Hagemann, R.; Smit, M.G.D.; Frost, T.K. [Statoil ASA, Stavenger (Norway); Firth, S.K. [Firth Consultants, Bristol (United Kingdom); Stone, K. [WorleyParsons, Victoria, BC (Canada)

    2009-07-01

    The proper management of environmental risk is a key requirement of StatoilHydro's governing documents and is a key consideration in all phases of StatoilHydro's activities. In order to help manage risks in an effective and sustainable manner, StatoilHydro has led the development of the environmental impact factor (EIF) risk assessment tool. The EIF is utilized by all operators on the Norwegian Continental Shelf for reporting continuous improvements in produced water management to the authorities. The EIF concept has also been applied to evaluate environmental risk from air emissions, offshore oil spills and drilling discharges, discharges from onshore facilities to sea and discharges and spills from onshore installations. In order to identify the remaining hypothetical risk from a new facility, optimized with respect to environmental protection, this paper presented a case study, where the tool was applied to an oil sands steam assisted gravity drainage facility in Alberta. The paper discussed the EIF model and results of the case study. It was concluded that as a result of the use of generic principles for environmental risk assessment, combined with databases with parameter information for common soil and aquifer types, the EIF tool could be applied to any site ranging from wetlands to deserts. 5 refs., 2 tabs., 3 figs.

  1. Risk-informed approaches to assess ecological safety of facilities with radioactive waste

    International Nuclear Information System (INIS)

    Vashchenko, V.N.; Zlochevskij, V.V.; Skalozubov, V.I.

    2011-01-01

    Ingenious risk-informed methods to assess ecological safety of facilities with radioactive waste are proposed in the paper. Probabilistic norms on lethal outcomes and reliability of safety barriers are used as safety criteria. Based on the probability measures, it is established that ecological safety conditions are met for the standard criterion of lethal outcomes

  2. Risk assessment on hazards for decommissioning safety of a nuclear facility

    International Nuclear Information System (INIS)

    Jeong, Kwan-Seong; Lee, Kune-Woo; Lim, Hyeon-Kyo

    2010-01-01

    A decommissioning plan should be followed by a qualitative and quantitative safety assessment of it. The safety assessment of a decommissioning plan is applied to identify the potential (radiological and non-radiological) hazards and risks. Radiological and non-radiological hazards arise during decommissioning activities. The non-radiological or industrial hazards to which workers are subjected during a decommissioning and dismantling process may be greater than those experienced during an operational lifetime of a facility. Workers need to be protected by eliminating or reducing the radiological and non-radiological hazards that may arise during routine decommissioning activities and as well as during accidents. The risk assessment method was developed by using risk matrix and fuzzy inference logic, on the basis of the radiological and non-radiological hazards for a decommissioning safety of a nuclear facility. Fuzzy inference of radiological and non-radiological hazards performs a mapping from radiological and non-radiological hazards to risk matrix. Defuzzification of radiological and non-radiological hazards is the conversion of risk matrix and priorities to the maximum criterion method and the mean criterion method. In the end, a composite risk assessment methodology, to rank the risk level on radiological and non-radiological hazards of the decommissioning tasks and to prioritize on the risk level of the decommissioning tasks, by simultaneously combining radiological and non-radiological hazards, was developed.

  3. Development and validation of fall risk screening tools for use in residential aged care facilities.

    Science.gov (United States)

    Delbaere, Kim; Close, Jacqueline C T; Menz, Hylton B; Cumming, Robert G; Cameron, Ian D; Sambrook, Philip N; March, Lyn M; Lord, Stephen R

    2008-08-18

    To develop screening tools for predicting falls in nursing home and intermediate-care hostel residents who can and cannot stand unaided. Prospective cohort study in residential aged care facilities in northern Sydney, New South Wales, June 1999-June 2003. 2005 people aged 65-104 years (mean +/- SD, 85.7+/-7.1 years). Demographic, health, and physical function assessment measures; number of falls over a 6-month period; validity of the screening models. Ability to stand unaided was identified as a significant event modifier for falls. In people who could stand unaided, having either poor balance or two of three other risk factors (previous falls, nursing home residence, and urinary incontinence) increased the risk of falling in the next 6 months threefold (sensitivity, 73%; specificity, 55%). In people who could not stand unaided, having any one of three risk factors (previous falls, hostel residence, and using nine or more medications) increased the risk of falling twofold (sensitivity, 87%; specificity, 29%). These two screening models are useful for identifying older people living in residential aged care facilities who are at increased risk of falls. The screens are easy to administer and contain items that are routinely collected in residential aged care facilities in Australia.

  4. Environmental risk analysis of oil handling facilities in port areas. Application to Tarragona harbor (NE Spain).

    Science.gov (United States)

    Valdor, Paloma F; Gómez, Aina G; Puente, Araceli

    2015-01-15

    Diffuse pollution from oil spills is a widespread problem in port areas (as a result of fuel supply, navigation and loading/unloading activities). This article presents a method to assess the environmental risk of oil handling facilities in port areas. The method is based on (i) identification of environmental hazards, (ii) characterization of meteorological and oceanographic conditions, (iii) characterization of environmental risk scenarios, and (iv) assessment of environmental risk. The procedure has been tested by application to the Tarragona harbor. The results show that the method is capable of representing (i) specific local pollution cases (i.e., discriminating between products and quantities released by a discharge source), (ii) oceanographic and meteorological conditions (selecting a representative subset data), and (iii) potentially affected areas in probabilistic terms. Accordingly, it can inform the design of monitoring plans to study and control the environmental impact of these facilities, as well as the design of contingency plans. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence.

    Science.gov (United States)

    de Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina

    2016-09-01

    Most people with mental disorders are not violent. However, the lack of specific studies in this area and recent radical changes in Italy, including the closure of six Forensic Mental Hospitals, has prompted a more detailed investigation of patients with aggressive behaviour. To compare socio-demographic, clinical and treatment-related characteristics of long-term inpatients with a lifetime history of serious violence with controls; to identify predictors of verbal and physical aggressive behaviour during 1-year follow-up. In a prospective cohort study, patients living in Residential Facilities (RFs) with a lifetime history of serious violence were assessed with a large set of standardized instruments and compared to patients with no violent history. Patients were evaluated bi-monthly with MOAS in order to monitor any aggressive behaviour. The sample included 139 inpatients, 82 violent and 57 control subjects; most patients were male. The bi-monthly monitoring during the 1-year follow-up did not show any statistically significant differences in aggressive behaviour rates between the two groups. The subscale explaining most of the MOAS total score was aggression against objects, although verbal aggression was the most common pattern. Furthermore, verbal aggression was significantly associated with aggression against objects and physical aggression. Patients with a history of violence in RFs, where treatment and clinical supervision are available, do not show higher rates of aggressiveness compared to patients with no lifetime history of violence. Since verbal aggression is associated with more severe forms of aggression, prompt intervention is warranted to reduce the risk of escalation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Inpatient preanalytic process improvements.

    Science.gov (United States)

    Wagar, Elizabeth A; Phipps, Ron; Del Guidice, Robert; Middleton, Lavinia P; Bingham, John; Prejean, Cheryl; Johnson-Hamilton, Martha; Philip, Pheba; Le, Ngoc Han; Muses, Waheed

    2013-12-01

    Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services. To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders. The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement. After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%. Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

  7. Overview of seismic probabilistic risk assessment for structural analysis in nuclear facilities

    International Nuclear Information System (INIS)

    Reed, J.W.

    1989-01-01

    Probabilistic Risk Assessment (PRA) for seismic events is currently being performed for nuclear and DOE facilities. The background on seismic PRA is presented along with a basic description of the method. The seismic PRA technique is applicable to other critical facilities besides nuclear plants. The different approaches for obtained structure fragility curves are discussed and their applications to structures and equipment, in general, are addressed. It is concluded that seismic PRA is a useful technique for conducting probability analysis for a wide range of classes of structures and equipment

  8. 42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...

    Science.gov (United States)

    2010-10-01

    ... payment system for inpatient hospital services of psychiatric facilities. 412.404 Section 412.404 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... must meet the conditions of this section to receive payment under the prospective payment system...

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

    Science.gov (United States)

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

    2017-09-15

    A semi-quantitative model for risk ranking of aquaculture facilities in Switzerland with regard to the introduction and spread of Viral Haemorrhagic Septicaemia (VHS) and Infectious Haematopoietic Necrosis (IHN) was developed in a previous study (Diserens et al., 2013). The objective of the present study was to validate this model using data collected during field visits on aquaculture sites in four Swiss cantons compared to data collected through a questionnaire in the previous study. A discrepancy between the values obtained with the two different methods was found in 32.8% of the parameters, resulting in a significant difference (pranking of Swiss aquaculture facilities according to their risk of getting infected with or spreading of VHS and IHN, as the five facilities that tested positive for these diseases in the last ten years were ranked as medium or high risk. Moreover, because the seven fish farms that were infected with Infectious Pancreatic Necrosis (IPN) during the same period also belonged to the risk categories medium and high, the classification appeared to correlate with the occurrence of this third viral fish disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Suicide risk in long-term care facilities: a systematic review.

    Science.gov (United States)

    Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

    2014-12-01

    Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Prevalence and cost of imaging in inpatient falls: the rising cost of falling

    Directory of Open Access Journals (Sweden)

    Fields J

    2015-06-01

    Full Text Available Jessica Fields,1 Tahani Alturkistani,2 Neal Kumar,3 Arjun Kanuri,3 Deeb N Salem,1 Samson Munn,2 Deborah Blazey-Martin1 1Department of Medicine, Tufts Medical Center, Boston, MA, USA; 2Department of Radiology, Tufts Medical Center, Boston, MA, USA; 3Tufts University School of Medicine, Boston, MA, USA Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design: Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting: Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010. Patients: All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results: Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98. More than half of falls were men (55% and patients considered at risk of falls (56%. Falls were evenly distributed across morning (33%, evening (34%, and night (33% shifts. Of 530 falls, 178 (34% patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700 from head computed tomography (CT. Conclusion: Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward

  12. Risk management considerations for seismic upgrading of an older facility for short-term residue stabilization

    International Nuclear Information System (INIS)

    Additon, S.L.; Peregoy, W.L.; Foppe, T.L.

    1999-01-01

    Building 707 and its addition, Building 707A, were selected, after the production mission of Rocky Flats was terminated a few years ago, to stabilize many of the plutonium residues remaining at the site by 2002. The facility had undergone substantial safety improvements to its safety systems and conduct of operations for resumption of plutonium operations in the early 1990s and appeared ideally suited for this new mission to support accelerated Site closure. During development of a new authorization basis, a seismic evaluation was performed. This evaluation addressed an unanalyzed expansion joint and suspect connection details for the precast concrete tilt-up construction and concluded that the seismic capacity of the facility is less than half of that determined by previous analysis. Further, potential seismic interaction was identified between a collapsing Building 707 and the seismically upgraded Building 707A, possibly causing the partial collapse of the latter. Both the operating contractor and the Department of Energy sought a sound technical basis for deciding how to proceed. This paper addresses the risks of the as-is facility and possible benefits of upgrades to support a decision on whether to upgrade the seismic capacity of Building 707, accept the risk of the as-is facility for its short remaining mission, or relocate critical stabilization missions. The paper also addresses the Department of Energy's policy on natural phenomena

  13. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

    Science.gov (United States)

    Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-01-01

    Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805

  14. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

    Science.gov (United States)

    Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-07-01

    We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.

  15. Current state of the construction of an integrated test facility for hydrogen risk

    Energy Technology Data Exchange (ETDEWEB)

    Na, Young Su; Hong, Seong-Ho; Hong, Seong-Wan [KAERI, Daejeon (Korea, Republic of)

    2015-05-15

    Experimental research on hydrogen as a combustible gas is important for an assessment of the integrity of a containment building under a severe accident. The Korea Atomic Energy Research Institute (KAERI) is preparing a large-scaled test facility, called SPARC (SPray-Aerosol-Recombiner-Combustion), to estimate the hydrogen behavior such as the distribution, combustion and mitigation. This paper introduces the experimental research activity on hydrogen risk, which was presented at International Congress on Advances in Nuclear Power Plants (ICAPP) this year. The KAERI is preparing a test facility, called SPARC (SPray-Aerosol-Recombiner-Combustion test facility), for an assessment of the hydrogen risk. In the SPARC, hydrogen behavior such as mixing with steam and air, distribution, and combustion in the containment atmosphere will be observed. The SPARC consists of a pressure vessel with a 9.5 m height and 3.4 m in diameter and the operating system to control the thermal hydraulic conditions up to 1.5 MPa at 453 K in a vessel. The temperature, pressure, and gas concentration at various locations will be measured to estimate the atmospheric behavior in a vessel. To install the SPARC, an experimental building, called LIFE (Laboratory for Innovative mitigation of threats from Fission products and Explosion), was constructed at the KAERI site. LIFE has an area of 480 m''2 and height of 18.6 m, and it was designed by considering the experimental safety and specification of a large-sized test facility.

  16. Race, region and risk: An examination of minority proximity to noxious facilities

    Energy Technology Data Exchange (ETDEWEB)

    Nieves, A.L. [Wheaton Coll., IL (United States)]|[Argonne National Lab., IL (United States); Nieves, L.A. [Argonne National Lab., IL (United States)

    1996-04-01

    The past decade has given rise to terms like environmental racism, eco-racism, and environmental inequities to characterize a disproportional distribution of environmental disamenities among minority communities. Much of the literature supports the contention that racial and ethnic minorities and low-income groups bear a disproportionate burden of risk from hazardous activities and substances in the environment. This study expands the scope of prior studies by employing county-level data for the entire nation and including a broad range of facility types associated with environmental disamenities. In addition, it addresses the issue of the distribution of noxious facilities among white and non-white populations in an attempt to determine the relative exposure to risk among different racial and ethnic groups. In addition, the authors also explore the relative importance of nonurban versus urban residence.

  17. Risk-informing safety reviews for non-reactor nuclear facilities: an example application

    International Nuclear Information System (INIS)

    Mubayi, V.; Yue, M.; Bari, R.A.; Azarm, M.A.; Mukaddam, W.; Good, G.; Gonzalez, F.

    2013-01-01

    This paper describes a methodology used to model potential accidents in fuel cycle facilities that employ chemical processes to separate and purify nuclear materials. The methodology is illustrated with an example that uses event and fault trees to estimate the frequency of a specific energetic reaction that can occur in nuclear material processing facilities. The methodology used probabilistic risk assessment (PRA)-related tools as well as information about the chemical reaction characteristics, information on plant design and operational features, and generic data about component failure rates and human error rates. The accident frequency estimates for the specific reaction can be useful to help to risk-inform a safety review process and assess compliance with regulatory requirements. (authors)

  18. Risk-Informing Safety Reviews for Non-Reactor Nuclear Facilities

    International Nuclear Information System (INIS)

    Mubayi, V.; Azarm, A.; Yue, M.; Mukaddam, W.; Good, G.; Gonzalez, F.; Bari, R.A.

    2011-01-01

    This paper describes a methodology used to model potential accidents in fuel cycle facilities that employ chemical processes to separate and purify nuclear materials. The methodology is illustrated with an example that uses event and fault trees to estimate the frequency of a specific energetic reaction that can occur in nuclear material processing facilities. The methodology used probabilistic risk assessment (PRA)-related tools as well as information about the chemical reaction characteristics, information on plant design and operational features, and generic data about component failure rates and human error rates. The accident frequency estimates for the specific reaction help to risk-inform the safety review process and assess compliance with regulatory requirements.

  19. Accident Management ampersand Risk-Based Compliance With 40 CFR 68 for Chemical Process Facilities

    International Nuclear Information System (INIS)

    O'Kula, K.R.; Taylor, R.P. Jr.; Ashbaugh, S.G.

    1995-01-01

    A risk-based logic model is suggested as an appropriate basis for better predicting accident progression and ensuing source terms to the environment from process upset conditions in complex chemical process facilities. Under emergency conditions, decision-makers may use the Accident Progression Event Tree approach to identify the best countermeasure for minimizing deleterious consequences to receptor groups before the atmospheric release has initiated. It is concluded that the chemical process industry may use this methodology as a supplemental information provider to better comply with the Environmental Protection Agency's proposed 40 CFR 68 Risk Management Program rule. An illustration using a benzene-nitric acid potential interaction demonstrates the value of the logic process. The identification of worst-case releases and planning for emergency response are improved through these methods, at minimum. It also provides a systematic basis for prioritizing facility modifications to correct vulnerabilities

  20. Risk-Informing Safety Reviews for Non-Reactor Nuclear Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Mubayi, V.; Azarm, A.; Yue, M.; Mukaddam, W.; Good, G.; Gonzalez, F.; Bari, R.A.

    2011-03-13

    This paper describes a methodology used to model potential accidents in fuel cycle facilities that employ chemical processes to separate and purify nuclear materials. The methodology is illustrated with an example that uses event and fault trees to estimate the frequency of a specific energetic reaction that can occur in nuclear material processing facilities. The methodology used probabilistic risk assessment (PRA)-related tools as well as information about the chemical reaction characteristics, information on plant design and operational features, and generic data about component failure rates and human error rates. The accident frequency estimates for the specific reaction help to risk-inform the safety review process and assess compliance with regulatory requirements.

  1. Application of Bayesian network methodology to the probabilistic risk assessment of nuclear waste disposal facility

    International Nuclear Information System (INIS)

    Lee, Chang Ju

    2006-02-01

    The scenario in a risk analysis can be defined as the propagating feature of specific initiating event which can go to a wide range of undesirable consequences. If one takes various scenarios into consideration, the risk analysis becomes more complex than do without them. A lot of risk analyses have been performed to actually estimate a risk profile under both uncertain future states of hazard sources and undesirable scenarios. Unfortunately, in case of considering some stochastic passive systems such as a radioactive waste disposal facility, since the behaviour of future scenarios is hardly predicted without special reasoning process, we cannot estimate their risk only with a traditional risk analysis methodology. Moreover, it is believed that the sources of uncertainty at future states can be reduced pertinently by setting up dependency relationships interrelating geological, hydrological, and ecological aspects of the site with all the scenarios. It is then required current methodology of uncertainty analysis of the waste disposal facility be revisited under this belief. In order to consider the effects predicting from an evolution of environmental conditions of waste disposal facilities, this study proposes a quantitative assessment framework integrating the inference process of Bayesian network to the traditional probabilistic risk analysis. In this study an approximate probabilistic inference program for the specific Bayesian network developed and verified using a bounded-variance likelihood weighting algorithm. Ultimately, specific models, including a Monte-Carlo model for uncertainty propagation of relevant parameters, were developed with a comparison of variable-specific effects due to the occurrence of diverse altered evolution scenarios (AESs). After providing supporting information to get a variety of quantitative expectations about the dependency relationship between domain variables and AESs, this study could connect the results of probabilistic

  2. 77 FR 55269 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.11, 2013; Fiscal Year Update

    Science.gov (United States)

    2012-09-07

    ... amounts for the following types of charges: Acute inpatient facility charges; skilled nursing facility/sub... this notice. These changes are effective October 1, 2012. When charges for medical care or services... section of this notice, only the acute inpatient facility charges and skilled nursing facility/sub-acute...

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

    Directory of Open Access Journals (Sweden)

    Wacquier W.

    2013-07-01

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

  4. Citizen perceptions of information flow around a nuclear facility: A study in risk communication

    International Nuclear Information System (INIS)

    Price, M.O.

    1997-01-01

    Responses of focus group members from the region around a Nuclear Facility provide the data for this qualitative study concerning citizen perceptions of available site information. Analyses of three of the focus group discussion questions and the answers they elicited showed a dominant perception among participants of insufficient easily available information about the site. These respondents also indicated that most of them obtain site information through mass media and hearsay, that many lack trust in the information they have and would trust only an independent entity to provide accurate information. A new area in communication studies, variously called environmental risk communication, risk communication and health risk communication, continues to evolve among those working in various allied disciplines, some far removed from communication. As science attempts to solve environmental problems caused by technological advances, this field acquires numerous practitioners. Some of these risk communication experts may however, be overlooking basic and necessary components of effective communication, because their expertise is in another discipline. One result of this can be communication breakdown in which those involved, assume that meaning is shared, when in fact the opposite is true. This paper seeks to clarify a necessary ingredient of effective interpersonal risk communication, using data obtained from citizens living around one of the nation's nuclear facilities as an example

  5. Pilot study risk assessment for selected problems at three US Department of Energy Facilities

    International Nuclear Information System (INIS)

    Hamilton, L.D.; Holtzman, S.; Meinhold, A.F.; Morris, S.C.; Pardi, R.; Rowe, M.D.; Sun, C.; Anspaugh, L.R.; Bogen, K.T.; Daniels, J.I.

    1994-01-01

    Objective and realistic human health risk assessments were performed for environmental problems at the Savannah River Site (SRS), the Fernald Environmental Management Project (FEMP), and the Nevada Test Site (NTS). At the SRS, cancer mortality risks were analyzed for projected public exposure to 3 H and 137 Cs released into the Savannah River. For annual human exposures to SRS tritium in Savannah River water, calculated incremental individual lifetime risks in two human receptor populations were small (8x10 -7 ; upper 95 percentile point of the distribution). The 95th percentile point of the distribution for incremental individual lifetime risks from one year's exposure to 137 Cs is less than 10 -8 . No deaths are expected in either populations as a result of exposures to tritium or cesium released to the Savannah River. Routine releases of radon and radon progeny from the K-65 silos at FEMP resulted in individual lifetime risks greater than 1x10 -4 only for onsite workers and fenceline residents. Assessment of risks from exposure to uranium in ground water released by the FEMP predicted no toxic effects for human receptors. All estimated cancer risks were small. The largest predicted individual lifetime risk was for a well close to the facility. For various above-ground shot sites at the NTS, highest predicted lifetime cancer risks are for a resident farmer. At 50,000 and 100,000 y in the future, the predicted cancer risks are all below 10 -6 . In the assessment of exposure to radionuclides in ground water at the NTS, for an individual onsite near the site boundary, the geometric mean of the maximum potential excess lifetime risk of cancer mortality for an individual is 7x10 -3 . For an individual using water offsite, the geometric mean of the maximum potential excess lifetime risk of cancer mortality is 7x10 -7 . 40 refs., 6 figs., 2 tabs

  6. Use of risk-matrix methods in the radiation safety analysis of PET/CT facilities

    International Nuclear Information System (INIS)

    Calderón Marín, Carlos F.; González González, Joaquín J.; Quesada Cepero, Waldo; Sinconegui Gómez, Belkys; Solá Rodríguez, Yeline; Duménigo Ámbar, Cruz; Guerrero Cancio, Mayka

    2016-01-01

    Introduction. Radiological safety is essential during clinical applications of ionizing radiations. Cuban legislation considers it mandatory to carry out risk analysis during safety assessments of facilities where Nuclear Medicine practices are performed. The Risk Matrix (R-M) method has been used in risk assessments in Radiotherapy and some experiences in Nuclear Medicine have been reported. In the present work the results of the safety evaluation, using the M-R method, of the first PET / CT center constructed at the Institute of Oncology and Radiobiology in Havana, are shown. The facilities will work as a satellite center and the production of radioactive drugs of 68 Ga will be conceived. The images will be acquired with a Philips Gemini TF64 scanner. Several stages and sub-stages were considered, including the design of the facility, quality control programs, review of the relevance of study requests, radiopharmaceutical reception and fractionation, 68 Ga radiopharmaceuticals production, management of Patient during the administration of radiopharmaceuticals and patient positioning. Initiating events (IEs), available barriers, as well as measures for the reduction of frequency (RFMs) of IEs and consequences (RCMs) were identified. In addition, IEs sequences are considered for CT scans. The incidence of risk reduction was assessed by the ratio of the number of times they were used and the total number of IEs. The calculation of the R-M was made by modeling the practice with the SEVRRA code R iskAssessmentSystem . Results. As a result, 76 IEs were identified with a distribution of 72% affecting patients, 7.9% in the Public and 19.7% on Occupationally Exposed Workers (TOEs). 89.5% of IEs are caused by human errors. Barriers and consequences and frequency reducers produced a risk distribution of 2.6% of high risk IEs, 64.5% medium risk and 32.9% low risk. The high-risk IEs are related to errors in the calculation of the shielding requirements of the facility that

  7. Comparison of risk-dominant scenario assumptions for several TRU waste facilities in the DOE complex

    International Nuclear Information System (INIS)

    Foppe, T.L.; Marx, D.R.

    1999-01-01

    In order to gain a risk management perspective, the DOE Rocky Flats Field Office (RFFO) initiated a survey of other DOE sites regarding risks from potential accidents associated with transuranic (TRU) storage and/or processing facilities. Recently-approved authorization basis documents at the Rocky Flats Environmental Technology Site (RFETS) have been based on the DOE Standard 3011 risk assessment methodology with three qualitative estimates of frequency of occurrence and quantitative estimates of radiological consequences to the collocated worker and the public binned into three severity levels. Risk Class 1 and 2 events after application of controls to prevent or mitigate the accident are designated as risk-dominant scenarios. Accident Evaluation Guidelines for selection of Technical Safety Requirements (TSRs) are based on the frequency and consequence bin assignments to identify controls that can be credited to reduce risk to Risk Class 3 or 4, or that are credited for Risk Class 1 and 2 scenarios that cannot be further reduced. This methodology resulted in several risk-dominant scenarios for either the collocated worker or the public that warranted consideration on whether additional controls should be implemented. RFFO requested the survey because of these high estimates of risks that are primarily due to design characteristics of RFETS TRU waste facilities (i.e., Butler-type buildings without a ventilation and filtration system, and a relatively short distance to the Site boundary). Accident analysis methodologies and key assumptions are being compared for the DOE sites responding to the survey. This includes type of accidents that are risk dominant (e.g., drum explosion, material handling breach, fires, natural phenomena, external events, etc.), source term evaluation (e.g., radionuclide material-at-risk, chemical and physical form, damage ratio, airborne release fraction, respirable fraction, leakpath factors), dispersion analysis (e.g., meteorological

  8. Use of precautionary principle in risk assessment of radioactive and nuclear facilities: benefits, costs and difficulties of implementing

    International Nuclear Information System (INIS)

    Reis, Helio G. dos; Jordao, Elizabete; Vasconcelos, Vanderley de

    2007-01-01

    The Precautionary Principle is a consequence of the understanding of both the limits of the science to predict risks, and the duty of government to protect the public and environment. An international declaration on the Principle, signed by most of world's nations, was made in 1992, during the United Nation Conference on Environment and Development. The key element of the origin and application of the Principle is the matter of acting in face of uncertainties about risks. The use of nuclear energy and ionizing radiation often involves complex facilities that pose special risks to public and environment. In order to comply with legal requirements during licensing process a risk assessment of such facilities shall be conducted. Risk assessment is often used for identifying and analyzing risks from project and complex systems. It is useful for facilitating risk management activities through the identification of dominant contributors to risk so that resources can be effectively allocated. However, risk assessment alone does not provide all of the information needed to determine an appropriate precaution level and the actions to be taken. Limitations of risk assessment are related to difficulties to solve problems, inclusion of public priorities and limited consideration of uncertainties. This work intends to discuss the current application of Precautionary Principle in risk assessment of radioactive and nuclear facilities, and propose an approach to consider it in Quantitative Risk Assessment. They are also analyzed where the Principle has been used, formally or implicitly, inside safety and risk assessment of such facilities. (author)

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

    International Nuclear Information System (INIS)

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

    1998-03-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

  11. Radiological risk guidelines for nonreactor nuclear facilities at the Pacific Northwest Laboratory

    International Nuclear Information System (INIS)

    Lucas, D.E.; Ikenberry, T.A.

    1994-03-01

    Radiological risk evaluation guidelines for the public and workers have been developed at the Pacific Northwest Laboratory (PNL) based upon the Nuclear Safety Policy of the US Department of Energy (DOE) established in Secretary of Energy Notice SEN-35-91 (DOE 1991). The DOE nuclear safety policy states that the general public be protected-such that no individual bears significant additional risk to health and safety from the operation of a DOE nuclear facility above the risks to which members of the general population are normally exposed. The radiological risk evaluation guidelines developed at PNL are unique in that they are (1) based upon quantitative risk goals and (2) provide a consistent level of risk management. These guidelines are used to evaluate the risk from radiological accidents that may occur during research and development activities at PNL. A safety analyst uses the frequency of the potential accident and the radiological dose to a given receptor to determine if the accident consequences meet the objectives of the Nuclear Safety Policy

  12. Predictors of Readmission after Inpatient Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Umang Jain

    2014-03-01

    Full Text Available Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020, previous percutaneous coronary intervention (PCI (OR, 2.69; CI, 1.21-5.97; P=0.015, hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001, bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046, American Society of Anesthesiologists (ASA class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004, and obesity (body mass index ≥30 (OR, 1.43; CI, 1.09-1.88, P=0.011 to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

  13. Dose and risk assessment of norm Contaminated waste released from trench disposal facility

    International Nuclear Information System (INIS)

    Abdel Geleel, M.; Ramadan, A.B.; Tawfik, A.A.

    2005-01-01

    Oil and gas extraction and processing operations accumulate naturally occurring radioactive material (NORM) at concentrations above normal in by-product waste streams. The petroleum industry adopted methods for managing of NORM that are more restrictive than past practices and are likely to provide greater isolation of the radioactivity. Trench was used as a disposal facility for NORM contaminated wastes at one site of the petroleum industry in Egypt. The aim of this work is to calculate the risk and dose assessment received from trench disposal facility directly and after closure (1000 year). RESRAD computer code was used. The results indicated that the total effective dose (TED) received after direct closure of trench disposal facility was 7.7E-4 mSv/y while after 1000 years, it will he 3.4E-4. The health cancer risk after direct closure was 3.3E-8 while after 1000 years post closure it was 6E-8. Results of this assessment will help examine policy issues concerning different options and regulation of NORM contaminated waste generated by petroleum industry

  14. Use of risk assessment methods for security design and analysis of nuclear and radioactive facilities

    International Nuclear Information System (INIS)

    Vasconcelos, Vanderley de; Andrade, Marcos C.; Jordao, Elizabete

    2011-01-01

    The objective of this work is to evaluate the applicability of risk assessment methods for analyzing the physical protection of nuclear and radioactive facilities. One of the important processes for physical protection in nuclear and radioactive facilities is the identifying of areas containing nuclear materials, structures, systems or components to be protected from sabotage, which could directly or indirectly lead to unacceptable radiological consequences. A survey of the international guidelines and recommendations about vital area identification, design basis threat (DBT), and the security of nuclear and radioactive facilities was carried out. The traditional methods used for quantitative risk assessment, like FMEA (Failure Mode and Effect Analysis), Event and Decision Trees, Fault and Success Trees, Vulnerability Assessment, Monte Carlo Simulation, Probabilistic Safety Assessment, Scenario Analysis, and Game Theory, among others, are highlighted. The applicability of such techniques to security issues, their pros and cons, the general resources needed to implement them, as data or support software, are analyzed. Finally, an approach to security design and analysis, beginning with a qualitative and preliminary examination to determine the range of possible scenarios, outcomes, and the systems to be included in the analyses, and proceeding to a progressively use of more quantitative techniques is presented. (author)

  15. The relationship of music preferences and the selected risk-taking and autodestructive behaviour among teenage girls subject to inpatient stay due to mental condition – pilot study

    Directory of Open Access Journals (Sweden)

    Katarzyna Krajewska

    2017-03-01

    Full Text Available During adolescence, related to the crisis of identity, attempts to separate from the family and rebellion against the reality result in the youth to be particularly susceptible to the impact of peers. Identification with the group is most often based on common interests, one of which being music. The aim of the pilot study was to assess the relationship of autodestructive and  antisocial behaviour and  music preferences of  girls subject to  inpatient stay due to  mental problems. Material and methods: Own questionnaire was used concerning music preferences, consisting of the following genres: metal, rock, pop, jazz, hip-hop, reggae, film music, sung poetry, electronic music. The studied group comprised of 26 girls diagnosed with mood disorders, neurotic, stress-related and somatoform disorders, eating disorders and behavioural and emotional disorders according to ICD-10. Exclusion criteria were the remaining diagnostic categories, especially active psychotic process and mental retardation as well as lack of understanding of the questionnaire questions or not being familiar with basic types of music. Among the patients aged 13–18 subject to inpatient stay at the Department of Adolescent Psychiatry in Łódź in the period 2013–2014 and consented to the study, the incidence of attempted suicide, inflicting self-harm, alcohol abuse, taking psychoactive substances and the presence of antisocial disorders were assessed. Questionnaire verification was carried out in a group of 30 people tested with a test–retest method with a two-week break; reliability was obtained: 0.89–1. Analysis was carried out with the use of Statistica 9.1 programme. Results: Among the teenage girls subject to inpatient stay, music preferences were not related in a statistically significant manner (p > 0.05 with a greater incidence of attempted suicide, inflicting self-harm, alcohol abuse and contact with psychoactive

  16. Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale.

    Science.gov (United States)

    McGirt, Matthew J; Parker, Scott L; Chotai, Silky; Pfortmiller, Deborah; Sorenson, Jeffrey M; Foley, Kevin; Asher, Anthony L

    2017-10-01

    OBJECTIVE Extended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. METHODS The Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0-12 points), discharge to inpatient facility (0-18 points), and 90-day readmission (0-6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic). RESULTS A total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System

  17. Seismic risk analysis for the Atomics International Nuclear Materials Development Facility, Santa Susana California

    International Nuclear Information System (INIS)

    1978-01-01

    This report presents the results of a detailed seismic risk analysis of the Nuclear Materials Development Facility (NMDF) operated by Atomics International at Santa Susana, California. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases including the USGS, California Institute of Technology and NEIS data bases. The resulting seismic record, covering the period 1969 to 1977, was used to identify all possible sources of seismicity that could affect the site. The best estimate curve indicates that the facility will experience 30% g with a return period of 55 years and 60% g with a return period of 750 years

  18. Seismic risk analysis for the Atomics International Nuclear Materials Development Facility, Santa Susana California

    Energy Technology Data Exchange (ETDEWEB)

    1978-12-29

    This report presents the results of a detailed seismic risk analysis of the Nuclear Materials Development Facility (NMDF) operated by Atomics International at Santa Susana, California. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases including the USGS, California Institute of Technology and NEIS data bases. The resulting seismic record, covering the period 1969 to 1977, was used to identify all possible sources of seismicity that could affect the site. The best estimate curve indicates that the facility will experience 30% g with a return period of 55 years and 60% g with a return period of 750 years.

  19. Inpatient Consultative Dermatology.

    Science.gov (United States)

    Biesbroeck, Lauren K; Shinohara, Michi M

    2015-11-01

    Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Risk-based investment trade-off related to building facility management

    Energy Technology Data Exchange (ETDEWEB)

    Taillandier, F. [Departement TIDS, Centre Scientifique et Technique du Batiment, 06904 Sophia Antipolis (France); Laboratoire Optimisation de la conception et Ingenierie de l' environnement, Polytech' Savoie, Universite de Savoie, 73376 Le Bourget du lac (France)], E-mail: franck.taillandier@univ-savoie.fr; Sauce, G. [Laboratoire Optimisation de la conception et Ingenierie de l' environnement, Polytech' Savoie, Universite de Savoie, 73376 Le Bourget du lac (France); Bonetto, R. [Departement TIDS, Centre Scientifique et Technique du Batiment, 06904 Sophia Antipolis (France)

    2009-04-15

    Due to his or her profession, any building facility manager has to face many decision-making situations. One of the most important to be mentioned is the arbitration of a multi-year maintenance plan for buildings. Deciding between proposed maintenance actions, according to several constraints, so as to aim at satisfying corporate strategy is a complex choice. Risk approaches can be particularly effective because of their ability to handle complexity and uncertainties. The problem is then to be able to propose a method considering risks, adapted to the specific context of building facility management. Our method, regarded as a traditional approach, includes needed resources (i.e. costs) according to constraints (i.e. budget), but it also considers several risk domains (safety, technical preservation, client satisfaction, etc.), through the consequences (gain and loss). It proposes an ergonomic arbitration system based on filters following two complementary approaches: a selection of the fundamental actions and then an optimization of the plan (in a global view). The aim, for decision-makers, is to build their own solution by testing multiple angles of vision in simulation logic. This article presents the principles of the method, illustrated by an example of a real case conducted for a leading French company.

  1. Risk-based investment trade-off related to building facility management

    International Nuclear Information System (INIS)

    Taillandier, F.; Sauce, G.; Bonetto, R.

    2009-01-01

    Due to his or her profession, any building facility manager has to face many decision-making situations. One of the most important to be mentioned is the arbitration of a multi-year maintenance plan for buildings. Deciding between proposed maintenance actions, according to several constraints, so as to aim at satisfying corporate strategy is a complex choice. Risk approaches can be particularly effective because of their ability to handle complexity and uncertainties. The problem is then to be able to propose a method considering risks, adapted to the specific context of building facility management. Our method, regarded as a traditional approach, includes needed resources (i.e. costs) according to constraints (i.e. budget), but it also considers several risk domains (safety, technical preservation, client satisfaction, etc.), through the consequences (gain and loss). It proposes an ergonomic arbitration system based on filters following two complementary approaches: a selection of the fundamental actions and then an optimization of the plan (in a global view). The aim, for decision-makers, is to build their own solution by testing multiple angles of vision in simulation logic. This article presents the principles of the method, illustrated by an example of a real case conducted for a leading French company

  2. Where schizophrenic patients commit suicide: a review of suicide among inpatients and former inpatients.

    Science.gov (United States)

    Pompili, Maurizio; Mancinelli, Iginia; Ruberto, Amedeo; Kotzalidis, Giorgio D; Girardi, Paolo; Tatarelli, Roberto

    2005-01-01

    To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies for future interventions. A computerized MedLine, Excerpta Medica and PsycLit search supplemented by an examination of cross-references and reviews. Up to half the suicides among patients with schizophrenia occur during inpatient admission. Inpatient suicides were found among those of a young age group who were predominantly single, childless and socially isolated. The vast majority experienced an illness characterized by long duration and prolonged psychiatric hospitalizations or multiple admissions and discharges. Up to 50% of the suicides occurred in the first few weeks and months following discharge from the hospital. The paranoid subtype of schizophrenia, where positive symptoms prevail and negative symptoms are few, is associated with a suicide risk that is three times greater than that associated with nonparanoid subtypes and eight times greater than the risk associated with the deficit subtype. Treatment of suicide is a major problem among inpatients with schizophrenia. Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital. Strategies aimed at preventing this phenomenon have been introduced to the medical personnel, but suicide in these patients does not seem to have been reduced. We emphasize the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia.

  3. Integral resource capacity planning for inpatient care services based on bed census predictions by hour

    NARCIS (Netherlands)

    Kortbeek, Nikky; Braaksma, Aleida; Smeenk, Ferry H.F.; Bakker, Piet J.M.; Boucherie, Richardus J.

    2015-01-01

    The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of

  4. Integral resource capacity planning for inpatient care services based on hourly bed census predictions

    NARCIS (Netherlands)

    Kortbeek, Nikky; Braaksma, Aleida; Smeenk, H.F.; Bakker, P.J.M; Boucherie, Richardus J.

    The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of

  5. The Impact of the Term Auction Facility on the Liquidity Risk Premium and Unsecured Interbank Spreads

    OpenAIRE

    Syrstad, Olav

    2014-01-01

    This paper investigates the effectiveness of the Federal Reserve's Term Auction Facility (TAF) in alleviating the liquidity shortage in USD and reducing the spread between the 3-month Libor rate and the expected policy rate. I construct a proxy for the 3-month liquidity risk premium based on data from the FX forward market which enables me to (i) decompose the Libor spread into a liquidity premium and a credit premium, and (ii) test the effectiveness of the TAF in reducing the liquidity premi...

  6. Risk management at the stage of design of high-rise construction facilities

    Science.gov (United States)

    Politi, Violetta

    2018-03-01

    This paper describes the assessment of the probabilistic risk of an accident formed in the process of designing a technically complex facility. It considers values of conditional probabilities of the compliance of load-bearing structures with safety requirements, provides an approximate list of significant errors of the designer and analyzes the relationship between the degree of compliance and the level of danger of errors. It describes and proposes for implementation the regulated procedures related to the assessment of the safety level of constructive solutions and the reliability of the construction process participants.

  7. Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study.

    Science.gov (United States)

    Mayer-Berger, Wolfgang; Simic, Dusan; Mahmoodzad, Jawad; Burtscher, Ralph; Kohlmeyer, Martin; Schwitalla, Birgitta; Redaèlli, Marcus

    2014-02-01

    The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (≤58 years) coronary artery disease (CAD) patients of low educational level compared to usual care. The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS. Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p > 0.05 intention-to-treat). The average IMT increased by 0.04 mm in the CG and was reduced by 0.03 mm in the IG (p = 0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although 'other cardiac events' (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p quality of life between the IG and CG, despite the relatively positive outcomes in the CG. In this low-education (predominantly male), middle-aged cohort, the positive impact on cardiovascular risk was

  8. Seismic risk analysis for General Electric Plutonium Facility, Pleasanton, California. Final report, part II

    International Nuclear Information System (INIS)

    1980-01-01

    This report is the second of a two part study addressing the seismic risk or hazard of the special nuclear materials (SNM) facility of the General Electric Vallecitos Nuclear Center at Pleasanton, California. The Part I companion to this report, dated July 31, 1978, presented the seismic hazard at the site that resulted from exposure to earthquakes on the Calaveras, Hayward, San Andreas and, additionally, from smaller unassociated earthquakes that could not be attributed to these specific faults. However, while this study was in progress, certain additional geologic information became available that could be interpreted in terms of the existance of a nearby fault. Although substantial geologic investigations were subsequently deployed, the existance of this postulated fault, called the Verona Fault, remained very controversial. The purpose of the Part II study was to assume the existance of such a capable fault and, under this assumption, to examine the loads that the fault could impose on the SNM facility. This report first reviews the geologic setting with a focus on specifying sufficient geologic parameters to characterize the postulated fault. The report next presents the methodology used to calculate the vibratory ground motion hazard. Because of the complexity of the fault geometry, a slightly different methodology is used here compared to the Part I report. This section ends with the results of the calculation applied to the SNM facility. Finally, the report presents the methodology and results of the rupture hazard calculation

  9. Financial risks of post-closure custodial care for the Barnwell radioactive waste disposal facility - 16155

    International Nuclear Information System (INIS)

    Baird, Robert D.; Newberry, William F.

    2009-01-01

    This paper reports evaluations of the adequacy of the Barnwell Extended Care Fund in light of identified risks, with the conclusion that the fund is sufficient to cover the costs and uncertainties associated with planned post-closure care of the Barnwell, South Carolina low-level radioactive waste disposal facility. It reviews background information pertinent to the facility's post-closure monitoring and maintenance and describes financial responsibility for post-closure activities. It identifies and briefly characterizes the activities planned to be conducted following facility closure and presents the midrange estimate of planned post-closure costs. The paper identifies and quantifies sources of uncertainty in activities and costs planned for post-closure care and presents 50-, 80-, and 95-percent confidence levels of planned costs. The fund is currently sufficient to cover some but not all of the costs that might be incurred as a result of unplanned events. The paper identifies, characterizes, and quantifies unplanned events, possible consequences, and probabilities of occurrence. The paper presents costs that might be incurred in responding to the unplanned initiating events and identifies levels of confidence that the fund is adequate to cover such costs. (authors)

  10. Proactive information provision for reducing social construct risk of nuclear facility

    International Nuclear Information System (INIS)

    Kitamura, Masaharu; Takahashi, Makoto; Hashizume, Hidetoshi; Shiraishi, Natsuki; Yagi, Ekou

    2006-01-01

    Outlines of, and the empirical observations from, an action research project aiming at improvement of relationship between nuclear community and the public have been reported in this paper. Ultimate goal of the project is effective reduction of social construct risk of nuclear power plants. As an initial approach to the goal, a proactive information provision scheme has been designed based on the knowledge acquired during our previous attempt of public communication named repetitive dialogue forum. The information contents consistent with the actual need of local citizens has been derived from the previous experiences and provided in the present project. Although the project is in its incipient stage, the observations are informative enough to develop the project further to attain the ultimate purpose of reducing the social construct component of technological risk of nuclear facilities. (author)

  11. Ten Years Experience In Geo-Databases For Linear Facilities Risk Assessment (Lfra)

    Science.gov (United States)

    Oboni, F.

    2003-04-01

    Keywords: geo-environmental, database, ISO14000, management, decision-making, risk, pipelines, roads, railroads, loss control, SAR, hazard identification ABSTRACT: During the past decades, characterized by the development of the Risk Management (RM) culture, a variety of different RM models have been proposed by governmental agencies in various parts of the world. The most structured models appear to have originated in the field of environmental RM. These models are briefly reviewed in the first section of the paper focusing the attention on the difference between Hazard Management and Risk Management and the need to use databases in order to allow retrieval of specific information and effective updating. The core of the paper reviews a number of different RM approaches, based on extensions of geo-databases, specifically developed for linear facilities (LF) in transportation corridors since the early 90s in Switzerland, Italy, Canada, the US and South America. The applications are compared in terms of methodology, capabilities and resources necessary to their implementation. The paper then focuses the attention on the level of detail that applications and related data have to attain. Common pitfalls related to decision making based on hazards rather than on risks are discussed. The paper focuses the last sections on the description of the next generation of linear facility RA application, including examples of results and discussion of future methodological research. It is shown that geo-databases should be linked to loss control and accident reports in order to maximize their benefits. The links between RA and ISO 14000 (environmental management code) are explicitly considered.

  12. Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?

    Science.gov (United States)

    Patel, Rikinkumar S; Patel, Priya; Shah, Kaushal; Kaur, Mandeep; Mansuri, Zeeshan; Makani, Ramkrishna

    2018-01-07

    Objective To determine the impact of cannabis use disorder (CUD) on the inpatient outcomes of attention deficit hyperactivity disorder (ADHD) in adolescents Background Previous studies have evaluated the impact of CUD on the health-related quality of life in ADHD patients. Methods We used the nationwide inpatient sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2010--2014. We identified ADHD and cannabis use (CU) as the primary and the other diagnosis, respectively, using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9--CM) codes. We used the binomial logistic regression model to generate adjusted odds ratios (aOR). Results We analyzed a total of 11,232 ADHD adolescent hospital admissions from years 2010-2014; of these, 1.79% had CUD. The mean age of adolescents was 14.1 years (SD = 1.79). The prevalence of CUD was highest in ADHD adolescents of 15-18 years (73%) and common in the white race (71%). A higher proportion of ADHD with CUD was transferred to acute care hospitals and skilled/other nursing facilities (5.4% and 7.4% vs. 1.1% and 2.6%, respectively, p-value $12,247 (median) by 0.6 times (aOR = 1.835; p-value = 0.002) and increases the risk of inpatient stay > 5 days (median) by 0.7 times (aOR = 2.099; p-value ADHD with CUD adolescents by 0.8 times (aOR = 0.448; p-value = 0.017), and the implication of behavioral therapy in the management of ADHD with CUD adolescents was reduced by 0.9 times (aOR = 0.412; p-value = 0.048). Also, there is a 2.8 times higher risk of comorbid alcohol abuse in ADHD with CUD adolescents (aOR = 17.141; p-value ADHD in adolescents. It has been determined that comorbid CUD in patients with ADHD not only increases the risk of acute inpatient care but also prolongs the inpatient stay, thus increasing the healthcare cost. Surprisingly, comorbid CUD decreases the utilization of psychotropic medications and behavioral therapy in ADHD. Another major

  13. Need to use probabilistic risk approach in performance assessment of waste disposal facilities

    International Nuclear Information System (INIS)

    Bonano, E.J.; Gallegos, D.P.

    1991-01-01

    Regulations governing the disposal of radioactive, hazardous, and/or mixed wastes will likely require, either directly or indirectly, that the performance of disposal facilities be assessed quantitatively. Such analyses, commonly called ''performance assessments,'' rely on the use of predictive models to arrive at a quantitative estimate of the potential impact of disposal on the environment and the safety and health of the public. It has been recognized that a suite of uncertainties affect the results of a performance assessment. These uncertainties are conventionally categorized as (1) uncertainty in the future state of the disposal system (facility and surrounding medium), (2) uncertainty in models (including conceptual models, mathematical models, and computer codes), and (3) uncertainty in data and parameters. Decisions regarding the suitability of a waste disposal facility must be made in light of these uncertainties. Hence, an approach is needed that would allow the explicit consideration of these uncertainties so that their impact on the estimated consequences of disposal can be evaluated. While most regulations for waste disposal do not prescribe the consideration of uncertainties, it is proposed that, even in such cases, a meaningful decision regarding the suitability of a waste disposal facility cannot be made without considering the impact of the attendant uncertainties. A probabilistic risk assessment (PRA) approach provides the formalism for considering the uncertainties and the technical basis that the decision makers can use in discharging their duties. A PRA methodology developed and demonstrated for the disposal of high-level radioactive waste provides a general framework for assessing the disposal of all types of wastes (radioactive, hazardous, and mixed). 15 refs., 1 fig., 1 tab

  14. Probalistisk short-term risk modeling for back-end fuel cycle and waste management facilities

    International Nuclear Information System (INIS)

    Kjellbert, N.A.

    1980-03-01

    This study of probabilistic short-term risk modeling of back-end fuel cycle and waste management facilities represents the continuation of work started in 1977. The purpose of the report is to present a more detailed survey of models and analysis techniques that mey be applicable. The definition of the risk concept and the nature of the facilities and events which are to be analyzed are described. The most important criteria are that the model or method shall be quantitative, logically/scientifically based, and be able to handle systems of some complexity. Several formalized analysis methods are described, most of them emanating from reliability theory. No single model will fulfill all criteria simultaneously, to the degree desired. Nevertheless, fault tree analysis seems to be an efficient tool in many applications, although it must probably be used together with other models in most cases. Other methodologies described can also be useful, such as failure modes and effects analysis, renewal theory and Markov chains, reliability block diagrams, event trees and cause/consequence diagrams, the GO methodology, Monte Carlo simulation, and, often necessary, various consequence modeling techniques. (author)

  15. Nominal radio ecological benchmarks for the ecological risk assessment of radioactive waste management facilities

    Energy Technology Data Exchange (ETDEWEB)

    Garisto, N.C. [SENES Consultants Ltd., Richmond Hill, Ontario (Canada)]. E-mail: ngaristo@senes.ca

    2006-07-01

    Ecological risk assessments are used to assess potential ecological impacts from contaminated sites, such as radioactive waste management and disposal facilities. These assessments determine the overall significance of the impact of such facilities on non-human biota. Specific indicator species are selected as representative non-human biota at the study sites for the purposes of these risk assessments. Potential environmental impacts are generally assessed in terms of 'screening indices'. In simple terms, a screening index is the ratio of an estimated exposure level of the indicator species (or environmental concentration) divided by a level or concentration deemed unlikely to have a significant ecological effect. These latter levels or concentrations are referred to as 'estimated no effect value' or ENEVs. Nominal ENEV values for chronic radiation effects based on our current interpretation of literature data are presented in this paper. They are: 5 mGy/d for fish and amphibians; 2.4 mGy/d for aquatic plants; 2 mGy/d for reptiles; 5 mGy/d for benthic and terrestrial invertebrates; 1 mGy/d for slow-growing terrestrial animals that reproduce late in life; 10 mGy/d for short-lived prolific terrestrial animals; 2.4 mGy/d for terrestrial plants; 5 mGy/d for birds. The paper identifies major areas of uncertainty regarding the selection of these nominal ENEVs for practical applications. (author)

  16. Nominal radio ecological benchmarks for the ecological risk assessment of radioactive waste management facilities

    International Nuclear Information System (INIS)

    Garisto, N.C.

    2006-01-01

    Ecological risk assessments are used to assess potential ecological impacts from contaminated sites, such as radioactive waste management and disposal facilities. These assessments determine the overall significance of the impact of such facilities on non-human biota. Specific indicator species are selected as representative non-human biota at the study sites for the purposes of these risk assessments. Potential environmental impacts are generally assessed in terms of 'screening indices'. In simple terms, a screening index is the ratio of an estimated exposure level of the indicator species (or environmental concentration) divided by a level or concentration deemed unlikely to have a significant ecological effect. These latter levels or concentrations are referred to as 'estimated no effect value' or ENEVs. Nominal ENEV values for chronic radiation effects based on our current interpretation of literature data are presented in this paper. They are: 5 mGy/d for fish and amphibians; 2.4 mGy/d for aquatic plants; 2 mGy/d for reptiles; 5 mGy/d for benthic and terrestrial invertebrates; 1 mGy/d for slow-growing terrestrial animals that reproduce late in life; 10 mGy/d for short-lived prolific terrestrial animals; 2.4 mGy/d for terrestrial plants; 5 mGy/d for birds. The paper identifies major areas of uncertainty regarding the selection of these nominal ENEVs for practical applications. (author)

  17. 76 FR 60136 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.8, 2012 Fiscal Year Update

    Science.gov (United States)

    2011-09-28

    ... amounts for the following types of charges: acute inpatient facility charges; skilled nursing facility/sub... this notice. These changes are effective October 1, 2011. When charges for medical care or services... in the Summary section of this notice, only the acute inpatient facility charges and skilled nursing...

  18. burden and cost of inpatient care for hiv-positive paediatric patients

    African Journals Online (AJOL)

    paediatric inpatient facilities in the teaching hospitals of the. Cape metropole and ... lifetime hospitalisation cost per infected child was calculated to be RI9 712. ... Prevention Protocol, Provincial Administration of the Western. Cape, 1999) and ...

  19. A reliability-risk modelling of nuclear rad-waste facilities

    International Nuclear Information System (INIS)

    Lehmann, P.H.; El-Bassioni, A.A.

    1975-01-01

    Rad-waste disposal systems of nuclear power sites are designed and operated to collect, delay, contain, and concentrate radioactive wastes from reactor plant processes such that on-site and off-site exposures to radiation are well below permissible limits. To assist the designer in achieving minimum release/exposure goals, a computerized reliability-risk model has been developed to simulate the rad-waste system. The objectives of the model are to furnish a practical tool for quantifying the effects of changes in system configuration, operation, and equipment, and for the identification of weak segments in the system design. Primarily, the model comprises a marriage of system analysis, reliability analysis, and release-risk assessment. Provisions have been included in the model to permit the optimization of the system design subject to constraints on cost and rad-releases. The system analysis phase involves the preparation of a physical and functional description of the rad-waste facility accompanied by the formation of a system tree diagram. The reliability analysis phase embodies the formulation of appropriate reliability models and the collection of model parameters. Release-risk assessment constitutes the analytical basis whereupon further system and reliability analyses may be warranted. Release-risk represents the potential for release of radioactivity and is defined as the product of an element's unreliability at time, t, and the radioactivity available for release in time interval, Δt. A computer code (RARISK) has been written to simulate the tree diagram of the rad-waste system. Reliability and release-risk results have been generated for cases which examined the process flow paths of typical rad-waste systems, the effects of repair and standby, the variations of equipment failure and repair rates, and changes in system configurations. The essential feature of this model is that a complex system like the rad-waste facility can be easily decomposed into its

  20. Tsunami risk assessment for facility group over a wide area using inundation assessment method considering energy conservation law

    International Nuclear Information System (INIS)

    Fukutani, Yo; Imamura, Fumihiko; Tokunaga, Takeshi; Sato, Ichiro

    2015-01-01

    We propose a quantitative evaluation method of overall tsunami risk that the entire facility group over a wide area holds. We considerably reduced the calculation cost for tsunami inundation depth by adopting the evaluation method using energy conservation law as compared with the evaluation method using non-linear long wave equation. For financial institutions such as banks and insurance companies with contractors over a wide area and business companies with multiple their assets and facilities in various places, the proposed evaluation method in this study could be a useful approach to implement their risk-based management decisions for tsunami risk. (author)

  1. 78 FR 59427 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.13, Fiscal Year 2014 Update

    Science.gov (United States)

    2013-09-26

    ... medical services, items, and supplies identified by Healthcare Common Procedure Coding System (HCPCS... were based on 2013 Medicare severity diagnosis related groups (MS-DRG). Acute inpatient facility...

  2. Seismic risk analysis for the Babcock and Wilcox facility, Leechburg, Pennsylvania

    International Nuclear Information System (INIS)

    1977-01-01

    The results of a detailed seismic risk analysis of the Babcock and Wilcox Plutonium Fuel Fabrication facility at Leechburg, Pennsylvania are presented. This report focuses on earthquakes; the other natural hazards, being addressed in separate reports, are severe weather (strong winds and tornados) and floods. The calculational method used is based on Cornell's work (1968); it has been previously applied to safety evaluations of major projects. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases. Because of the aseismicity of the region around the site, an analysis different from the conventional closest approach in a tectonic province was adapted. Earthquakes as far from the site as 1,000 km were included, as were the possibility of earthquakes at the site. In addition, various uncertainties in the input were explicitly considered in the analysis. The results of the risk analysis, which include a Bayesian estimate of the uncertainties, are presented, expressed as return period accelerations. The best estimate curve indicates that the Babcock and Wilcox facility will experience 0.05 g every 220 years and 0.10 g every 1400 years. The bounding curves roughly represent the one standard deviation confidence limits about the best estimate, reflecting the uncertainty in certain of the input. Detailed examination of the results show that the accelerations are very insensitive to the details of the source region geometries or the historical earthquake statistics in each region and that each of the source regions contributes almost equally to the cumulative risk at the site. If required for structural analysis, acceleration response spectra for the site can be constructed by scaling the mean response spectrum for alluvium in WASH 1255 by these peak accelerations

  3. 6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Determination that a chemical facility âpresents... SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.205 Determination that a chemical facility “presents a high level of security risk.” (a...

  4. Control de configuraciones peligrosas en instalaciones con riesgo asociado // Hazardous configurations control in risk related facilities

    Directory of Open Access Journals (Sweden)

    Antonio Torres - Valle

    2010-05-01

    Full Text Available ResumenEl control de configuraciones peligrosas en instalaciones con riesgo asociado es una aplicación delos Análisis Probabilistas de Seguridad (APS previos de las mismas. Una opción de mayor alcancees el uso de monitores de riesgo los que permiten la detección en tiempo real de talesconfiguraciones. Dada la complejidad de los APS y de los monitores de riesgo, esta tarea requiere depersonal experto. El documento presenta un método cualitativo de control de configuracionespeligrosas basado en matrices de dependencias. El algoritmo, informatizado en el códigoCONFIGURACION, puede ser aplicado sin necesidad de APS previos ni uso de monitores de riesgo.La sencillez del método justifica su extensión a instalaciones donde tales herramientas no se handesarrollado, permitiendo así la detección de las configuraciones peligrosas durante su explotación yelevando la seguridad de las plantas. Un sistema similar al descrito se utiliza como ayuda en laoperación de la central nuclear de Embalse. El artículo muestra el uso del método utilizando comobase un sistema de seguridad simplificado.Palabras claves: control de configuración, Análisis Probabilista de Seguridad (APS, matriz de___________________________________________________________________________AbstractThe hazardous configurations control in risk related facilities is an application of the previousProbabilistic Safety Analysis (PSA. A more complete option is the risk monitoring for the on-linedetection of these configurations. The expert personnel are required for this task take into account thecomplexity of the PSA and risk monitor. The paper presents a method of configuration control, basedon dependence matrixes. The algorithm is included in a computer code called CONFIGURACION, todetermine these situations in a qualitative way, without previous PSA results or using a Risk Monitor.The simplicity of the method warrants its application to facilities where these tools have not

  5. Nutrition-related risk indexes and long-term mortality in noncritically ill inpatients who receive total parenteral nutrition (prospective multicenter study).

    Science.gov (United States)

    Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, Ma Carmen; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P; Cabrerizo, Lucio; Rubio, Miguel A; Chicharro, Luisa; Burgos, Rosa; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, Estrella; Manjón, Laura; Diéguez, Marta; Carrera, Ma José; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; del Olmo, Dolores; Pereira, José Luis; Tous, María C; Olveira, Gabriel

    2015-10-01

    Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (Nutrition and Metabolism. All rights reserved.

  6. Impacts of the use of institutional controls on risk assessments at Department of Energy facilities

    International Nuclear Information System (INIS)

    White, R.K.; Swindle, D.W. Jr.; Redfearn, A.; King, A.D.; Shaw, R.A.

    1992-01-01

    The United States Environmental Protection Agency (EPA), in the National Oil and Hazardous Waste Pollution Contingency Plan (NCP), has determined that institutional controls cannot be applied when determining baseline human health risks from exposure to contaminants present at a hazardous waste site. Environmental restoration activities at DOE-OR/ER sites are primarily driven by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Therefore, the report focuses on the approaches and assumptions relating to institutional controls under CERCLA. In order to demonstrate the implications of the use of institutional controls at DOE facilities, this report summarizes the approaches and results of the recent baseline risk assessment for Solid Waste Storage Area 6 at Oak Ridge National Laboratory. The report concludes with possible options on the use of institutional controls at DOE-OR/ER sites. This report summarizes some of the major issues related to the use of institutional controls at hazardous waste sites under the auspices of DOE-OR/ER. In particular, the report addresses the impacts that assumptions regarding institutional controls have on the results and interpretation of the risk assessment, [in both the Remedial Investigation (RI) and the FS] and provides a case study from an actual DOE site

  7. Risk assessment and early warning systems for industrial facilities in seismic zones

    International Nuclear Information System (INIS)

    Salzano, Ernesto; Garcia Agreda, Anita; Di Carluccio, Antonio; Fabbrocino, Giovanni

    2009-01-01

    Industrial equipments and systems can suffer structural damage when hit by earthquakes, so that accidental scenarios as fire, explosion and dispersion of toxic substances can take place. As a result, overall damage to people, environment and properties increases. The present paper deals with seismic risk analysis of industrial facilities where atmospheric storage tanks (anchored or unanchored to ground), horizontal pressurised tanks, reactors and pumps are installed. Simplified procedures and methodologies based on historical database and literature data on natural-technological (Na-Tech) accidents for seismic risk assessment are discussed. Equipment-specific fragility curves have been thus derived depending on a single earthquake measure, peak ground acceleration (PGA). Fragility parameters have been then transformed to linear probit coefficients in order to obtain reliable threshold values for earthquake intensity measure, both for structural damage and loss of containment. These threshold values are of great interest when development of active and passive mitigation actions and systems, safety management, and the implementation of early warning system are concerned. The approach is general and can be implemented in any available code or procedure for risk assessment. Some results of seismic analysis of atmospheric storage tanks are also presented for validation.

  8. Financial Risk Factor Analysis for Facility Gas Leakages of H2 and NG

    Directory of Open Access Journals (Sweden)

    In-Bok Lee

    2016-09-01

    Full Text Available Fuel cells may be the key to a more environmentally-friendly future because they emit low carbon dioxide per unit of energy supplied. However, little work has investigated the potential financial risks pertaining to fuel cell systems. Often used in the analysis of the safety of systems involving flammable or hazardous materials, risk factor analysis has recently been used to analyze the potential financial losses that may occur from industrial hazards. Therefore, this work undertakes a financial risk factor analysis to determine the costs of leakages of hydrogen and natural gas, which are used in fuel cell systems. Total leakage was calculated from an analysis of several leakage rates and modes. The impact of applying appropriate detection and prevention systems was also investigated. The findings were then used to analyze the consequences for various sections of the system and to calculate the overall cost based on facility outage or damage, and the cost of taking safety precautions. This provides a basis for comparison among proposed potential reactionary measures.

  9. Safety, reliability, risk management and human factors: an integrated engineering approach applied to nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Vasconcelos, Vanderley de; Silva, Eliane Magalhaes Pereira da; Costa, Antonio Carlos Lopes da; Reis, Sergio Carneiro dos [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)], e-mail: vasconv@cdtn.br, e-mail: silvaem@cdtn.br, e-mail: aclc@cdtn.br, e-mail: reissc@cdtn.br

    2009-07-01

    Nuclear energy has an important engineering legacy to share with the conventional industry. Much of the development of the tools related to safety, reliability, risk management, and human factors are associated with nuclear plant processes, mainly because the public concern about nuclear power generation. Despite the close association between these subjects, there are some important different approaches. The reliability engineering approach uses several techniques to minimize the component failures that cause the failure of the complex systems. These techniques include, for instance, redundancy, diversity, standby sparing, safety factors, and reliability centered maintenance. On the other hand system safety is primarily concerned with hazard management, that is, the identification, evaluation and control of hazards. Rather than just look at failure rates or engineering strengths, system safety would examine the interactions among system components. The events that cause accidents may be complex combinations of component failures, faulty maintenance, design errors, human actions, or actuation of instrumentation and control. Then, system safety deals with a broader spectrum of risk management, including: ergonomics, legal requirements, quality control, public acceptance, political considerations, and many other non-technical influences. Taking care of these subjects individually can compromise the completeness of the analysis and the measures associated with both risk reduction, and safety and reliability increasing. Analyzing together the engineering systems and controls of a nuclear facility, their management systems and operational procedures, and the human factors engineering, many benefits can be realized. This paper proposes an integration of these issues based on the application of systems theory. (author)

  10. Safety, reliability, risk management and human factors: an integrated engineering approach applied to nuclear facilities

    International Nuclear Information System (INIS)

    Vasconcelos, Vanderley de; Silva, Eliane Magalhaes Pereira da; Costa, Antonio Carlos Lopes da; Reis, Sergio Carneiro dos

    2009-01-01

    Nuclear energy has an important engineering legacy to share with the conventional industry. Much of the development of the tools related to safety, reliability, risk management, and human factors are associated with nuclear plant processes, mainly because the public concern about nuclear power generation. Despite the close association between these subjects, there are some important different approaches. The reliability engineering approach uses several techniques to minimize the component failures that cause the failure of the complex systems. These techniques include, for instance, redundancy, diversity, standby sparing, safety factors, and reliability centered maintenance. On the other hand system safety is primarily concerned with hazard management, that is, the identification, evaluation and control of hazards. Rather than just look at failure rates or engineering strengths, system safety would examine the interactions among system components. The events that cause accidents may be complex combinations of component failures, faulty maintenance, design errors, human actions, or actuation of instrumentation and control. Then, system safety deals with a broader spectrum of risk management, including: ergonomics, legal requirements, quality control, public acceptance, political considerations, and many other non-technical influences. Taking care of these subjects individually can compromise the completeness of the analysis and the measures associated with both risk reduction, and safety and reliability increasing. Analyzing together the engineering systems and controls of a nuclear facility, their management systems and operational procedures, and the human factors engineering, many benefits can be realized. This paper proposes an integration of these issues based on the application of systems theory. (author)

  11. Risk assessment methodology for extreme wind and missile effects on critical facilities

    International Nuclear Information System (INIS)

    Twisdale, L.A.; Dunn, W.L.

    1985-01-01

    The TORMIS methodology has been applied to a number of probabilistic risk assessments of critical facilities in the continental United States. These analyses have centered on the estimation of tornado missile impact and damage risks to individual targets as well as to groups of targets at specific plants. A number of advancements and generalizations in the approach have recently been made. These include: (1) generalization of windfield options to include straight winds (WINMIS) and hurricanes (HURMIS); (2) generalization of the scoring to enable analysis of Boolean system expressions for damage probabilities on compound series and parallel safety trains; (3) generalization of the failure criteria to include wind pressure as well as missile impact; (4) generalization of the plant modeling capability to enable more detailed treatment of targets partially or fully enclosed by vulnerable cladding and to allow tracking of missiles inside such enclosures; and (5) incorporation of windspeed criteria for structural failure and subsequent production of potential missiles. This paper will present some of the basic theory and key results of recent TORMIS, WINMIS, and HURMIS applications. The influence of uncertainties in the estimation process and the data needed for plant-specific risk assessments will also be discussed

  12. Probabilistic risk assessment for back-end facilities: Improving the treatment of fire and explosion scenarios

    International Nuclear Information System (INIS)

    Sunman, C.R.J.; Campbell, R.J.; Wakem, M.J.

    1996-01-01

    The nuclear reprocessing facilities at Sellafield are a key component of the International business of BNFL. The operations carried out at the site extend from the receipt and storage of irradiated fuel, chemical reprocessing, plutonium and uranium finishing, through mixed oxide fuel production. Additionally there are a wide range of supporting processes including solid waste encapsulation, vitrification, liquid waste evaporation and treatment. Decommissioning of the site's older facilities is also proceeding. The comprehensive range of these activities requires that the safety assessment team keeps up to date with developments in the field, as well as conducting and sponsoring appropriate research into methodologies and modelling in order to deliver a cost effective, timely service. This paper will review the role of Probabilistic Risk Assessment (PRA) in safety cases for operations at Sellafield and go on to describe some areas of PRA methodology development in the UK and in which BNFL is a contributor. Finally the paper will summarise some specific areas of methodology development associated with improving the modelling of fire and explosion hazards which are specific to BNFL. (author)

  13. Polycyclic aromatic hydrocarbon levels and risk assessment for food from service facilities in Korea.

    Science.gov (United States)

    Park, Shin-Woong; Jeong, Jun-Hyun; Her, Jae-Young; Kim, Mina K; Lee, Kwang-Geun

    2017-06-01

    In this study, levels of benzo[a]anthracene, chrysene, benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[a]pyrene (BaP), dibenzo[a,h]anthracene, benzo[g,h,i]perylene and indeno[1,2,3-c,d]pyrene in 412 food items collected from food service facilities in Korea were analysed. The concentrations of the eight polycyclic aromatic hydrocarbons (PAHs) ranged 0.13-0.48 μg/kg. The concentrations of benzo[a]pyrene in all food samples were foods regulated by European Union legislation. PAH contents were employed to conduct exposure and risk assessment. The chronic daily intake of PAHs from 412 food samples was 5.48 × 10 -6 -4.70 ×x 10 -4  µg-TEQ BaP /kg/day with margins of exposure of 1.04 × 10 9 -1.16 × 10 11 .

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

    International Nuclear Information System (INIS)

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

    1998-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Dionne, B.J.; Morris, S. III; Baum, J.W. [and others

    1998-03-01

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

  17. Surgical inpatient satisfaction: what are the real drivers?

    Science.gov (United States)

    Danforth, Rachel M; Pitt, Henry A; Flanagan, Mindy E; Brewster, Benjamin D; Brand, Elizabeth W; Frankel, Richard M

    2014-08-01

    Inpatient satisfaction is a key element of hospital pay-for-performance programs. Communication and pain management are known to influence results, but additional factors may affect satisfaction scores. We tested the hypothesis that patient factors and outcome parameters not considered previously are clinically important drivers of inpatient satisfaction. Medical records were reviewed for 1,340 surgical patients who returned nationally standardized inpatient satisfaction questionnaires. These patients were managed by 41 surgeons in seven specialties at two academic medical centers. Thirty-two parameters based on the patient, surgeon, outcomes, and survey were measured. Univariate and multivariable analyses were performed. Inpatients rated their overall experience favorably 75.7% of the time. Less-satisfied patients were more likely to be female, younger, less ill, taking outpatient narcotics, and admitted via the emergency department (all P expectations of patients with cancer, and postoperative complications are important and clinically relevant drivers of surgical inpatient satisfaction. Programs to manage expectations of cancer patient expectations and decrease postoperative morbidity should improve surgical inpatient satisfaction. Further efforts to risk-adjust patient satisfaction scores should be undertaken. Copyright © 2014 Mosby, Inc. All rights reserved.

  18. Awareness regarding risk factors, symptoms and treatment facilities for cancer in selected states of India.

    Science.gov (United States)

    Raj, Sherin; Piang, Lam Khan; Nair, K S; Tiwari, V K; Kaur, H; Singh, Bacchu

    2012-01-01

    To study the level of awareness and knowledge about cancers and associated risk factors among households in selected states of India. In the study 3070 households were interviewed from six states viz, West Bengal, Kerala, Madhya Pradesh, Rajasthan and Mizoram. Knowledge of cancers other than those related to tobacco was very low (prostate 8%, colon 11% ) among the communities, with a poor awareness of warning signs and symptoms. The knowledge varied from state to state. It is found that the major source of information related to cancers was television (38%) followed by friends and relatives (36%). Only about 15 % of respondents had knowledge about cancer awareness camps organized in their districts but they did not have knowledge about the organizers of the camp. Findings suggested a strong need for strengthening of DCCP. It is important to create awareness among community through educational programs on cancer prevention, preventable cancer risk factors, benefits of early diagnosis, and availability of screening facilities. Integration of District Cancer Control activities with NRHM could be the most cost-effective strategy to prevent cancers and rural population.

  19. Geomatic techniques for assessing ecological and health risk at U.S. Department of Energy facilities

    International Nuclear Information System (INIS)

    Regens, J.L.; White, L.; Albers, B.J.; Purdy, C.

    1994-01-01

    Hazardous substances, including radionuclides, heavy metals, and chlorinated hydrocarbons, pose unique challenges in terms of environmental restoration and waste management, especially in aquatic environments. When stored, used or disposed of improperly, hazardous materials including transuranic wastes, high level wastes, low level wastes, greater than class C wastes, mixed wastes or chemical wastes can contaminate an array of environmental receptors ranging from soils, sediments, groundwater to surface water. Depending on the specific hazardous substance and site attributes, assessing ecological and health risk as a basis for environmental restoration and waste management can be a complex, problematic activity. This is basis for environmental restoration and waste management can be a complex, problematic activity. This is particularly true for the major Defense Programs facilities managed by the U.S. Department of Energy (DOE). The Environmental Restoration (ER) program of DOE was initiated in 1987 to consolidate and coordinate those regulatory activities designed to identify and remediate sites at installations contaminated with radioactive, chemical or mixed wastes. To supply the tools necessary for defining, describing, and characterizing the nature of contaminants within the DOE complex and identifying alternative post-remediation land use options, DOE has implemented a program for the research and development of spatial data technologies to aid in assessing ecological and health risk

  20. A Novel Mental Health Crisis Service - Outcomes of Inpatient Data.

    Science.gov (United States)

    Morrow, R; McGlennon, D; McDonnell, C

    2016-01-01

    Northern Ireland has high mental health needs and a rising suicide rate. Our area has suffered a 32% reduction of inpatient beds consistent with the national drive towards community based treatment. Taking these factors into account, a new Mental Health Crisis Service was developed incorporating a high fidelity Crisis Response Home Treatment Team (CRHTT), Acute Day Care facility and two inpatient wards. The aim was to provide alternatives to inpatient admission. The new service would facilitate transition between inpatient and community care while decreasing bed occupancy and increasing treatment in the community. All services and processes were reviewed to assess deficiencies in current care. There was extensive consultation with internal and external stakeholders and process mapping using the COBRAs framework as a basis for the service improvement model. The project team set the service criteria and reviewed progress. In the original service model, the average inpatient occupancy rate was 106.6%, admission rate was 48 patients per month and total length of stay was 23.4 days. After introducing the inpatient consultant hospital model, the average occupancy rate decreased to 90%, admissions to 43 per month and total length of stay to 22 days. The results further decreased to 83% occupancy, 32 admissions per month and total length of stay 12 days after CRHTT initiation. The Crisis Service is still being evaluated but currently the model has provided safe alternatives to inpatient care. Involvement with patients, carers and all multidisciplinary teams is maximised to improve the quality and safety of care. Innovative ideas including structured weekly timetable and regular interface meetings have improved communication and allowed additional time for patient care.

  1. Risks, costs and benefits analysis for exhumation of buried radioactive materials at a nuclear fuel fabrication facility

    International Nuclear Information System (INIS)

    Kirk, J.S.; Moore, R.A.; Huston, T.E.

    1996-01-01

    A Risks, Costs and Benefits analysis provides a tool for selecting a cost-effective remedial action alternative. This analysis can help avoid transferring risks to other populations and can objectively measure the benefits of a specific remedial action project. This paper describes the methods and results of a Risks, Costs and Benefits analysis performed at a nuclear fuel fabrication facility. The analysis examined exhuming and transporting radioactive waste to an offsite disposal facility. Risks evaluated for the remedial action project were divided into two categories: risks posed to the worker and risks posed to public health. Risks to workers included exposure to radioactive contaminants during excavation and packaging of waste materials and the use of heavy machinery. Potential public health risks included exposure to radioactive materials during transport from the exhumation site to the disposal facility. Methods included use of site-specific and published data, and existing computer models. Occupational risks were quantified using data from similar onsite remedial action projects. Computer modeling was used to evaluate public health risks from transporting radioactive materials; the consequences or probability of traffic accidents; and radiation exposure to potential inhabitants occupying the site considering various land use scenarios. A costs analysis was based on data obtained from similar onsite remedial action projects. Scenarios used to identify benefits resulting from the remedial action project included (1) an evaluation of reduction in risks to human health; (2) cost reductions associated with the unrestricted release of the property; and (3) benefits identified by evaluating regulatory mandates applicable to decommissioning. This paper will provide an overview of the methods used and a discussion of the results of a Risks, Costs and Benefits analysis for a site-specific remedial action scenario

  2. Incorporating uncertainties into risk assessment with an application to the exploratory studies facilities at Yucca Mountain

    International Nuclear Information System (INIS)

    Fathauer, P.M.

    1995-08-01

    A methodology that incorporates variability and reducible sources of uncertainty into the probabilistic and consequence components of risk was developed. The method was applied to the north tunnel of the Exploratory Studies Facility at Yucca Mountain in Nevada. In this assessment, variability and reducible sources of uncertainty were characterized and propagated through the risk assessment models using a Monte Carlo based software package. The results were then manipulated into risk curves at the 5% and 95% confidence levels for both the variability and overall uncertainty analyses, thus distinguishing between variability and reducible sources of uncertainty. In the Yucca Mountain application, the designation of the north tunnel as an item important to public safety, as defined by 10 CFR 60, was determined. Specifically, the annual frequency of a rock fall breaching a waste package causing an off-site dose of 500 mrem (5x10 -3 Sv) was calculated. The annual frequency, taking variability into account, ranged from 1.9x10 -9 per year at the 5% confidence level to 2.5x10 -9 per year at the 95% confidence level. The frequency range after including all uncertainty was 9.5x10 -10 to 1.8x10 -8 per year. The maximum observable frequency, at the 100% confidence level, was 4.9x10 -8 per year. This is below the 10 -6 per year frequency criteria of 10 CFR 60. Therefore, based on this work, the north tunnel does not fall under the items important to public safety designation for the event studied

  3. Predictors of dropout from inpatient dialectical behavior therapy among women with borderline personality disorder.

    Science.gov (United States)

    Rüsch, Nicolas; Schiel, Sarah; Corrigan, Patrick W; Leihener, Florian; Jacob, Gitta A; Olschewski, Manfred; Lieb, Klaus; Bohus, Martin

    2008-12-01

    Inpatient dialectical behavior therapy (DBT) is an effective treatment for borderline personality disorder (BPD), but often treatment is ended prematurely and predictors of dropout are poorly understood. We, therefore, studied predictors of dropout among 60 women with BPD during inpatient DBT. Non-completers had higher experiential avoidance and trait anxiety at baseline, but fewer life-time suicide attempts than completers. There was a trend for more anger-hostility and perceived stigma among non-completers. Experiential avoidance and anxiety may be associated with dropout in inpatient DBT. Low life-time suicidality and high anger could reflect a subtype at risk for discontinuation of inpatient treatment.

  4. Nuclear-fuel-cycle risk assessment: descriptions of representative non-reactor facilities. Sections 1-14

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, K.J.

    1982-09-01

    The Fuel Cycle Risk Assessment Program was initiated to provide risk assessment methods for assistance in the regulatory process for nuclear fuel cycle facilities other than reactors. This report, the first from the program, defines and describes fuel cycle elements that are being considered in the program. One type of facility (and in some cases two) is described that is representative of each element of the fuel cycle. The descriptions are based on real industrial-scale facilities that are current state-of-the-art, or on conceptual facilities where none now exist. Each representative fuel cycle facility is assumed to be located on the appropriate one of four hypothetical but representative sites described. The fuel cycles considered are for Light Water Reactors with once-through flow of spent fuel, and with plutonium and uranium recycle. Representative facilities for the following fuel cycle elements are described for uranium (or uranium plus plutonium where appropriate): mining, milling, conversion, enrichment, fuel fabrication, mixed-oxide fuel refabrication, fuel reprocessing, spent fuel storage, high-level waste storage, transuranic waste storage, spent fuel and high-level and transuranic waste disposal, low-level and intermediate-level waste disposal, and transportation. For each representative facility the description includes: mainline process, effluent processing and waste management, facility and hardware description, safety-related information and potential alternative concepts for that fuel cycle element. The emphasis of the descriptive material is on safety-related information. This includes: operating and maintenance requirements, input/output of major materials, identification and inventories of hazardous materials (particularly radioactive materials), unit operations involved, potential accident driving forces, containment and shielding, and degree of hands-on operation.

  5. Nuclear-fuel-cycle risk assessment: descriptions of representative non-reactor facilities. Sections 1-14

    International Nuclear Information System (INIS)

    Schneider, K.J.

    1982-09-01

    The Fuel Cycle Risk Assessment Program was initiated to provide risk assessment methods for assistance in the regulatory process for nuclear fuel cycle facilities other than reactors. This report, the first from the program, defines and describes fuel cycle elements that are being considered in the program. One type of facility (and in some cases two) is described that is representative of each element of the fuel cycle. The descriptions are based on real industrial-scale facilities that are current state-of-the-art, or on conceptual facilities where none now exist. Each representative fuel cycle facility is assumed to be located on the appropriate one of four hypothetical but representative sites described. The fuel cycles considered are for Light Water Reactors with once-through flow of spent fuel, and with plutonium and uranium recycle. Representative facilities for the following fuel cycle elements are described for uranium (or uranium plus plutonium where appropriate): mining, milling, conversion, enrichment, fuel fabrication, mixed-oxide fuel refabrication, fuel reprocessing, spent fuel storage, high-level waste storage, transuranic waste storage, spent fuel and high-level and transuranic waste disposal, low-level and intermediate-level waste disposal, and transportation. For each representative facility the description includes: mainline process, effluent processing and waste management, facility and hardware description, safety-related information and potential alternative concepts for that fuel cycle element. The emphasis of the descriptive material is on safety-related information. This includes: operating and maintenance requirements, input/output of major materials, identification and inventories of hazardous materials (particularly radioactive materials), unit operations involved, potential accident driving forces, containment and shielding, and degree of hands-on operation

  6. Evaluating Potential Human Health Risks Associated with the Development of Utility-Scale Solar Energy Facilities on Contaminated Sites

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, J. -J. [Argonne National Lab. (ANL), Argonne, IL (United States); Chang, Y. -S. [Argonne National Lab. (ANL), Argonne, IL (United States); Hartmann, H. [Argonne National Lab. (ANL), Argonne, IL (United States); Wescott, K. [Argonne National Lab. (ANL), Argonne, IL (United States); Kygeris, C. [Indiana Univ. of Pennsylvania, PA (United States)

    2013-09-01

    This report presents a general methodology for obtaining preliminary estimates of the potential human health risks associated with developing a utility-scale solar energy facility on a contaminated site, based on potential exposures to contaminants in soils (including transport of those contaminants into the air).

  7. Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

    Science.gov (United States)

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

    2009-05-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging.

  8. Risk analysis and risk acceptance criteria in the planning processes of hazardous facilities-A case of an LNG plant in an urban area

    International Nuclear Information System (INIS)

    Vinnem, Jan Erik

    2010-01-01

    Planning of hazardous facilities is usually carried out on the basis of a risk-informed decision-making and planning process making use of risk analysis. This practice is well established in Norway under petroleum legislation but less so for onshore facilities under non-petroleum legislation. The present paper focuses on the use of risk analysis studies for risk evaluation against risk acceptance criteria, risk communication and derivation of technical and operational requirements in these circumstances. This is demonstrated through reference to a case study involving an LNG plant currently under construction in an urban area in Norway. The main finding is that risk-informed legislation is a fragile legislative system which is dependent on conscientious and open-minded use by the industrial developer. In the opposite case, the authorities may well be unable to correct the situation and the legislation may fail to protect the neighbourhood from unreasonable exposure to risk. Reference is also made to the international perspective where authorities define what is deemed tolerable risk, which would appear to be a more robust and defensible approach.

  9. Risk factors related to methicillin-resistant Staphylococcus aureus infection among inpatients at Prof. dr. R. D. Kandou general hospital Manado

    Science.gov (United States)

    Utomo, H. T.; Nugroho, A.; Harijanto, P. N.

    2018-03-01

    Methicillin-resistant Staphylococcus aureus (MRSA) presents nosocomial infection problemsin hospitals. Identification of risk factors related to MRSA infection is a concern among healthcare provider. A retrospective case-control study was conducted to identify MRSA infection proportion among isolates, also to identify risk factors amonginpatients at Prof. dr.R. D. Kandou General Hospital, Manado. Data were from themedical record, from patient’s culture isolateswith positive Staphylococcus aureus infection from January-December 2015. Case subject isolated cultures of MRSA and control subject isolated cultures of non-MRSA. Bivariate analysis were performed in 10 independent variables (age, length of stay, prior use of antibiotics before cultures, history of HIV infection, prior use of corticosteroid, history of malignancy, history of chronic disease, prior use of medical tools (catheter, ventilator, etc), history of invasive medical procedure, history of hospitalization before). All variables with a p-value<0.05 were into multivariate analysis with forwarding stepwise logistic regression. Mean subjects age were 48.13 ± 2.05 years old and length of stay were 8.65 ± 0.25 days, and only prior antibiotic use-variable were considered statistically significant (p = 0.017; OR 1.889; 95%CI 1.595 – 2.238).

  10. Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions.

    Science.gov (United States)

    Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C

    1993-11-01

    The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

  11. [Psychiatric Inpatient Treatment and Return to Work].

    Science.gov (United States)

    Mernyi, Lena; Hölzle, Patricia; Hamann, Johannes

    2017-05-12

    Objective People with mental diseases have a high risk of unemployment and they have only limited access to the labor market. The return to work is often associated with fears.The present study aims to provide an overview of the number of hospitalized psychiatric patients with permanent employment. Moreover it should give an insight into the process of return to work, the experiences patients gain and the support they receive. Methods In the participating clinics we measured the number of patients with permanent employment. The main inclusion criteria for further survey were the status of permanent employment and age between 18 and 65. The participating patients were interviewed on two occasions, at the time of inclusion and 3 months after the patient was discharged. The questions addressed working conditions, job satisfaction and the process of return-to-work. For statistical analysis, descriptive statistics (frequencies, means, standard deviations) were used. Results Only 21 % of n = 815 inpatients of the participating hospitals were permanently employed. Many patients did not return to work after being discharged. In many cases the interviewed patients saw a connection between their job and their current episode of illness. In this context patients reported unsatisfying workplace conditions such as long working hours, bad work organization and social conflicts. Conclusions For mentally ill patients, the employment rate in the primary labor market is devastating low. After psychiatric inpatient treatment patients are at high risk to lose their jobs. In order to prevent this development, work-related stress factors should be discussed with inpatients at an early stage and support should be provided during the return-to-work-process. © Georg Thieme Verlag KG Stuttgart · New York.

  12. [Termination of inpatient treatment for anorexia nervosa].

    Science.gov (United States)

    Zeeck, A; Herzog, T

    2000-07-01

    Dropout is a neglected area of research; patients with anorexia nervosa are a group with high risk for dropout. 1. What are the frequency and type of dropout in disorder-specific, integrated treatment programs for anorexic patients? 2. What are the predictors for dropout? Analysis of 80 prospectively documented, consecutive treatment episodes of anorexic inpatients, based on multimodal clinical and psychometric parameters. Twenty percent of patients terminated on their own initiative, often after reaching target weight; 10% were discharged by the treatment team. At least 43% of dropouts continued with some sort of psychotherapy within the 3 months after discharge. Previous dropout was a predictor for dropout in the present episodes. Patients with no comorbidity had a higher risk of dropout. Patients discharged by the team had personality disorders more often. Patients with comorbid depression stayed in treatment. The form of termination of treatment should be routinely assessed. Previous dropout and comorbidity are indicators of the risk of dropout.

  13. Toxic chemical hazard classification and risk acceptance guidelines for use in DOE facilities. Revision 2

    International Nuclear Information System (INIS)

    Craig, D.K.; Davis, J.S.; Prowse, J.; Hoffman, P.W.

    1995-01-01

    The concentration-limit guidelines presented in this document apply to airborne releases of chemicals evaluated with respect to human health effects for the purposes of hazard classification and categorization, risk assessment and safety analysis. They apply to all DOE facilities and operations involving the use of potentially hazardous chemicals. The guidelines do not address other nonradiological hazards such as fire, pressure releases (including explosions), and chemical reactivity, but the guidelines are applicable to hazardous chemical releases resulting from these events. This report presents the subcommittee's evaluation and recommendations regarding analyses of accidentally released toxic chemicals. The premise upon which these recommendations are based is that the mechanism of action of toxic chemicals is fundamentally different from that associated with radionuclides, with the exception of carcinogens. The recommendations reported herein are restricted to the airborne pathway because in an accident scenario this typically represents the most immediately significant route of public exposure. However, the subcommittee recognizes that exposure to chemicals through other pathways, in particular waterborne, can have significant impacts on human health and the environment. Although there are a number of chemicals for which absorption through the skin can contribute measurably to the total dose in chronic (e.g., occupational) exposure situations, this pathway has not been considered for the acute exposure scenarios considered in this report. Later studies. will address these issues if it appears desirable

  14. Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2010-02-01

    We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home). Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility. A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores. Copyright 2010 Mosby, Inc. All rights reserved.

  15. Public Health Risks from Mismanagement of Healthcare Wastes in Shinyanga Municipality Health Facilities, Tanzania

    Directory of Open Access Journals (Sweden)

    Kizito Kuchibanda

    2015-01-01

    Full Text Available The increase of healthcare facilities in Shinyanga municipality has resulted in an increase of healthcare wastes, which poses serious threats to the environment, health workers, and the general public. This research was conducted to investigate management practices of healthcare wastes in Shinyanga municipality with a view of assessing health risks to health workers and the general public. The study, which was carried out in three hospitals, involved the use of questionnaires, in-depth interview, and observation checklist. The results revealed that healthcare wastes are not quantified or segregated in all the three hospitals. Healthcare wastes at the Shinyanga Regional Referral Hospital are disposed of by on-site incineration and burning and some wastes are disposed off-site. At Kolandoto DDH only on-site burning and land disposal are practiced, while at Kambarage UHC healthcare solid wastes are incinerated, disposed of on land disposal, and burned. Waste management workers do not have formal training in waste management techniques and the hospital administrations pay very little attention to appropriate management of healthcare wastes. In light of this, it is evident that management of healthcare solid wastes is not practiced in accordance with the national and WHO’s recommended standards.

  16. Factors of risk for relapse of pulmonary tuberculosis in-patient of the Hospital Santa Clara from Bogota 1992/2000

    International Nuclear Information System (INIS)

    Hidalgo Martinez, Patricia; Awad Garcia, Carlos; Pavia Albor, Jacqueline

    2002-01-01

    Pulmonary tuberculosis relapse is defined as these patients that make recurrence of tuberculosis after complete an adequate treatment, and these patients are again diagnosed bacteriologically with tuberculosis. We tried to identify the risk factors for relapse among adults, through an analytical study of cases and controls, with eighty patients among the tuberculosis programmed of Santa Clara Hospital between 1992-2000 with relapse diagnosis which meet criterion of case and eighty patients which meet criterion of control. We did a bivariate analysis with confidence intervals and univariate calculation with logistic regression analysis to predict the development of relapse for the different variables. Diabetes mellitus, chronic renal failure, silicosis are associated with relapse, but in our study we found another factors which are joined to relapse and we suggest that if we find these factors among tuberculosis patients would indicate the chance of relapse and this would create the necessity of use a larger number of doses of antituberculosis medicaments

  17. Assessment of risk of potential exposures on facilities industries; Estimativa do risco de exposicao potencial em instalacoes industriais

    Energy Technology Data Exchange (ETDEWEB)

    Leocadio, Joao Carlos

    2007-03-15

    This work develops a model to evaluate potential exposures on open facilities of industrial radiography in Brazil. This model will decisively contribute to optimize operational, radiological protection and safety procedures, to prevent radiation accidents and to reduce human errors in industrial radiography. The probabilistic safety assessment (PSA) methodology was very useful to assess potential exposures. The open facilities of industrial radiography were identified as the scenario to be analyzed in what concerns the evaluation of potential exposures, due to their high accidents indices. The results of the assessment of potential exposures confirm that the industrial radiography in Brazil is a high-risk practice as classified by the IAEA. The risk of potential exposure was estimated to be 40,5 x 10{sup -2} per year in Brazil, having as main consequences injuries to the workers' hands and arms. In the world scene, the consequences are worst, leading to fatalities of people, thus emphasizing the high risk of industrial radiography. (author)

  18. Analyses in Support of Risk-Informed Natural Gas Vehicle Maintenance Facility Codes and Standards: Phase II.

    Energy Technology Data Exchange (ETDEWEB)

    Blaylock, Myra L.; LaFleur, Chris Bensdotter; Muna, Alice Baca; Ehrhart, Brian David

    2018-03-01

    Safety standards development for maintenance facilities of liquid and compressed natural gas fueled vehicles is required to ensure proper facility design and operating procedures. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase II work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest using risk ranking. Detailed simulations and modeling were performed to estimate the location and behavior of natural gas releases based on these scenarios. Specific code conflicts were identified, and ineffective code requirements were highlighted and resolutions proposed. These include ventilation rate basis on area or volume, as well as a ceiling offset which seems ineffective at protecting against flammable gas concentrations. ACKNOWLEDGEMENTS The authors gratefully acknowledge Bill Houf (SNL -- Retired) for his assistance with the set-up and post-processing of the numerical simulations. The authors also acknowledge Doug Horne (retired) for his helpful discussions. We would also like to acknowledge the support from the Clean Cities program of DOE's Vehicle Technology Office.

  19. Compensation for risks: host community benefits in siting locally unwanted facilities

    Science.gov (United States)

    Himmelberger, Jeffery J.; Ratick, Samuel J.; White, Allen L.

    1991-09-01

    This article analyzes the recent negotiations connected with siting 24 solid-waste landfills in Wisconsin. We examine the association between the type and amount of compensation paid to host communities by facility developers and the size of facilities, certain facility characteristics, the timing of negotiated agreements, the size of the host community, and the socioeconomic status of the host area. Our findings suggest that the level of compensation after adjusting for landfill capacity is positively associated with the percentage of total facility capacity dedicated to host community use, positively associated with the percentage of people of the host area who are in poverty, and larger for public facilities that accept municipal wastes. Other explanatory variables we examined, whose association with levels of compensation proved statistically insignificant, were facility size, facility status (new vs expansion), facility use (countyonly vs multicounty), timing of negotiation, host community size, and the host area education level, population density, and per capita income. We discuss the policy implications of our principal findings and future research questions in light of the persistent opposition surrounding the siting of solid-waste and other waste-management facilities.

  20. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05 and staff competencies (Coef. = 7.1, p<0.05. Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period

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

    Science.gov (United States)

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

    2018-06-01

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

  2. Basic Stand Alone Medicare Inpatient Claims PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...

  3. In-patient costs of agitation and containment in a mental health catchment area

    OpenAIRE

    Serrano-Blanco, Antoni; Rubio-Valera, Maria; Aznar-Lou, Ignacio; Balad?n Higuera, Luisa; Gibert, Karina; Gracia Canales, Alfredo; Kaskens, Lisette; Ortiz, Jos? Miguel; Salvador-Carulla, Luis

    2017-01-01

    Background There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. Methods A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients ...

  4. In-patient costs of agitation and containment in a mental health catchment area

    OpenAIRE

    Serrano-Blanco, Antoni; Rubio-Valera, Maria; Aznar, Ignacio; Baladón, Luisa; Gibert, Karina; Gracia Canales, Alfredo; Kaskens, Lisette; Ortiz, José Miguel; Salvador Carulla, Luís

    2017-01-01

    Background: There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. Methods: A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatient...

  5. Environmental health-risk assessment for tritium releases from the National Tritium Labeling Facility (NTLF) at Lawrence Berkeley Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    McKone, T.E.; Brand, K.P.

    1994-12-01

    This report is a health risk assessment that addresses continuous releases of tritium to the environment from the National Tritium Labeling Facility (NTLF) at the Lawrence Berkeley Laboratory (LBL). The NTLF contributes approximately 95% of all tritium releases from LBL. Transport and transformation models were used to determine the movement of tritium releases from the NRLF to the air, surface water, soils, and plants and to determine the subsequent doses to humans. These models were calibrated against environmental measurements of tritium levels in the vicinity of the NTLF and in the surrounding community. Risk levels were determined for human populations in each of these zones. Risk levels to both individuals and populations were calculated. In this report population risks and individual risks were calculated for three types of diseases--cancer, heritable genetic effects, and developmental and reproductive effects.

  6. Environmental health-risk assessment for tritium releases from the National Tritium Labeling Facility (NTLF) at Lawrence Berkeley Laboratory

    International Nuclear Information System (INIS)

    McKone, T.E.; Brand, K.P.

    1994-12-01

    This report is a health risk assessment that addresses continuous releases of tritium to the environment from the National Tritium Labeling Facility (NTLF) at the Lawrence Berkeley Laboratory (LBL). The NTLF contributes approximately 95% of all tritium releases from LBL. Transport and transformation models were used to determine the movement of tritium releases from the NRLF to the air, surface water, soils, and plants and to determine the subsequent doses to humans. These models were calibrated against environmental measurements of tritium levels in the vicinity of the NTLF and in the surrounding community. Risk levels were determined for human populations in each of these zones. Risk levels to both individuals and populations were calculated. In this report population risks and individual risks were calculated for three types of diseases--cancer, heritable genetic effects, and developmental and reproductive effects

  7. Medication errors in pediatric inpatients

    DEFF Research Database (Denmark)

    Rishoej, Rikke Mie; Almarsdóttir, Anna Birna; Christesen, Henrik Thybo

    2017-01-01

    The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010–2014. We included reports from public hospitals on pati...... safety in pediatric inpatients.(Table presented.)...

  8. The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population

    Directory of Open Access Journals (Sweden)

    Mordre Marianne

    2012-10-01

    Full Text Available Abstract Background Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Methods Former Norwegian child-psychiatric in-patients (n = 257 were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing. Results At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01. Low psychosocial functioning (assessed by the Children’s Global Assessment Scale at admission uniquely predicted future DP (p = 0.04. Conclusions ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.

  9. An application of the value tree analysis methodology within the integrated risk informed decision making for the nuclear facilities

    International Nuclear Information System (INIS)

    Borysiewicz, Mieczysław; Kowal, Karol; Potempski, Sławomir

    2015-01-01

    A new framework of integrated risk informed decision making (IRIDM) has been recently developed in order to improve the risk management of the nuclear facilities. IRIDM is a process in which qualitatively different inputs, corresponding to different types of risk, are jointly taken into account. However, the relative importance of the IRIDM inputs and their influence on the decision to be made is difficult to be determined quantitatively. An improvement of this situation can be achieved by application of the Value Tree Analysis (VTA) methods. The aim of this article is to present the VTA methodology in the context of its potential usage in the decision making on nuclear facilities. The benefits of the VTA application within the IRIDM process were identified while making the decision on fuel conversion of the research reactor MARIA. - Highlights: • New approach to risk informed decision making on nuclear facilities was postulated. • Value tree diagram was developed for decision processes on nuclear installations. • An experiment was performed to compare the new approach with the standard one. • Benefits of the new approach were reached in fuel conversion of a research reactor. • The new approach makes the decision making process more transparent and auditable

  10. Risk management for operations of the Los Alamos critical experiments facility

    International Nuclear Information System (INIS)

    Paternoster, R.; Butterfield, K.

    1998-01-01

    The Los Alamos Critical Experiments Facility (LACEF) currently operates two burst reactors (Godiva-IV and Skua), one solution assembly (SHEBA 2--Solution high-Energy Burst Assembly), two fast-spectrum benchmark assemblies (Flattop and Big Ten), and five general-purpose remote assembly machines which may be configured with nuclear materials and assembled by remote control. SNM storage vaults support these and other operations at the site. With this diverse set of operations, several approaches are possible in the analysis and management of risk. The most conservative approach would be to write a safety analysis report (SAR) for each assembly and experiment. A more cost-effective approach is to analyze the probability and consequences of several classes of operations representative of operations on each critical assembly machine and envelope the bounding case accidents. Although the neutron physics of these machines varies widely, the operations performed at LACEF fall into four operational modes: steady-state mode, approach-to-critical mode, prompt burst mode, and nuclear material operations which can include critical assembly fuel loading. The operational sequences of each mode are very nearly the same, whether operated on one assembly machine or another. The use of an envelope approach to accident analysis is facilitated by the use of classes of operations and the use of bounding case consequence analysis. A simple fault tree analysis of operational modes helps resolve which operations are sensitive to human error and which are initiated by hardware of software failures. Where possible, these errors and failures are blocked by TSR LCOs

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

    International Nuclear Information System (INIS)

    Sasser, K.

    1994-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Sasser, K.

    1994-06-01

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

  13. Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Jaski, Brian E; Grigoriadis, Christopher E; Dai, Xuming; Meredith, Richard D; Ortiz, Bryan C; Stouffer, George A; Thomas, Lorie; Smith, Sidney C

    2016-08-01

    Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P PCI (50.7% vs 80.9%; P PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P PCI in both groups. Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes. © 2016, Wiley Periodicals, Inc.

  14. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.

    Science.gov (United States)

    Reistetter, Timothy A; Graham, James E; Deutsch, Anne; Granger, Carl V; Markello, Samuel; Ottenbacher, Kenneth J

    2010-03-01

    To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. Retrospective cross-sectional design. Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. Not applicable. Discharge FIM rating and discharge setting (community vs institutional). Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Multi-site risk-based project planning, optimization, sequencing, & budgeting process and tool for the integrated facility disposition project

    International Nuclear Information System (INIS)

    Nelson, J.G.; Castillo, C.; Huntsman, J.; Killoy, S.; Lucek, H.; Marks, T.C.

    2011-01-01

    Faced with the Department of Energy (DOE) Complex Transformation, National Nuclear Security Administration (NNSA) was tasked with developing an integrated plan for the decommissioning of over 400 facilities and 300 environmental remediation units, as well as the many reconfiguration and modernization projects at the Oak Ridge National Laboratory (ORNL) and Y-12 Complex. Manual scheduling of remediation activities is time-consuming and inherently introduces bias of the scheduler or organization into the process. Clearly a well-defined process, quantitative risk-based tool was needed to develop an objective, unbiased baseline sequence and schedule with a sound technical foundation for the Integrated Facility Disposition Project (IFDP). Faced with limited available data, innovation was needed to extrapolate intelligent relative data for key risk parameters based on known data elements. The IFDP Supermodel was customized and expanded to provide this capability for conceptual planning of diverse project portfolios and multiple sites. (author)

  16. An assessment of potential risk resulting from a maximum credible accident scenario at the proposed explosive waste storage facility (EWSF)

    International Nuclear Information System (INIS)

    Otsuki, K.; Harrach, R.; Berger, R.

    1992-10-01

    Lawrence Livermore National Laboratory (LLNL) proposes to build, permit, and operate a storage facility for explosive wastes at LLNL's Explosive Test Site, Site 300. The facility would consist of four existing magazines, four new magazettes (small concrete vaults), and a new prefabricated metal building. Ash from on-site treatment of explosive waste would also be stored in the prefabricated metal building prior to sampling analysis, and shipment. The magazettes would be installed at each magazine-and would provide segregated storage for explosive waste types including detonators, actuators, and other initiating devices. The proposed facility would be used to store explosive wastes generated by the Hydrotest and Explosive Development Programs at LLNL prior to treatment on-site or shipment to permitted, commercial, off-site treatment facilities. Explosive wastes to be stored in the proposed facility represent a full spectrum of Department of Energy (DOE) and LLNL explosive wastes. This document identifies and evaluates the risk to human health and the environment associated with the operation of the proposed EWSF

  17. Draft CSA standard on environmental risk assessments at class I nuclear facilities and uranium mines and mills

    International Nuclear Information System (INIS)

    Hart, D.; Garisto, N.; Parker, R.; Kovacs, R.; Thompson, B.

    2012-01-01

    The Canadian Standards Association (CSA) is preparing a draft Standard on environmental risk assessments (ERAs) at Class I nuclear facilities and uranium mines and mills (CSA N288.6). It is being prepared by a technical subcommittee of the CSA N288 Technical Committee, including experts from across the nuclear industry, government and regulatory authorities, and environmental service providers, among others. It addresses the design, implementation, and management of environmental risk assessment programs, and is intended to standardize practice across the industry. This paper outlines the scope of the draft Standard and highlights key features. It is under development and subject to change. (author)

  18. Appendix E: Supplemental Risk Management Program Guidance for Ammonia Refrigeration Facilities

    Science.gov (United States)

    Additional information for food processors, food distributors, refrigerated warehouses, and any other facility that has an ammonia refrigeration system. Includes details on exemption for farms, threshold quantity, and offsite consequence analysis.

  19. Applying of Decision Tree Analysis to Risk Factors Associated with Pressure Ulcers in Long-Term Care Facilities.

    Science.gov (United States)

    Moon, Mikyung; Lee, Soo-Kyoung

    2017-01-01

    The purpose of this study was to use decision tree analysis to explore the factors associated with pressure ulcers (PUs) among elderly people admitted to Korean long-term care facilities. The data were extracted from the 2014 National Inpatient Sample (NIS)-data of Health Insurance Review and Assessment Service (HIRA). A MapReduce-based program was implemented to join and filter 5 tables of the NIS. The outcome predicted by the decision tree model was the prevalence of PUs as defined by the Korean Standard Classification of Disease-7 (KCD-7; code L89 * ). Using R 3.3.1, a decision tree was generated with the finalized 15,856 cases and 830 variables. The decision tree displayed 15 subgroups with 8 variables showing 0.804 accuracy, 0.820 sensitivity, and 0.787 specificity. The most significant primary predictor of PUs was length of stay less than 0.5 day. Other predictors were the presence of an infectious wound dressing, followed by having diagnoses numbering less than 3.5 and the presence of a simple dressing. Among diagnoses, "injuries to the hip and thigh" was the top predictor ranking 5th overall. Total hospital cost exceeding 2,200,000 Korean won (US $2,000) rounded out the top 7. These results support previous studies that showed length of stay, comorbidity, and total hospital cost were associated with PUs. Moreover, wound dressings were commonly used to treat PUs. They also show that machine learning, such as a decision tree, could effectively predict PUs using big data.

  20. Risk informed regulation of nuclear facilities: Overview of the current status

    International Nuclear Information System (INIS)

    2005-02-01

    This report provides guidance on the use of risk information by regulatory bodies as part of an integrated decision making process. This addresses the way in which risk information is being used in decisions about safety issues at nuclear plants, sometimes referred to as risk informed decision making, and how risk information is being used by regulatory bodies as an input into the activities that they carry out, sometimes referred to as risk informed regulation

  1. Associação entre risco de disfagia e risco nutricional em idosos internados em hospital universitário de Brasília Association between risk of dysphagia and nutritional risk in elderly inpatients at a univesity hospital of Brasília, Brazil

    Directory of Open Access Journals (Sweden)

    Juliana Rolim Vieira Maciel

    2008-08-01

    Full Text Available OBJETIVOS: Investigar a associação entre o grau de risco de disfagia e o risco nutricional dos pacientes idosos internados na clínica médica do Hospital Universitário de Brasília. MÉTODOS: Estudo transversal, analítico, original, observacional, não-controlado, com amostra de conveniência e estratificada. Foram aplicados a Mini Avaliação Nutricional e o questionário de risco de disfagia em 49 pacientes idosos nas primeiras 48 horas após admissão na clínica médica, em setembro de 2006. RESULTADOS: A freqüência de idosos foi maior na faixa etária entre 60-74 anos 11meses (78%, com média de idade de 69 anos, sendo 41% mulheres e 59% homens. A proporção de risco de disfagia dos pacientes idosos foi de 69% e do estado nutricional inadequado de 71%, valor elevado principalmente entre as mulheres. Ambos os sexos se encontram em risco nutricional, masculino (20,5, Desvio-padrão - DP=5 e feminino (19, DP=6. O estudo mostrou que as mulheres apresentam uma tendência maior para risco de disfagia, porém os homens apresentam um quadro de maior gravidade (risco moderado. Foi encontrada uma correlação negativa moderada entre os valores de risco de disfagia e seus respectivos scores da Mini Avaliação Nutricional. CONCLUSÃO: Foi verificado neste estudo que os idosos apresentam dois agravantes de sua qualidade de vida: estado nutricional e disfagia, que podem ser agudizados na internação hospitalar.OBJECTIVES: This study aimed to verify the association between the degree of risk of dysphagia and nutritional risk of elderly inpatients at the medical clinic of Brasília´s University Hospital. METHODS: This is a cross-sectional, analytic, original, observational, uncontrolled study with convenience and stratified sample. The Mini Nutritional Assessment and a questionnaire to assess risk of dysphagia were administered to 49 elderly patients within the first 48 hours after admission to the medical clinic, in September 2006. RESULTS

  2. Results of the application of the Risk Evaluation System in Radiotherapy (RESRA) in radiotherapy facilities in Mexico

    International Nuclear Information System (INIS)

    Paz G, A.; Godinez S, V.

    2013-10-01

    The present work describes the main results of the risk evaluation for some radiotherapy treatments with lineal accelerators, cobalt 60, brachytherapy of high dose rate and brachytherapy of low dose rate that are realize in Mexico. These evaluations were carried out applying the risk matrices method with the tool computer risk evaluation system in radiotherapy, accessible for the national users through internet, and developed by the Comision Nacional de Seguridad Nuclear y Salvaguardias in Mexico, in cooperation with the Forum of Ibero-American regulators. The used methodology is based on the risk matrices method that is a mathematical tool for the risk evaluation, and it was centered in the evaluation from the risk to which are exposed the patients, the occupational exposed personnel and people in general, by the mechanical faults of the treatment equipment s, bad calibrations, human errors, or any other event initiator of accidents. The events initiators of accidents are defined as those undesirable events that can produce and administration of an excessive dose or a sub-dose of the prescribed dose by the doctor, to the planned objective volume, or undesirable dose to the patient's regions or dose to occupational exposed personnel or people in general. The barriers are the actions and systems as mechanical switches, interlocks or alarms, dedicated to avoid that these accidents take place. The evaluation analysis of the risk developed by the members of the Forum for radiotherapy facilities together with the software RESRA has demonstrated to be useful in the prevention of many possible accidents that have happened in the past in other facilities and can avoid many others in the future. (Author)

  3. The role of human error in risk analysis: Application to pre- and post-maintenance procedures of process facilities

    International Nuclear Information System (INIS)

    Noroozi, Alireza; Khakzad, Nima; Khan, Faisal; MacKinnon, Scott; Abbassi, Rouzbeh

    2013-01-01

    Human factors play an important role in the safe operation of a facility. Human factors include the systematic application of information about human characteristics and behavior to increase the safety of a process system. A significant proportion of human errors occur during the maintenance phase. However, the quantification of human error probabilities in the maintenance phase has not been given the amount of attention it deserves. This paper focuses on a human factors analysis in pre-and post- pump maintenance operations. The procedures for removing process equipment from service (pre-maintenance) and returning the equipment to service (post-maintenance) are considered for possible failure scenarios. For each scenario, human error probability is calculated for each activity using the Success Likelihood Index Method (SLIM). Consequences are also assessed in this methodology. The risk assessment is conducted for each component and the overall risk is estimated by adding individual risks. The present study is aimed at highlighting the importance of considering human error in quantitative risk analyses. The developed methodology has been applied to a case study of an offshore process facility

  4. Risk Management Plan (RMP) Facility Points, Region 9, 2011, US EPA Region 9

    Data.gov (United States)

    U.S. Environmental Protection Agency — Risk Management Plan (RMP): Under the Clean Air Act, Section 112(r), the EPA established a program requiring risk management plans to be provided to the EPA by...

  5. Risk Management Plan (RMP) Facility Points, Region 9, 2014, US EPA Region 9

    Data.gov (United States)

    U.S. Environmental Protection Agency — Risk Management Plan (RMP): Under the Clean Air Act, Section 112(r), the EPA established a program requiring risk management plans to be provided to the EPA by...

  6. Predictors of Dropout From Inpatient Substance Use Treatment: A Prospective Cohort Study.

    Science.gov (United States)

    Andersson, Helle Wessel; Steinsbekk, Aslak; Walderhaug, Espen; Otterholt, Eli; Nordfjærn, Trond

    2018-01-01

    Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing challenge. The aim of this study was to identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment. A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this naturalistic, prospective cohort study. A total of 132 patients (28%) did not complete the planned treatment stay (dropped out). Cox regression analysis showed that higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95% confidence interval [CI]: 0.48-0.79). Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95% CI: 1.11-1.97). The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future prospective intervention studies.

  7. Mastery of risks: we build the memory of radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Lacourcelle, C.

    2011-01-01

    The ANDRA, the French national agency of radioactive wastes, is organizing today the information needs of tomorrow. The aim is to allow the future generations to have access to the knowledge of the existence of subsurface radioactive waste facilities and to understand the context and technologies of such facilities. The storage of this information is made on 'permanent paper', a high resistant paper with a lifetime of 600 to 1000 years. An updating of these data is made every 5 years for each waste disposal center. Another project, still in progress, concerns the memory management of deep geologic waste disposal facilities for which the time scale to be considered is of the order of millennia. (J.S.)

  8. Health risks for the population living in the vicinity of an Integrated Waste Management Facility: Screening environmental pollutants

    International Nuclear Information System (INIS)

    Domingo, José L.; Rovira, Joaquim; Vilavert, Lolita; Nadal, Martí; Figueras, María J.; Schuhmacher, Marta

    2015-01-01

    We performed a screening investigation to assess the human health risks of the Integrated Waste Management Facility (IWMF: mechanical–biological treatment (MBT) plant plus municipal solid waste incinerator (MSWI); Ecoparc-3) of Barcelona (Spain). Air concentrations of pollutants potentially released by the MBT plant (VOCs and bioaerosols) and the MSWI (trace elements, PCDD/Fs and PCBs) were determined. Trace elements, PCDD/Fs and PCBs were also analyzed in soil samples. The concentrations of trace elements and bioaerosols were similar to those previously reported in other areas of similar characteristics, while formaldehyde was the predominant VOC. Interestingly, PCDD/F concentrations in soil and air were the highest ever reported near a MSWI in Catalonia, being maximum concentrations 10.8 ng WHO-TEQ/kg and 41.3 fg WHO-TEQ/m 3 , respectively. In addition, there has not been any reduction in soils, even after the closure of a power plant located adjacently. Human health risks of PCDD/F exposure in the closest urban nucleus located downwind the MSWI are up to 10-times higher than those nearby other MSWIs in Catalonia. Although results must be considered as very preliminary, they are a serious warning for local authorities. We strongly recommend to conduct additional studies to confirm these findings and, if necessary, to implement measures to urgently mitigate the impact of the MSWI on the surrounding environment. We must also state the tremendous importance of an individual evaluation of MSWIs, rather than generalizing their environmental and health risks. - Highlights: • Health risks of an Integrated Waste Management Facility in Catalonia are assessed. • PCDD/F exposure near this facility is up to 10-times higher than that near others. • Environmental monitoring of incineration plants should be performed case-by-case. • Since results are very preliminary, confirmatory studies should be conducted

  9. Health risks for the population living in the vicinity of an Integrated Waste Management Facility: Screening environmental pollutants

    Energy Technology Data Exchange (ETDEWEB)

    Domingo, José L., E-mail: joseluis.domingo@urv.cat [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Rovira, Joaquim [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Departament d' Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia (Spain); Vilavert, Lolita; Nadal, Martí [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Figueras, María J. [Microbiology Unit, School of Medicine, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Schuhmacher, Marta [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Departament d' Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia (Spain)

    2015-06-15

    We performed a screening investigation to assess the human health risks of the Integrated Waste Management Facility (IWMF: mechanical–biological treatment (MBT) plant plus municipal solid waste incinerator (MSWI); Ecoparc-3) of Barcelona (Spain). Air concentrations of pollutants potentially released by the MBT plant (VOCs and bioaerosols) and the MSWI (trace elements, PCDD/Fs and PCBs) were determined. Trace elements, PCDD/Fs and PCBs were also analyzed in soil samples. The concentrations of trace elements and bioaerosols were similar to those previously reported in other areas of similar characteristics, while formaldehyde was the predominant VOC. Interestingly, PCDD/F concentrations in soil and air were the highest ever reported near a MSWI in Catalonia, being maximum concentrations 10.8 ng WHO-TEQ/kg and 41.3 fg WHO-TEQ/m{sup 3}, respectively. In addition, there has not been any reduction in soils, even after the closure of a power plant located adjacently. Human health risks of PCDD/F exposure in the closest urban nucleus located downwind the MSWI are up to 10-times higher than those nearby other MSWIs in Catalonia. Although results must be considered as very preliminary, they are a serious warning for local authorities. We strongly recommend to conduct additional studies to confirm these findings and, if necessary, to implement measures to urgently mitigate the impact of the MSWI on the surrounding environment. We must also state the tremendous importance of an individual evaluation of MSWIs, rather than generalizing their environmental and health risks. - Highlights: • Health risks of an Integrated Waste Management Facility in Catalonia are assessed. • PCDD/F exposure near this facility is up to 10-times higher than that near others. • Environmental monitoring of incineration plants should be performed case-by-case. • Since results are very preliminary, confirmatory studies should be conducted.

  10. Risk management in facility transition and management decision making: Needs and opportunities

    International Nuclear Information System (INIS)

    Stillwell, W.; Seaver, D.; Keller, J.; Smith, D.; Weaver, D.; Sanders, T.; Thullen, P.

    1993-02-01

    An overall approach to risk management is described in this paper. Many of these concepts have been developed and applied as part of Hanford Mission Planning (HMP) (Hanford Mission Plan, 1992). At Hanford, HMP provides a mechanism for integrating planning across all the missions and programs of the site. This paper discusses the decision context within which EM must make and defend decisions, the types of decisions that are being and will need to be made in order to progress with the cleanup of the DOE complex, and the resulting need for risk management. Risk management, in turn, requires quality health and ecological risk information to make these decisions. Other types of information are also needed, but the risk information is typically the most important and the most difficult to obtain. The paper then describes a general technical approach to risk management, including particular methods for developing the high quality of human health and ecological risk information that will be needed to support risk management. We next turn to several special issues that make risk management more complex than many other decisions. We discuss these issues and offer some practical suggestions with respect to addressing them in the risk management framework. Finally, we conclude with some discussion of other opportunities for applying risk management

  11. RISK ASSESSMENT BY STRUCTURAL ANALYSIS AND VIBRATION MEASUREMENT EQUIPMENT OPERATING AT OIL FACILITIES

    Directory of Open Access Journals (Sweden)

    Marius STAN

    2013-05-01

    Full Text Available Vibration analysis applications in operation is one of the diagnostic methods ofoperation of the facility. Analysis of these types of failures indicated the existence of specificfeatures prints and related equipment vibration spectra. Modeling and identification of theseparticular aspects in the spectrum of vibration machines help to control the operation of oilfacilities built safely.

  12. RISK ASSESSMENT BY STRUCTURAL ANALYSIS AND VIBRATION MEASUREMENT EQUIPMENT OPERATING AT OIL FACILITIES

    OpenAIRE

    Marius STAN

    2013-01-01

    Vibration analysis applications in operation is one of the diagnostic methods ofoperation of the facility. Analysis of these types of failures indicated the existence of specificfeatures prints and related equipment vibration spectra. Modeling and identification of theseparticular aspects in the spectrum of vibration machines help to control the operation of oilfacilities built safely.

  13. Risk-Based Disposal Plan for PCB Paint in the TRA Fluorinel Dissolution Process Mockup and Gamma Facilities Canal

    Energy Technology Data Exchange (ETDEWEB)

    R. A. Montgomery

    2008-05-01

    This Toxic Substances Control Act Risk-Based Polychlorinated Biphenyl Disposal plan was developed for the Test Reactor Area Fluorinel Dissolution Process Mockup and Gamma Facilities Waste System, located in Building TRA-641 at the Reactor Technology Complex, Idaho National Laboratory Site, to address painted surfaces in the empty canal under 40 CFR 761.62(c) for paint, and under 40 CFR 761.61(c) for PCBs that may have penetrated into the concrete. The canal walls and floor will be painted with two coats of contrasting non-PCB paint and labeled as PCB. The canal is covered with open decking; the access grate is locked shut and signed to indicate PCB contamination in the canal. Access to the canal will require facility manager permission. Protective equipment for personnel and equipment entering the canal will be required. Waste from the canal, generated during ultimate Decontamination and Decommissioning, shall be managed and disposed as PCB Bulk Product Waste.

  14. [Risk of tuberculosis infection among care workers during an outbreak of tuberculosis at a care facility for the elderly].

    Science.gov (United States)

    Yanagihara, Hiroki

    2014-07-01

    Owing to limited evidence, the risk of and factors related to tuberculosis (TB) infection among care workers is not understood. We experienced an outbreak of TB with 2 cases of active TB (positive cultures) and 34 cases of latent TB infection at a care facility for the elderly. Using an epidemiological investigation of the outbreak, this study aimed to investigate the risk of and factors related to TB infection among care workers and to establish a system for TB control in care facilities for the elderly. The index patient (80-year-old woman; fever for 1.5 months) was diagnosed with TB [bI3: GAKKAI classification, sputum smear (3+)]. We investigated the contacts of the patient. On the basis of the epidemiological investigation, we conducted a contact examination of close contacts, including those of residents and care workers at the care facility and staff at the medical facility to which the patient was referred. Reviewing this information, we compared both the results of the QuantiFERON-TB Gold (QFT-GIT) test and the degree of contact in 10 care workers and 7 nurses who had close contact while providing care services to the patient. The QFT-GIT test was conducted twice: 3 weeks and 11-12 weeks after the last contact with the patient. The number of care workers who tested positive while providing care services to the patient were 3, 0, and 5 according to the contact time of patient, while each of the nurses spent approximately 20 min for the same. Care workers provided daily care services such as feeding, changing the patient's posture, turning in bed, diaper changing, bathing, and providing a bed bath, and nurses provided services such as the measurement of vital signs, hydration, administration of medication, and exchange of cooling material for lowering body temperature. In addition, care workers had been in contact with the patient while providing care services before the patient developed fever, and nurses initiated contact with the patient for care after the

  15. Risks assessment associated with the possibility of intrusion into the low and intermediate level waste disposal facility

    International Nuclear Information System (INIS)

    Didita, L.; Ilie, P.; Pavelescu, M.

    1997-01-01

    In post-closure performance assessment of low and intermediate level waste disposal facilities it is necessary to assess the individual risks associated with the possibility of intrusion into repository. Intruder induced disruptive events can potentially compromise the integrity of the disposal unit and result in exhumation of the waste and radionuclides migration into environment. In this way, the main routes of exposure are: -inhalation of radioactive materials by the intruder; - external gamma irradiation of the intruder, - long-term pathways resulting from the transfer of radioactive materials to the surface of the site. This paper describes the evaluation of conditional and absolute risks associated with each route of exposure as a function of time. To evaluate the risks, it is necessary to calculate the time-dependent activities of each nuclide considered. This is achieved by employing an analytic solution to the Bateman equation at specified times of evaluation. Conditional risks by inhalation, external exposure and long-term pathways and different modes of intrusion are evaluated on the basis of an annual probability of intrusion of unity. Absolute risks are calculated by scaling the user-supplied probabilities of intrusion at various times of evaluation. The evaluation of absolute risks by long-term exposure pathways involves an interpolation procedure in time. The calculations have been performed for the most important radionuclides present in low and intermediate wastes. (authors)

  16. Environmental health-risk assessment for tritium releases at the National Tritium Labeling Facility at Lawrence Berkeley National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    McKone, T.E.; Brand, K.P. [Lawrence Livermore National Lab., CA (United States). Health and Ecological Assessment Div.; Shan, C. [Lawrence Berkeley National Lab., CA (United States). Earth Sciences Div.

    1997-04-01

    This risk assessment calculates the probability of experiencing health effects, including cancer incidence due to tritium exposure for three groups of people: (1) LBNL workers near the LBNL facility--Building 75--that uses tritium; (2) other workers at LBNL and nearby neighbors; and (3) people who use the UC Berkeley campus area, and some Berkeley residents. All of these groups share the same probability of health effects from the background radiation from natural sources in the Berkeley area environment, including an increased risk of developing a cancer of 11,000 chances per million. In calculating risk the authors assumed continuous operation in Building 75 for at least a human lifetime. Under this assumption, LBNL workers located near Building 75 have an additional risk of 60 chances out of one million to suffer a cancer; other workers at LBNL and people who live near LBNL have an additional risk of six chances out of one million over a lifetime of exposure; and users of the UC Berkeley campus area and other residents of Berkeley have an additional risk of less than once chance out of one million over a lifetime.

  17. Environmental health-risk assessment for tritium releases at the National Tritium Labeling Facility at Lawrence Berkeley National Laboratory

    International Nuclear Information System (INIS)

    McKone, T.E.; Brand, K.P.; Shan, C.

    1997-04-01

    This risk assessment calculates the probability of experiencing health effects, including cancer incidence due to tritium exposure for three groups of people: (1) LBNL workers near the LBNL facility--Building 75--that uses tritium; (2) other workers at LBNL and nearby neighbors; and (3) people who use the UC Berkeley campus area, and some Berkeley residents. All of these groups share the same probability of health effects from the background radiation from natural sources in the Berkeley area environment, including an increased risk of developing a cancer of 11,000 chances per million. In calculating risk the authors assumed continuous operation in Building 75 for at least a human lifetime. Under this assumption, LBNL workers located near Building 75 have an additional risk of 60 chances out of one million to suffer a cancer; other workers at LBNL and people who live near LBNL have an additional risk of six chances out of one million over a lifetime of exposure; and users of the UC Berkeley campus area and other residents of Berkeley have an additional risk of less than once chance out of one million over a lifetime

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

    Science.gov (United States)

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

  19. Assessment of risk of potential exposures on facilities industries; Estimativa do risco de exposicao potencial em instalacoes industriais

    Energy Technology Data Exchange (ETDEWEB)

    Leocadio, Joao Carlos

    2007-03-15

    This work develops a model to evaluate potential exposures on open facilities of industrial radiography in Brazil. This model will decisively contribute to optimize operational, radiological protection and safety procedures, to prevent radiation accidents and to reduce human errors in industrial radiography. The probabilistic safety assessment (PSA) methodology was very useful to assess potential exposures. The open facilities of industrial radiography were identified as the scenario to be analyzed in what concerns the evaluation of potential exposures, due to their high accidents indices. The results of the assessment of potential exposures confirm that the industrial radiography in Brazil is a high-risk practice as classified by the IAEA. The risk of potential exposure was estimated to be 40,5 x 10{sup -2} per year in Brazil, having as main consequences injuries to the workers' hands and arms. In the world scene, the consequences are worst, leading to fatalities of people, thus emphasizing the high risk of industrial radiography. (author)

  20. Using Probablilistic Risk Assessment to Model Medication System Failures in Long-Term Care Facilities

    National Research Council Canada - National Science Library

    Comden, Sharon C; Marx, David; Murphy-Carley, Margaret; Hale, Misti

    2005-01-01

    .... Discussion: The models provide contextual maps of the errors and behaviors that lead to medication delivery system failures, including unanticipated risks associated with regulatory practices and common...

  1. Pediatric aspects of inpatient health information technology systems.

    Science.gov (United States)

    Lehmann, Christoph U

    2015-03-01

    In the past 3 years, the Health Information Technology for Economic and Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children. Copyright © 2015 by the American Academy of Pediatrics.

  2. Cost effectiveness of robotics and remote tooling for occupational risk reduction at a nuclear fuel fabrication facility

    Energy Technology Data Exchange (ETDEWEB)

    Lochard, Jacques

    1989-08-01

    This case study, related to the design stage of a fuel fabrication facility, presents the evaluation of alternative options to manipulate mixed oxide fuel rods in a quality control shop. It is based on a study performed in the framework of the 'MELOX project' developed by COGEMA in France. The methodology for evaluating robotic actions is resulting from a research work part funded by the IAEA under the co-ordinated research programme on 'Comparison of cost-effectiveness of risk reduction among different energy systems', and by the commission of the European Communities under the research and training programme on radiation protection.

  3. Assessment of uncertainties in core melt phenomenology and their impact on risk at the Z/IP facilities

    International Nuclear Information System (INIS)

    Pratt, W.T.; Ludewig, H.; Bari, R.A.; Meyer, J.F.

    1983-01-01

    An evaluation of core meltdown accidents in the Z/IP facilities has been performed. Containment event trees have been developed to relate the progression of a given accident to various potential containment building failure modes. An extensive uncertainty analysis related to core melt phenomenology has been performed. A major conclusion of the study is that large variations in parameters associated with major phenomenological uncertainties have a relatively minor impact on risk when external initiators are considered. This is due to the inherent capability fo the Z/IP containment buildings to contain a wide range of core meltdown accidents. 12 references, 2 tables

  4. Cost effectiveness of robotics and remote tooling for occupational risk reduction at a nuclear fuel fabrication facility

    International Nuclear Information System (INIS)

    Lochard, Jacques

    1989-01-01

    This case study, related to the design stage of a fuel fabrication facility, presents the evaluation of alternative options to manipulate mixed oxide fuel rods in a quality control shop. It is based on a study performed in the framework of the 'MELOX project' developed by COGEMA in France. The methodology for evaluating robotic actions is resulting from a research work part funded by the IAEA under the co-ordinated research programme on 'Comparison of cost-effectiveness of risk reduction among different energy systems', and by the commission of the European Communities under the research and training programme on radiation protection

  5. Building Automation System Cyber Networks: An Unmitigated Risk to Federal Facilities

    Science.gov (United States)

    2015-12-01

    Cybersecurity, Appendix III, IV. xviii on the GSA network, and protected behind the GSA firewall ; the remaining facilities are operated on private...control systems by delaying or blocking the flow of information through control networks, thereby denying availability of the networks to control system...a worm, malware , or virus with no specific target.43 A targeted attack occurs when an individual or group attacks a specific system at a specific

  6. Hanford 300 Area Treated Effluent Disposal Facility inventory at risk calculations and safety analysis

    International Nuclear Information System (INIS)

    Olander, A.R.

    1995-11-01

    The 300 Area Treated Effluent Disposal Facility (TEDF) is a wastewater treatment plant being constructed to treat the 300 Area Process Sewer and Retention Process Sewer. This document analyzes the TEDF for safety consequences. It includes radionuclide and hazardous chemical inventories, compares these inventories to appropriate regulatory limits, documents the compliance status with respect to these limits, and identifies administrative controls necessary to maintain this status

  7. Design risk analysis comparison between low-activation composite and aluminum alloy target chamber for the National Ignition Facility

    International Nuclear Information System (INIS)

    Streckert, H.H.; Schleicher, R.W.

    1997-01-01

    The baseline design for the target chamber for the National Ignition Facility (NIF) consists of an aluminum alloy spherical shell. A low-activation composite chamber (e.g., carbon fiber/epoxy) has important advantages such as enhanced environmental and safety characteristics, improved chamber accessibility due to reduced neutron-induced radioactivity, and elimination of the concrete shield. However, it is critical to determine the design and manufacturing risk for the first application. The replacement of such a critical component requires a detailed development risk assessment. A semiquantitative approach to risk assessment has been applied to this problem based on failure modes, effects, and criticality analysis. This analysis consists of a systematic method for organizing the collective judgment of the designers to identify failure modes, estimate probabilities, judge the severity of the consequence, and illustrate risk in a matrix representation. The results of the analyses indicate that the composite chamber has a reasonably high probability of success in the NIF application. The aluminum alloy chamber, however, represents a lower risk, partially based on a more mature technology. 8 refs., 4 figs., 5 tabs

  8. Benefit and Risk Perceptions of Controversial Facilities: A Comparison between Local Officials and the Public in China

    Directory of Open Access Journals (Sweden)

    Qingduo Mao

    2018-04-01

    Full Text Available This article investigates the perception biases of local government officials and the general public by comparing their benefit and risk perceptions towards controversial facilities. The analysis framework of Social Judgement Theory (SJT—i.e., (a economic benefits, (b environmental health, and (c social and political factors—was used to design the research. SJT is a widely recognized theoretical framework that includes experimental approaches to the study of cognitive conflicts. An experimental survey was conducted to collect data in order to make a comparison of the weight of different elements. Results demonstrate that there are perception differences between the general public and local officials on controversial facilities. Local officials responsible for endorsing and supervising plants attach more significance to environmental factors than the public, while the public focuses more on social and political factors than officials. There is no significant difference in the cognition of economic benefits. Factors such as demolition compensation and legitimacy may provoke these perception gaps. This paper enriches the current understanding of SJT and policy making for controversial facilities by investigating the perception gaps between officials and the general public.

  9. The remaining risk to be accepted with test facilities and prototype plants, and the relevant legal provisions of nuclear law

    International Nuclear Information System (INIS)

    Mayinger, T.

    1995-01-01

    The first chapter explains the provisions laid down in nuclear law to assure that precaution is taken to prevent damage resulting from the operation of nuclear power reactors, in order to set a line for comparison with the relevant legal provisions relating to test facilities and prototype plants. The comparative analysis shows that the means and methods of precaution are defined to comprise three approaches, namely measures taken to avert danger, measures taken to prevent danger, and measures for (remaining) risk minimization. All three approaches are intended to prevent occurrence of specifically nuclear events. The second chapter characterizes power reactors, prototype plant and test facilities and develops criteria for distinction. The third chapter establishes the systematics for comparison, showing whether and how the mandatory precaution to prevent damage defined for power reactors, prototype plant, and test facilities can be distinguished from each other, the results being represented in a systematic survey of licensing requirements as laid down in section 7, sub-section 2 ATG (Atomic Energy Act). (orig./HP) [de

  10. Development of stand-alone risk assessment software for optimized maintenance planning of power plant facilities

    International Nuclear Information System (INIS)

    Choi, Woo Sung; Song, Gee Wook; Kim, Bum Shin; Chang, Sung Ho; Lee, Sang Min

    2015-01-01

    Risk-Risk-based inspection (RBI) has been developed in order to identify risky equipment that can cause major accidents or damages in large-scale plants. This assessment evaluates the equipment's risk, categorizes their priorities based on risk level, and then determines the urgency of their maintenance or allocates maintenance resources. An earlier version of the risk-based assessment software is already installed within the equipment management system; however, the assessment is based on examination by an inspector, and the results can be influenced by his subjective judgment, rather than assessment being based on failure probability. Moreover, the system is housed within a server, which limits the inspector's work space and time, and such a system can be used only on site. In this paper, the development of independent risk-based assessment software is introduced; this software calculates the failure probability by an analytical method, and analyzes the field inspection results, as well as inspection effectiveness. It can also operate on site, since it can be installed on an independent platform, and has the ability to generate an I/O function for the field inspection results regarding the period for an optimum maintenance cycle. This program will provide useful information not only to the field users who are participating in maintenance, but also to the engineers who need to decide whether to extend the life cycle of the power machinery or replace only specific components

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

    Science.gov (United States)

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

    2018-03-01

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

  12. Magnitude estimate of occupational risks located in a radiative facility and its main health impacts

    International Nuclear Information System (INIS)

    Alves, Alice dos Santos; Gerulis, Eduardo; Carneiro, Janete C.G.G.

    2014-01-01

    The work routine of Radiopharmacy Center (CR) personnel of the Institute of Energy Research and Nuclear (IPEN / CNEN-SP) includes singularities not exist in other professions. Relevant examples to this study can be cited: exposure to physical, chemical, biological hazards, to accidents and ergonomic risks. The objective of this study is to conduct a quantitative and qualitative evaluation of occupational exposure existing in the workplace and its impact on the health of occupationally exposed individuals (IOE's). The proposed methodology was based on systematic observation and a questionnaire to the managers of each practice held at CR. The evaluation process involved three steps: a) characterization of exposure; b) identification of the main points of exposure and possible routes of exposure; c) quantifying of exposure. Seventeen occupational agents related to the tasks of different groups of IOE's were identified. Ionizing radiation (physical risk) and the situations that cause stress (ergonomic risk) had the highest frequencies. According to the applied methodology risks was considered mostly acceptable. Quantification of exposure was basically referring to physical risk agent (Ionizing radiation), because it is a radioactive installation. Based on the records analyzed, not was observed health risks to workers arising from the activities undertaken

  13. Introduction and preparation of the nuclear fuel cycle facility risk analysis code: STAR

    International Nuclear Information System (INIS)

    Nomura, Yasushi

    1990-09-01

    STAR code is a computer program, by which one can perform the probabilistic safety assessment (PSA) for the nuclear fuel cycle facility in both the normal and the accidental event of environmental radioactive material release. This code was originally developed by NUKEM GmbH in West Germany as a fruit of the PSE (Projekt Sicherheitsstudien Entsorgung) aiming at R and D of safety analysis methods for use in nuclear fuel cycle facilities such as reprocessing plants. In JAERI, efforts have been made to research and develop safety assessment methods applicable to the accidental situations assumed to happen in the reprocessing plants. In this line of objectives, the STAR code was introduced from NUKEM GmbH in 1986 and, since then, has been improved and prepared to add an ability to analyze public radiation exposure by released activities from the plants. At the first stage of this code preparation, the program conversion was made to adapt the STAR code, originally operative on IBM-compatible PC's and Hewlett Packard 7550A plotters, to NEC PC 9801RX and NEC PR 602R page printers installed in the Fuel Cycle Safety Assessment Laboratory of JAERI. This report describes calculational performances of the STAR code, results of the improvement and preparation works together with input/output data format in illustration of a sample HALW (High Activity Liquid Waste) tank PSA problem, thus making a users' manual for the STAR code. (author)

  14. Decision-Making for Risk Management in Sustainable Renewable Energy Facilities: A Case Study in the Dominican Republic

    Directory of Open Access Journals (Sweden)

    Guido C. Guerrero-Liquet

    2016-05-01

    Full Text Available Today, Renewable Energy Sources (RES are a key pillar to achieving sustainable development, which is the main reason why energy projects are being carried out not only in developed countries but also in many emerging countries. Since the technical and financial risk remains a major barrier to financing renewable energy projects, several mechanisms are available to reduce risks on investment into clean energy projects. This paper discusses risk management tools in solar photovoltaic facilities based on the guide to the Project Management (PMBOK Guide. To do this, a combination of different decision-making methodologies will be carried out. These methodologies enable to not only extract the knowledge by experts but also to know the causes and effects that help to make the best decision. In order to do so, techniques to seek information (Delphi and Checklist as well as diagram techniques such as cause and effect diagrams or Strengths Weaknesses Opportunities and Threats (SWOT are applied. The categorization and prioritization of risks will be carried out through the Analytic Hierarchy Process (AHP. Finally, a sensitivity analysis will allow for providing consistency to the obtained results. A real case in the Dominican Republic will also be presented as case study.

  15. Risk assessment of occupational radiation dose at the teletherapy facility of the Korle-Bu Teaching Hospital, Ghana

    International Nuclear Information System (INIS)

    Gollo, Selasie Richie Valens Kweku

    2016-07-01

    The National centre for Radiotherapy and Nuclear Medicine at the Korle-bu Teaching Hospital in Ghana uses a Theratron Equinox 100 Cobalt-60 teletherapy machine that was commissioned in 2014 with a source activity of 370.4TBq. The prime objective of this research was to estimate the risk and probability of cancer induction to workers and also to evaluate the level of radiation safety at the facility. Data was collected by means of TLDs and personal dose records available between the periods February 2010 and April 2016. The results from 2010-2016 were used to compute the mean annual dose, mean annual collective dose as well as risk assessments using the ICRP 1990 and 2007 recommendations. Ambient dose rate measurements were also done using a Thermo electron survey meter. The Results showed that mean effective dose recorded from TLDs used in this research ranged from 0.08mSv-0.36mSv whiles dose records from 2010-2016 showed mean annual effective doses ranged between 0.23mSv-0.65mSv. Mean annual collective dose was 0.09 mSv. Annual cancer risk estimates also showed that workers probability of developing cancers had a mean value of 2.37 x 10"-"2±7.75 x 10"-"3 whiles risk of passing hereditary traits to offspring born after exposure showed a mean value 3.96 x 10"-"3± 1.29 x 10"-"3 according to the ICRP 1990 recommendations and ICRP 2007 showed that possibility of cancer induction to workers showed a mean value of 2.03 x 10"-"2±1.61 x 10"-"3. Mean annual dose rates did not exceed 14.8mSv/a,5mSv/a and 0.74mSv/a for the treatment room, control console room and the controlled area respectively. This shows that workers at the facility are not likely to exceed the recommended dose limit within a year while working at the facility. Ambient dose rates did not exceed 7.39μSv/hr, 2.80μSv/hr and 0.37μSv/hr for the treatment room, control console room and the controlled area respectively. These values obtained are below the recommended limit of 20μSv/hr. (au)

  16. Comparative risk assessments for the production and interim storage of glass and ceramic waste forms: defense waste processing facility

    International Nuclear Information System (INIS)

    Huang, J.C.; Wright, W.V.

    1982-04-01

    The Defense Waste Processing Facility (DWPF) for immobilizing nuclear high level waste (HLW) is scheduled to be built at the Savannah River Plant (SRP). High level waste is produced when SRP reactor components are subjected to chemical separation operations. Two candidates for immobilizing this HLW are borosilicate glass and crystalline ceramic, either being contained in weld-sealed stainless steel canisters. A number of technical analyses are being conducted to support a selection between these two waste forms. The present document compares the risks associated with the manufacture and interim storage of these two forms in the DWPF. Process information used in the risk analysis was taken primarily from a DWPF processibility analysis. The DWPF environmental analysis provided much of the necessary environmental information. To perform the comparative risk assessments, consequences of the postulated accidents are calculated in terms of: (1) the maximum dose to an off-site individual; and (2) the dose to off-site population within 80 kilometers of the DWPF, both taken in terms of the 50-year inhalation dose commitment. The consequences are then multiplied by the estimated accident probabilities to obtain the risks. The analyses indicate that the maximum exposure risk to an individual resulting from the accidents postulated for both the production and interim storage of either waste form represents only an insignificant fraction of the natural background radiation of about 90 mrem per year per person in the local area. They also show that there is no disaster potential to the off-site population. Therefore, the risks from abnormal events in the production and the interim storage of the DWPF waste forms should not be considered as a dominant factor in the selection of the final waste form

  17. Nurses' Assessment of Rehabilitation Potential and Prediction of Functional Status at Discharge from Inpatient Rehabilitation

    Science.gov (United States)

    Myers, Jamie S.; Grigsby, Jim; Teel, Cynthia S.; Kramer, Andrew M.

    2009-01-01

    The goals of this study were to evaluate the accuracy of nurses' predictions of rehabilitation potential in older adults admitted to inpatient rehabilitation facilities and to ascertain whether the addition of a measure of executive cognitive function would enhance predictive accuracy. Secondary analysis was performed on prospective data collected…

  18. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-05-10

    ... Readmission 5. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Reverse... hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are..., (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee, (410) 786-8691 and...

  19. Associations between Relational Aggression, Depression, and Suicidal Ideation in a Child Psychiatric Inpatient Sample

    Science.gov (United States)

    Fite, Paula J.; Stoppelbein, Laura; Greening, Leilani; Preddy, Teresa M.

    2011-01-01

    The current study examined relations between relational aggression, depressive symptoms, and suicidal ideation in a child clinical population. Participants included 276 children (M age = 9.55 years; 69% Male) who were admitted to a child psychiatric inpatient facility. Findings suggested that relational aggression was associated with depressive…

  20. The logistics of an inpatient dermatology service.

    Science.gov (United States)

    Rosenbach, Misha

    2017-03-01

    Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.

  1. 75 FR 59329 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; 2011 Fiscal Year Update

    Science.gov (United States)

    2010-09-27

    ...-connected disability incurred as a result of a motor vehicle accident in a State that requires automobile... the following types of charges: Acute inpatient facility charges; skilled nursing facility/sub-acute... number.) SUPPLEMENTARY INFORMATION: Of the charge types listed in the Summary section of this notice...

  2. User involvement in structured violence risk management within forensic mental health facilities -- a systematic literature review.

    Science.gov (United States)

    Eidhammer, Gunnar; Fluttert, Frans A J; Bjørkly, Stål

    2014-10-01

    To examine empirical literature on user involvement in collaboration between patients and nurses. The scope of the review was limited to structured violence risk management interventions in forensic mental health settings. Violence in forensic mental health settings represents a significant problem for patients and staff. Structured violence risk management interventions in forensic mental health have been reported to ignore patient participation, despite the growing attention on user involvement in clinical practice. A systematic review. Searches were conducted in six databases: the Cochrane Systematic Reviews, MEDLINE, CINAHL, ProQuest, ScienceDirect and PsycINFO. Papers were assessed according to a predetermined set of inclusion and exclusion criteria. After searches of the reference lists of retrieved articles were conducted, only three papers met the inclusion criteria. This review has shown that empirical research on the topic of risk management interventions in which patients are involved is scarce. There is barely any research evidence of the clinical effect of user involvement approaches on violence risk management in forensic mental health practice. Therefore, we suggest that clinicians may learn from positive experiences concerning user involvement in general psychiatry and carefully adapt and test them out in the forensic treatment context. © 2014 John Wiley & Sons Ltd.

  3. Chemical Risk Evaluation: A Case Study in an Automotive Air Conditioner Production Facility

    Directory of Open Access Journals (Sweden)

    Tengku Hanidza T.I.

    2010-01-01

    Full Text Available There has been limited knowledge on worker’s exposure to chemicals used in the automotive industries. The purpose of this study is to assess chemical risk and to determine the adequacy of the existing control measures to reduce chemical exposure. A cross sectional survey was conducted in a factory involving installation and servicing of automotive air conditioner units. Qualitative exposure assessment was carried out following the Malaysian Chemical Health Risk Assessment Manual (CHRA. There were 180 employees, 156 workers worked in the production line, which constitutes six work units Tube fin pressed, Brazing, Welding, Final assembly, Piping and Kit II. From the chemical risk evaluation for each work unit, 26 chemical compounds were used. Most of the chemicals were irritants (eye and skin and some were asphyxiants and sensitizers. Based on the work assignment, 93 out of 180 (51.67% of the workers were exposed to chemicals. The highest numbers of workers exposed to chemicals were from the Brazing section (22.22% while the Final Assembly section was the lowest (1.67%. Health survey among the workers showed occurrence of eye irritation, skin irritation, and respiratory irritation, symptoms usually associated with chemical exposure. Using a risk rating matrix, several work process were identified as having ‘significant risk’. For these areas, the workers are at risk of adverse health effects since chemical exposure is not adequately controlled. This study recommends corrective actions be taken in order to control the level of exposure and to provide a safe work environment for workers.

  4. Residual cognitive disability after completion of inpatient rehabilitation among injured children.

    Science.gov (United States)

    Zonfrillo, Mark R; Durbin, Dennis R; Winston, Flaura K; Zhang, Xuemei; Stineman, Margaret G

    2014-01-01

    To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury. Copyright © 2014 Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-09-01

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

  6. Environmental risks of power generation from fossil fuels and nuclear facilities

    International Nuclear Information System (INIS)

    Probert, D.; Tarrant, C.

    1989-01-01

    The nuclear power industry, when considered via statistical arguments, is far less dangerous than the average 'man in the street' in the UK perceives it to be. To support this assertion, an elementary analysis of the risk factors associated with commonplace hazards (e.g. road accidents and smoking) is presented. The radiological risks resulting from the Chernobyl nuclear power station accident, even in the most badly affected areas of the UK and at the times of highest intensity, were much less than those due to natural background radiation. Radioactive elements occur naturally in coal and are released as a result of combustion into the UK environment via flue gases and ash in significantly greater amounts than those from nuclear power stations. (author)

  7. Overall risk estimation for nonreactor nuclear facilities and implementation of safety goals

    International Nuclear Information System (INIS)

    Kim, Kyo S.; Bradley, R.F.

    1992-01-01

    A typical safety analysis report (SAR) contains estimated frequencies and consequences of various design basis accident (DBA) analyses. However, the results are organized and presented in such a way that they are not conducive for summing up with mathematical rigor to give total or overall risk. This paper describes a simple protocol and mathematical formalism to derive overall risk indicators. These indicators provide some insight into the capability of confinement barriers with characteristics of source terms, and provide comparison to the Safety Goals. The protocol makes maximum use of the results of DBA analyses typically available from an SAR. The mathematical formalism is based on the cumulative complementary distribution function (CCDF) or exceedance probability of radioactivity release fraction and individual radiation dose. An example case analysis is presented to illustrate how to use the proposed protocol and mathematical formalism. A discussion of the result is also presented in terms of confinement characteristic and compliance to Safety Goals

  8. Assessing risks to fish populations near a proposed disposal facility for used nuclear fuel

    International Nuclear Information System (INIS)

    Hart, D.; Miesenheimer, P.; Hull, R.

    1995-01-01

    The concept of used nuclear fuel disposal in the Canadian Shield is currently undergoing a federal environmental assessment review process. As part of this review, potential risks to brook trout populations in the vicinity of such an underground repository were considered. Chemical fate, transport and exposure models have been utilized to estimate the dose rates from released radionuclides and other fuel constituents, and these likely will not be sufficient to harm fish in nearby streams. However, other stressors such as habitat alteration (e.g., loss of upwelling) and/or fishing pressure associated with increased public access could have significant population impacts if the site is located in a pristine northern region. Population models are utilized to explore the risks of local population reduction for different combinations of fishing pressure and habitat degradation

  9. Risk factors for birth asphyxia in an urban health facility in cameroon.

    Science.gov (United States)

    Chiabi, Andreas; Nguefack, Seraphin; Mah, Evelyne; Nodem, Sostenne; Mbuagbaw, Lawrence; Mbonda, Elie; Tchokoteu, Pierre-Fernand; Doh Frcog, Anderson

    2013-01-01

    The World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates. This study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour, prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% had a satisfactory outcome. The incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal visits through informing and communicating with pregnant women should be reinforced.

  10. Replacement of HEPA Filters at the LANL CMR Facility: Risks Reduced by Comprehensive Waste Characterization

    International Nuclear Information System (INIS)

    Corpion, J.; Barr, A.; Martinez, P.; Bader, M.

    2002-01-01

    In March 2001, the Los Alamos National Laboratory (LANL) completed the replacement of 720 radioactively contaminated HEPA filters for $5.7M. This project was completed five months ahead of schedule and $6.0M under budget with no worker injuries or contaminations. Numerous health and safety, environmental, and waste disposal problems were overcome, including having to perform work in a radioactively contaminated work environment, that was also contaminated with perchlorates (potential explosive). High waste disposal costs were also an issue. A project risk analysis and government cost estimate determined that the cost of performing the work would be $11.8M. To reduce risk, a $1.2M comprehensive condition assessment was performed to determine the degree of toxic and radioactive contamination trapped on the HEPA filters; and to determine whether explosive concentrations of perchlorates were present. Workers from LANL and personnel from Waldheim International of Knoxville, TN collected hundreds of samples wearing personnel protective gear against radioactive, toxic, and explosive hazards. LANL also funded research at the New Mexico Institute of Mining and Technology to determine the explosivity of perchlorates. The data acquired from the condition assessment showed that toxic metals, toxic organic compounds, and explosive concentrations of perchlorates were absent. The data also showed that the extent of actinide metal contamination was less than expected, reducing the potential of transuranic waste generation by 50%. Consequently, $4.2M in cost savings and $1.8M in risk reduction were realized by increased worker productivity and waste segregation

  11. Children using Day Nurseries' Facilities can be Associated with more Risk to Nonnutritive Sucking Habits.

    Science.gov (United States)

    Alves, Fabiana Bt; Wambier, Denise S; Alvarez, Jenny Ha; da Rocha, José Cf; Kummer, Thais R; de Castro, Vanessa C; Cabral, Howard; Kozlowski, Vitoldo A

    2016-09-01

    This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that

  12. An integrated approach to risk-based remediation of a former bulk fuel storage facility adjacent a marine environment

    Energy Technology Data Exchange (ETDEWEB)

    Kemp, L.; Hers, I. [Golder Associates Ltd., Vancouver, BC (Canada)

    2006-07-01

    An integrated approach to risk-based remediation of a former bulk fuel storage facility adjacent to a marine environment was discussed. The presentation provided an introduction and illustration to the site location and history, located close to Skagway, Alaska and northwestern British Columbia. The site investigation and conceptual model were also presented. The remedial approach was also described with reference to a risk-based action approach, remedial objectives, soil vapour extraction (SVE)-bioventing, and air sparging-biosparging. The objectives were to minimize potential exposure to aquatic receptors by minimizing non-aqueous phase liquids (NAPL) mobility and dissolved transport of petroleum hydrocarbons. Groundwater modeling to assess the attenuation rate and to determine remedial targets was also discussed. Model validation and results of groundwater modeling as well as remediation system details and performance were then provided. It was determined that significant attenuation is occurring and that effective mass removal and concentrations have been decreasing over time. It was demonstrated that risk-based remedial goals and hydrogeology can change with land use/development. tabs., figs.

  13. Collective statement on major nuclear safety research facilities and programmes at risk

    International Nuclear Information System (INIS)

    2001-01-01

    Nuclear safety research remains necessary, since nuclear power programmes are dynamic. In addition to maintaining in-depth competencies, its aim is to provide information to plant designers, operators and regulators in support of the resolution of safety issues, to strengthen confidence in their solution and their implementation, and also to anticipate problems of potential significance. New fields of research open up as a result of plant ageing, plant life extension, plant up-rating, optimisation of plant economics and the associated need to further reduce uncertainties in safety margins quantification. The safety evaluation of future reactor systems being developed or considered in several Member countries also requires new research efforts. Accordingly, Member countries are encouraged to support efforts to maintain key research data, facilities and programmes through national support of international co-operation and funding. This should be under-pinned by development of short-, medium- and long-term strategic visions of the needs of the nuclear safety research community, including a strong component of international collaboration given the international nature of nuclear safety issues. (author)

  14. Probabilistic risk assessment for salt repository conceptual design of subsurface facilities: A techical basis for Q-list determination

    International Nuclear Information System (INIS)

    Chen, C.P.; Mayberry, J.J.; Shepherd, J.; Koza, H.; Rahmani, H.; Sinsky, J.

    1987-12-01

    Subpart G ''Quality Assurance'' of 10 CFR Part 60 requires that the US Department of Energy (DOE) apply a quality assurance program to ''all systems, structures, and components important to safety'' and to ''design and characterization of barriers important to waste isolation.'' In April 1986, DOE's Office of Geologic Repositories (OGR) issued general guidance for formulating a list of such systems, structures, and components---the Q-list. This guidance called for the use of probabilistic risk assessment (PRA) techniques to identify Q-list items. In this report, PRA techniques are applied to the underground facilities and systems described in the conceptual design report for the Salt Repository Project (SRP) in Deaf Smith County, Texas. Based on probability and dose consequence calculations, no specific items were identified for the Q-list. However, evaluation of the analyses indicated that two functions are important in precluding off-site releases of radioactivity: disposal container integrity; and isolation of the underground facility by the heating, ventilation, and air conditioning (HVAC) systems. Items related to these functions are recommended for further evaluation as the repository design progresses. 13 refs., 20 figs

  15. Evaluation of risks associated with nuclear facilities: Variation of results according to the models proposed

    International Nuclear Information System (INIS)

    Hubert, Ph.

    1983-01-01

    The methods employed in evaluating radiological risk are based, by and large, on the non-threshold linear relationships proposed by the ICRP and the Advisory Committee on the Biological Effects of Ionizing Radiations (BEIR) of the US Academy of Sciences in its 1972 report. Recently, the contentious discussions surrounding the latest BEIR report and the publication of new estimates of the doses received at Hiroshima and Nagasaki have reopened the controversy surrounding dose-effect relationships. The chief point at issue is the shape of this relationship - whether or not it is linear and whether it has a threshold - and the role of radiation in carcinogenesis, both in association with other risk factors and as an independent factor. The present paper leaves the theoretical questions aside and instead shows how, by marshalling information on irradiated human populations, a sequence of calculations can be set up to enable specialists to assign numerical values to the coefficients for these relationships. In an empirical approach such as this, theoretical hypotheses are no longer the sole factors at work. Comparatively pragmatic choices, such as the sample on the basis of which the curves are adjusted, the survival tables used, or even the simplifications made in taking account of sex and age, can also influence the result obtained. Sensitivity analyses are presented for the value of the coefficient of cancer induction per unit dose, showing that controversial theoretical options such as the transformation of a linear into a quadratic linear relationship have no greater effect on the result than other more contingent choices. Lastly, the implications of these sensitivity analyses for the practical application of dose-risk relationships are examined in relation to impact studies, optimization procedures, etc. (author)

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

    Science.gov (United States)

    Mantravadi, S

    2017-04-01

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

  17. Development of Risk Insights for Regulatory Review of a Near-Surface Disposal Facility for Radioactive Waste

    International Nuclear Information System (INIS)

    Esh, D.W.; Ridge, A.C.; Thaggard, M.

    2006-01-01

    Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA) requires the Department of Energy (DOE) to consult with the Nuclear Regulatory Commission (NRC) about non-High Level Waste (HLW) determinations. In its consultative role, NRC performs technical reviews of DOE's waste determinations but does not have regulatory authority over DOE's waste disposal activities. The safety of disposal is evaluated by comparing predicted disposal facility performance to the performance objectives specified in NRC regulations for the disposal of low-level waste (10 CFR Part 61 Subpart C). The performance objectives contain criteria for protection of the public, protection of inadvertent intruders, protection of workers, and stability of the disposal site after closure. The potential radiological dose to receptors typically is evaluated with a performance assessment (PA) model that simulates the release of radionuclides from the disposal site, transport of radionuclides through the environment, and exposure of potential receptors to residual contamination for thousands of years. This paper describes NRC's development and use of independent performance assessment modeling to facilitate review of DOE's non-HLW determination for the Saltstone Disposal Facility (SDF) at the Savannah River Site. NRC's review of the safety of near-surface disposal of radioactive waste at the SDF was facilitated and focused by risk insights developed with an independent PA model. The main components of NRC's performance assessment model are presented. The development of risk insights that allow the staff to focus review efforts on those areas that are most important to satisfying the performance objectives is discussed. Uncertainty analysis was performed of the full stochastic model using genetic variable selection algorithms. The results of the uncertainty analysis were then used to guide the development of simulations of other scenarios to understand the key risk

  18. Policy for introduction of risk-informed regulation for nuclear facilities in Japan

    International Nuclear Information System (INIS)

    Akihide Hidaka; Shoichiro Sakaguchi; Toshihiro Bannai; Kunihiro Matsui

    2005-01-01

    The nuclear safety regulations in Japan place a basis on the deterministic approach with the defence-in-depth philosophy and engineering judgments. However, as the development of PSA (Probabilistic Safety Assessment) technologies in recent years, the Nuclear Safety Commission (NSC) began to consider that the utilization of risk information in addition to the traditional deterministic approach could be very effective for the safety regulations to improve rationality, consistency, transparency and efficiency by appropriate allocation of limited resources for the regulatory activities. In order to show the basic strategy, the NSC published the policy for introduction of Risk-Informed Regulation (RIR) in November 2003. The safety goals that play an important role in RIR were tentatively established in December 2003 while the performance goals are under development as of May, 2005. It is expected that RIR be gradually introduced from the applicable area. The NSC is now examining what the RIR system in Japan should be by making each role and incentive of the competent organizations clear. In the future, when the experiences on application of the safety goals are accumulated, RIR will be consistently applied from design to operational area. This paper describes the recent activities of the NSC for introduction of RIR in Japan and development of the safety goals including the performance goals. (authors)

  19. Health risks associated with ingesting venison from a uranium enrichment facility with multiple operable units

    International Nuclear Information System (INIS)

    Duncan, J.; Welsh, C.

    1995-01-01

    Ingestion of game, including venison, may be a significant exposure pathway in human health risk assessments at hazardous waste sites. The difficulty associated with modeling contaminant tissue concentrations in a wide-ranging herbivorous mammal is compounded when the home range of the mammal extends over multiple operable units (OUs) of varying size and media contaminant concentration. Using biotransfer factors extracted from the literature and species-specific parameter information (e.g., home range size, diet, forage and water ingestion rates) the authors estimate contaminant concentrations in venison based on soil and surface water contaminant concentrations and determine the contribution of individual OUs to modeled venison tissue concentrations. Estimated tissue concentrations are calculated through the use of site foraging factors (SFFS) that adjust exposure contributions from individual OUs to account for the size of the OU in relation to the animals home range. The authors then use the venison tissue concentrations to estimate human health risk associated with ingesting venison under both a current and future exposure scenario

  20. Using the weight-of-evidence approach for ecological risk assessment at a DOE facility

    International Nuclear Information System (INIS)

    Hull, R.N.; Suter, G.W.

    1994-01-01

    The Portsmouth Gaseous Diffusion Plant (PORTS), an uranium enrichment plant, has released various contaminants into the environment. An ecological risk assessment is underway for the site, which includes an evaluation of Little Beaver Creek, which flows along the eastern and northern sides of PORTS. For this assessment, the creek was divided into reaches which were defined in terms of contaminant sources. This creek receives contaminants from permitted outfalls, groundwater discharge, non-point sources, and accidental releases. Metal contamination is the major concern at the site. Receptors include the fish and benthic communities in the creek, and soil invertebrates and plants in the floodplain. A weight-of-evidence approach was used to evaluate risks to those receptors, based on chemical analyses, toxicity tests and field surveys. The fish and benthic communities are impacted on Little Beaver Creek in a reach near a permitted discharge, with improvements seen downstream of this location. Ambient water, sediment and soil samples were not toxic to laboratory organisms. Either these toxicity tests were not sufficiently sensitive to detect toxicity, or the observed changes in the aquatic communities did not result from toxicity. Because conditions improved downstream from the permitted discharge, it was concluded that this is the major source of toxicity in the creek

  1. 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.

  2. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Science.gov (United States)

    2012-01-01

    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. PMID:23122411

  3. Best practices: increased attendance in inpatient group psychotherapy improves patient outcomes.

    Science.gov (United States)

    Page, Andrew C; Hooke, Geoffrey R

    2009-04-01

    This column describes an initiative that promoted increased attendance in group psychotherapy and its effect on patient outcomes. Information on patient- and staff-rated outcomes, readmission rates, and patient satisfaction was gathered for 2,782 inpatients in a private psychiatric facility in Australia. On average, after the initiative was implemented, patients went from attending one session per day to two sessions. Inpatients admitted after implementation had better patient- and staff-rated outcomes and lower rates of readmission within one month of discharge. However, patients' treatment satisfaction ratings declined. These findings indicate that increasing attendance in group psychotherapy can be a useful adjunct to hospital treatment.

  4. A survey of atmospheric dispersion models applicable to risk studies for nuclear facilities in complex terrain

    International Nuclear Information System (INIS)

    Wittek, P.

    1985-09-01

    Atmospheric dispersion models are reviewed with respect to their application to the consequence assessment within risk studies for nuclear power plants located in complex terrain. This review comprises: seven straight-line Gaussian models, which have been modified in order to take into account in a crude way terrain elevations, enhanced turbulence and some others effects; three trajectory/puff-models, which can handle wind direction changes and the resulting plume or puff trajectories; five three-dimensional wind field models, which calculate the wind field in complex terrain for the application in a grid model; three grid models; one Monte-Carlo-model. The main features of the computer codes are described, along with some informations on the necessary computer time and storage capacity. (orig.) [de

  5. Topography and its effects on atmospheric dispersion in a risk study for nuclear facilities

    International Nuclear Information System (INIS)

    Wittek, P.

    1985-07-01

    In the consequence assessment model, applied in the German Reactor Risk Study (GRRS), atmospheric dispersion of radioactive substances is beeing treated with a straight line Gaussian dispersion model. But some of the German nuclear power plants are located in complex terrain. In this report, the 19 sites which are considered in the GRRS, are described and classified by two different methods in respect to terrain complexity. The relevant effects of the terrain on the dispersion are commented. Two modifications of the GRRS consequence assessment code UFOMOD take into account in a simple way the terrain elevation and the enhanced turbulence effected eventually by the terrain structure. Sample calculations for two release categories of the GRRS demonstrate the effect of these modifications on the calculated number of early fatalities. (orig.) [de

  6. Medical weather forecast as the risk management facilities of meteopathia with population

    Science.gov (United States)

    Efimenko, Natalya; Chalaya, Elena; Povolotskaia, Nina; Senik, Irina; Topuriya, David

    2013-04-01

    Frequent cases of extreme deviations of weather conditions and anthropogenic press on the Earth atmosphere are external stressors and provoke the development of meteopathic reactions (DMR) with people suffering from dysadaptation (DA). [EGU2011-6740-3; EGU2012-6103]. The influence of weather factors on the person is multivariate which complicates the search of physiological indicators of this exposure. The results of long-term researches of meteodependence and risks development of weather-conditional pathologic reactions with people suffering from DA (1640 observed people) in various systems and human body subsystems (thermal control, cardiovascular, respiratory, vegetative and central nervous systems) were taken as a principle of calculation methodology of estimation of weather pathogenicity (EWP). This estimation is used in the system of medical weather forecast (MWF) in the resorts of Caucasian Mineral Waters and is marked as an organized structure in prevention of DMR risks. Nowadays MWF efficiency is from 78% to 95% as it depends not only on the performance of models of dynamic, synoptic, heliogeophysical forecasts, but also on the underestimation of environmental factors which often act as dominating stressors. The program of atmospheric global system monitoring and real-time forecasts doesn`t include atmospheric electricity factors, ionization factors, range and chemistry factors of aerosol particles and organic volatile plant matters in atmospheric boundary layer. New fractality researches of control mechanisms processes providing adaptation to external and internal environmental conditions with patients suffering from DA allowed us to understand the meaning of the phenomenon of structural similarity and similarity of physiological response processes to the influence of weather types with similar dominating environmental factors. Particularly, atmospheric conditions should be regarded as stressor natural factors that create deionization conditions of the

  7. Dissociative disorders in acute psychiatric inpatients in Taiwan.

    Science.gov (United States)

    Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A

    2017-04-01

    Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  8. The effects of hospital competition on inpatient quality of care.

    Science.gov (United States)

    Mutter, Ryan L; Wong, Herbert S; Goldfarb, Marsha G

    2008-01-01

    Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However, the effect is not unidirectional: some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain.

  9. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all...... hospitalizations in the United States. Hospitalization rates for AD or eczema were highest in the northeast during the winter and south during the summer. Geometric mean cost of care (95% confidence interval) was lower for a primary diagnosis of AD or eczema versus no AD or eczema in adults ($3,502 [$3......,360-$3,651] vs. $6,849 [$6,775-$6,925]; P = 0.0004) and children ($2,716 [$2,542-$2,903] vs. $4,488 [$4,302-$4,682]; P = 0.0004). However, the high prevalence of hospitalization resulted in total inpatient costs of $8,288,083 per year for adults and $3,333,868 per year for children. In conclusion...

  10. Can a GIS toolbox assess the environmental risk of oil spills? Implementation for oil facilities in harbors.

    Science.gov (United States)

    Valdor, Paloma F; Gómez, Aina G; Velarde, Víctor; Puente, Araceli

    2016-04-01

    Oil spills are one of the most widespread problems in port areas (loading/unloading of bulk liquid, fuel supply). Specific environmental risk analysis procedures for diffuse oil sources that are based on the evolution of oil in the marine environment are needed. Diffuse sources such as oil spills usually present a lack of information, which makes the use of numerical models an arduous and occasionally impossible task. For that reason, a tool that can assess the risk of oil spills in near-shore areas by using Geographical Information System (GIS) is presented. The SPILL Tool provides immediate results by automating the process without miscalculation errors. The tool was developed using the Python and ArcGIS scripting library to build a non-ambiguous geoprocessing workflow. The SPILL Tool was implemented for oil facilities at Tarragona Harbor (NE Spain) and validated showing a satisfactory correspondence (around 0.60 RSR error index) with the results obtained using a 2D calibrated oil transport numerical model. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Using the MMPI 168 with Medical Inpatients

    Science.gov (United States)

    Erickson, Richard C.; Freeman, Charles

    1976-01-01

    Explores the potential utility of the MMPI 168 with two inpatient medical populations. Correlations and clinically relevant comparisons suggest that the MMPI 168 predicted the standard MMPI with a high degree accuracy. (Editor/RK)

  12. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  13. Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

    Science.gov (United States)

    Lavigne, Jenifer L; Portwood, Sharon G; Warren-Findlow, Jan; Brunner Huber, Larissa R

    The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Inpatient Psychiatric Prospective Payment System (IPF PPS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains case level data for inpatient psychiatric stays and is derived from 2011 MEDPAR data file and the latest available provider specific file. The...

  15. Predictors of psychiatric inpatient suicide: a national prospective register-based study

    DEFF Research Database (Denmark)

    Madsen, Trine; Agerbo, Esben; Mortensen, Preben B

    2012-01-01

    significantly decreased, about 6% each year (HR = 0.94; 95% CI, 0.90-0.99), over this 10-year period. Several significant predictors of suicide were found, including the following: Patients with a bachelor's degree had a significantly higher hazard ratio (HR) of suicide compared with those with a primary school...... (within the last year) with a private psychologist (HR = 1.85; 95% CI, 1.05-3.28). Recent suicide attempt before admission to the hospital was associated with the highest risk of inpatient suicide (HR = 4.99; 95% CI, 3.57-6.96). CONCLUSIONS: This study demonstrated a high risk of psychiatric inpatient...

  16. [The state of quality management implementation in ambulatory care nursing and inpatient nursing].

    Science.gov (United States)

    Farin, E; Hauer, J; Schmidt, E; Kottner, J; Jäckel, W H

    2013-02-01

    The demands being made on quality assurance and quality management in ambulatory care nursing and inpatient nursing facilities continue to grow. As opposed to health-care facilities such as hospitals and rehabilitation centres, we know of no other empirical studies addressing the current state of affairs in quality management in nursing institutions. The aim of this investigation was, by means of a questionnaire, to analyse the current (as of spring 2011) dissemination of quality management and certification in nursing facilities using a random sample as representative as possible of in- and outpatient institutions. To obtain our sample we compiled 800 inpatient and 800 outpatient facilities as a stratified random sample. Federal state, holder and, for inpatient facilities, the number of beds were used as stratification variables. 24% of the questionnaires were returned, giving us information on 188 outpatient and 220 inpatient institutions. While the distribution in the sample of outpatient institutions is equivalent to the population distribution, we observed discrepancies in the inpatient facilities sample. As they do not seem to be related to any demonstrable bias, we assume that our data are sufficiently representative. 4 of 5 of the responding facilities claim to employ their own quality management system, however the degree to which the quality management mechanisms are actually in use is an estimated 75%. Almost 90% of all the facilities have a quality management representative who often possesses specific additional qualifications. Many relevant quality management instruments (i. e., nursing standards of care, questionnaires, quality circles) are used in 75% of the responding institutions. Various factors in our data give the impression that quality management and certification efforts have made more progress in the inpatient facilities. Although 80% of the outpatient institutions claim to have a quality management system, only 32.1% of them admit to

  17. A Collision Risk Model to Predict Avian Fatalities at Wind Facilities: An Example Using Golden Eagles, Aquila chrysaetos.

    Science.gov (United States)

    New, Leslie; Bjerre, Emily; Millsap, Brian; Otto, Mark C; Runge, Michael C

    2015-01-01

    Wind power is a major candidate in the search for clean, renewable energy. Beyond the technical and economic challenges of wind energy development are environmental issues that may restrict its growth. Avian fatalities due to collisions with rotating turbine blades are a leading concern and there is considerable uncertainty surrounding avian collision risk at wind facilities. This uncertainty is not reflected in many models currently used to predict the avian fatalities that would result from proposed wind developments. We introduce a method to predict fatalities at wind facilities, based on pre-construction monitoring. Our method can directly incorporate uncertainty into the estimates of avian fatalities and can be updated if information on the true number of fatalities becomes available from post-construction carcass monitoring. Our model considers only three parameters: hazardous footprint, bird exposure to turbines and collision probability. By using a Bayesian analytical framework we account for uncertainties in these values, which are then reflected in our predictions and can be reduced through subsequent data collection. The simplicity of our approach makes it accessible to ecologists concerned with the impact of wind development, as well as to managers, policy makers and industry interested in its implementation in real-world decision contexts. We demonstrate the utility of our method by predicting golden eagle (Aquila chrysaetos) fatalities at a wind installation in the United States. Using pre-construction data, we predicted 7.48 eagle fatalities year-1 (95% CI: (1.1, 19.81)). The U.S. Fish and Wildlife Service uses the 80th quantile (11.0 eagle fatalities year-1) in their permitting process to ensure there is only a 20% chance a wind facility exceeds the authorized fatalities. Once data were available from two-years of post-construction monitoring, we updated the fatality estimate to 4.8 eagle fatalities year-1 (95% CI: (1.76, 9.4); 80th quantile, 6

  18. [Physical medicine in hospital. Minimum standards in a physical medical department in acute inpatient areas in rheumatology].

    Science.gov (United States)

    Reißhauer, A; Liebl, M E

    2012-07-01

    Standards for what should be available in terms of equipment and services in a department of physical medicine caring for acute inpatients do not exist in Germany. The profile of a department determines the therapeutic services it focuses on and hence the technical facilities required. The German catalogue of operations and procedures defines minimum thresholds for treatment. In the opinion of the authors a department caring for inpatients with acute rheumatic diseases must, as a minimum, have the facilities and equipment necessary for offering thermotherapeutic treatment. Staff trained in physical therapeutic procedures and occupational therapy is also crucial. Moreover, it is desirable that the staff should be trained in manual therapy.

  19. So, you want to design an acute mental health inpatient unit: physical issues for consideration.

    Science.gov (United States)

    Arya, Dinesh

    2011-04-01

    The aim of this paper is to explore important considerations when planning an acute mental health inpatient unit. Planning a mental health acute inpatient facility should be about more than just building a beautiful, fabulous facility. A novel architectural design, fancy gadgets, safe tapware, new lounge suites, good light and air circulation are all incredibly important and good architects and designers can inform us about new developments in architecture and design that we must incorporate in our design plans. However, to design a facility that is right for tomorrow, it is also important to spend time trying to understand what happens in the facility and how the new facility is going to make things different and better. Planning of a health facility should be about creating an environment that is not only pleasant, comfortable and safe but also one that would enable and facilitate better care. It is important to map processes before rather than after building a facility, so that this process mapping can inform design and we do not keep falling into the trap of building a beautiful new facility but losing the opportunity to make care better.

  20. Radiological transportation risk assessment of the shipment of sodium-bonded fuel from the Fast Flux Test Facility to the Idaho National Engineering Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Green, J.R.

    1995-01-31

    This document was written in support of Environmental Assessment: Shutdown of the Fast Flux Test Facility (FFTF), Hanford Site, Richland, Washington. It analyzes the potential radiological risks associated with the transportation of sodium-bonded metal alloy and mixed carbide fuel from the FFTF on the Hanford Site in Washington State to the Idaho Engineering Laboratory in Idaho in the T-3 Cask. RADTRAN 4 is used for the analysis which addresses potential risk from normal transportation and hypothetical accident scenarios.

  1. Radiological transportation risk assessment of the shipment of sodium-bonded fuel from the Fast Flux Test Facility to the Idaho National Engineering Laboratory

    International Nuclear Information System (INIS)

    Green, J.R.

    1995-01-01

    This document was written in support of Environmental Assessment: Shutdown of the Fast Flux Test Facility (FFTF), Hanford Site, Richland, Washington. It analyzes the potential radiological risks associated with the transportation of sodium-bonded metal alloy and mixed carbide fuel from the FFTF on the Hanford Site in Washington State to the Idaho Engineering Laboratory in Idaho in the T-3 Cask. RADTRAN 4 is used for the analysis which addresses potential risk from normal transportation and hypothetical accident scenarios

  2. Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

    Science.gov (United States)

    Reed, John L; Lyne, Maggi

    2000-01-01

    Objective To investigate the facilities for inpatient care of mentally disordered people in prison. Design Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. Setting 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. Main outcomes measures Appraisals of quality of care against published standards. Results The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. Conclusion The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration. PMID:10764360

  3. Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units.

    Science.gov (United States)

    Kidd, Sean A; McKenzie, Kwame; Collins, April; Clark, Carrie; Costa, Lucy; Mihalakakos, George; Paterson, Jane

    2014-02-01

    This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

  4. The Determinants of the Technical Efficiency of Acute Inpatient Care in Canada.

    Science.gov (United States)

    Wang, Li; Grignon, Michel; Perry, Sheril; Chen, Xi-Kuan; Ytsma, Alison; Allin, Sara; Gapanenko, Katerina

    2018-04-17

    To evaluate the technical efficiency of acute inpatient care at the pan-Canadian level and to explore the factors associated with inefficiency-why hospitals are not on their production frontier. Canadian Management Information System (MIS) database (CMDB) and Discharge Abstract Database (DAD) for the fiscal year of 2012-2013. We use a nonparametric approach (data envelopment analysis) applied to three peer groups (teaching, large, and medium hospitals, focusing on their acute inpatient care only). The double bootstrap procedure (Simar and Wilson 2007) is adopted in the regression. Information on inpatient episodes of care (number and quality of outcomes) was extracted from the DAD. The cost of the inpatient care was extracted from the CMDB. On average, acute hospitals in Canada are operating at about 75 percent efficiency, and this could thus potentially increase their level of outcomes (quantity and quality) by addressing inefficiencies. In some cases, such as for teaching hospitals, the factors significantly correlated with efficiency scores were not related to management but to the social composition of the caseload. In contrast, for large and medium nonteaching hospitals, efficiency related more to the ability to discharge patients to postacute care facilities. The efficiency of medium hospitals is also positively related to treating more clinically noncomplex patients. The main drivers of efficiency of acute inpatient care vary by hospital peer groups. Thus, the results provide different policy and managerial implications for teaching, large, and medium hospitals to achieve efficiency gains. © Health Research and Educational Trust.

  5. Pregnant Adolescents Admitted to an Inpatient Child and Adolescent Psychiatric Unit: An Eight-Year Review.

    Science.gov (United States)

    Fletcher, Teresa M; Markley, Laura A; Nelson, Dana; Crane, Stephen S; Fitzgibbon, James J

    2015-12-01

    To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  6. Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda

    Directory of Open Access Journals (Sweden)

    Turyakira Eleanor

    2011-10-01

    Full Text Available Abstract Background Obstructed labour is still a major cause of maternal morbidity and mortality and of adverse outcome for newborns in low-income countries. The aim of this study was to investigate the role of individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda. Methods A review was performed on 12,463 obstetric records for the year 2006 from six hospitals located in south-western Uganda and 11,180 women records were analysed. Multivariate logistic regression analyses were applied to control for probable confounders. Results Prevalence of obstructed labour for the six hospitals was 10.5% and the main causes were cephalopelvic disproportion (63.3%, malpresentation or malposition (36.4% and hydrocephalus (0.3%. The risk of obstructed labour was statistically significantly associated with being resident of a particular district [Isingiro] (AOR 1.39, 95% CI: 1.04-1.86, with nulliparous status (AOR 1.47, 95% CI: 1.22-1.78, having delivered once before (AOR 1.57, 95% CI: 1.30-1.91 and age group 15-19 years (AOR 1.21, 95% CI: 1.02-1.45. The risk for perinatal death as an adverse outcome was statistically significantly associated with districts other than five comprising the study area (AOR 2.85, 95% CI: 1.60-5.08 and grand multiparous status (AOR 1.89, 95% CI: 1.11-3.22. Women who lacked paid employment were at increased risk of obstructed labour. Perinatal mortality rate was 142/1000 total births in women with obstructed labour compared to 65/1000 total births in women without the condition. The odds of having maternal complications in women with obstructed labour were 8 times those without the condition. The case fatality rate for obstructed labour was 1.2%. Conclusions Individual socio-demographic and health system factors are strongly associated with obstructed labour and its adverse outcome in south-western Uganda. Our study provides baseline information which may be used by

  7. The IRSN Risk Perception Barometer: analyzing the 1997 - 2008 period and comparing expert, public and residents of a nuclear facility perceptions

    International Nuclear Information System (INIS)

    El Jammal, Marie H.

    2008-01-01

    Full text: Since 1997, IRSN conducts a yearly survey designed to understand how the French population perceives risk: the IRSN barometer. In this survey, 30 risks are investigated from three different angles: a) Seriousness of the risk; b) Trust in the authorities; c) Credibility of information given about these risks. The 30 risks include situations widely covered by the media (traffic accidents, smoking, alcohol, etc.), as well as situations of which the public can be unaware (such as radon in homes) and situations perceived as low risk (X-rays, noise, etc.). The list includes nuclear power plants, nuclear waste storage, Chernobyl pollution impacts, chemical industries, chemical waste, transportation of hazardous chemicals, etc. Statistical analysis of the answers highlighted five groups of risks in relation with a common rationale of perception by the French people. This will be presented as the first part of the paper. The conclusion will show that the risk perceptions of the French population are not at all versatile. Their perception logic is based on the perceived seriousness of the risk, on their 'trust in the protective measures taken by the French authorities' and on the perceived credibility of information. Risk perception varies greatly with age, gender, culture and level of education. We know this with the IRSN Barometer and others opinion pools. However, few surveys are carried out among experts in risk. Do they have a different perception of risk from the general public? It's the subject of a study entitled PERPLEX (Perception of Risk by the Public and Experts) who was realized in October 2004. This will be presented in the second part of the paper. The same question can be asked for the population who live near a nuclear power plant or other nuclear facility. So, in November 2007, 318 residents in the vicinity of twenty nuclear facility have answered at the IRSN's annual barometer questionnaire. The results of these three surveys will be presented

  8. Biomonitoring of genotoxic risk in radar facility workers: comparison of the comet assay with micronucleus assay and chromatid breakage assay

    International Nuclear Information System (INIS)

    Garaj-Vrhovac, V.; Kopjar, N.

    2003-01-01

    Genotoxic risks of occupational exposure in a radar facility were evaluated by using alkaline comet assay, micronucleus assay and chromatid breakage assay on peripheral blood leukocytes in exposed subjects and corresponding controls. Results show that occupational exposure to microwave radiation correlates with an increase of genome damage in somatic cells. The levels of DNA damage in exposed subjects determined by using alkaline comet assay were increased compared to control and showed interindividual variations. Incidence of micronuclei was also significantly increased compared to baseline control values. After short exposure of cultured lymphocytes to bleomycin, cells of occupationally exposed subjects responded with high numbers of chromatid breaks. Although the level of chromosome damage generated by bleomycin varied greatly between individuals, in exposed subjects a significantly elevated number of chromatid breaks was observed. Our results support data reported in literature indicating that microwave radiation represents a potential DNA-damaging hazard. Alkaline comet assay is confirmed as a sensitive and highly reproducible technique for detection of primary DNA damage inflicted in somatic cells. Micronucleus assay was confirmed as reliable bio-markers of effect and chromatid breakage assay as sensitive bio-marker of individual cancer susceptibility. The results obtained also confirm the necessity to improve measures and to perform accurate health surveillance of individuals occupationally exposed to microwave radiation

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

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, Justin [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-02-01

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

  10. Inpatient dermatology: Characteristics of patients and admissions in a tertiary level hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Arpita Sen

    2016-01-01

    Full Text Available Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27% were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33% and infective disorders (73 patients, 19.47%. Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2% improved after hospitalization; while 29 (7.73% patients died from their illness. About 133 patients (35.64% required referral services during their stay, while 8 patients (2.13% were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

  11. Portuguese Adaptation and Input for the Validation of the Views on Inpatient Care (VOICE) Outcome Measure to Assess Service Users'Perceptions of Inpatient Psychiatric Care.

    Science.gov (United States)

    Palha, João; Palha, Filipa; Dias, Pedro; Gonçalves-Pereira, Manuel

    2017-11-29

    Patient satisfaction is an important measure of health care quality. Patients' views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users' perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants' satisfaction. Internal consistency of the questionnaire was high (α = 0.87). Participants' age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. The Portuguese version of VOICE is a promising tool to assess service users' perceptions of inpatient psychiatric care in Portugal.

  12. Are people at high risk for diabetes visiting health facility for confirmation of diagnosis? A population-based study from rural India.

    Science.gov (United States)

    Srinivasapura Venkateshmurthy, Nikhil; Soundappan, Kathirvel; Gummidi, Balaji; Bhaskara Rao, Malipeddi; Tandon, Nikhil; Reddy, K Srinath; Prabhakaran, Dorairaj; Mohan, Sailesh

    2018-01-01

    India is witnessing a rising burden of type 2 diabetes mellitus. India's National Programme for Prevention and Control of Diabetes, Cancer, Cardiovascular diseases and Stroke recommends population-based screening and referral to primary health centre for diagnosis confirmation and treatment initiation. However, little is known about uptake of confirmatory tests among screen positives. To estimate the uptake of confirmatory tests and identify the reasons for not undergoing confirmation by those at high risk for developing diabetes. We analysed data collected under project UDAY, a comprehensive diabetes and hypertension prevention and management programme, being implemented in rural Andhra Pradesh, India. Under UDAY, population-based screening for diabetes was carried out by project health workers using a diabetes risk score and capillary blood glucose test. Participants at high risk for diabetes were asked to undergo confirmatory tests. On follow-up visit, health workers assessed if the participant had undergone confirmation and ask for reasons if not so. Of the 35,475 eligible adults screened between April 2015 and August 2016, 10,960 (31%) were determined to be at high risk. Among those at high risk, 9670 (88%) were followed up, and of those, only 616 (6%) underwent confirmation. Of those who underwent confirmation, 'lack of symptoms of diabetes warranting visit to health facility' (52%) and 'being at high risk was not necessary enough to visit' (41%) were the most commonly reported reasons for non-confirmation. Inconvenient facility time (4.4%), no nearby facility (3.2%), un-affordability (2.2%) and long waiting time (1.6%) were the common health system-related factors that affected the uptake of the confirmatory test. Confirmation of diabetes was abysmally low in the study population. Low uptake of the confirmatory test might be due to low 'risk perception'. The uptake can be increased by improving the population risk perception through individual and

  13. Measuring outcomes in psychiatry: an inpatient model.

    Science.gov (United States)

    Davis, D E; Fong, M L

    1996-02-01

    This article describes a system for measuring outcomes recently implemented in the department of psychiatry of Baptist Memorial Hospital, a 78-bed inpatient and day treatment unit that represents one service line of a large, urban teaching hospital in Memphis. In June 1993 Baptist Hospital began a 15-month pilot test of PsychSentinel, a measurement tool developed by researchers in the Department of Community Medicine at the University of Connecticut. The hospital identified the following four primary goals for this pilot project: provide data for internal hospital program evaluation, provide data for external marketing in a managed care environment, satisfy requirements of the Joint Commission on Accreditation of Health Care Organizations, and generate studies that add to the literature in psychiatry and psychology. PsychSentinel is based on the standardized diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The outcome measure assesses the change in the number of symptoms of psychopathology that occurs between admission and discharge from the hospital. Included in the nonproprietary system are risk adjustment factors, as well as access to a national reference database for comparative analysis purposes. Data collection can be done by trained ancillary staff members, with as much or as little direct physician involvement as desired. The system has proven to be both time effective and cost effective, and it provides important outcome information both at the program level and at the clinician level. After the pilot test, the staff at Baptist Memorial Hospital determined that the system met all initial objectives identified and recently adopted the system as an ongoing measure of quality patient care in the department of psychiatry.

  14. FUNDAMENTALS OF OPTIMIZING INPATIENT CARE FOR CHILDREN

    Directory of Open Access Journals (Sweden)

    A.A. Baranov

    2006-01-01

    Full Text Available Inpatient care for children has been considered to play an important role and to be influential in Russian healthcare system. However, a long lasting extensive development of health care system lacking sufficient finance and recourses has created a gap between the healthcare structure and capacity to provide healthcare and the needs of qualitative healthcare in the population. High number of limited ability hospitals without appropriate recourse base has already had its's day as a stage of inpatients care development. These hospitals could not provide a base for modern technology implementation and provision of present day high b quality medical care. Moreover, the current mechanism of financing «the hospital bed» but the patient has hampered medical care intensification and implementation of new technologies through loss of result orientation in medical specialists. Elaboration of efficacious means to optimize inpatient care would allow to control the rates assessing TH children's health in the country's population and to promote medical, social and economic efficacy of the inpatient care system.Key words: inpatient care, healthcare quality.

  15. Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Gallegos, G; Daniels, J; Wegrecki, A

    2007-10-01

    This document contains the human health and ecological risk assessment for the Resource Recovery and Conservation Act (RCRA) permit renewal for the Explosives Waste Treatment Facility (EWTF). Volume 1 is the text of the risk assessment, and Volume 2 (provided on a compact disc) is the supporting modeling data. The EWTF is operated by the Lawrence Livermore National Laboratory (LLNL) at Site 300, which is located in the foothills between the cities of Livermore and Tracy, approximately 17 miles east of Livermore and 8 miles southwest of Tracy. Figure 1 is a map of the San Francisco Bay Area, showing the location of Site 300 and other points of reference. One of the principal activities of Site 300 is to test what are known as 'high explosives' for nuclear weapons. These are the highly energetic materials that provide the force to drive fissionable material to criticality. LLNL scientists develop and test the explosives and the integrated non-nuclear components in support of the United States nuclear stockpile stewardship program as well as in support of conventional weapons and the aircraft, mining, oil exploration, and construction industries. Many Site 300 facilities are used in support of high explosives research. Some facilities are used in the chemical formulation of explosives; others are locations where explosive charges are mechanically pressed; others are locations where the materials are inspected radiographically for such defects as cracks and voids. Finally, some facilities are locations where the machined charges are assembled before they are sent to the onsite test firing facilities, and additional facilities are locations where materials are stored. Wastes generated from high-explosives research are treated by open burning (OB) and open detonation (OD). OB and OD treatments are necessary because they are the safest methods for treating explosives wastes generated at these facilities, and they eliminate the requirement for further handling

  16. Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience.

    Science.gov (United States)

    Anwar, Jasim; Mpofu, Elias; Matthews, Lynda R; Shadoul, Ahmed Farah; Brock, Kaye E

    2011-06-30

    The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences. This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression. Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety. The relationship between women's post-earthquake mental health and

  17. Recovery orientation in mental health inpatient settings

    DEFF Research Database (Denmark)

    Waldemar, Anna Kristine; Esbensen, Bente Appel; Korsbek, Lisa

    2018-01-01

    Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept......-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants’ experiences were identified. The participants felt...... accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist...

  18. Irrational ideas. Older vs. younger inpatients.

    Science.gov (United States)

    Hyer, L A; Jacobsen, R; Harrison, W R

    1985-04-01

    The relationship to age of irrational beliefs among psychiatric inpatients has not been explored using the rational-emotive model. This study addressed the following two questions: 1) Do older and younger psychiatric inpatients differ in irrational beliefs? 2) Do older depressives differ from older nondepressives in irrational beliefs? Upon admission to a large medical center, 58 younger (less than 45 years old) and 54 older (greater than 55 years old) subjects were assessed on a battery of psychological tests, including the Idea Inventory and the Beck Depression Inventory. Results showed that older and younger inpatients did not differ on irrational beliefs. Results also showed that older and younger groups of depressives did not differ on the irrationality scores. When a correlational analysis was used, depression was related to irrationality within the older group but not within the younger group.

  19. Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application

    OpenAIRE

    Abderhalden, Christoph; Needham, Ian; Dassen, Theo; Halfens, Ruud; Haug, Hans-Joachim; Fischer, Joachim

    2006-01-01

    Abstract Background Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the B...

  20. Rising utilization of inpatient pediatric asthma pathways.

    Science.gov (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

    2018-02-01

    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  1. Performance of freestanding inpatient rehabilitation hospitals before and after the rehabilitation prospective payment system.

    Science.gov (United States)

    Thompson, Jon M; McCue, Michael J

    2010-01-01

    Inpatient rehabilitation hospitals provide important services to patients to restore physical and cognitive functioning. Historically, these hospitals have been reimbursed by Medicare under a cost-based system; but in 2002, Medicare implemented a rehabilitation prospective payment system (PPS). Despite the implementation of a PPS for rehabilitation, there is limited published research that addresses the operating and financial performance of these hospitals. We examined operating and financial performance in the pre- and post-PPS periods for for-profit and nonprofit freestanding inpatient rehabilitation hospitals to test for pre- and post-PPS differences within the ownership groups. We identified freestanding inpatient rehabilitation hospitals from the Centers for Medicare and Medicaid Services Health Care Cost Report Information System database for the first two fiscal years under PPS. We excluded facilities that had fiscal years less than 270 days, facilities with missing data, and government facilities. We computed average values for performance variables for the facilities in the two consecutive fiscal years post-PPS. For the pre-PPS period, we collected data on these same facilities and, once facilities with missing data and fiscal years less than 270 days were excluded, computed average values for the two consecutive fiscal years pre-PPS. Our final sample of 140 inpatient rehabilitation facilities was composed of 44 nonprofit hospitals and 96 for-profit hospitals both pre- and post-PPS. We utilized a pairwise comparison test (t-test comparison) to measure the significance of differences on each performance variable between pre- and post-PPS periods within each ownership group. Findings show that both nonprofit and for-profit freestanding inpatient rehabilitation hospitals reduced length of stay, increased discharges, and increased profitability. Within the for-profit ownership group, the percentage of Medicare discharges increased and operating expense per

  2. Inpatient Therapeutic Assessment With Narcissistic Personality Disorder.

    Science.gov (United States)

    Hinrichs, Jon

    2016-01-01

    Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a "hard to reach" personality.

  3. Suicide after absconding from inpatient care in England: an exploration of mental health professionals' experiences.

    Science.gov (United States)

    Hunt, Isabelle M; Clements, Caroline; Saini, Pooja; Rahman, Mohammad Shaiyan; Shaw, Jenny; Appleby, Louis; Kapur, Nav; Windfuhr, Kirsten

    2016-06-01

    Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients. To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff. A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff. Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors. Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.

  4. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    Science.gov (United States)

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  5. Thwarted interpersonal needs and suicide ideation: Comparing psychiatric inpatients with bipolar and non-bipolar mood disorders.

    Science.gov (United States)

    Taylor, Nathanael J; Mitchell, Sean M; Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Cukrowicz, Kelly C

    2016-12-30

    Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation. Published by Elsevier Ireland Ltd.

  6. HCUP State Inpatient Databases (SID) - Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...

  7. Inpatient management of borderline personality disorder at Helen ...

    African Journals Online (AJOL)

    Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg. ... South African Journal of Psychiatry ... to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over ...

  8. Missed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients.

    Science.gov (United States)

    MacMillan, Thomas E; Kamali, Reza; Cavalcanti, Rodrigo B

    2016-09-01

    Hospital admissions provide an opportunity to deprescribe ineffective medications and reduce pill burden. Docusate sodium is a stool softener that is frequently prescribed to treat constipation despite poor evidence for efficacy, thus providing a good target for deprescription. The aims of this study were to characterize rates of use and discontinuation of docusate among internal medicine inpatients, as well as use of other laxatives. We conducted a retrospective observational study over 1 year on all patients admitted to internal medicine at 2 urban academic hospitals to determine rates of docusate use. We also evaluated laxative and opioid medication use on a random sample of 500 inpatients who received docusate to characterize patterns of prescription and deprescription. Fifteen percent (1169/7581) of all admitted patients received 1 or more doses of docusate. Among our random sample, 53% (238/452) received docusate before admission, and only 13% (31/238) had docusate deprescribed. Among patients not receiving docusate before admission, 33.2% (71/214) received a new prescription for docusate on discharge. Patients receiving opioids were frequently prescribed no laxatives or given docusate monotherapy (28%, 51/185). Docusate was frequently prescribed to medical inpatients despite its known ineffectiveness, with low deprescription and high numbers of new prescriptions. Docusate use was common even among patients at high risk of constipation. One third of patients not receiving docusate before admission were prescribed docusate on discharge, potentially exacerbating polypharmacy. Among patients already receiving docusate, 80% had it continued on discharge, indicating significant missed opportunities for deprescribing. Given the availability of effective alternatives, our results suggest that quality-improvement initiatives are needed to promote evidence-based laxative use in hospitalized patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Impulse control disorders in psychiatric inpatients.

    Science.gov (United States)

    Müller, Astrid; Rein, Katharina; Kollei, Ines; Jacobi, Andrea; Rotter, Andrea; Schütz, Patricia; Hillemacher, Thomas; de Zwaan, Martina

    2011-08-15

    The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine. 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Psychiatric nurses' experiences with inpatient aggression

    NARCIS (Netherlands)

    Nijman, H.; Bowers, L.; Oud, N.; Jansen, G.

    2005-01-01

    Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this "Perceptions of Prevalence Of Aggression Scale" (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff

  11. Onconeural Antibodies in Acute Psychiatric Inpatient Care

    DEFF Research Database (Denmark)

    Sæther, Sverre Georg; Schou, Morten; Stoecker, Winfried

    2017-01-01

    , GLRA1B, DPPX, GRM1, GRM5, DNER, Yo, ZIC4, GAD67, amphiphysin, CV2, Hu, Ri, Ma2, and recoverin. Only one sample was positive (antirecoverin IgG). The present findings suggest that serum onconeural antibody positivity is rare among patients acutely admitted for inpatient psychiatric care. The clinical...

  12. Qualify of Life of Forensic Psychiatric Inpatients

    NARCIS (Netherlands)

    Nieuwenhuizen, C. van; Nijman, H.L.I.

    2009-01-01

    In this article, the quality of life (QoL) of mentally disordered offenders was investigated. The data of 44 forensic psychiatric inpatients were analyzed using the Lancashire Quality of Life Profile (LQoLP), Rehabilitation Evaluation Hall and Baker (REHAB), and the Psychopathy Checklist-Revised

  13. A Framework for Seismic Design of Items in Safety-Critical Facilities for Implementing a Risk-Informed Defense-in-Depth-Based Concept

    Directory of Open Access Journals (Sweden)

    Tatsuya Itoi

    2017-05-01

    Full Text Available Recently, especially after the 2011 off the Pacific coast of Tohoku earthquake and the Fukushima Daiichi nuclear power plant accident, the need for treating residual risks and cliff-edge effects in safety-critical facilities has been widely recognized as an extremely important issue. In this article, the sophistication of seismic designs in safety-critical facilities is discussed from the viewpoint of mitigating the consequences of accidents, such as the avoidance of cliff-edge effects. For this purpose, the implementation of a risk-informed defense-in-depth-based framework is proposed in this study. A basic framework that utilizes diversity in the dynamic characteristics of items and also provides additional seismic margin to items important for safety when needed is proposed to prevent common cause failure and to avoid cliff-edge effects as far as practicable. The proposed method is demonstrated to be effective using an example calculation.

  14. Quality of care indicators for the structure and organization of inpatient rehabilitation care of children with traumatic brain injury.

    Science.gov (United States)

    Zumsteg, Jennifer M; Ennis, Stephanie K; Jaffe, Kenneth M; Mangione-Smith, Rita; MacKenzie, Ellen J; Rivara, Frederick P

    2012-03-01

    To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care. Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities. Inpatient rehabilitation units in the United States. A sample of rehabilitation programs identified using data from the National Association of Children's Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all age units. Not applicable. Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI. Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least 1 child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and more than 75% of therapists with pediatric training. There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Quality assurance system for sitting high risk facilities; Sistema de aseguramiento de la calidad para el emplazamiento de obras de alto riesgo

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Aymee; Peralta, Jose L.; Fernandez, Manuel [Centro de Tecnologia Nuclear, San Jose de las Lajas (Cuba)

    1999-11-01

    The paper shows how we have conceived and designed the quality assurance system for the site selection process of an area for sitting the facility of high risk in correspondence with the approved methodology. The results obtained in the implementation of the system have permitted the satisfactory performance of each one the expected stage, defining the most favorable sectors in order to continue the studies of the repository site for the disposal of low and intermedium. (author) 7 refs., 1 tab.

  16. Predictors of Dropout From Inpatient Substance Use Treatment: A Prospective Cohort Study

    Science.gov (United States)

    Andersson, Helle Wessel; Steinsbekk, Aslak; Walderhaug, Espen; Otterholt, Eli; Nordfjærn, Trond

    2018-01-01

    Introduction: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing challenge. The aim of this study was to identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment. Materials and methods: A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this naturalistic, prospective cohort study. Results: A total of 132 patients (28%) did not complete the planned treatment stay (dropped out). Cox regression analysis showed that higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95% confidence interval [CI]: 0.48-0.79). Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95% CI: 1.11-1.97). Conclusions: The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future prospective intervention studies. PMID:29531472

  17. Predictors of Dropout From Inpatient Substance Use Treatment: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Helle Wessel Andersson

    2018-02-01

    Full Text Available Introduction: Dropout from inpatient treatment for substance use disorder (SUD is an ongoing challenge. The aim of this study was to identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment. Materials and methods: A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this naturalistic, prospective cohort study. Results: A total of 132 patients (28% did not complete the planned treatment stay (dropped out. Cox regression analysis showed that higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95% confidence interval [CI]: 0.48-0.79. Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95% CI: 1.11-1.97. Conclusions: The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future prospective intervention studies.

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

    Science.gov (United States)

    Mabaso, Raymond G; Oduntan, Olalekan A

    2014-11-21

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

  19. Multi-site risk-based project planning, optimization, sequencing and budgeting process and tool for the integrated facility disposition project - 59394

    International Nuclear Information System (INIS)

    Nelson, Jerel; Castillo, Carlos; Huntsman, Julie; Lucek, Heather; Marks, Tim

    2012-01-01

    Document available in abstract form only. Full text of publication follows: Faced with the DOE Complex Transformation, NNSA was tasked with developing an integrated plan for the decommissioning of over 400 facilities and 300 environmental remediation units, as well as the many reconfiguration and modernization projects at the Oak Ridge National Laboratory (ORNL) and Y-12 Complex. Manual scheduling of remediation activities is time-consuming, labor intensive, and inherently introduces bias and unaccounted for aspects of the scheduler or organization in the process. Clearly a tool was needed to develop an objective, unbiased baseline optimized project sequence and schedule with a sound technical foundation for the Integrated Facility Disposition Project (IFDP). In generating an integrated disposition schedule, each project (including facilities, environmental sites, and remedial action units) was identified, characterized, then ranked relative to other projects. Risk matrices allowed for core project data to be extrapolated into probable contamination levels, relative risks to the public, and other technical and risk parameters to be used in the development of an overall ranking. These matrices ultimately generated a complete data set that were used in the Ranking and Sequencing Model (RSM), commonly referred to as the SUPER model, for its numerous abilities to support D and D planning, prioritization, and sequencing

  20. Average annual doses, lifetime doses and associated risk of cancer death for radiation workers in various fuel fabrication facilities in India

    International Nuclear Information System (INIS)

    Iyer, P.S.; Dhond, R.V.

    1980-01-01

    Lifetime doses based on average annual doses are estimated for radiation workers in various fuel fabrication facilities in India. For such cumulative doses, the risk of radiation-induced cancer death is computed. The methodology for arriving at these estimates and the assumptions made are discussed. Based on personnel monitoring records from 1966 to 1978, the average annual dose equivalent for radiation workers is estimated as 0.9 mSv (90 mrem), and the maximum risk of cancer death associated with this occupational dose as 1.35x10 -5 a -1 , as compared with the risk of death due to natural causes of 7x10 -4 a -1 and the risk of death due to background radiation alone of 1.5x10 -5 a -1 . (author)

  1. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

    Directory of Open Access Journals (Sweden)

    Latha KS

    2011-04-01

    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  2. Development of mental health quality indicators (MHQIs for inpatient psychiatry based on the interRAI mental health assessment

    Directory of Open Access Journals (Sweden)

    Perlman Christopher M

    2013-01-01

    Full Text Available Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs using the Resident Assessment Instrument - Mental Health (RAI-MH, a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI and Cognitive Performance Scale (CPS, were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance

  3. [Dropout behavior during inpatient psychotherapy ].

    Science.gov (United States)

    Martens, Ute; Rempel, Irene; Zipfel, Stephan; Enck, Paul; Teufel, Martin

    2014-01-01

    Dropouts result in far-reaching consequences for the individual patient, fellow patients, therapists, and the clinic. This study was aimed at early identification of patients with a dropout risk. Data from patients of the Department of Psychosomatic Medicine and Psychotherapy of the Medical University Clinic of Tübingen (Germany) were analyzed retrospectively in a case-control study (matched). Differences in the results of various questionnaires (SCL-90-R, IIP-D, SF-36) regarding reasons for dropout and sociodemographic data were analyzed. A total of 59 dropouts, 50 females and 9 males, were included. They were split into 28 early dropouts and 31 late dropouts. The data were compared between early and late dropouts and control group. Early dropouts were significantly younger than late dropouts; they tended to live with their parents or on their own, and suffered more frequently from eating disorders. Late dropouts lived together with partners and suffered from somatoform disorders more frequently than early dropouts. The reasons given for dropout did not differ between the groups. No differences between dropouts and the controls were found with respect to psychopathology (SCL- 90-R) and quality of life (SF-36). Late dropouts did show significantly lower scores on the scale "autocracy/dominance" than the controls (IIP). Therapy dr