WorldWideScience

Sample records for treatment units revision

  1. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization.

  2. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    International Nuclear Information System (INIS)

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization

  3. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men--United States, 2003, and revised recommendations for gonorrhea treatment, 2004.

    Science.gov (United States)

    2004-04-30

    In the United States, an estimated 700,000-800,000 persons are infected with Neisseria gonorrhoeae each year. Since 1993, CDC has recommended use of fluoroquinolones (i.e., ciprofloxacin, floxacin, or levofloxacin) for gonorrhea treatment. Fluoroquinolone therapy is used frequently because it is an inexpensive, oral, and single-dose therapy. However, because of increased prevalence of fluoroquinolone-resistant N. gonorrhoeae (QRNG) in Asia, the Pacific Islands (including Hawaii), and California, fluoroquinolones are no longer recommended for treating gonorrhea acquired in those locations. This report describes increases in QRNG among men who have sex with men (MSM) in Massachusetts, New York City, and 30 sites surveyed by the Gonococcal Isolate Surveillance Project (GISP) during 2003. CDC recommends that clinicians no longer use fluoroquinolones as a first-line treatment for gonorrhea in MSM.

  4. Waste Water Treatment Unit

    International Nuclear Information System (INIS)

    Ramadan, A.E.K.

    2004-01-01

    A wastewater treatment plant to treat both the sanitary and industrial effluent originated from process, utilities and off site units of the refinery is described. The purpose is to obtain at the end of the treatment plant, a water quality that is in compliance with contractual requirements and relevant environmental regulations. first treatment (pretreatment). Primary de-oiling, Equalization, Neutralization, Secondary de-oiling. Second treatment (Biological), The mechanism of BOD removal, Biological flocculation, Nutrient requirements, Nitrification, De-nitrification, Effect of temperature, Effect of ph, Toxicity

  5. [Revised guideline 'Diabetic retinopathy: screening, diagnosis and treatment'

    NARCIS (Netherlands)

    Polak, B.C.P.; Hartstra, W.W.; Ringens, P.J.; Scholten, R.J.

    2008-01-01

    The revised evidence-based guideline 'Diabetic retinopathy: screening, diagnosis and treatment' contains important recommendations concerning screening, diagnosis and treatment of diabetic retinopathy. Regular screening and the treatment of risk factors, such as hyperglycemia, hypertension,

  6. 78 FR 6740 - Revisions to the California State Implementation Plan, San Joaquin Valley United Air Pollution...

    Science.gov (United States)

    2013-01-31

    ... the California State Implementation Plan, San Joaquin Valley United Air Pollution Control District... revisions to the San Joaquin Valley United Air Pollution Control District (SJVUAPCD) portion of the... CFR Part 52 Environmental protection, Air pollution control, Incorporation by reference...

  7. 76 FR 62074 - Proposed Revision of Performance Standards for State Medicaid Fraud Control Units

    Science.gov (United States)

    2011-10-06

    ...] Proposed Revision of Performance Standards for State Medicaid Fraud Control Units AGENCY: Office of... Control Units (MFCUs or Units). This proposal would replace and supersede standards published on September..., including 42 CFR Sec. 455.21, ``Cooperation with State Medicaid fraud control units,'' and 42 CFR 455.23...

  8. 77 FR 32645 - Revision of Performance Standards for State Medicaid Fraud Control Units

    Science.gov (United States)

    2012-06-01

    ...] Revision of Performance Standards for State Medicaid Fraud Control Units AGENCY: Office of Inspector... Fraud Control Units (MFCU or Unit). These standards replace and supersede standards published on... Association of Medicaid Fraud Control Units (the Association), which submitted extensive comments on each of...

  9. Harmonized Tariff Schedule of the United States (2015) - Revision 1

    Data.gov (United States)

    US International Trade Commission — This dataset is the 2015 Harmonized Tariff Schedule Revision 1 effective July 1, 2015. It provides the applicable tariff rates and statistical categories for all...

  10. Current Epidemiology of Revision Total Knee Arthroplasty in the United States.

    Science.gov (United States)

    Delanois, Ronald E; Mistry, Jaydev B; Gwam, Chukwuweike U; Mohamed, Nequesha S; Choksi, Ujval S; Mont, Michael A

    2017-09-01

    Revision surgery for failed total knee arthroplasty (TKA) continues to pose a substantial burden for the United States healthcare system. The predominant etiology of TKA failure has changed over time and may vary between studies. This report aims to update the current literature on this topic by using a large national database. Specifically, we analyzed: (1) etiologies for revision TKA; (2) frequencies of revision TKA procedures; (3) various demographics including payer type and region; and (4) the length of stay (LOS) and total charges based on type of revision TKA procedure. The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was used to identify all revision TKA procedures performed between 2009 and 2013. Clinical, economic, and demographic data were collected and analyzed for 337,597 procedures. Patients were stratified according to etiology of failure, age, sex, race, US census region, and primary payor class. The mean LOS and total charges were also calculated. Infection was the most common etiology for revision TKA (20.4%), closely followed by mechanical loosening (20.3%). The most common revision TKA procedure performed was all component revision (31.3%). Medicare was the primary payor for the greatest proportion of revisions (57.7%). The South census region performed the most revision TKAs (33.2%). The overall mean LOS was 4.5 days, with arthrotomy for removal of prosthesis without replacement procedures accounting for the longest stays (7.8 days). The mean total charge for revision TKAs was $75,028.07. Without appropriate measures in place, the burden of revision TKAs may become overwhelming and pose a strain on providers and institutions. Continued insight into the etiology and epidemiology of revision TKAs may be the principle step towards improving outcomes and mitigating the need for future revisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Revised Final Remedial Investigation. Addendum Report for Operable Units 4, 8, and 9. Volume I

    National Research Council Canada - National Science Library

    Davis, Karl Clune

    1997-01-01

    This revised final report presents the results of previous investigations as well as the results of the Phase I and Phase II RI sampling and analysis for 11 SWMUs within three operable units at Tooele Army Depot (TEAD...

  12. Revised

    DEFF Research Database (Denmark)

    Johannsen, Vivian Kvist; Nord-Larsen, Thomas; Riis-Nielsen, Torben

    This report is a revised analysis of the Danish data on CO2 emissions from forest, afforestation and deforestation for the period 1990 - 2008 and a prognosis for the period until 2020. Revision have included measurements from 2009 in the estimations. The report is funded by the Ministry of Climate...

  13. 75 FR 81853 - Inmate Discipline Program/Special Housing Units: Subpart Revision and Clarification

    Science.gov (United States)

    2010-12-29

    ... [Docket No. BOP-1118-F] RIN 1120-AB18 Inmate Discipline Program/Special Housing Units: Subpart Revision... Discipline Program and Special Housing Units (SHU) regulations. The Bureau issues this correction document in... INFORMATION: The Bureau corrects its Inmate Discipline and Special Housing Units (SHU) regulations (28 CFR...

  14. Proposal for revisions of the United Nations Moon Treaty

    Science.gov (United States)

    Fernandes, Vera; Abreu, Neyda; Fritz, J.; Knapmeyer, Martin; Smeenk, Lisa; Ten Kate, Inge; Trüninger, Monica

    During this new 2010-decade, it will be imperative to reconsider the effectiveness of the current United Nations (U.N.) Moon Treaty (c.1979). Amendments are necessary to underline the mandatory human stewardship of this fragile planetary body of our Solar System, indispensible to life on Earth. After the very successful Apollo and Luna missions to the Moon (ending in 1976), which brought a wide array of data (samples, surface and orbital experiments), the Moon lost its exploratory attraction in favor of other programs, such as the International Space Station and potential human exploration of Mars. However, since the mid-90's, the enthusiasm for the Moon has been revived, which resulted in several space agencies worldwide (NASA, ESA, ISRO, JAXA, and the Chinese Space Agency) having made great efforts to re-start ex-ploratory and scientific campaigns even though budgetary changes may delay the process. As a result, a wide array of peoples and their interests are put together in each mission planned to reach the Moon (e.g., orbiters and landers). Up to now, mission plans focus on technical requirements and the desires of scientists and engineers, but hardly any other aspects. Field specialists on issues regarding the social, economic, political, cultural, ethical and environmen-tal impacts of Moon exploration and colonization have had little to no involvement in current and past lunar missions. However, these fields would provide different and essential points of view regarding the planning of lunar missions. Moreover, recent documents written by the scientific community, such as "The Scientific Context for Exploration of the Moon: Final Re-port" Committee on the Scientific Context for Exploration of the Moon, National Research Council (2007), or the recent (summer 2009) White Papers for the National Research Council Planetary Science Decadal Survey 2011-2020, do not seem to leave space for a multidisciplinary approach regarding the future lunar exploration either

  15. 76 FR 11078 - Inmate Discipline Program/Special Housing Units: Subpart Revision and Clarification

    Science.gov (United States)

    2011-03-01

    ... DEPARTMENT OF JUSTICE Bureau of Prisons 28 CFR Part 541 [Docket No. BOP-1118-F] RIN 1120-AB18 Inmate Discipline Program/Special Housing Units: Subpart Revision and Clarification AGENCY: Bureau of... Discipline Program and Special Housing Units (SHU) regulations (28 CFR part 541, subpart A and subpart B...

  16. A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty.

    Science.gov (United States)

    Peterson, Jennifer; Sodhi, Nipun; Khlopas, Anton; Piuzzi, Nicolas S; Newman, Jared M; Sultan, Assem A; Stearns, Kim L; Mont, Michael A

    2017-12-06

    In total knee arthroplasty (TKA), revision cases are often technically more challenging, and require more operative time and aftercare than primary cases. These time and effort differences should therefore be appropriately compensated for when using the relative value unit (RVU) system. Therefore, the purpose of this study is to compare the mean (1) RVUs; (2) operative times; and (3) RVU/min; and (4) perform an individualized idealized surgeon annual cost difference analysis for primary vs revision TKA. Current Procedural Terminology code 27447 identified 165,439 primary TKA patients, while Current Procedural Terminology code 27487 identified 8081 revision TKA patients from the National Surgical Quality Improvement Program database. The mean RVUs, operative times, and RVU/min were calculated. Dollar amount per minute, per case, per day, and year were also calculated. Student's t-test, with a cut-off P-value of dollar amounts calculated for primary vs revision TKA were per minute ($9.33 vs $7.90), per case ($877.12 vs $1176.43), per day ($4385.60 vs $3529), and projected a $137,008.70 annual cost difference. Orthopedic surgeons are reimbursed at a higher rate per minute for primary cases compared to revision TKA (0.26 vs 0.22, P increase the RVU per unit time for revision TKAs. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Are We Appropriately Compensated by Relative Value Units for Primary vs Revision Total Hip Arthroplasty?

    Science.gov (United States)

    Sodhi, Nipun; Piuzzi, Nicolas S; Khlopas, Anton; Newman, Jared M; Kryzak, Thomas J; Stearns, Kim L; Mont, Michael A

    2018-02-01

    Relative value units (RVUs) are used to evaluate the effort required for providing a service to patients in order to determine compensation. Thus, more complicated cases, like revision arthroplasty cases, should yield a greater compensation. However, there are limited data comparing RVUs to the time required to complete the service. Therefore, the purpose of this study is to compare the (1) mean RVUs, (2) mean operative times, and (3) mean RVU/minute between primary and revision total hip arthroplasty (THA) and (4) perform an individualized idealized surgeon annual cost difference analysis. A total of 103,702 patients who underwent primary (current procedural terminology code 27130) and 7273 patients who underwent revision THA (current procedural terminology code 27134) were identified using the National Surgical Quality Improvement Program database. Mean RVUs, operative times (minutes), and RVU/minute were calculated and compared using Student t-test. Dollar amount per minute, per case, per day, and year was calculated to find an individualized idealized surgeon annual cost difference. The mean RVU was 21.24 ± 0.53 (range, 20.72-21.79) for primary and 30.27 ± 0.03 (range, 30.13-30.28) for revision THA (P revision THA (P revision cases (P revision THA were as follows: per minute ($9.33 vs $8.93), per case ($877.12 vs $1358.32), per day ($6139.84 vs $5433.26), and a projected $113,052.28 annual cost difference for an individual surgeon. Maximizing the RVU/minute provides the greatest "hourly rate." The RVU/minute for primary (0.260) being significantly greater than revision THA (0.249) and an annualized $113,052.28 cost difference reveal that although revision THAs are more complex cases requiring longer operative time, greater technical skill, and aftercare, compensation per time is not greater. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Electrical Power Generation. A Basic Teaching Unit on Energy. Revised.

    Science.gov (United States)

    McDermott, Hugh, Ed.; Scharmann, Larry, Ed.

    Four classroom activities are included in this 8-10 period unit suitable for high school chemistry and physics classes. The first activity is a reading (12th-grade readability level determined by the Fry procedure) which explains electricity conversion, transportation, and efficiency ratings. The second and third activities are electrical energy…

  19. Conformance to Regulatory Guide 1.97, Wolf Creek Station, Unit No. 1. Revision 1

    International Nuclear Information System (INIS)

    Udy, A.C.

    1985-01-01

    This EG and G Idaho, Inc., report provides a review of the submittals for the Wolf Creek Station, Unit No. 1, and identifies areas of full conformance to Regulatory Guide 1.97, Revision 2. Any exceptions to these guidelines are evaluated and those areas where sufficient basis for acceptability is not provided are identified

  20. Approved Site Treatment Plan, Volumes 1 and 2. Revision 4

    International Nuclear Information System (INIS)

    Helmich, E.H.; Molen, G.; Noller, D.

    1996-01-01

    The US Department of Energy, Savannah River Operations Office (DOE-SR), has prepared the Site Treatment Plan (STP) for Savannah River Site (SRS) mixed wastes in accordance with RCRA Section 3021(b), and SCDHEC has approved the STP (except for certain offsite wastes) and issued an order enforcing the STP commitments in Volume 1. DOE-SR and SCDHEC agree that this STP fulfills the requirements contained in the FFCAct, RCRA Section 3021, and therefore, pursuant to Section 105(a) of the FFCAct (RCRA Section 3021(b)(5)), DOE's requirements are to implement the plan for the development of treatment capacities and technologies pursuant to RCRA Section 3021. Emerging and new technologies not yet considered may be identified to manage waste more safely, effectively, and at lower cost than technologies currently identified in the plan. DOE will continue to evaluate and develop technologies that offer potential advantages in public acceptance, privatization, consolidation, risk abatement, performance, and life-cycle cost. Should technologies that offer such advantages be identified, DOE may request a revision/modification of the STP in accordance with the provisions of Consent Order 95-22-HW. The Compliance Plan Volume (Volume 1) identifies project activity schedule milestones for achieving compliance with Land Disposal Restrictions (LDR). Information regarding the technical evaluation of treatment options for SRS mixed wastes is contained in the Background Volume (Volume 2) and is provided for information

  1. Approved Site Treatment Plan, Volumes 1 and 2. Revision 4

    Energy Technology Data Exchange (ETDEWEB)

    Helmich, E.H.; Molen, G.; Noller, D.

    1996-03-22

    The US Department of Energy, Savannah River Operations Office (DOE-SR), has prepared the Site Treatment Plan (STP) for Savannah River Site (SRS) mixed wastes in accordance with RCRA Section 3021(b), and SCDHEC has approved the STP (except for certain offsite wastes) and issued an order enforcing the STP commitments in Volume 1. DOE-SR and SCDHEC agree that this STP fulfills the requirements contained in the FFCAct, RCRA Section 3021, and therefore, pursuant to Section 105(a) of the FFCAct (RCRA Section 3021(b)(5)), DOE`s requirements are to implement the plan for the development of treatment capacities and technologies pursuant to RCRA Section 3021. Emerging and new technologies not yet considered may be identified to manage waste more safely, effectively, and at lower cost than technologies currently identified in the plan. DOE will continue to evaluate and develop technologies that offer potential advantages in public acceptance, privatization, consolidation, risk abatement, performance, and life-cycle cost. Should technologies that offer such advantages be identified, DOE may request a revision/modification of the STP in accordance with the provisions of Consent Order 95-22-HW. The Compliance Plan Volume (Volume 1) identifies project activity schedule milestones for achieving compliance with Land Disposal Restrictions (LDR). Information regarding the technical evaluation of treatment options for SRS mixed wastes is contained in the Background Volume (Volume 2) and is provided for information.

  2. 75 FR 13253 - Plan Revision for Lake Tahoe Basin Management Unit, Alpine, El Dorado, and Placer Counties, CA...

    Science.gov (United States)

    2010-03-19

    ... management concept as required by the National Forest Management Act and the Multiple Use Sustained Yield Act... revised forest plan will describe the strategic intent of managing the Lake Tahoe Basin Management Unit... DEPARTMENT OF AGRICULTURE Forest Service Plan Revision for Lake Tahoe Basin Management Unit...

  3. 76 FR 3077 - Notice of Decision To Revise a Heat Treatment Schedule for Emerald Ash Borer

    Science.gov (United States)

    2011-01-19

    ...] Notice of Decision To Revise a Heat Treatment Schedule for Emerald Ash Borer AGENCY: Animal and Plant... revise a heat treatment schedule for the emerald ash borer in the Plant Protection and Quarantine... treat emerald ash borer. DATES: Effective Date: January 19, 2011. FOR FURTHER INFORMATION CONTACT: Dr...

  4. Design of automated oil sludge treatment unit

    Science.gov (United States)

    Chukhareva, N.; Korotchenko, T.; Yurkin, A.

    2015-11-01

    The article provides the feasibility study of contemporary oil sludge treatment methods. The basic parameters of a new resource-efficient oil sludge treatment unit that allows extracting as much oil as possible and disposing other components in efficient way have been outlined. Based on the calculation results, it has been revealed that in order to reduce the cost of the treatment unit and the expenses related to sludge disposal, it is essential to apply various combinations of the existing treatment methods.

  5. Integrated thermal treatment system study -- Phase 2 results. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Feizollahi, F.; Quapp, W.J.

    1996-02-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 1 systems. The alternatives evaluated were: rotary kiln, slagging kiln, plasma furnace, plasma gasification, molten salt oxidation, molten metal waste destruction, steam gasification, Joule-heated vitrification, thermal desorption and mediated electrochemical oxidation, and thermal desorption and supercritical water oxidation. The quantities, and physical and chemical compositions, of the input waste used in the Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr). 28 refs., 88 figs., 41 tabs.

  6. Integrated thermal treatment system study -- Phase 2 results. Revision 1

    International Nuclear Information System (INIS)

    Feizollahi, F.; Quapp, W.J.

    1996-02-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 1 systems. The alternatives evaluated were: rotary kiln, slagging kiln, plasma furnace, plasma gasification, molten salt oxidation, molten metal waste destruction, steam gasification, Joule-heated vitrification, thermal desorption and mediated electrochemical oxidation, and thermal desorption and supercritical water oxidation. The quantities, and physical and chemical compositions, of the input waste used in the Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr). 28 refs., 88 figs., 41 tabs

  7. Design of automated oil sludge treatment unit

    OpenAIRE

    Chukhareva, Natalia Vyacheslavovna; Korotchenko, Tatiana Valerievna; Yurkin, A.

    2015-01-01

    The article provides the feasibility study of contemporary oil sludge treatment methods. The basic parameters of a new resource-efficient oil sludge treatment unit that allows extracting as much oil as possible and disposing other components in efficient way have been outlined. Based on the calculation results, it has been revealed that in order to reduce the cost of the treatment unit and the expenses related to sludge disposal, it is essential to apply various combinations of the existing t...

  8. A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation.

    Science.gov (United States)

    Yuan, Frank; McGlinn, Evan P; Giladi, Aviram M; Chung, Kevin C

    2015-07-01

    Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly understood. The authors performed a systematic review to evaluate outcomes of revision amputation and amputation wound coverage techniques. The authors searched all available English literature in the PubMed and Embase databases for articles reporting outcomes of nonreplantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes, and complications. A total of 1659 articles were screened, yielding 43 studies for review. Mean static two-point discrimination was 5.0 ± 1.5 mm (n = 23 studies) overall, 6.1 ± 2.4 mm after local flap procedures, and 3.8 ± 0.4 mm after revision amputation. Mean total active motion was 93 ± 8 percent of normal (n = 6 studies) overall. It was 90 ± 9 percent of normal after local flap procedures and 95 percent of normal after revision amputation. Seventy-seven percent of patients reported cold intolerance after revision amputation. Ninety-one percent of patients (217 of 238) reported "satisfactory" or "good/excellent" ratings regardless of treatment. Revision amputation and conservative treatments result in better static two-point discrimination outcomes compared with local flaps. All techniques preserve total active motion, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report "satisfactory," "good," or "excellent" ratings in appearance and quality of life with all nonreplantation techniques.

  9. Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013.

    Science.gov (United States)

    Gwam, Chukwuweike U; Mistry, Jaydev B; Mohamed, Nequesha S; Thomas, Melbin; Bigart, Kevin C; Mont, Michael A; Delanois, Ronald E

    2017-07-01

    Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure. We queried the National Inpatient Sample database for all revision THA procedures performed between January 1, 2009 and December 31, 2013. This yielded 258,461 revision THAs. Patients specific demographics were identified in order to determine the prevalence of revision procedure performed. Dislocation was the main indication for revision THA (17.3%), followed by mechanical loosening (16.8%). All-component revision was the most common procedure performed (41.8%). Patients were most commonly white (77.4%), aged 75 years and older (31.6%), and resided in the South US Census region (37.0%). The average length of stay for all procedures was 5.29 days. The mean total charge for revision THA procedures was $77,851.24. Dislocation and mechanical loosening is the predominant indication for revision THA in the United States. With the frequency of revision THAs projected to double in the next decade, orthopedists must take steps to mitigate this potentially devastating complication. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Higher Total Knee Arthroplasty Revision Rates Among United States Blacks Than Whites: A Systematic Literature Review and Meta-Analysis.

    Science.gov (United States)

    Bass, Anne R; McHugh, Kelly; Fields, Kara; Goto, Rie; Parks, Michael L; Goodman, Susan M

    2016-12-21

    Reportedly 2% to 5.7% of total knee arthroplasties (TKAs) require revision within 5 years. The purpose of this study was to determine whether blacks are at higher risk of TKA revision than whites in the United States. We performed a systematic review of English-language articles published from 2000 to 2015. Study inclusion criteria were (1) performance of the study in the United States, (2) TKA as the primary procedure studied, (3) a follow-up period at least 2 years, (4) reporting of revision rates, and (5) analysis of patient race as an independent predictor of revision. We then performed a random-effects meta-analysis to calculate a pooled hazard ratio for TKA revision in blacks compared with whites. A total of 4,286 studies were identified and screened by title; 106, by abstract; and 24, by full text. Six studies met the inclusion criteria. Only 4 of the 6 studies could undergo meta-analysis because of overlapping study populations in 3 of them. The meta-analysis represented 451,960 patients who underwent TKA, of whom 28,772 (6.4%) were black. Of the total, 31,568 patients (7.0%) underwent revision surgery. The risk of revision TKA was significantly higher among blacks than whites (pooled hazard ratio, 1.38; 95% confidence interval, 1.20 to 1.58; p revision TKA than whites. Socioeconomic status contributed to revision risk and is an important confounder in analyses of race. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  11. Revision report about the in-situ tests of 1000 MW unit 5 Kozloduy (Bulgaria)

    International Nuclear Information System (INIS)

    Muzzi, F.

    1995-01-01

    This report refers to the technical revision performed on the technical report about the in-situ tests performed on 1000 Unit 5 nuclear power station of Kozloduy (Bulgaria), within the frame of the IAEA benchmark study for the seismic analysis and testing of an existing Nuclear Power Plant. After a foreword to define the aims of the job and the identification of the scope of the work, a brief description of the plant is made. A brief description of the theory about the modal parameter determination and the soil-structure interaction analysis by experimental tests is made. The following chapters collect some comments about the tests carried out in Kozloduy, with special reference to the general correctness of testing procedure and to data special requirements for the seismic safety margin assessment procedures to be applied on the existing power station

  12. Critical revision of the medical treatment of gout in Brazil.

    Science.gov (United States)

    Azevedo, Valderilio Feijó; Lopes, Maicon Piana; Catholino, Nathan Marostica; Paiva, Eduardo Dos Santos; Araújo, Vitor Andrei; Pinheiro, Geraldo da Rocha Castelar

    Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems. Copyright © 2017 Elsevier Editora Ltda. All rights reserved.

  13. 300 Area waste acid treatment system closure plan. Revision 1

    International Nuclear Information System (INIS)

    1996-03-01

    This section provides a description of the Hanford Site, identifies the proposed method of 300 Area Waste Acid Treatment System (WATS) closure, and briefly summarizes the contents of each chapter of this plan

  14. 300 Area waste acid treatment system closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    This section provides a description of the Hanford Site, identifies the proposed method of 300 Area Waste Acid Treatment System (WATS) closure, and briefly summarizes the contents of each chapter of this plan.

  15. 76 FR 34200 - Land Disposal Restrictions: Revision of the Treatment Standards for Carbamate Wastes

    Science.gov (United States)

    2011-06-13

    ... 2050-AG65 Land Disposal Restrictions: Revision of the Treatment Standards for Carbamate Wastes AGENCY... wastes from the production of carbamates and carbamate commercial chemical products, off-specification or... or intended to be discarded. Currently, under the LDR program, most carbamate wastes must be treated...

  16. Conformance to Regulatory Guide 1.97, Callaway Plant, Unit No. 1 (Docket No. 50-483). Revision 1

    International Nuclear Information System (INIS)

    Udy, A.C.

    1985-01-01

    This EG and G Idaho, Inc., report provides a review of the submittals for the Callaway Plant, Unit No. 1, and identifies areas of full conformance to Regulatory Guide 1.97, Revision 2. Any exceptions to these guidelines are evaluated and those areas where sufficient basis for acceptability is not provided are identified

  17. Primary Treatment and Sludge Digestion Workshop. Second Edition (Revised).

    Science.gov (United States)

    Ontario Ministry of the Environment, Toronto.

    This manual was developed for use at workshops designed to upgrade the knowledge of experienced wastewater treatment plant operators. Each of the sixteen lessons has clearly stated behavioral objectives to tell the trainee what he should know or do after completing that topic. The body of the text provides content information, procedure outlines,…

  18. Adductor canal block for postoperative pain treatment after revision knee arthroplasty

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M

    2014-01-01

    BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total...... knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. METHODS: We included patients scheduled for revision knee......01191593. RESULTS: We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1-8 h/7 h...

  19. Single-Stage Revision Arthroplasty for Infection-An Underutilized Treatment Strategy.

    Science.gov (United States)

    Negus, Jonathan J; Gifford, Peter B; Haddad, Fares S

    2017-07-01

    The burden of revision arthroplasty surgery for infection is rising as the rate of primary arthroplasty surgery increases. Infected arthroplasty rates are now relatively low, but the sheer increase in volume is leading to considerable patient morbidity and significant increases in costs to the health care system. Single-stage revision for infection is one of the several accepted treatment options, but the indications and results are debated. This review aims to clarify the current evidence. MEDLINE/PubMed databases were reviewed for studies that looked at single- or one-stage revision knee or hip arthroplasty for infection. There is increasing evidence that single-stage revision for infection can control infection and with decreased morbidity, mortality, and health care costs compared with a staged approach. However, the indications are still debated. Recently, there has been a determined effort to define an infected arthroplasty in a manner that will allow for standardization of reporting in the literature. The evidence supporting single stage for knee arthroplasty is catching up with the result with hip arthroplasty. High-quality data from randomized controlled trials are now pending. After the gradual evolution of using the single-stage approach, with the widespread acceptance of this definition, we can now standardize comparisons across the world and move toward a refined definition of the ideal patient population for single-stage arthroplasty revision in both the hip and the knee population. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture.

    Science.gov (United States)

    Glimåker, Martin; Johansson, Bibi; Grindborg, Örjan; Bottai, Matteo; Lindquist, Lars; Sjölin, Jan

    2015-04-15

    In suspected acute bacterial meningitis (ABM), cerebral computerized tomography (CT) is recommended before lumbar puncture (LP) if mental impairment. Despite guideline emphasis on early treatment, performing CT prior to LP implies a risk of delayed treatment and unfavorable outcome. Therefore, Swedish guidelines were revised in 2009, deleting impaired mental status as a contraindication for LP without prior CT scan. The aim of the present study was to evaluate the guideline revision. The Swedish quality registry for community-acquired ABM was analyzed retrospectively. Door-to-antibiotic time and outcome were compared among patients treated 2005-2009 (n=394) and 2010-2012 (n=318). The effect of different LP-CT sequences was analyzed during 2008-2012. Adequate treatment was started 1.2 hours earlier, and significantly more patients were treated treatment, significant increase in door-to-antibiotic times of Treatment delay resulted in a significantly increased risk for fatal outcome, with a relative increase in mortality of 12.6% per hour of delay. The deletion of impaired mental status as contraindication for prompt LP and LP without prior CT scan are associated with significantly earlier treatment and a favorable outcome. A revision of current international guidelines should be considered. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Improved perception of communication and compliance with a revised, intensive care unit-specific bedside communication sheet.

    Science.gov (United States)

    Aponte-Patel, Linda; Sen, Anita

    2015-01-01

    Although many pediatric intensive care units (PICUs) use beside communication sheets (BCSs) to highlight daily goals, the optimal format is unknown. A site-specific BCS could improve both PICU communication and compliance completing the BCS. Via written survey, PICU staff at an academic children's hospital provided recommendations for improving and revising an existing BCS. Pre- and post-BCS revision, PICU staff were polled regarding PICU communication and BCS effectiveness, and daily compliance for completing the BCS was monitored. After implementation of the revised BCS, staff reporting "excellent" or "very good" day-to-day communication within the PICU increased from 57% to 77% (P = .02). Compliance for completing the BCS also increased significantly (75% vs 83%, P = .03). Introduction of a focused and concise BCS tailored to a specific PICU leads to improved perceptions of communication by PICU staff and increased compliance completing the daily BCS. © The Author(s) 2014.

  2. Re-visioning the doctoral research degree in nursing in the United Kingdom.

    Science.gov (United States)

    Burton, Christopher R; Duxbury, Joy; French, Beverley; Monks, Rob; Carter, Bernie

    2009-05-01

    In the light of concerns about the wider social and economic value of the PhD training programme, this article discusses the challenges being directed primarily at the traditional doctoral programme of study. While the PhD is primarily concerned with the student making an original contribution to knowledge, the value-added component of the doctoral research degree needs to respond to the needs of a wider market of purchasers, and to meet practice and policy requirements for research leadership. The United Kingdom Research Councils (UK GRAD, 2001. Joint Skills Statement of Skills Training Requirements. Available at http://www.grad.ac.uk/downloads/documents/general/Joint%20Skills%20Statementpdf. (last accessed 1st April 2008.) suggest a range of seven skill domains over and above research design and management that should be offered to students. The seven domains are research skills and techniques, participation in the research environment, research management, personal effectiveness, communication, networking and team working, and career management. This article develops and extends these skill domains for the current healthcare context and considers how these should guide the development and evaluation of the value-added components of doctoral research degree programmes in nursing. The challenges that these issues present to academic departments are also discussed. Our conclusion is that PhD research training needs re-visioning and broadening so that the students' experience includes these value-added components.

  3. Revision of testing criteria for air cleaning unit of renovated APR-1000 and APR-1400 NPPS.

    Science.gov (United States)

    Jeong, Seung-Young

    2011-07-01

    Designing Air Cleaning Units (ACU) of an Engineered Safety Feature and normal atmosphere clean-up system at the renovated APR-1000 and APR-1400 NPP, and fuel cycle facilities in Korea, is required to meet the standards of ASME AG-1 (1997), ASME N509/N510 (1989) and KEPIC-MH (2001) to enhance the removal efficiency of aerosols and particulates from the effluents. The revised ACU testing criteria are allowed to use alternative challenge agents of the dioctyl phthalate and Refrigerant-11 for in situ testing of high efficiency particulate air filters and adsorption banks. The operability testing time of engineered safety feature (ESF) trains was changed from 10 h to 15 min. The activated carbon in adsorption banks should undergo laboratory tests at a temperature of 30 °C and relative humidity 95 %. The removal criteria of methyl iodide should be over 99.5 % for ESF and 99 % for normal systems. This paper provides the background of the changed criteria for designing and testing of the ACU system in nuclear facilities.

  4. Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices

    DEFF Research Database (Denmark)

    Deharo, Jean-Claude; Sciaraffia, Elena; Leclercq, Christophe

    2016-01-01

    The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment...... therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6...... (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88...

  5. Revision of Calibration Method of CT-Number to Stopping-Power-Ratio Conversion for Treatment Planning of Particle Therapy.

    Science.gov (United States)

    Kanematsu, Nobuyuki; Mori, Shinichiro; Inaniwa, Taku

    A calibration method for CT-number to stopping-power-ratio conversion was recently proposed as a revision of the Japanese de facto standard method that has been used at particle therapy centers in Japan for over a decade. The revised method deals with 11 representative tissues of specific elemental composition and density, based on a latest compilation of standard tissue data. We report here how the revision was actually implemented into clinical practice. We applied the revised method to 7 CT-scanning conditions currently in use for treatment planning. For each condition, we derived CT numbers and stopping-power ratios of the representative tissues to constitute a polyline conversion function. We analyzed the change of target water-equivalent depth by the revision for 38 beams in treatment plans for 13 randomly sampled patients. The revision caused a mean change of +0.3 mm with a standard deviation of 0.4 mm. The maximum change was +1.2 mm or +0.5% of the depth, which may be clinically insignificant. The transition to the revised method was straightforward and would slightly improve the accuracy of the beam range in particle therapy.

  6. Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol.

    Science.gov (United States)

    Pulford, Justin; Mueller, Ivo; Siba, Peter M; Hetzel, Manuel W

    2012-05-07

    This study aimed to document malaria case management practices in Papua New Guinea prior to the introduction of a revised national malaria treatment protocol. The revised protocol stipulates routine testing of malaria infection by rapid diagnostic test or microscopy, anti-malarial prescription to test positive cases only, and the introduction of a new artemisinin-based first-line anti-malarial. Findings presented in this paper primarily focus on diagnostic, prescription and treatment counselling practices. In a national cross-sectional survey of 79 randomly selected health facilities, data were collected via non-participant observation of the clinical case management of patients presenting with fever or a recent history of fever. Data were recorded on a structured clinical observation instrument. Overall, 15% of observed fever patients (n=468) were tested for malaria infection by rapid diagnostic test and a further 3.6% were tested via microscopy. An anti-malarial prescription was made in 96.4% (451/468) of cases, including 100% (17/17) of test positive cases and 82% (41/50) of test negative cases. In all, 79.8% of anti-malarial prescriptions conformed to the treatment protocol current at the time of data collection. The purpose of the prescribed medication was explained to patients in 63.4% of cases, dosage/regimen instructions were provided in 75.7% of cases and the possibility of adverse effects and what they might look like were discussed in only 1.1% of cases. The revised national malaria treatment protocol will require a substantial change in current clinical practice if it is to be correctly implemented and adhered to. Areas that will require the most change include the shift from presumptive to RDT/microscopy confirmed diagnosis, prescribing (or rather non-prescribing) of anti-malarials to patients who test negative for malaria infection, and the provision of thorough treatment counselling. A comprehensive clinician support programme, possibly inclusive of

  7. 77 FR 62270 - Proposed Revision Treatment of Non-Safety Systems for Passive Advanced Light Water Reactors

    Science.gov (United States)

    2012-10-12

    ... NUCLEAR REGULATORY COMMISSION [NRC-2012-0237] Proposed Revision Treatment of Non-Safety Systems for Passive Advanced Light Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Standard... its Standard Review Plan (SRP), Section 19.3, ``Regulatory Treatment of Non-Safety Systems (RTNSS) for...

  8. 78 FR 41436 - Proposed Revision to Treatment of Non-Safety Systems for Passive Advanced Light Water Reactors

    Science.gov (United States)

    2013-07-10

    ..., ``Regulatory Treatment of Non- Safety Systems (RTNSS) for Passive Advanced Light Water Reactors.'' This area... NUCLEAR REGULATORY COMMISSION [NRC-2013-0150] Proposed Revision to Treatment of Non-Safety Systems for Passive Advanced Light Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Standard...

  9. Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A; Mueller, Sebastian; Gondan, Matthias

    2015-01-01

    Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases......) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased...

  10. What Is a Kilogram in the Revised International System of Units (SI)?

    Science.gov (United States)

    Davis, Richard S.

    2015-01-01

    The definition of the kilogram, the unit of mass in the International System of Units (SI), has not changed in more than 125 years. The kilogram is still defined by the mass of a Pt-Ir cylinder conserved at the International Bureau of Weights and Measures. Science and technology have progressed to the point where it is likely the kilogram will be…

  11. Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

    Science.gov (United States)

    Shin, Jeong Eun; Jung, Hye-Kyung; Lee, Tae Hee; Jo, Yunju; Lee, Hyuk; Song, Kyung Ho; Hong, Sung Noh; Lim, Hyun Chul; Lee, Soon Jin; Chung, Soon Sup; Lee, Joon Seong; Rhee, Poong-Lyul; Lee, Kwang Jae; Choi, Suck Chei; Shin, Ein Soon

    2016-01-01

    The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods. PMID:27226437

  12. Unit for continuous heat treatment of molasses

    Energy Technology Data Exchange (ETDEWEB)

    Shvets, V.N.; Savchuk, M.Ya.; Egorov, A.A.

    1981-01-01

    An apparatus is described for continuous heat treatment of molasses for alcohol fermentation. Repeated short-term heating of molasses at 120 degrees followed by cooling in vacuo results in the removal of 25% volatile fatty acids, stabilization of yeast during fermentation, and increase of alcohol yield by 0.33%.

  13. The impact of new insights and revised practice guidelines on prescribing drugs in the treatment of type 2 diabetes mellitus

    NARCIS (Netherlands)

    Lub, Rene; Denig, Petra; van den Berg, Paulus; Hoogenberg, Klaas; de Jong-van den Berg, Lolkje

    2006-01-01

    Aims. The aim of this study was to investigate the impact of new insights and revised guidelines on initial and follow-up treatment with antihyperglycaemic drugs over the period 1998-2003. Methods. The InterAction Database (IADB), which contains pharmacy dispensing data from 53 community pharmacies

  14. REVISING/UPDATING EPA 625/1-79-011, PROCESS DESIGN MANUAL FOR SLUDGE TREATMENT AND DISPOSAL

    Science.gov (United States)

    The US Environmental Protection Agency (EPA) wishes to revise/update its very large and comprehensive 1979 Process Design Manual for Sludge Treatment and Disposal, EPA 625/1-79-011. As you might imagine the task is not trivial, as already in 1979 the original manual cost more tha...

  15. Savannah River Site mixed waste Proposed Site Treatment Plan (PSTP). Volumes 1 and 2 and reference document: Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Helmich, E.; Noller, D.K.; Wierzbicki, K.S.; Bailey, L.L.

    1995-07-13

    The DOE is required by the Resource Conservation and Recovery Act to prepare site treatment plans describing the development of treatment capacities and technologies for treating mixed waste. This proposed plan contains Savannah River Site`s preferred options and schedules for constructing new facilities, and otherwise obtaining treatment for mixed wastes. The proposed plan consists of 2 volumes. Volume 1, Compliance Plan, identifies the capacity to be developed and the schedules as required. Volume 2, Background, provides a detailed discussion of the preferred options with technical basis, plus a description of the specific waste streams. Chapters are: Introduction; Methodology; Mixed low level waste streams; Mixed transuranic waste; High level waste; Future generation of mixed waste streams; Storage; Process for evaluation of disposal issues in support of the site treatment plans discussions; Treatment facilities and treatment technologies; Offsite waste streams for which SRS treatment is the Preferred Option (Naval reactor wastes); Summary information; and Acronyms and glossary. This revision does not contain the complete revised report, but only those pages that have been revised.

  16. Savannah River Site mixed waste Proposed Site Treatment Plan (PSTP). Volumes 1 and 2 and reference document: Revision 2

    International Nuclear Information System (INIS)

    Helmich, E.; Noller, D.K.; Wierzbicki, K.S.; Bailey, L.L.

    1995-01-01

    The DOE is required by the Resource Conservation and Recovery Act to prepare site treatment plans describing the development of treatment capacities and technologies for treating mixed waste. This proposed plan contains Savannah River Site's preferred options and schedules for constructing new facilities, and otherwise obtaining treatment for mixed wastes. The proposed plan consists of 2 volumes. Volume 1, Compliance Plan, identifies the capacity to be developed and the schedules as required. Volume 2, Background, provides a detailed discussion of the preferred options with technical basis, plus a description of the specific waste streams. Chapters are: Introduction; Methodology; Mixed low level waste streams; Mixed transuranic waste; High level waste; Future generation of mixed waste streams; Storage; Process for evaluation of disposal issues in support of the site treatment plans discussions; Treatment facilities and treatment technologies; Offsite waste streams for which SRS treatment is the Preferred Option (Naval reactor wastes); Summary information; and Acronyms and glossary. This revision does not contain the complete revised report, but only those pages that have been revised

  17. Insights from a national survey into why substance abuse treatment units add prevention and outreach services

    Directory of Open Access Journals (Sweden)

    Lemak Christy

    2006-08-01

    Full Text Available Abstract Background Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1 environmental, (2 unit-level, and (3 unit leadership. Results A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care

  18. Feasibility study report for the 200-BP-1 operable unit. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This feasibility study (FS) examines a range of alternatives and provides recommendations for selecting a preferred altemative for remediating contamination at the 200-BP-1 operable unit. The 200-BP-1 operable unit is located in the center of the Hanford Site along the northern boundary of the 200 East Area. The 241-BY Tank Farm is located immediately to the south of the operable unit. 200-BP-1 is a source operable unit with contaminated soils associated primarily with nine inactive cribs (known as the 216-B cribs). These cribs were used for disposal of low-level radioactive liquid waste from U Plant uranium recovery operations, and waste storage tank condensate from the adjacent 241-BY Tank Farm. The cribs used for disposal of U Plant waste were in operation from 1955--1965, and the cribs used for disposal of tank condensate were in operation from 1965-1975. In addition to the cribs, four unplanned releases of radioactive materials have occurred within the operable unit. Contaminated surface soils associated with the unplanned releases have been consolidated over the cribs and covered with clean soil to reduce contaminant migration and exposure. Discharge of wastes to the cribs has resulted in soil and groundwater contamination. The groundwater is being addressed as part of the 200 East Aggregate Area groundwater operable unit. Contaminated soils at the site can be categorized by the types of contaminants, their distribution in the soil column, and the risk posed by the various potential exposure pathways. Below the clean soil cover, the near surface soils contain low-:levels of contamination with cesium-137, radium-226, strontium-90, thorium-228 and uranium. The lifetime incremental cancer risk associated with these soils if they were exposed at the surface is 9 {times} 10{sup 5}.

  19. Proposed plan for interim remedial measure at the 100-KR-4 operable unit, Revision 1

    International Nuclear Information System (INIS)

    1995-09-01

    This proposed plan identifies the preferred alternative for an interim remedial action plan for the 100-KR-4 Operable Unit at the Hanford Site. The alternative presented is to remove contaminated groundwater from the Unit, treat it by ion exchange, and then dispose of treated groundwater by using upgradient injection wells to return it to the acquifer. This will protect the Columbia River environment from toxic hexavalent chromium. This alternative is the initial recommendation of the EPA, Ecology, and the DOE. Public comment on this plan is invited

  20. RCRA facility investigation report for the 200-PO-1 operable unit. Revision 1

    International Nuclear Information System (INIS)

    1997-05-01

    This Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) report is prepared in support of the RFI/corrective measures study process for the 200-PO-1 Groundwater Operable Unit in the 200 East Area of the Hanford Site. This report summarizes existing information on this operable unit presented in the 200 East and PUREX Aggregate Area Management Study Reports, contaminant specific studies, available modeling data, and groundwater monitoring data summary reports. Existing contaminant data are screened against current regulatory limits to determine contaminants of potential concern (COPC). Each identified COPC is evaluated using well-specific and plume trend analyses

  1. Corrective Action Investigation Plan for Corrective Action Unit 374: Area 20 Schooner Unit Crater Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2010-02-01

    Corrective Action Unit 374 is located in Areas 18 and 20 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 374 comprises the five corrective action sites (CASs) listed below: • 18-22-05, Drum • 18-22-06, Drums (20) • 18-22-08, Drum • 18-23-01, Danny Boy Contamination Area • 20-45-03, U-20u Crater (Schooner) These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on October 20, 2009, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 374.

  2. Closure report for housekeeping category, Corrective Action Unit 344, Nevada Test Site. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-09-01

    This Closure Report summarizes the corrective actions which were completed at the Corrective Action Sites within Corrective Action Unit 344 at the Nevada Test Site. Current site descriptions, observations and identification of wastes removed are included on FFACO Corrective Action Site housekeeping closure verification forms.

  3. Energy from the Atom. A Basic Teaching Unit on Energy. Revised.

    Science.gov (United States)

    McDermott, Hugh, Ed.; Scharmann, Larry, Ed.

    Recommended for grades 9-12 social studies and/or physical science classes, this 4-8 day unit focuses on four topics: (1) the background and history of atomic development; (2) two common types of nuclear reactors (boiling water and pressurized water reactors); (3) disposal of radioactive waste; and (4) the future of nuclear energy. Each topic…

  4. Qualitative risk assessment for the 100-NR-2 Operable Unit. Revision 1

    International Nuclear Information System (INIS)

    1995-03-01

    This qualitative risk assessment provides information about the 100- NR-2 Groundwater Operable Unit of the Hanford reservation. Topics discussed in this report are: data evaluation; human health risk assessment overview; ecological evaluations; summary of uncertainty; results of both the ecological and human health evaluations; toxicity assessment; risk characterization; and a summary of contaminants of potential concern

  5. Coffee Connections. A Precollegiate Curriculum Unit. Grades Nine through Twelve. Revised.

    Science.gov (United States)

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    This unit, designed for grades 9-12, introduces students to economic concepts of international trade through the case of the international coffee industry in California and Brazil. The following concepts are among those examined: commodities, factors of production (human resources, capital resources, and environmental resources), imports and…

  6. Corrective Action Investigation Plan for Corrective Action Unit 543: Liquid Disposal Units, Nevada Test Site, Nevada: Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2004-05-03

    The general purpose of this Corrective Action Investigation Plan is to ensure that adequate data are collected to provide sufficient and reliable information to identify, evaluate, and select technically viable corrective action alternatives (CAAs) for Corrective Action Unit (CAU) 543: Liquid Disposal Units, Nevada Test Site (NTS), Nevada. Located in Areas 6 and 15 on the NTS, CAU 543 is comprised of a total of seven corrective action sites (CASs), one in Area 6 and six in Area 15. The CAS in Area 6 consists of a Decontamination Facility and its components which are associated with decontamination of equipment, vehicles, and materials related to nuclear testing. The six CASs in Area 15 are located at the U.S. Environmental Protection Agency Farm and are related to waste disposal activities at the farm. Sources of possible contamination at Area 6 include potentially contaminated process waste effluent discharged through a process waste system, a sanitary waste stream generated within buildings of the Decon Facility, and radiologically contaminated materials stored within a portion of the facility yard. At Area 15, sources of potential contamination are associated with the dairy operations and the animal tests and experiments involving radionuclide uptake. Identified contaminants of potential concern include volatile organic compounds, semivolatile organic compounds, petroleum hydrocarbons, pesticides, herbicides, polychlorinated biphenyls, metals, and radionuclides. Three corrective action closure alternatives - No Further Action, Close in Place, or Clean Closure - will be recommended for CAU 543 based on an evaluation of all the data quality objective-related data. Field work will be conducted following approval of the plan. The results of the field investigation will support a defensible evaluation of CAAs that will be presented in the Corrective Action Decision Document.

  7. Taxonomic revision of the tarantula genus Aphonopelma Pocock, 1901 (Araneae, Mygalomorphae, Theraphosidae) within the United States.

    Science.gov (United States)

    Hamilton, Chris A; Hendrixson, Brent E; Bond, Jason E

    2016-01-01

    This systematic study documents the taxonomy, diversity, and distribution of the tarantula spider genus Aphonopelma Pocock, 1901 within the United States. By employing phylogenomic, morphological, and geospatial data, we evaluated all 55 nominal species in the United States to examine the evolutionary history of Aphonopelma and the group's taxonomy by implementing an integrative approach to species delimitation. Based on our analyses, we now recognize only 29 distinct species in the United States. We propose 33 new synonymies (Aphonopelma apacheum, Aphonopelma minchi, Aphonopelma rothi, Aphonopelma schmidti, Aphonopelma stahnkei = Aphonopelma chalcodes; Aphonopelma arnoldi = Aphonopelma armada; Aphonopelma behlei, Aphonopelma vogelae = Aphonopelma marxi; Aphonopelma breenei = Aphonopelma anax; Aphonopelma chambersi, Aphonopelma clarum, Aphonopelma cryptethum, Aphonopelma sandersoni, Aphonopelma sullivani = Aphonopelma eutylenum; Aphonopelma clarki, Aphonopelma coloradanum, Aphonopelma echinum, Aphonopelma gurleyi, Aphonopelma harlingenum, Aphonopelma odelli, Aphonopelma waconum, Aphonopelma wichitanum = Aphonopelma hentzi; Aphonopelma heterops = Aphonopelma moderatum; Aphonopelma jungi, Aphonopelma punzoi = Aphonopelma vorhiesi; Aphonopelma brunnius, Aphonopelma chamberlini, Aphonopelma iviei, Aphonopelma lithodomum, Aphonopelma smithi, Aphonopelma zionis = Aphonopelma iodius; Aphonopelma phanum, Aphonopelma reversum = Aphonopelma steindachneri), 14 new species (Aphonopelma atomicum sp. n., Aphonopelma catalina sp. n., Aphonopelma chiricahua sp. n., Aphonopelma icenoglei sp. n., Aphonopelma johnnycashi sp. n., Aphonopelma madera sp. n., Aphonopelma mareki sp. n., Aphonopelma moellendorfi sp. n., Aphonopelma parvum sp. n., Aphonopelma peloncillo sp. n., Aphonopelma prenticei sp. n., Aphonopelma saguaro sp. n., Aphonopelma superstitionense sp. n., and Aphonopelma xwalxwal sp. n.), and seven nomina dubia (Aphonopelma baergi, Aphonopelma cratium, Aphonopelma hollyi

  8. Combined coagulation flocculation pre treatment unit for municipal wastewater

    Directory of Open Access Journals (Sweden)

    Ibrahim M. Ismail

    2012-10-01

    Full Text Available The potentials of using the hydraulic technique in combined unit for municipal wastewater treatment were studied. A combined unit in which processes of coagulation, flocculation and sedimentation, has been designed utilizing hydraulic mixing instead of mechanical mixing. A jar test treatability study has been conducted to locate the optimum dose of the coagulants to be used. Alum, ferrous sulfate, ferric sulfate, a mixture of ferric and ferrous sulfates, and mixture of lime and ferrous sulfate were all tested. A pilot unit was constructed in the existing wastewater treatment plant at El Mansoura governorate located in north Egypt. The optimum dose of coagulants used in the combined unit gives removal efficiencies for COD, BOD, and total phosphorous as 65%, 55%, and 83%, respectively.

  9. Closure Report for Corrective Action Unit 130: Storage Tanks Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2009-03-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 130: Storage Tanks, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 130 are located within Areas 1, 7, 10, 20, 22, and 23 of the Nevada Test Site. Corrective Action Unit 130 is comprised of the following CASs: • 01-02-01, Underground Storage Tank • 07-02-01, Underground Storage Tanks • 10-02-01, Underground Storage Tank • 20-02-03, Underground Storage Tank • 20-99-05, Tar Residue • 22-02-02, Buried UST Piping • 23-02-07, Underground Storage Tank This CR provides documentation supporting the completed corrective action investigations and provides data confirming that the closure objectives for CASs within CAU 130 were met. To achieve this, the following actions were performed: • Reviewed the current site conditions, including the concentration and extent of contamination. • Implemented any corrective actions necessary to protect human health and the environment. • Properly disposed of corrective action and investigation-derived wastes. From August 4 through September 30, 2008, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 130, Storage Tanks, Nevada Test Site, Nevada. The purposes of the activities as defined during the data quality objectives process were: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, confirm that no residual contamination is present, and properly dispose of wastes. Constituents detected during the closure activities were evaluated against final action levels to identify

  10. Modeling Approach/Strategy for Corrective Action Unit 97, Yucca Flat and Climax Mine , Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Janet Willie

    2003-08-01

    The objectives of the UGTA corrective action strategy are to predict the location of the contaminant boundary for each CAU, develop and implement a corrective action, and close each CAU. The process for achieving this strategy includes modeling to define the maximum extent of contaminant transport within a specified time frame. Modeling is a method of forecasting how the hydrogeologic system, including the underground test cavities, will behave over time with the goal of assessing the migration of radionuclides away from the cavities and chimneys. Use of flow and transport models to achieve the objectives of the corrective action strategy is specified in the FFACO. In the Yucca Flat/Climax Mine system, radionuclide migration will be governed by releases from the cavities and chimneys, and transport in alluvial aquifers, fractured and partially fractured volcanic rock aquifers and aquitards, the carbonate aquifers, and in intrusive units. Additional complexity is associated with multiple faults in Yucca Flat and the need to consider reactive transport mechanisms that both reduce and enhance the mobility of radionuclides. A summary of the data and information that form the technical basis for the model is provided in this document.

  11. The United States Transuranium and Uranium Registries. Revision 1, [Annual] report, October 1, 1990--April 1992

    Energy Technology Data Exchange (ETDEWEB)

    Kathren, R.L.

    1992-09-01

    This paper describes the history, organization, activities and recent scientific accomplishments of the United States Transuranium and Uranium Registries. Through voluntary donations of tissue obtained at autopsies, the Registries carry out studies of the concentration, distribution and biokinetics of plutonium in occupationally exposed persons. Findings from tissue analyses from more than 200 autopsies include the following: a greater proportion of the americium intake, as compared with plutonium, was found in the skeleton; the half-time of americium in liver is significantly shorter than that of plutonium; the concentration of actinide in the skeleton is inversely proportional to the calcium and ash content of the bone; only a small percentage of the total skeletal deposition of plutonium is found in the marrow, implying a smaller risk from irradiation of the marrow relative to the bone surfaces; estimates of plutonium body burden made from urinalysis typically exceed those made from autopsy data; pathologists were unable to discriminate between a group of uranium workers and persons without known occupational exposure on the basis of evaluation of microscopic kidney slides; the skeleton is an important long term depot for uranium, and that the fractional uptake by both skeleton and kidney may be greater than indicated by current models. These and other findings and current studies are discussed in depth.

  12. Clinical consequences of the revised DSM-5 definition of agoraphobia in treatment-seeking anxious youth

    Science.gov (United States)

    Cornacchio, Danielle; Chou, Tommy; Sacks, Hayley; Pincus, Donna; Comer, Jonathan

    2015-01-01

    Background In DSM-5, the agoraphobia core symptom criterion has been revised to require fear about multiple situations from across at least two distinct domains in which escape might be difficult or panic-like symptoms might develop. The present study examined patterns and correlates of the recent change in a sample of anxious youth with symptom presentations consistent with the DSM-IV agoraphobia definition and/or specific phobia (SP) to consider how the recent diagnostic change impacts the prevalence and composition of agoraphobia in children and adolescents. Method Analyses (N=151) evaluated impairment and correlates of agoraphobic youth who no longer meet the DSM-5 agoraphobia criteria relative to agoraphobic youth who do meet the new DSM-5 criteria. Secondary analyses compared agoraphobic youth not meeting DSM-5 criteria to SP youth. Results One-quarter of youth with symptom presentations consistent with the DSM-IV agoraphobia definition no longer met criteria for DSM-5 agoraphobia, but showed comparable severity and impairment across most domains to youth who do meet criteria for DSM-5 agoraphobia. Further, these youth showed higher levels of anxiety sensitivity and internalizing psychopathology relative to youth with SP. Conclusions A substantial proportion of impaired youth with considerable agoraphobic symptom presentations have been left without a specified anxiety diagnosis by the DSM-5, which may affect their ability to receive and/or get coverage for services and their representation in treatment evaluations. Future DSM iterations may do well to include a “circumscribed” agoraphobia specifier that would characterize presentations of fear or anxiety about multiple situations, but that do not span across at least two distinct situational domains. PMID:25845579

  13. Phase II Transport Model of Corrective Action Unit 98: Frenchman Flat, Nevada Test Site, Nye County, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Gregg Ruskuaff

    2010-01-01

    This document, the Phase II Frenchman Flat transport report, presents the results of radionuclide transport simulations that incorporate groundwater radionuclide transport model statistical and structural uncertainty, and lead to forecasts of the contaminant boundary (CB) for a set of representative models from an ensemble of possible models. This work, as described in the Federal Facility Agreement and Consent Order (FFACO) Underground Test Area (UGTA) strategy (FFACO, 1996; amended 2010), forms an essential part of the technical basis for subsequent negotiation of the compliance boundary of the Frenchman Flat corrective action unit (CAU) by Nevada Division of Environmental Protection (NDEP) and National Nuclear Security Administration Nevada Site Office (NNSA/NSO). Underground nuclear testing via deep vertical shafts was conducted at the Nevada Test Site (NTS) from 1951 until 1992. The Frenchman Flat area, the subject of this report, was used for seven years, with 10 underground nuclear tests being conducted. The U.S. Department of Energy (DOE), NNSA/NSO initiated the UGTA Project to assess and evaluate the effects of underground nuclear tests on groundwater at the NTS and vicinity through the FFACO (1996, amended 2010). The processes that will be used to complete UGTA corrective actions are described in the “Corrective Action Strategy” in the FFACO Appendix VI, Revision No. 2 (February 20, 2008).

  14. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity, and ini...

  15. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity......, and initial stroke severity....

  16. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Diagnostic capacity and antimalarial availability in Papua New Guinea before the introduction of a revised national malaria treatment protocol.

    Science.gov (United States)

    Kurumop, Serah F; Pulford, Justin; Mueller, Ivo; Siba, Peter M; Hetzel, Manuel W

    2014-01-01

    Papua New Guinea (PNG) introduced a revised national malaria treatment protocol (NMTP) in late 2011. Successful implementation of the revised protocol requires all health facilities in PNG to have reliable access to microscopy or malaria rapid diagnostic kits as well as a reliable supply of all recommended first-line medications. This paper presents findings from a study that sought to assess the availability of microscopy, malaria rapid diagnostic kits and recommended first-line antimalarial medication in Papua New Guinean health facilities across the country before the introduction of the revised treatment protocol. A country-wide cross-sectional survey of 79 randomly selected health centres, health subcentres and aid posts. Data were collected via an interviewer-administered questionnaire completed with the officer in charge of participating health facilities. Overall, 15% of surveyed health facilities had unexpired rapid diagnostic test (RDT) in stock or working microscopy available. A recommended first-line antimalarial for uncomplicated malaria was available in 85% of health facilities. The preferred first-line antimalarial combination for treating severe malaria was present in 42% of health facilities, although 68% had the capacity to provide either the preferred or recommended substitute first-line medication for severe malaria. The total number of health workers employed in the 79 surveyed health facilities was 443, only 3 of whom were medical doctors. Our findings indicate that diagnostic capacity was low in Papua New Guinean health facilities before the introduction of the new NMTP and that access to recommended first-line antimalarial medication was variable. Substantial improvements in diagnostic capacity and antimalarial procurement and distribution will need to be made if the revised protocol is to be adhered to.

  18. Two-unit cantilevered resin-bonded fixed partial denture as a substitute for a prosthodontic-orthodontic treatment plan: a 5-year case report.

    Science.gov (United States)

    Emami, Elham; St-Georges, Annie; de Grandmont, Pierre

    2012-01-01

    In this case report, we describe the successful long-term treatment of a patient with dental agenesis. The initial treatment plan included an orthodontic phase to provide adequate space for replacing missing lateral incisors with implants. However, because of some complications encountered after 2 years of orthodontic treatment, a revised treatment plan was considered to achieve functional and esthetic goals. The patient was completely satisfied 5 years after being treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost.

  19. Alendronate treatment in the revision setting, with and without controlled implant motion

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Chen, Xinqian; Jensen, Thomas B

    2007-01-01

    conditions, even with alendronate. With alendronate and stabilized implants, increased bone was observed near the sclerotic shell of the revision cavity, but it was reduced with alendronate when the implant was unstable. Interpretation Our findings suggest that it may be difficult for alendronate...

  20. Study on the Development of Household Wastewater Treatment Unit

    Directory of Open Access Journals (Sweden)

    Ali Hadi Ghawi

    2018-03-01

    Full Text Available The cities of Iraq in general and the city of Al Diwaniyah in particular are characterized by the fact that the majority of households use septic tank to dispose of sewage, leading to contamination of ground and surface water and a disturbance to the environment. The objective of this study is to protect the water and soil sources from the risk of pollution, eliminate the process of perfusion and thus, reduce costs, maintain public health, as well as design and implement the proposed purification unit for domestic wastewater treatment. A domestic wastewater treatment unit has been improved to meet the standard specifications for the quality of the effluent wastewater. In this study, a compact non-electric sewage treatment unit was improved and implemented. Treatment is based on an effective modern biological purification process. Experimental verification and analysis of results were performed to demonstrate the improvement of physical and chemical parameters. The performance of the septic tanks-bioreactor gave satisfactory results. The removal efficiencies of Total Biochemical Oxygen Demand (BOD, Total Chemical Oxygen Demand (COD, NH4-N, Total Nitrogen and Total Suspended Solid (TSS were 96.9%, 84.6%, 78.8%, 79.9% and 95.3%, respectively.

  1. [Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision].

    Science.gov (United States)

    Gao, Zhi-Sen; Zhou, Yong-Gang; Du, Yin-Qiao; Piao, Shang; Sun, Jing-Yang; Peng, Ya-Wen; Wu, Wen-Ming

    2018-02-25

    To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision. From January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females. Follow-up for at least 2 years, the inflammatory markers, incidence rate of sinus and the duration of the symptoms, reinfection or persistent infection rate after two-stage revision were compared between two groups. MSCoN group and MRCoN group were followed up(81.7±38.3) months and(65.9±33.8) months, respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups( P =0.643). The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery[OR=4.04, 95%CI(0.62, 26.5)]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus[OR=4.26, 95%CI(0.7, 25.9)]. Two-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN. There is no significant difference of treatment failure rate between MSCoN and MRCoN group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure, while methicillin-resistance is not. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  2. Functional design criteria for project W-252, phase II liquid effluent treatment and disposal. Revision 2

    International Nuclear Information System (INIS)

    Hatch, C.E.

    1995-05-01

    This document is the Functional Design Criteria for Project W-252. Project W-252 provides the scope to provide BAT/AKART (best available technology...) to 200 Liquid Effluent Phase II streams (B-Plant). This revision (Rev. 2) incorporates a major descoping of the project. The descoping was done to reflect a combination of budget cutting measures allowed by a less stringent regulatory posture toward the Phase II streams

  3. The United States Revised Uniform Anatomical Gift Act (2006: New challenges to balancing patient rights and physician responsibilities

    Directory of Open Access Journals (Sweden)

    McGregor Joan L

    2007-09-01

    Full Text Available Abstract Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006 and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006 for legislation and remaining states are likely to follow soon. The Revised UAGA (2006 poses challenges to the Patient Self Determination Act (PSDA embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006 overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006 towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support

  4. Revised correlation chart of coal beds, coal zones, and key stratigraphic units in the Pennsylvanian rocks of eastern Kentucky

    Science.gov (United States)

    Rice, Charles L.; Hiett, John K.

    1994-01-01

    This report revises Miscellaneous Field Studies Map MF-1188 (Rice and Smith, 1980). Major revisions to the original correlation chart include formal naming of key marine units in Kentucky and replacement of informally named marine units incorrectly projected into Kentucky from adjacent states. Also included in the report is the proper correlation of some regionally recognized coal bed names that have been incorrectly projected into Kentucky, particularly from Ohio and West Virginia. Besides these additions and corrections, minor changes have been made to the correlation chart, all of which are discussed below in detail. The Pennsylvania rocks of the eastern Kentucky coal field underlie an area of about 27,000 square kilometers (see index map). Largely because of the size and stratigra[hic complexity of the area, Huddle and others (1963, p. 31) divided the coal field into six coal-reserve districts. District boundaries utilize state and county line as well as geologic features, drainage areas, and coal producing areas. Their division is followed herein because, in general, each of the districts has a characteristic stratigraphic nomenclature, particularly with regard to coal bed names. The six districts are the Princess, Licking River, Big Sandy, Hazard, Southwestern, and Upper Cumberland River district is divided into the Middlesboro and Harlan subdistricts. The correlation chart lists most of the stratigraphic units of Pennsylvanian age used in eastern Kentucky, and is concerned principally with coal bed names used in publications since about 1950, especially all of the names of coal beds for which resources and reserves have been calculated. Coal constitutes only a small percentage of the total Pennsylvanian-rock sequence, but is present in as many as 26 major coal zones that have been prospected and mined extensively in all parts of the coal field since the early 1900's. Coal names listed in this chart represent coal beds that have been mined commercially or

  5. Laser scar revision: comparison of CO2 laser vaporization with and without simultaneous pulsed dye laser treatment.

    Science.gov (United States)

    Alster, T S; Lewis, A B; Rosenbach, A

    1998-12-01

    Over the past decade, the 585-nm pulsed dye laser (PDL) has been used successfully to treat a variety of cutaneous vascular lesions as well as hypertrophic scars. Laser scar revision has been revolutionized by the recent development of high-energy, pulsed carbon dioxide (CO2) laser systems. These new CO2 lasers allow controlled vaporization of thin layers of skin while minimizing damage to surrounding dermal structures. To determine the effect of a high-energy, pulsed CO2 laser alone and in combination with a 585-nm PDL on nonerythematous hypertrophic scars. Twenty patients with nonerythematous hypertrophic scars were treated with a high-energy, pulsed CO2 laser. One-half of each scar was additionally treated with the 585-nm PDL laser. Sequential clinical and photographic analyses were performed independently by two blinded assessors. In addition, erythema reflectance spectrometry measurements were obtained from the scars before and at regular postoperative intervals. Global assessment scores and erythema spectrometry measurements were significantly improved after laser treatment. Combination CO2 and PDL laser treatment resulted in more significant improvement than CO2 laser irradiation alone. Concomitant use of the high-energy, pulsed CO2 and PDL laser systems was superior to CO2 laser vaporization alone for revision of nonerythematous hypertrophic scars. Once again, the vascular specificity of the 585-nm PDL has been linked to improvement in hypertrophic scar tissue.

  6. Low openness on the revised NEO personality inventory as a risk factor for treatment-resistant depression.

    Directory of Open Access Journals (Sweden)

    Michio Takahashi

    Full Text Available BACKGROUND: Recently, we reported that low reward dependence, and to a lesser extent, low cooperativeness in the Temperature and Character Inventory (TCI may be risk factors for treatment-resistant depression. Here, we analyzed additional psychological traits in these patients. METHODS: We administered Costa and McCrae's five-factor model personality inventory, NEO Personality Inventory-Revised (NEO-PI-R, to antidepressant-treatment resistant depressed patients (n=35, remitted depressed patients (n=27, and healthy controls (n=66. We also evaluated the relationships between scores on NEO and TCI, using the same cohort of patients with treatment-resistant depression, as our previous study. RESULTS: Patients with treatment-resistant depression showed high scores for neuroticism, low scores for extraversion, openness and conscientiousness, without changes in agreeableness, on the NEO. However, patients in remitted depression showed no significant scores on NEO. Patients with treatment-resistant depression and low openness on NEO showed positive relationships with reward dependence and cooperativeness on the TCI. CONCLUSIONS: Many studies have reported that depressed patients show high neuroticism, low extraversion and low conscientiousness on the NEO. Our study highlights low openness on the NEO, as a risk mediator in treatment-resistant depression. This newly identified trait should be included as a risk factor in treatment-resistant depression.

  7. Study the Stability of a Wastewater Treatment Unit using LABVIEW

    Directory of Open Access Journals (Sweden)

    Ghainm M. Alwan

    2013-05-01

    Full Text Available This study was devoted to limit the stability conditions of the wastewater treatment unit.       LABVIEW was a powerful and versatile graphical programming language in automation control and date acquisition of the system. The on-line show that accurate and stable control responses were obtained in the present work. The actual phase plane proved to a better technique to limit the regions of the non-linear system stability compared to other theoretical techniques. Limit cycle did not appear in the present system. 

  8. High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis

    DEFF Research Database (Denmark)

    Laursen, Jens Ole

    2017-01-01

    pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients...

  9. Treatment of symptomatic macromastia in a breast unit

    Directory of Open Access Journals (Sweden)

    Schneider José

    2010-11-01

    Full Text Available Abstract Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28% presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy

  10. Treatment of symptomatic macromastia in a breast unit

    Science.gov (United States)

    2010-01-01

    Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages

  11. Age-related macular degeneration with choroidal neovascularization in the setting of pre-existing geographic atrophy and ranibizumab treatment. Analysis of a case series and revision paper

    Directory of Open Access Journals (Sweden)

    Miguel Hage Amaro

    2012-12-01

    Full Text Available PURPOSE: To report the response of choroidal neovascularization (CNV to intravitreal ranibizumab treatment in the setting of age-related macular degeneration (AMD with extensive pre-existing geographic atrophy (GA and a revision paper. METHODS: This is a revision paper and a retrospective case series of 10 eyes in nine consecutive patients from a photographic database. The patients were actively treated with ranibizumab for neovascular AMD with extensive pre-existing GA. Patients were included if they had GA at or adjacent to the foveal center that was present before the development of CNV. The best corrected visual acuity and optical coherence tomography (OCT analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab were administered until there was resolution of any subretinal fluid clinically or on OCT. Data over the entire follow-up period were analyzed for overall visual and OCT changes. All patients had been followed for at least 2 years since diagnosis. RESULTS: The patients received an average of 6 ± 3 intravitreal injections over the treatment period. Eight eyes had reduced retinal thickening on OCT. On average, the central macular thickness was reduced by 94 ± 101 µm. Eight eyes had improvement of one or more lines of vision, where as one eye had dramatic vision loss and one had no change. The average treatment outcome for all patients was -0.07 ± 4.25 logMAR units, which corresponded to a gain of 0.6 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with the disappearance of the subretinal fluid, improved visual acuity, and stabilized final visual results. CONCLUSION: The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF agent (ranibizumab for CNV in AMD with extensive pre-existing GA is effective. Our results are not as striking as published results from large-scale trials of anti

  12. Analysis on the revision of the United States authorizing procedure for the transfer of unclassified nuclear technology

    International Nuclear Information System (INIS)

    Yoon, Sung-ho; Seo, Hana; Lee, Chansuh; Kim, Jong-sook

    2015-01-01

    The DOE (Department Of Energy) has not comprehensively update 10CFR810 since 1986. Since then, the global civil nuclear market has expanded, particularly in China, the Middle East, and Eastern Europe, with vendors from France, Japan, the Republic of Korea, Russia, and Canada. In result, DOE issued revised 810 in respond to comments received from the public and commercial nuclear market changes. This regulation revision improves the efficiency of authorization process to promote national nuclear industry while maintaining nonproliferation control. Even though ROK has initiated a legal basis for Intangible technology transfer (ITT) for nuclear export control, working implementation system is not set up. This research proposes recommendable ITT implementation of the ROK according to the analysis result of the US regulation. In this revision, of 124 countries had been classified as general authorization under 10CFR810, 80 countries reclassified into the specific authorization. By remaining 'fast track' for specific authorization, in particular, time frames for internal DOE and interagency reviews are reduced. This means the US government actively copes with commercial nuclear market expands to promote their industry. Meanwhile, by remaining some of nuclear-weapon states (China, Russia, India) as specific authorization maintaining that the determinations are consistent with current US national security, diplomatic, and trade policy. By benchmarking the US regulation, Korea can improve the efficiency of the technology transfer authorization process easing the regulatory burden by reducing uncertainty and timelines while maintaining the highest level of nonproliferation control

  13. Remedial Investigation/Feasibility Study Work Plan for the 200-UP-1 Groundwater Operable Unit, Hanford Site, Richland, Washington. Revision

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This work plan identifies the objectives, tasks, and schedule for conducting a Remedial Investigation/Feasibility Study for the 200-UP-1 Groundwater Operable Unit in the southern portion of the 200 West Groundwater Aggregate Area of the Hanford Site. The 200-UP-1 Groundwater Operable Unit addresses contamination identified in the aquifer soils and groundwater within its boundary, as determined in the 200 West Groundwater Aggregate Area Management Study Report (AAMSR) (DOE/RL 1992b). The objectives of this work plan are to develop a program to investigate groundwater contaminants in the southern portion of the 200 West Groundwater Aggregate Area that were designated for Limited Field Investigations (LFIs) and to implement Interim Remedial Measures (IRMs) recommended in the 200 West Groundwater AAMSR. The purpose of an LFI is to evaluate high priority groundwater contaminants where existing data are insufficient to determine whether an IRM is warranted and collect sufficient data to justify and implement an IRM, if needed. A Qualitative Risk Assessment (QRA) will be performed as part of the LFI. The purpose of an IRM is to develop and implement activities, such as contaminant source removal and groundwater treatment, that will ameliorate some of the more severe potential risks of groundwater contaminants prior to the RI and baseline Risk Assessment (RA) to be conducted under the Final Remedy Selection (FRS) at a later date. This work plan addresses needs of a Treatability Study to support the design and implementation of an interim remedial action for the Uranium-{sup 99}{Tc}-Nitrate multi-contaminant IRM plume identified beneath U Plant.

  14. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  15. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder : A revision of the 2005 guidelines from the British Association for Psychopharmacology

    NARCIS (Netherlands)

    Baldwin, David S.; Anderson, Ian M.; Nutt, David J.; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A.; Christmas, David M.; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich

    This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination

  16. The 2012 revised Dutch national guidelines for the treatment of chronic hepatitis B virus infection

    NARCIS (Netherlands)

    Buster, E. H. C. J.; Baak, B. C.; Bakker, C. M.; Beuers, U. H. W.; Brouwer, J. T.; Drenth, J. P. H.; van Erpecum, K. J.; van Hoek, B.; Honkoop, P.; Kerbert-Dreteler, M. J.; Koek, G. H.; van Nieuwkerk, K. M. J.; van Soest, H.; van der Spek, B. W.; Tan, A. C. I. T. L.; Vrolijk, J. M.; Janssen, H. L. A.

    2012-01-01

    In 2008, the Netherlands Association of Gastroenterologists and Hepatologists (Nederlands Vereniging van Maag-Darm-Leverartsen) published the Dutch national guidelines for the treatment of chronic hepatitis B virus infection. New insights into the treatment of chronic hepatitis B with relevance for

  17. Water Treatment Plant Operation Volume 2. A Field Study Training Program. Revised.

    Science.gov (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  18. Operation of Wastewater Treatment Plants. Volume 1. A Field Study Training Program. Third Edition. Revised.

    Science.gov (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The purpose of this wastewater treatment field study training program is to: (1) develop new qualified wastewater treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  19. Integrated Waste Treatment Unit GFSI Risk Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    W. A. Owca

    2007-06-21

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP).

  20. Integrated Waste Treatment Unit GFSI Risk Management Plan

    International Nuclear Information System (INIS)

    W. A. Owca

    2007-01-01

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP)

  1. [Repair and revision 4. Cracked tooth and crown fractures: diagnostics and treatment].

    Science.gov (United States)

    Willemsen, W L; van der Meer, W J

    2001-05-01

    Trauma to the teeth can result in the formation of cracks in the crown or root of the tooth. The location and the extent of these cracks determine the proper treatment choice. This treatment is oriented towards saving pulp vitality and/or tooth integrity. In this paper the diagnosis of these cracks is described as well as the desired treatment. These are discussed relative to the location of the cracks, namely in the clinical crown of the tooth, resulting in enamel infraction, cracked tooth and crown fractures, and in the root of the tooth, resulting in a vertical or horizontal root fracture.

  2. Treatment Study Plan for Nitrate Salt Waste Remediation Revision 1.0

    Energy Technology Data Exchange (ETDEWEB)

    Juarez, Catherine L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Funk, David John [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vigil-Holterman, Luciana R. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Naranjo, Felicia Danielle [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-03-07

    The two stabilization treatment methods that are to be examined for their effectiveness in the treatment of both the unremediated and remediated nitrate salt wastes include (1) the addition of zeolite and (2) cementation. Zeolite addition is proposed based on the results of several studies and analyses that specifically examined the effectiveness of this process for deactivating nitrate salts. Cementation is also being assessed because of its prevalence as an immobilization method used for similar wastes at numerous facilities around the DOE complex, including at Los Alamos. The results of this Treatment Study Plan will be used to provide the basis for a Resource Conservation and Recovery Act (RCRA) permit modification request of the LANL Hazardous Waste Facility Permit for approval by the New Mexico Environment Department-Hazardous Waste Bureau (NMED-HWB) of the proposed treatment process and the associated facilities.

  3. Outpatient management of febrile neutropenia: time to revise the present treatment strategy

    DEFF Research Database (Denmark)

    Carstensen, M.; Sørensen, Jens Benn

    2008-01-01

    treatment failure (P management of adult cancer patients with low-risk febrile neutropenia is safe, effective, and comparable to standard hospital-based therapy. Patients at low risk are outpatients and are hemodynamically...

  4. Outpatient management of febrile neutropenia: time to revise the present treatment strategy

    DEFF Research Database (Denmark)

    Carstensen, M.; Sørensen, Jens Benn

    2008-01-01

    We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low-risk febr......We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low...

  5. 78 FR 70530 - Notice of Determination; New and Revised Treatments for the Imported Fire Ant Program

    Science.gov (United States)

    2013-11-26

    ... the updates to the PPQ Treatment Manual will not have a significant impact on the quality of the human..., stinging insect that, in large numbers, can seriously injure or even kill livestock, pets, and humans. The imported fire ant feeds on crops and builds large, hard mounds that damage farm and field machinery...

  6. THE ROLE OF FOLLICULAR UNIT GRAFTING IN TREATMENT ALOPECIA

    Directory of Open Access Journals (Sweden)

    Duhita Ayuningtyas

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Alopecia is usually treatable and self-limited, but it may be permanent. Careful diagnosis of the type of hair loss will aid in selecting effective treatment. Many drugs used to treat alopecia, but in many people not satisfied with the result. One of the treatment currently used to treat alopecia is hair transplantation with follicular unit grafting (FUG. The advantages of hair transplantation is to create a natural appearance, one that mimics natural hair growth both in terms of numbers and pattern /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  7. Directly observed treatment short course in immunocompetent patients of tuberculous cervical lymphadenopathy treated in revised national tuberculosis control programme

    Directory of Open Access Journals (Sweden)

    Venu Kandala

    2012-01-01

    Full Text Available Background: Prospective observation analysis to evaluate the cure in tuberculous cervical lymphadenopathy with directly observed treatment short course category III (DOTS CAT III treatment as per revised national tuberculosis control program (RNTCP at a tertiary care hospital in AP, India, from October 2007 to September 2009. These cases were followed up for period of 22 months. Materials and Methods: Total 1521 tuberculous cases were screened in KIMS both pulmonary and extra pulmonary cases out of which 146 cases were tuberculous lymphadenitis. Fifty cases of tuberculous cervical lymphadenopathy were included after diagnostic and treatment algorithm and fine needle biopsy or excision biopsy. Patients below 5 yrs, immunocompromised, having diabetes mellitus, pulmonary tuberculosis and with other co-morbid conditions were excluded from the study. All patients were put on DOTS CAT III as per RNTCP guidelines. Follow-up was done every 2 months till 6 months for 1 Constitution symptoms 2 Weight gain or loss 3 Appetite gain or loss 4 Regression of lymph nodes or increase 5 Compliance 6 Side effects 7 Failures by demonstration of organism by direct smear, culture or histopathological examination. Results: In this study, lymph node regression was found in 78% at the end of 2 months, 94% at the end of 4 months and 96% at the end of 6 months, 9 patients had regression in size though the nodes were palpable, 2 had no regression but fresh lymph nodes appeared on the same side and sinus discharge was present, culture was negative in these cases. Two cases had immune reconstitution syndrome, constitutional symptoms disappeared and showed clinical improvement. Four cases were subjected for surgical intervention. Conclusion: DOTS CAT III is effective in the treatment of tuberculous cervical lymphadenopathy. Compliance was good with minimal, minor side effects, only two had immune reconstitution syndrome and two had sinus formation; they were referred for

  8. Transport of Pathogen Surrogates in Soil Treatment Units: Numerical Modeling

    Directory of Open Access Journals (Sweden)

    Ivan Morales

    2014-04-01

    Full Text Available Segmented mesocosms (n = 3 packed with sand, sandy loam or clay loam soil were used to determine the effect of soil texture and depth on transport of two septic tank effluent (STE-borne microbial pathogen surrogates—green fluorescent protein-labeled E. coli (GFPE and MS-2 coliphage—in soil treatment units. HYDRUS 2D/3D software was used to model the transport of these microbes from the infiltrative surface. Mesocosms were spiked with GFPE and MS-2 coliphage at 105 cfu/mL STE and 105–106 pfu/mL STE, respectively. In all soils, removal rates were >99.99% at 25 cm. The transport simulation compared (1 optimization; and (2 trial-and-error modeling approaches. Only slight differences between the transport parameters were observed between these approaches. Treating both the die-off rates and attachment/detachment rates as variables resulted in an overall better model fit, particularly for the tailing phase of the experiments. Independent of the fitting procedure, attachment rates computed by the model were higher in sandy and sandy loam soils than clay, which was attributed to unsaturated flow conditions at lower water content in the coarser-textured soils. Early breakthrough of the bacteria and virus indicated the presence of preferential flow in the system in the structured clay loam soil, resulting in faster movement of water and microbes through the soil relative to a conservative tracer (bromide.

  9. Nevada Test Site site treatment plan. Final annual update. Revision 1

    International Nuclear Information System (INIS)

    1998-04-01

    A Site Treatment Plan (STP) is required for facilities at which the US Department of Energy Nevada Operations Office (DOE/NV) generates or stores mixed waste (MW), defined by the Federal Facility Compliance Act (FFCAct) as waste containing both a hazardous waste subject to the Resource Conservation and Recovery Act (RCRA) and a radioactive material subject to the Atomic Energy Act. This STP was written to identify specific treatment facilities for treating DOE/NV generated MW and provides proposed implementation schedules. This STP was approved by the Nevada Division of Environmental Protection (NDEP) and provided the basis for the negotiation and issuance of the FFCAct Consent Order (CO) dated March 6, 1996. The FFCAct CO sets forth stringent regulatory requirements to comply with the implementation of the STP

  10. Review of private sector treatment, storage, and disposal capacity for radioactive waste. Revision 1

    International Nuclear Information System (INIS)

    Smith, M.; Harris, J.G.; Moore-Mayne, S.; Mayes, R.; Naretto, C.

    1995-01-01

    This report is an update of a report that summarized the current and near-term commercial and disposal of radioactive and mixed waste. This report was capacity for the treatment, storage, dating and written for the Idaho National Engineering Laboratory (INEL) with the objective of updating and expanding the report entitled ''Review of Private Sector Treatment, Storage, and Disposal Capacity for Radioactive Waste'', (INEL-95/0020, January 1995). The capacity to process radioactively-contaminated protective clothing and/or respirators was added to the list of private sector capabilities to be assessed. Of the 20 companies surveyed in the previous report, 14 responded to the request for additional information, five did not respond, and one asked to be deleted from the survey. One additional company was identified as being capable of performing LLMW treatability studies and six were identified as providers of laundering services for radioactively-contaminated protective clothing and/or respirators

  11. Corrective Action Plan for Corrective Action Unit 214: Bunkers and Storage Areas, Nevada Test Site, Nevada - Revision 0 - March 2005

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration, Nevada Site Office; Bechtel Nevada

    2005-03-01

    Corrective Action Unit 214, Bunkers and Storage Areas, is identified in the Federal Facility Agreement and Consent Order of 1996. Corrective Action Unit 214 consists of nine Corrective Action Sites located in Areas 5, 11, and 25 of the Nevada Test Site. The Nevada Test Site is located approximately 105 kilometers (65 miles) northwest of Las Vegas, Nevada, in Nye County. Corrective Action Unit 214 was previously characterized in 2004, and results were presented in the Corrective Action Decision Document for 214. Site characterization indicated that soil and/or debris exceeded clean-up criteria for Total Petroleum Hydrocarbons, pesticides, metals, and radiological contamination.

  12. Characterization report for Area 23, Building 650 Leachfield, Corrective Action Unit Number 94, Nevada Test Site. Revision 1

    International Nuclear Information System (INIS)

    1998-01-01

    Corrective Action Unit (CAU) Number 94, Building 650 Leachfield, is an historic laboratory disposal unit located in Area 23 at the Nevada Test Site (NTS) in Nye County, Nevada. The objectives of this project were twofold: characterize subsurface conditions at the CAU with respect to the on-site disposal unit, and provide sufficient information to develop a closure strategy for the leachfield. To this end, subsurface sampling was conducted in the vicinity of the piping above the distribution box, under and around the distribution box, and within the leachfield

  13. Opioid Misuse Trends in Treatment Seeking Populations: Revised Prescription Opioid Policy and Temporally Corresponding Changes.

    Science.gov (United States)

    Hoffman, Lauren A; Lewis, Ben; Nixon, Sara Jo

    2017-12-06

    Over the last two decades, U.S. rates of prescription opioid (PO) misuse have risen drastically. In response, federal and state governments have begun to implement new PO policies. Recent legislative changes warrant up-to-date assessments of today's misuse rates. To explore potential changes in opioid misuse trends among substance-using treatment seekers, in temporal relation to legislative response. Substance-use data were collected from two cross-sectional Florida-based inpatient cohorts during periods preceding (pre-policy; n = 647) and following (post-policy; n = 396) statewide PO policy initiatives. Participants provided information concerning their most frequently used drugs before treatment. PO and illicit opioid (IO) use prevalence, frequency and route of administration were examined for pre-policy vs. post-policy cohort differences. Relative to the pre-policy cohort, a greater percentage of the post-policy cohort reported recent misuse, daily use, and intravenous administration of POs. IO use was also more frequently reported post-policy. Non-opioid drug use prevalence did not significantly differ between cohorts. Among the opioid-using subsample, equivalent percentages of the pre- and post-policy cohorts reported the use of POs without IOs, IOs without POs, and POs/IOs concurrently. Conclusions/Importance: Florida's PO policy amendments were temporally accompanied by a higher prevalence of PO misuse and IO use among treatment-seekers assessed in this study. Whether our data reflect increased awareness of and treatment seeking for opioid use disorders or insufficient efficacy of new policies to reduce opioid misuse remains in question. Regardless, findings suggest the need for enhanced emphasis on mitigating hazardous PO-use behaviors (e.g., IV use).

  14. Revising Translations

    DEFF Research Database (Denmark)

    Rasmussen, Kirsten Wølch; Schjoldager, Anne

    2011-01-01

    out by specialised revisers, but by staff translators, who revise the work of colleagues and freelancers on an ad hoc basis. Corrections are mostly given in a peer-to-peer fashion, though the work of freelancers and inexperienced in-house translators is often revised in an authoritative (nonnegotiable...

  15. 3718-F Alkali Metal Treatment and Storage Facility Closure Plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1992-11-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 3718-F Alkali Metal Treatment and Storage Facility (3718-F Facility), located in the 300 Area, was used to store and treat alkali metal wastes. Therefore, it is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989) and 40 CFR 270.1. Closure also will satisfy the thermal treatment facility closure requirements of 40 CFR 265.381. This closure plan presents a description of the 3718-F Facility, the history of wastes managed, and the approach that will be followed to close the facility. Only hazardous constituents derived from 3718-F Facility operations will be addressed.

  16. Revision of documents guide to obtain the renovation of licence of the nuclear power plant of Laguna Verde, Units I and II

    International Nuclear Information System (INIS)

    Jarvio C, G.; Fernandez S, G.

    2008-01-01

    Unquestionably the renovation of license of the nuclear power plants , it this converting in a promising option to be able to gather in sure, reliable form and economic those requests about future energy in the countries with facilities of this type. This work it analyzes four documents guide and their application for the determination of the renovation of it licenses in nuclear plants that will serve of base for their aplication in the Nuclear Power Plant of Laguna Verde Units I and 2. The four documents in question are: the one Inform Generic of Learned Lessons on the Aging (NUREG - 1801), the Standard Revision Plan for the Renovation of License (NUREG - 1800), the Regulatory Guide for Renovation of License (GR-1.188), and the NEI 95-10, developed by the Institute of Nuclear Energy that is an Industrial Guide to Implement the Requirements of the 1OCFR Part 54-the Rule of Renovation of It licenses. (Author)

  17. Atomic Oxygen Treatment as a Method of Recovering Smoke Damaged Paintings. Revised

    Science.gov (United States)

    Rutledge, Sharon K.; Banks, Bruce A.; Forkapa, Mark; Stueber, Thomas; Sechkar, Edward; Malinowski, Kevin

    1999-01-01

    A noncontact technique is described that uses atomic oxygen, generated under low pressure in the presence of nitrogen, to remove soot and charred varnish from the surface of a painting. The process, which involves surface oxidation, permits control of the amount of surface material removed. The effectiveness of the process was evaluated by reflectance measurements from selected areas made during the removal of soot from acrylic gesso, ink on paper, and varnished oil paint substrates. For the latter substrate, treatment also involved the removal of damaged varnish and paint binder from the surface.

  18. 77 FR 58470 - Irradiation Treatment; Location of Facilities in the Southern United States; Technical Amendment

    Science.gov (United States)

    2012-09-21

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... things, allow for irradiation treatment of mangoes from India upon arrival in the mainland United States... 20, 2012, we amended the regulations in Sec. 319.56-46 to allow for irradiation treatment of mangoes...

  19. 77 FR 42621 - Irradiation Treatment; Location of Facilities in the Southern United States

    Science.gov (United States)

    2012-07-20

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... amending the phytosanitary treatment regulations to provide generic criteria for new irradiation treatment facilities in the Southern States of the United States. This action will allow irradiation facilities to be...

  20. Loosening After Acetabular Revision

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.

    2014-01-01

    The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years......) to determine if a difference with regard to revision failure could be determined. Failure rates of the respective implants were compared statistically using a logistic regression model with adjustment for discrepancies in FU time. In our study, TM shows statistically significant decreased loosening rates...... relative to revision rings for all grades including severe acetabular defects and pelvic discontinuity. The severe defects appear to benefit the most from TM....

  1. Approach and plan for cleanup actions in the 100-FR-2 operable unit of the Hanford Site, Revision 0

    International Nuclear Information System (INIS)

    1995-06-01

    A new administrative approach is being used to reach a cleanup decision for the 100-FR-2 Operable Unit. The unit, located at the 100-F Area, contains solid waste sites and is one of the remaining operable units scheduled for characterization and cleanup in the 100 Area. This Focus Package (1) describes the new approach and activities needed to reach a decision on cleanup actions for the 100-FR-2 Operable Unit and (2) invites public participation into the planning process. The previous approach included the production of a Work Plan, a Limited Field Investigation Report, a Qualitative Risk Assessment, a Focused Feasibility Study, and a Proposed Plan, all culminating in an interim action Record of Decision. Information gathered to date on other operable units allows the analgous site approach to be used on the 100-FR-2 Operable Unit, and therefore, a reduction in documentation preparation. The U.S. Environmental Protection Agency, Washington State Department of Ecology, and the U.S. Department of Energy (Tri-Party Agreement) believe that the new approach will save time and funding. In the new approach, the Work Plan has been condensed into this 12 page Focus Package. The Focus Package includes a summary of 100-F Area information, a list of waste sites in the 100-FR-2 Operable Unit, a summary of proposed work, and a schedule. The new approach will also combine the Limited Field Investigation and Qualitative Risk Assessment reports into the Focused Feasibility Study. The Focused Feasibility Study will analyze methods and costs to clean up waste sites. Consolidating the documents should reduce the time to complete the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) process by 16 months, compared to the previous approach

  2. Revision on Renal Sympathetic Ablation in the Treatment of Resistant Hypertension.

    Science.gov (United States)

    Saraiva, Ana Filipa

    2016-01-01

    Hypertension is one of the most prevalent diseases in the world, with about 1 billion people affected and a possible increase to 1.5 billion by 2025. Despite advances in treatment, a proportion of patients remain resistant to conventional treatment and uncontrolled, and this can adversely affect future cardiovascular events and mortality. This alarming growth is already reflected in an important public health problem and one of the largest economic burdens of health, requiring new approaches and development of different strategies to fight this problem. This review will focus on the definition of resistant hypertension and its etiology, as well as in contemporary evidence supporting the usefulness of renal sympathetic denervation while addressing current and emerging devices, potential treatment indications in the future and unresolved issues that need to be addressed before renal sympathetic denervation can be adopted not only as a last resort exclusively for resistant hypertension. Finally an evaluation algorithm for patients with resistant hypertension which should be implemented before the execution of this technique will be proposed. Renal sympathetic denervation is a technique that possibly could have future implications in the population with hypertension, especially those with true resistant hypertension. This technique aims to reduce the renal sympathetic activation (a component in the pathophysiology of hypertension) through the destruction of the renal sympathetic nerves located in the adventitia of the renal arteries. There are several catheters that can be used; each with its specifications and therefore their selection should be made individually depending on the profile of the patient. However, a detailed pre-procedure evaluation is extremely important to exclude the large percentage of individuals with uncontrolled hypertension due to several factors that make it impossible to control blood pressure, but are likely to be corrected and as such should

  3. Resource Conservation and Recovery Act (RCRA) contingency plan for hazardous waste treatment, storage, and disposal units at the Oak Ridge Y-12 Plant

    Energy Technology Data Exchange (ETDEWEB)

    1994-08-01

    The Y-12 RCRA Contingency Plan will be continually reviewed and revised if any of the following occur: the facility permit is revised, the plan is inadequate in an emergency, the procedures can be improved, the operations of the facility change in a way that alters the plan, the emergency coordinator changes, or the emergency equipment list changes. Copies of the Y-12 Emergency Management Plan are available at the Plant Shift Superintendent`s Office and the Emergency Management Office. This document serves to supplement the Y-12 Emergency Management Plan to be appropriate for all RCRA hazardous waste treatment, storage, or disposal units. The 90-day accumulation areas at the Y-12 Plant have a separate contingency supplement as required by RCRA and are separate from this supplement.

  4. Resource Conservation and Recovery Act (RCRA) contingency plan for hazardous waste treatment, storage, and disposal units at the Oak Ridge Y-12 Plant

    International Nuclear Information System (INIS)

    1994-08-01

    The Y-12 RCRA Contingency Plan will be continually reviewed and revised if any of the following occur: the facility permit is revised, the plan is inadequate in an emergency, the procedures can be improved, the operations of the facility change in a way that alters the plan, the emergency coordinator changes, or the emergency equipment list changes. Copies of the Y-12 Emergency Management Plan are available at the Plant Shift Superintendent's Office and the Emergency Management Office. This document serves to supplement the Y-12 Emergency Management Plan to be appropriate for all RCRA hazardous waste treatment, storage, or disposal units. The 90-day accumulation areas at the Y-12 Plant have a separate contingency supplement as required by RCRA and are separate from this supplement

  5. Twenty years of vasoplegic syndrome treatment in heart surgery. Methylene blue revised

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Barbosa Evora

    2015-02-01

    Full Text Available Objective: This study was conducted to reassess the concepts established over the past 20 years, in particular in the last 5 years, about the use of methylene blue in the treatment of vasoplegic syndrome in cardiac surgery. Methods: A wide literature review was carried out using the data extracted from: MEDLINE, SCOPUS and ISI WEB OF SCIENCE. Results: The reassessed and reaffirmed concepts were 1 MB is safe in the recommended doses (the lethal dose is 40 mg/kg; 2 MB does not cause endothelial dysfunction; 3 The MB effect appears in cases of NO up-regulation; 4 MB is not a vasoconstrictor, by blocking the cGMP pathway it releases the cAMP pathway, facilitating the norepinephrine vasoconstrictor effect; 5 The most used dosage is 2 mg/kg as IV bolus, followed by the same continuous infusion because plasma concentrations sharply decrease in the first 40 minutes; and 6 There is a possible "window of opportunity" for MB's effectiveness. In the last five years, major challenges were: 1 Observations about side effects; 2 The need for prophylactic and therapeutic guidelines, and; 3 The need for the establishment of the MB therapeutic window in humans. Conclusion: MB action to treat vasoplegic syndrome is time-dependent. Therefore, the great challenge is the need, for the establishment the MB therapeutic window in humans. This would be the first step towards a systematic guideline to be followed by possible multicenter studies.

  6. Malaria case management in Papua New Guinea following the introduction of a revised treatment protocol.

    Science.gov (United States)

    Pulford, Justin; Kurumop, Serah F; Ura, Yangta; Siba, Peter M; Mueller, Ivo; Hetzel, Manuel W

    2013-11-27

    This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings. A countrywide cross-sectional survey in randomly selected primary health care facilities (n = 88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility. Malaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n = 445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%). PNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed.

  7. Physical activity in treatment units for eating disorders: clinical practice and attitudes.

    Science.gov (United States)

    Bratland-Sanda, S; Rosenvinge, J H; Vrabel, K A R; Norring, C; Sundgot-Borgen, J; Rø, Ø; Martinsen, E W

    2009-01-01

    Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

  8. Closure Report for Corrective Action Unit 124, Storage Tanks, Nevada Test Site, Nevada with Errata Sheet, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-01-01

    This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 124, Storage Tanks, Nevada Test Site (NTS), Nevada. This report complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996; as amended January 2007). This CR provides documentation and justification for the closure of CAU 124 without further corrective action. This justification is based on process knowledge and the results of the investigative activities conducted in accordance with the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 124: Storage Tanks, Nevada Test Site, Nevada (NNSA/NSO, 2007). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. Therefore, this information will not be repeated in this CR.

  9. Corrective Action Investigation Plan for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada, with Errata Sheet, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2007-01-01

    Corrective Action Unit 563, Septic Systems, is located in Areas 3 and 12 of the Nevada Test Site, which is 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 563 is comprised of the four corrective action sites (CASs) below: • 03-04-02, Area 3 Subdock Septic Tank • 03-59-05, Area 3 Subdock Cesspool • 12-59-01, Drilling/Welding Shop Septic Tanks • 12-60-01, Drilling/Welding Shop Outfalls These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation (CAI) before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document.

  10. Head Start: An Effective Program But the Fund Distribution Formula Needs Revision and Management Controls Need Improvement. Report to the Congress of the United States by the Comptroller General.

    Science.gov (United States)

    Comptroller General of the U.S., Washington, DC.

    This report from the Comptroller General to the United States Congress finds Head Start to be an effective program whose fund distribution formula needs revision and whose management controls need improvement. Head Start's funding for enrollment and operating costs increased significantly between 1977-81. However, these funding increases were not…

  11. Revised interface-current relations for the unit-cell transport problem in cylindrical and spherical geometries

    International Nuclear Information System (INIS)

    Bogado Leite, S.Q.

    1997-01-01

    Escape and transmission probabilities, defined in terms of both the region the neutron originates from and the region it penetrates, are used to develop new interface-current relations for unit-cells with an arbitrary number of annular regions in cylindrical and spherical geometries. Comparisons with currents, obtained in terms of standard transmission and escape probabilities, as well as with accurate results reported in the literature, are presented for selected situations, showing significant discrepancies between the two models. (author)

  12. Corrective Action Investigation Plan for Corrective Action Unit 232: Area 25 Sewage Lagoons, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    1999-01-01

    The Corrective Action Investigation Plan for Corrective Action Unit 232, Area 25 Sewage Lagoons, has been developed in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the U.S. Department of Energy, Nevada Operations Office; the State of Nevada Division of Environmental Protection; and the U. S. Department of Defense. Corrective Action Unit 232 consists of Corrective Action Site 25-03-01, Sewage Lagoon. Corrective Action Unit 232, Area 25 Sewage Lagoons, received sanitary effluent from four buildings within the Test Cell ''C'' Facility from the mid-1960s through approximately 1996. The Test Cell ''C'' Facility was used to develop nuclear propulsion technology by conducting nuclear test reactor studies. Based on the site history collected to support the Data Quality Objectives process, contaminants of potential concern include volatile organic compounds, semivolatile organic compounds, Resource Conservation and Recovery Act metals, petroleum hydrocarbons, polychlorinated biphenyls, pesticides, herbicides, gamma emitting radionuclides, isotopic plutonium, isotopic uranium, and strontium-90. A detailed conceptual site model is presented in Section 3.0 and Appendix A of this Corrective Action Investigation Plan. The conceptual model serves as the basis for the sampling strategy. Under the Federal Facility Agreement and Consent Order, the Corrective Action Investigation Plan will be submitted to the Nevada Division of Environmental Protection for approval. Field work will be conducted following approval of the plan. The results of the field investigation will support a defensible evaluation of corrective action alternatives in the Corrective Action Decision Document

  13. A novel anterior revision surgery for the treatment of cervical ossification of posterior longitudinal ligament: case report and review of the literature.

    Science.gov (United States)

    Miao, Jinhao; Sun, Jingchuan; Shi, Jiangang; Chen, Yu; Chen, Deyu

    2018-02-21

    A 62-year-old blind man with severe ossification of posterior longitudinal ligament was presented. The patient received posterior laminectomy and fixation. After surgery, the patient was not satisfied with the recovery of upper limbs although the JOA score increased from 9 to 12 points. Because the tactile sensation of his hands is especially important to his daily life, the patient asked for further treatment after 6 months. The paper is to report the novel revision surgery we invented and the outcome of the patient after the novel surgery. We performed the revision surgery using anteriorly approach from C3-7 with a novel technique, which named anterior controllable antedisplacement and fusion (ACAF). The patient was followed up for 6 months. The clinical data including JOA score and radiological images were collected and analyzed. After the revision surgery, the patient had improvement release of numbness of both hands and the JOA score was increased to 14 points. Satisfactory decompression was assessed by MRI post-operation. Bone fusion was confirmed by CT 3 months post-operation. No specific complications related to this surgery was observed. The application of such operative procedure in revision surgery for OPLL has not been reported and might be an alternative choice for patients with unsatisfied outcome from previous posterior surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Corrective Action Investigation Plan for Corrective Action Unit 573: Alpha Contaminated Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick

    2014-05-01

    Corrective Action Unit (CAU) 573 is located in Area 5 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. CAU 573 is a grouping of sites where there has been a suspected release of contamination associated with non-nuclear experiments and nuclear testing. This document describes the planned investigation of CAU 573, which comprises the following corrective action sites (CASs): • 05-23-02, GMX Alpha Contaminated Area • 05-45-01, Atmospheric Test Site - Hamilton These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives.

  15. Closure Report for Corrective Action Unit 177: Mud Pits and Cellars Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2007-02-01

    This Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 177: Mud Pits and Cellars, Nevada Test Site, Nevada. This Closure Report complies with the requirements of the Federal Facility Agreement and Consent Order (1996) that was agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. The Corrective Action Sites (CASs) within CAU 177 are located within Areas 8, 9, 19, and 20 of the Nevada Test Site. The purpose of this Closure Report is to provide documentation supporting the completed corrective actions and data that confirm the corrective actions implemented for CAU 177 CASs.

  16. Completion Report for Well ER-3-3 Corrective Action Unit 97: Yucca Flat/Climax Mine, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Wurtz, Jeffrey [Navarro, Las Vegas, NV (United States); Rehfeldt, Ken [Navarro, Las Vegas, NV (United States)

    2017-04-01

    Well ER-3-3 was drilled for the U.S. Department of Energy, Nevada National Security Administration Nevada Field Office in support of the Underground Test Area (UGTA) Activity. The well was drilled and completed from February 21 to March 15, 2016, as part of the Corrective Action Investigation Plan (CAIP) for Yucca Flat/Climax Mine Corrective Action Unit (CAU) 97. The primary purpose of the well was to collect hydrogeologic data to assist in validating concepts of the flow system within the Yucca Flat/Climax Mine CAU, and to test for potential radionuclides in groundwater from the WAGTAIL (U3an) underground test.

  17. How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

    Science.gov (United States)

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

    2013-01-01

    Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

  18. Shock treatment in a cohort of Scandinavian intensive care units in 2014

    DEFF Research Database (Denmark)

    Kollind, M; Wickbom, F; Wilkman, E

    2016-01-01

    BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units. METHODS: Seven-day inceptio...

  19. Corrective Action Investigation Plan for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada with ROTC1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2008-05-01

    Corrective Action Unit (CAU) 560 is located in Areas 3 and 6 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 560 is comprised of the seven corrective action sites (CASs) listed below: • 03-51-01, Leach Pit • 06-04-02, Septic Tank • 06-05-03, Leach Pit • 06-05-04, Leach Bed • 06-59-03, Building CP-400 Septic System • 06-59-04, Office Trailer Complex Sewage Pond • 06-59-05, Control Point Septic System These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on January 22, 2008, by representatives from the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 560.

  20. Corrective Action Investigation plan for Corrective Action Unit 546: Injection Well and Surface Releases, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-03-01

    Corrective Action Unit (CAU) 546 is located in Areas 6 and 9 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 546 is comprised of two Corrective Action Sites (CASs) listed below: •06-23-02, U-6a/Russet Testing Area •09-20-01, Injection Well These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation (CAI) before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on November 8, 2007, by representatives of the Nevada Division of Environmental Protection and U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process has been used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 546.

  1. Closure Report for Corrective Action Unit 553: Areas 19, 20 Mud Pits and Cellars, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Al Wickline

    2007-01-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 553: Areas 19, 20 Mud Pits and Cellars, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 553 are located within Areas 19 and 20 of the Nevada Test Site. Corrective Action Unit 553 is comprised of the following CASs: 19-99-01, Mud Spill 19-99-11, Mud Spill 20-09-09, Mud Spill 20-99-03, Mud Spill. The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 553 were met. To achieve this, the following actions were or will be performed: Review the current site conditions including the concentration and extent of contamination. Implement any corrective actions necessary to protect human health and the environment. Properly dispose of corrective action and investigation wastes. Document the Notice of Completion and closure of CAU 553 to be issued by Nevada Division of Environmental Protection

  2. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

    Science.gov (United States)

    Patel, A; Pavlou, G; Mújica-Mota, R E; Toms, A D

    2015-08-01

    Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future. ©2015 The British Editorial Society of Bone & Joint Surgery.

  3. Corrective Action Decision Document/Closure Report for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick and Sloop, Christy

    2011-04-01

    This Corrective Action Decision Document (CADD)/Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 372, Area 20 Cabriolet/Palanquin Unit Craters, located within Areas 18 and 20 at the Nevada National Security Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 372 comprises four corrective action sites (CASs): • 18-45-02, Little Feller I Surface Crater • 18-45-03, Little Feller II Surface Crater • 20-23-01, U-20k Contamination Area • 20-45-01, U-20L Crater (Cabriolet) The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 372 based on the implementation of the corrective action of closure in place with administrative controls at all CASs. Corrective action investigation (CAI) activities were performed from November 9, 2009, through December 10, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 372 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL was established of 25 millirem per year based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were found to be present at all four CASs. It is assumed that radionuclide levels present within the Little Feller I and Cabriolet high

  4. Present and Future Developments in Radiotherapy Treatment Units.

    Science.gov (United States)

    Boyer

    1995-04-01

    Technical advances in the design of medical accelerators are making possible the exploration of new treatment techniques. Technology currently available to the radiation oncologist allows the use of internal and dynamic wedges. Multileaf collimators can be used for static treatment ports, and dynamic field shaping and beam modulation using multileaf collimators has been shown to be feasible. Computer interfaces are necessary to transfer the complex treatment sequences that are possible with these devices. Such network interfaces also provide for more efficient conventional treatments. New machines such as X-band linear accelerators and advanced proton accelerators are being developed for applications such as boron neutron capture therapy and proton conformal therapy.

  5. NEW BIOSTRATIGRAPHIC DATA FROM THE REITANO FLYSCH AUCT. (SICILY, ITALY: A KEY TO A REVISED STRATIGRAPHY OF THE SICILIDE UNITS

    Directory of Open Access Journals (Sweden)

    STEFANO TORRICELLI

    2010-07-01

    Full Text Available The study of palynomorphs and calcareous nannofossils recovered from the volcano-arenitic succession outcropping at Troina and Cerami (Sicily documents Rupelian assemblages comparable to those published for the Tusa Tuffite. This new evidence, combined with petrographic, geochemical and sedimentological affinities documented in the literature, eventually proves the genetic relationships between these units. Accordingly, the new name Troina-Tusa Formation is proposed to include all these lower Oligocene volcano-sedimentary units and to replace inappropriate names formerly used. The Troina-Tusa Formation conformably lies on a mixed siliciclastic-carbonate turbidite succession, lacking volcanic detritus, reported in the literature with different names (Polizzi Formation, Varicoloured Shales, Troina-Tusa Flysch and different ages (ranging from Eocene to Early Miocene. Palynomorphs and nannofossils recovered from its uppermost part, indicate an earliest Oligocene age. The denomination Polizzi Formation is recommended for this unit that includes also the Varicoloured Shales (Eocene-basal Oligocene. The appearance of conglomerates and volcano-arenites in the basal portion of the Troina-Tusa Formation, immediately above the top of the Polizzi Formation, marks a sudden reorganization of the Rupelian depositional systems related to the rise and erosion of a volcanic belt. Apparently, no biostratigraphically detectable hiatus is associated to this boundary. Differences in the composition of sandstones, sedimentary features and relationships with the substratum do exist between the ‘internal’ Reitano Flysch, outcropping in the type-area on the northern slope of the Nebrodi Mountains, and the volcano-arenitic successions of Cerami and Troina, reported by some authors as ‘external’ Reitano Flysch. These differences are widely documented in the literature, where the ‘internal’ Reitano Flysch is shown to lack volcanic detritus and to rest

  6. Closure Report for Corrective Action Unit 538: Spill Sites, Nevada Test Site, Nevada with ROTC-1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2007-02-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 538, Spill Sites, located at the Nevada Test Site (NTS) in Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) (1996) that was agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. The corrective action sites (CASs) within CAU 538 are located within Areas 2, 3, 6, 12, and 23 of the NTS. The purpose of this CR is to provide documentation for the absence of contamination or that the closure objectives have been met for each CAS within CAU 538.

  7. Closure Report for Corrective Action Unit 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burmeister

    2009-06-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 117 comprises Corrective Action Site (CAS) 26-41-01, Pluto Disassembly Facility, located in Area 26 of the Nevada Test Site. The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CAU 117 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 117 issued by the Nevada Division of Environmental Protection. From May 2008 through February 2009, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 117, Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. The purpose of the activities as defined during the data quality objectives process were: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 117. Assessment of the data generated from closure activities indicated that the final action levels were exceeded for polychlorinated biphenyls (PCBs) reported as total Aroclor and

  8. Completion Report for Well ER-2-2 Corrective Action Unit 97: Yucca Flat/Climax Mine, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Wurtz, Jeffrey [Navarro, Las Vegas, NV (United States)

    2017-05-01

    Well ER-2-2 was drilled for the U.S. Department of Energy, Nevada National Security Administration Nevada Field Office in support of the Underground Test Area (UGTA) Activity. The well was drilled from January 17 to February 8, 2016, as part of the Corrective Action Investigation Plan (CAIP) for Corrective Action Unit 97: Yucca Flat/Climax Mine, Nevada Test Site, Nevada. The primary purpose of the well was to collect hydrogeologic data to evaluate uncertainty in the flow and transport conceptual model and its contamination boundary forecasts, and to detect radionuclides in groundwater from the CALABASH (U2av) underground test. Well ER-2-2 was not completed as planned due to borehole stability problems. As completed, the well includes a piezometer (p1) to 582 meters (m) (1,909 feet [ft]) below ground surface (bgs) installed in the Timber Mountain lower vitric-tuff aquifer (TMLVTA) and a 12.25-inch (in.) diameter open borehole to 836 m (2,743 ft) bgs in the Lower tuff confining unit (LTCU). A 13.375-in. diameter carbon-steel casing is installed from the surface to a depth of 607 m (1,990 ft) bgs. Data collected during borehole construction include composite drill cutting samples collected every 3.0 m (10 ft), geophysical logs to a depth of 672.4 m (2,206 ft) bgs, water-quality measurements (including tritium), water-level measurements, and slug test data. The well penetrated 384.05 m (1,260 ft) of Quaternary alluvium, 541.93 m (1,778 ft) of Tertiary Volcanics (Tv) rocks, and 127.71 m (419 ft) of Paleozoic carbonates. The stratigraphy and lithology were generally as expected. However, several of the stratigraphic units were significantly thicker then predicted—principally, the Tunnel formation (Tn), which had been predicted to be 30 m (100 ft) thick; the actual thickness of this unit was 268.22 m (880 ft). Fluid depths were measured in the borehole during drilling as follows: (1) in the piezometer (p1) at 552.15 m (1,811.53 ft) bgs and (2) in the main casing (m1) at

  9. Corrective Action Investigation Plan for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2009-06-01

    Corrective Action Unit (CAU) 372 is located in Areas 18 and 20 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 372 is comprised of the four corrective action sites (CASs) listed below: • 18-45-02, Little Feller I Surface Crater • 18-45-03, Little Feller II Surface Crater • 20-23-01, U-20k Contamination Area • 20-45-01, U-20L Crater (Cabriolet) These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation (CAI) before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on February 10, 2009, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; Desert Research Institute, and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 372.

  10. Corrective Action Investigation Plan for Corrective Action Unit 365: Baneberry Contamination Area, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2010-12-01

    Corrective Action Unit 365 comprises one corrective action site (CAS), CAS 08-23-02, U-8d Contamination Area. This site is being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for the CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The site will be investigated based on the data quality objectives (DQOs) developed on July 6, 2010, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for the Baneberry site. The primary release associated with Corrective Action Unit 365 was radiological contamination from the Baneberry nuclear test. Baneberry was an underground weapons-related test that vented significant quantities of radioactive gases from a fissure located in close proximity to ground zero. A crater formed shortly after detonation, which stemmed part of the flow from the fissure. The scope of this investigation includes surface and shallow subsurface (less than 15 feet below ground surface) soils. Radionuclides from the Baneberry test with the potential to impact groundwater are included within the Underground Test Area Subproject. Investigations and corrective actions associated with the Underground Test Area Subproject include the radiological inventory resulting from the Baneberry test.

  11. Closure Report for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro, Las Vegas, NV (United States)

    2016-08-22

    This Closure Report (CR) presents information supporting the clean closure of Corrective Action Unit (CAU) 412: Clean Slate I Plutonium Dispersion (TTR), located on the Tonopah Test Range, Nevada. CAU 412 consists of a release of radionuclides to the surrounding soil from a storage–transportation test conducted on May 25, 1963. Corrective action investigation (CAI) activities were performed in April and May 2015, as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR), Tonopah Test Range, Nevada; and in accordance with the Soils Activity Quality Assurance Plan. The purpose of the CAI was to fulfill data needs as defined during the data quality objectives process. The CAU 412 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the data needs identified by the data quality objectives process. This CR provides documentation and justification for the clean closure of CAU 412 under the FFACO without further corrective action. This justification is based on historical knowledge of the site, previous site investigations, implementation of the 1997 interim corrective action, and the results of the CAI. The corrective action of clean closure was confirmed as appropriate for closure of CAU 412 based on achievement of the following closure objectives: Radiological contamination at the site is less than the final action level using the ground troops exposure scenario (i.e., the radiological dose is less than the final action level): Removable alpha contamination is less than the high contamination area criterion: No potential source material is present at the site, and any impacted soil associated with potential source material has been removed so that remaining soil contains contaminants at concentrations less than the final action levels: and There is

  12. Closure Report for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Matthews, Patrick

    2016-01-01

    This Closure Report (CR) presents information supporting the clean closure of Corrective Action Unit (CAU) 412: Clean Slate I Plutonium Dispersion (TTR), located on the Tonopah Test Range, Nevada. CAU 412 consists of a release of radionuclides to the surrounding soil from a storage-transportation test conducted on May 25, 1963. Corrective action investigation (CAI) activities were performed in April and May 2015, as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR), Tonopah Test Range, Nevada; and in accordance with the Soils Activity Quality Assurance Plan. The purpose of the CAI was to fulfill data needs as defined during the data quality objectives process. The CAU 412 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the data needs identified by the data quality objectives process. This CR provides documentation and justification for the clean closure of CAU 412 under the FFACO without further corrective action. This justification is based on historical knowledge of the site, previous site investigations, implementation of the 1997 interim corrective action, and the results of the CAI. The corrective action of clean closure was confirmed as appropriate for closure of CAU 412 based on achievement of the following closure objectives: Radiological contamination at the site is less than the final action level using the ground troops exposure scenario (i.e., the radiological dose is less than the final action level): Removable alpha contamination is less than the high contamination area criterion: No potential source material is present at the site, and any impacted soil associated with potential source material has been removed so that remaining soil contains contaminants at concentrations less than the final action levels: and There is

  13. Bioremediation of pesticides in surface soil treatment unit using ...

    African Journals Online (AJOL)

    The manufacturing and use of pesticides has been rising tremendously in India. The waste generated by the pesticide industry has become an environmental problem due to the present insufficient and ineffective waste treatment technology involving physico-chemical and biological treatment. The available data indicates ...

  14. Safety assessment for the proposed pilot-scale treatability tests for the 200-UP-1 and 200-ZP-1 groundwater operable units. Revision 1

    International Nuclear Information System (INIS)

    1994-12-01

    This safety assessment provides an analysis of the proposed pilot-scale treatability test activities to be and conducted within the 200 Area groundwater operable units on the Hanford Site. The 200-UP-1 and 200-ZP-1 operable units are located in the 200 West Area of the Hanford Site. These tests will evaluate an ion exchange (IX) water purification treatment system and granular activated carbon (GAC). A detailed engineering analysis of (GAC) adsorption for remediation of groundwater contamination. A detailed engineering analysis of the IX treatment system. The principal source of information for this assessment, states that the performance objective of the treatment systems is to remove 90% of the uranium and technetium-99 ( 99 Tc) from the extracted groundwater at the 200-UP-1 site. The performance objective for 200-ZP-1 is to remove 90% of the carbon tetrachloride (CCl 4 ), chloroform, and trichloroethylene (TCE) from the extracted groundwater

  15. Closure Report for Corrective Action Unit 408: Bomblet Target Area Tonopah Test Range (TTR), Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-09-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 408: Bomblet Target Area (TTR), Tonopah Test Range, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 408 is located at the Tonopah Test Range, Nevada, and consists of Corrective Action Site (CAS) TA-55-002-TAB2, Bomblet Target Areas. This CAS includes the following seven target areas: • Mid Target • Flightline Bomblet Location • Strategic Air Command (SAC) Target Location 1 • SAC Target Location 2 • South Antelope Lake • Tomahawk Location 1 • Tomahawk Location 2 The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for the CAS within CAU 408 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 408 issued by the Nevada Division of Environmental Protection. From July 2009 through August 2010, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 408: Bomblet Target Area, Tonopah Test Range (TTR), Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Identify and remove munitions of explosive concern (MEC) associated with DOE activities. • Investigate potential disposal pit locations. • Remove depleted uranium-contaminated fragments and soil. • Determine whether contaminants of concern (COCs) are

  16. Closure Report for Corrective Action Unit 566: EMAD Compound, Nevada National Security Site, Nevada with ROTC-1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2011-06-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 566: EMAD Compound, Nevada National Security Site, Nevada. Corrective Action Unit 566 comprises Corrective Action Site (CAS) 25-99-20, EMAD Compound, located within Area 25 of the Nevada National Security Site. The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CAU 566 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 566 issued by the Nevada Division of Environmental Protection. From October 2010 through May 2011, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 566: EMAD Compound, Nevada National Security Site, Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels (FALs) to determine COCs for CAU 566. Assessment of the data from collected soil samples, and from radiological and visual surveys of the site, indicates the FALs were exceeded for polychlorinated biphenyls (PCBs), semivolatile organic compounds (SVOCs), and radioactivity. Corrective actions were implemented to remove the following: • Radiologically contaminated soil assumed greater than FAL at two locations • Radiologically contaminated soil assumed greater than FAL with

  17. Corrective Action Decision Document/Closure Report for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2011-06-01

    Corrective Action Unit 367 comprises four corrective action sites (CASs): • 10-09-03, Mud Pit • 10-45-01, U-10h Crater (Sedan) • 10-45-02, Ess Crater Site • 10-45-03, Uncle Crater Site The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation of the corrective actions and site closure activities implemented at CAU 367. A corrective action of closure in place with use restrictions was completed at each of the three crater CASs (10-45-01, 10-45-02, and 10-45-03); corrective actions were not required at CAS 10-09-03. In addition, a limited soil removal corrective action was conducted at the location of a potential source material release. Based on completion of these correction actions, no additional corrective action is required at CAU 367, and site closure is considered complete. Corrective action investigation (CAI) activities were performed from February 2010 through March 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters, Nevada Test Site, Nevada. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of non-test or other releases (e.g., migration in washes and potential source material). Based on the proximity of the Uncle, Ess, and Sedan craters, the impact of the Sedan test on the fallout deposited from the two earlier tests, and aerial radiological surveys, the CAU 367 investigation was designed to study the releases from the three crater CASs as one combined release (primary release). Corrective Action Site 10-09-03, Mud Pit, consists of two mud pits identified at CAU 367. The mud pits are considered non-test releases or other releases and were investigated independent of the three crater CASs. The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 367 dataset of

  18. Corrective Action Investigation Plan for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2009-12-01

    Corrective Action Unit 367 is located in Area 10 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 367 comprises the four corrective action sites (CASs) listed below: • 10-45-01, U-10h Crater (Sedan) • 10-45-02, Ess Crater Site • 10-09-03, Mud Pit • 10-45-03, Uncle Crater Site The CASs in CAU 367 are being investigated because hazardous and/or radioactive contaminants may be present in concentrations that exceed risk-based corrective action (RBCA) levels. Existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend CAAs for the CASs. Additional information will be generated by conducting a CAI before evaluating and selecting CAAs. The scope of the corrective action investigation for CAU 367 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling. • Conduct radiological surveys. • Collect and submit environmental samples for laboratory analysis to determine the area where TED at the site exceeds FALs (i.e., corrective action boundary). • Evaluate TED to potential receptors in areas along Mercury Highway that have been impacted by a release of radionuclides from the Sedan test. • Collect and submit environmental samples for laboratory analysis related to the drilling mud within CAS 10-09-03, Mud Pit, and any encountered stains or waste as necessary to determine whether COCs are present. • If COCs are present, collect additional step-out samples to define the extent of the contamination. • Collect samples of investigation-derived waste, as needed, for waste management purposes.

  19. Closure Report for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss and Catherine Birney

    2011-05-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 544 are located within Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada National Security Site. Corrective Action Unit 544 comprises the following CASs: • 02-37-08, Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mud Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for CASs within CAU 544 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 544 issued by the Nevada Division of Environmental Protection.

  20. Corrective Action Investigation Plan for Corrective Action Unit 410: Waste Disposal Trenches, Tonopah Test Range, Nevada, Revision No.:0

    International Nuclear Information System (INIS)

    2002-01-01

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 410 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 410 is located on the Tonopah Test Range (TTR), which is included in the Nevada Test and Training Range (formerly the Nellis Air Force Range) approximately 140 miles northwest of Las Vegas, Nevada. This CAU is comprised of five Corrective Action Sites (CASs): TA-19-002-TAB2, Debris Mound; TA-21-003-TANL, Disposal Trench; TA-21-002-TAAL, Disposal Trench; 09-21-001-TA09, Disposal Trenches; 03-19-001, Waste Disposal Site. This CAU is being investigated because contaminants may be present in concentrations that could potentially pose a threat to human health and/or the environment, and waste may have been disposed of with out appropriate controls. Four out of five of these CASs are the result of weapons testing and disposal activities at the TTR, and they are grouped together for site closure based on the similarity of the sites (waste disposal sites and trenches). The fifth CAS, CAS 03-19-001, is a hydrocarbon spill related to activities in the area. This site is grouped with this CAU because of the location (TTR). Based on historical documentation and process know-ledge, vertical and lateral migration routes are possible for all CASs. Migration of contaminants may have occurred through transport by infiltration of precipitation through surface soil which serves as a driving force for downward migration of contaminants. Land-use scenarios limit future use of these CASs to industrial activities. The suspected contaminants of potential concern which have been identified are volatile organic compounds; semivolatile organic compounds; high explosives; radiological constituents including depleted uranium

  1. Corrective Action Investigation Plan for Corrective Action Unit 561: Waste Disposal Areas, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Grant Evenson

    2008-01-01

    Corrective Action Unit (CAU) 561 is located in Areas 1, 2, 3, 5, 12, 22, 23, and 25 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 561 is comprised of the 10 corrective action sites (CASs) listed below: (1) 01-19-01, Waste Dump; (2) 02-08-02, Waste Dump and Burn Area; (3) 03-19-02, Debris Pile; (4) 05-62-01, Radioactive Gravel Pile; (5) 12-23-09, Radioactive Waste Dump; (6) 22-19-06, Buried Waste Disposal Site; (7) 23-21-04, Waste Disposal Trenches; (8) 25-08-02, Waste Dump; (9) 25-23-21, Radioactive Waste Dump; and (10) 25-25-19, Hydrocarbon Stains and Trench. These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on April 28, 2008, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 561. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to each CAS. The scope of the Corrective Action Investigation for CAU 561 includes the following activities: (1) Move surface debris and/or materials, as needed, to facilitate sampling. (2) Conduct

  2. Closure Report for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks Nevada National Security Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Kauss, Mark

    2011-01-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 539: Areas 25 and 26 Railroad Tracks, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 539 are located within Areas 25 and 26 of the Nevada National Security Site. Corrective Action Unit 539 comprises the following CASs: (1) 25-99-21, Area 25 Railroad Tracks; and (2) 26-99-05, Area 26 Railroad Tracks The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 539 were met. To achieve this, the following actions were performed: (1) Reviewed documentation on historical and current site conditions, including the concentration and extent of contamination; (2) Conducted radiological walkover surveys of railroad tracks in both Areas 25 and 26; (3) Collected ballast and soil samples and calculated internal dose estimates for radiological releases; (4) Collected in situ thermoluminescent dosimeter measurements and calculated external dose estimates for radiological releases; (5) Removed lead bricks as potential source material (PSM) and collected verification samples; (6) Implemented corrective actions as necessary to protect human health and the environment; (7) Properly disposed of corrective action and investigation wastes; and (8) Implemented an FFACO use restriction (UR) for radiological contamination at CAS 25-99-21. The approved UR form and map are provided in Appendix F and will be filed in the DOE, National Nuclear Security Administration Nevada Site Office (NNSA/NSO), Facility Information Management System; the FFACO database; and the NNSA/NSO CAU/CAS files. From

  3. Corrective Action Decision Document, Area 15 Environmental Protection Agency Farm Laboratory Building, Corrective Action Unit No. 95, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-18

    This report is the Corrective Action Decision Document (CADD) for the Nevada Test Site (NTS) Area 15 U.S. Environmental Protection Agency (EPA) Farm, Laboratory Building (Corrective Action Unit [CAU] No. 95), at the Nevada Test Site, Nye County, Nevada. The scope of this CADD is to identify and evaluate potential corrective action alternatives for the decommissioning and decontamination (D and D) of the Laboratory Building, which were selected based on the results of investigative activities. Based on this evaluation, a preferred corrective action alternative is recommended. Studies were conducted at the EPA Farm from 1963 to 1981 to determine the animal intake and retention of radionuclides. The main building, the Laboratory Building, has approximately 370 square meters (4,000 square feet) of operational space. Other CAUS at the EPA Farm facility that will be investigated and/or remediated through other environmental restoration subprojects are not included in this CADD, with the exception of housekeeping sites. Associated structures that do not require classification as CAUS are considered in the evaluation of corrective action alternatives for CAU 95.

  4. The impact of revised DSM-5 criteria on the relative distribution and inter-rater reliability of eating disorder diagnoses in a residential treatment setting.

    Science.gov (United States)

    Thomas, Jennifer J; Eddy, Kamryn T; Murray, Helen B; Tromp, Marilou D P; Hartmann, Andrea S; Stone, Melissa T; Levendusky, Philip G; Becker, Anne E

    2015-09-30

    This study evaluated the relative distribution and inter-rater reliability of revised DSM-5 criteria for eating disorders in a residential treatment program. Consecutive adolescent and young adult females (N=150) admitted to a residential eating disorder treatment facility were assigned both DSM-IV and DSM-5 diagnoses by a clinician (n=14) via routine clinical interview and a research assessor (n=4) via structured interview. We compared the frequency of diagnostic assignments under each taxonomy and by type of assessor. We evaluated concordance between clinician and researcher assignment through inter-rater reliability kappa and percent agreement. Significantly fewer patients received either clinician or researcher diagnoses of a residual eating disorder under DSM-5 (clinician-12.0%; researcher-31.3%) versus DSM-IV (clinician-28.7%; researcher-59.3%), with the majority of reassigned DSM-IV residual cases reclassified as DSM-5 anorexia nervosa. Researcher and clinician diagnoses showed moderate inter-rater reliability under DSM-IV (κ=.48) and DSM-5 (κ=.57), though agreement for specific DSM-5 other specified feeding or eating disorder (OSFED) presentations was poor (κ=.05). DSM-5 revisions were associated with significantly less frequent residual eating disorder diagnoses, but not with reduced inter-rater reliability. Findings support specific dimensions of clinical utility for revised DSM-5 criteria for eating disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Infertility Evaluation and Treatment among Women in the United States

    Science.gov (United States)

    Kessler, Lawrence M.; Craig, Benjamin M.; Plosker, Shayne M.; Reed, Damon R.; Quinn, Gwendolyn P.

    2013-01-01

    Objective To examine the characteristics of women seeking infertility evaluation and treatment. Design Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis. Participants 4,558 married or cohabitating women ages 25–44 Setting U.S. household population of women based on the 2006–2010 National Survey of Family Growth Intervention None Main Outcome Measure(s) Likelihood of seeking preliminary infertility evaluation. Likelihood of seeking infertility treatment once evaluated. Treatment type provided. Results 623 women (13.7%) reported seeking infertility evaluation, of which 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-White woman who married at 25 will seek evaluation was 12%. This probability increased to 34% for White women with a graduate degree who married at age 30. Among women who are evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used. Reproductive surgery and in vitro fertilization (IVF) were used the least. Conclusions The use of infertility services is not random and understanding the socio-demographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies (ARTs) such as IVF therapy. Future research aimed at improving access to effective healthcare treatments within the boundaries of affordability is warranted. PMID:23849845

  6. Corrective Action Decision Document/Closure Report for Corrective Action Unit 375: Area 30 Buggy Unit Craters, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2011-08-01

    Corrective Action Unit 375 comprises three corrective action sites (CASs): (1) 25-23-22, Contaminated Soils Site; (2) 25-34-06, Test Cell A Bunker; and (3) 30-45-01, U-30a, b, c, d, e Craters. The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 375 based on the implementation of corrective action of closure in place with administrative controls at CAS 25-23-22, no further action at CAS 25-34-06, and closure in place with administrative controls and removal of potential source material (PSM) at CAS 30-45-01. Corrective action investigation (CAI) activities were performed from July 28, 2010, through April 4, 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 375: Area 30 Buggy Unit Craters. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 375 dataset of investigation results was evaluated based on the data quality assessment. This assessment demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL of 25 millirem per year was established based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were assumed to be present within the default contamination boundaries at CASs 25-23-22 and 30-45-01. No contaminants were identified at CAS 25-34-06, and no corrective action is necessary. Potential source material in the form of lead plate, lead-acid batteries, and oil within an abandoned transformer were identified at CAS 30-45-01, and corrective actions were undertaken that

  7. Corrective Action Investigation Plan for Corrective Action Unit 98: Frenchman Flat, Nevada Test Site, Nevada (Revision 1)

    Energy Technology Data Exchange (ETDEWEB)

    USDOE/NV

    1999-07-01

    This Corrective Action Investigation Plan (CAIP) has been developed for Frenchman Flat Corrective Action Unit (CAU) 98. The Frenchman Flat CAU is located along the eastern border of the Nevada Test Site (NTS) and includes portions of Areas 5 and 11. The Frenchman Flat CAU constitutes one of several areas of the Nevada Test Site used for underground nuclear testing in the past. The nuclear tests resulted in groundwater contamination in the vicinity as well as downgradient of the underground test areas. The CAIP describes the Corrective Action Investigation (CAI) to be conducted at the Frenchman Flat CAU to evaluate the extent of contamination in groundwater due to the underground nuclear testing. The Frenchman Flat CAI will be conducted by the Underground Test Area (UGTA) Project which is a part of the U.S. Department of Energy, Nevada Operations Office (DOE/NV) Environmental Restoration Project. The CAIP is a requirement of the Federal Facility Agreement and Consent Order (FFACO) (1996 ) agreed to by the U.S. Department of Energy (DOE), the Nevada Division of Environmental Protection (NDEP), and the U.S. Department of Defense (DoD). Based on the general definition of a CAI from Section IV.14 of the FFACO, the purpose of the CAI is ''...to gather data sufficient to characterize the nature, extent, and rate of migration or potential rate of migration from releases or discharges of pollutants or contaminants and/or potential releases or discharges from corrective action units identified at the facilities...'' (FFACO, 1996). However, for the Underground Test Area (UGTA) CAUs, ''...the objective of the CAI process is to define boundaries around each UGTA CAU that establish areas that contain water that may be unsafe for domestic and municipal use.'', as stated in Appendix VI of the FFACO (1996). According to the UGTA strategy (Appendix VI of the FFACO), the CAI of a given CAU starts with the evaluation of the existing data. New

  8. Streamlined Approach for (SAFER) Plan for Corrective Action Unit 566: E-MAD Compound, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-06-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 566, EMAD Compound, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 566 comprises the following corrective action site (CAS) located in Area 25 of the Nevada Test Site: • 25-99-20, EMAD Compound This plan provides the methodology for field activities needed to gather the necessary information for closing CAS 25-99-20. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 566 using the SAFER process. Additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action. It is anticipated that the results of the field investigation and implementation of a corrective action of clean closure will support a defensible recommendation that no further corrective action is necessary. If it is determined that complete clean closure cannot be accomplished during the SAFER, then a hold point will have been reached and the Nevada Division of Environmental Protection (NDEP) will be consulted to determine whether the remaining contamination will be closed under the alternative corrective action of closure in place. This will be presented in a closure report that will be prepared and submitted to NDEP for review and approval. The data quality objective (DQO) strategy for CAU 566 was developed at a meeting on April 30, 2009, by representatives of NDEP and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for CAU 566. The following text summarizes the SAFER activities that will

  9. Corrective Action Investigation Plan for Corrective Action Unit 562: Waste Systems Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2009-04-01

    Corrective Action Unit 562 is located in Areas 2, 23, and 25 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 562 is comprised of the 13 corrective action sites (CASs) listed below: • 02-26-11, Lead Shot • 02-44-02, Paint Spills and French Drain • 02-59-01, Septic System • 02-60-01, Concrete Drain • 02-60-02, French Drain • 02-60-03, Steam Cleaning Drain • 02-60-04, French Drain • 02-60-05, French Drain • 02-60-06, French Drain • 02-60-07, French Drain • 23-60-01, Mud Trap Drain and Outfall • 23-99-06, Grease Trap • 25-60-04, Building 3123 Outfalls These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on December 11, 2008, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 562. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to each CAS. The scope of the corrective action investigation for CAU 562 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling.

  10. Corrective Action Decision Document for Corrective Action Unit 562: Waste Systems Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krause

    2010-08-01

    This Corrective Action Decision Document (CADD) presents information supporting the selection of corrective action alternatives (CAAs) leading to the closure of Corrective Action Unit (CAU) 562, Waste Systems, in Areas 2, 23, and 25 of the Nevada Test Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 562 comprises the following corrective action sites (CASs): • 02-26-11, Lead Shot • 02-44-02, Paint Spills and French Drain • 02-59-01, Septic System • 02-60-01, Concrete Drain • 02-60-02, French Drain • 02-60-03, Steam Cleaning Drain • 02-60-04, French Drain • 02-60-05, French Drain • 02-60-06, French Drain • 02-60-07, French Drain • 23-60-01, Mud Trap Drain and Outfall • 23-99-06, Grease Trap • 25-60-04, Building 3123 Outfalls The purpose of this CADD is to identify and provide the rationale for the recommendation of CAAs for the 13 CASs within CAU 562. Corrective action investigation (CAI) activities were performed from July 27, 2009, through May 12, 2010, as set forth in the CAU 562 Corrective Action Investigation Plan. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: • Determine whether COCs are present. • If COCs are present, determine their nature and extent. • Provide sufficient information and data to complete appropriate corrective actions. A data quality assessment (DQA) performed on the CAU 562 data demonstrated the quality and acceptability of the data for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against appropriate final action levels (FALs) to identify the COCs for each CAS. The results of the CAI identified COCs at 10 of the 13 CASs in CAU 562, and thus corrective

  11. Corrrective action decision document for the Cactus Spring Waste Trenches (Corrective Action Unit No. 426). Revision No. 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    The Corrective Action Decision Document (CADD) for the Cactus Spring Waste Trenches (Corrective Action Unit [CAU] No. 426) has been prepared for the US Department of Energy`s (DOE) Nevada Environmental Restoration Project. This CADD has been developed to meet the requirements of the Federal Facility Agreement and Consent Order (FFACO) of 1996, stated in Appendix VI, {open_quotes}Corrective Action Strategy{close_quotes} (FFACO, 1996). The Cactus Spring Waste Trenches Corrective Action Site (CAS) No. RG-08-001-RG-CS is included in CAU No. 426 (also referred to as the {open_quotes}trenches{close_quotes}); it has been identified as one of three potential locations for buried, radioactively contaminated materials from the Double Tracks Test. The trenches are located on the east flank of the Cactus Range in the eastern portion of the Cactus Spring Ranch at the Tonopah Test Range (TTR) in Nye County, Nevada, on the northern portion of Nellis Air Force Range. The TTR is approximately 225 kilometers (km) (140 miles [mi]) northwest of Las Vegas, Nevada, by air and approximately 56 km (35 mi) southeast of Tonopah, Nevada, by road. The trenches were dug for the purpose of receiving waste generated during Operation Roller Coaster, primarily the Double Tracks Test. This test, conducted in 1963, involved the use of live animals to assess the biological hazards associated with non-nuclear detonation of plutonium-bearing devices (i.e., inhalation uptake of plutonium aerosol). The CAS consists of four trenches that received solid waste and had an overall impacted area of approximately 36 meters (m) (120 feet [ft]) long x 24 m (80 ft) wide x 3 to 4.5 m (10 to 15 ft) deep. The average depressions at the trenches are approximately 0.3 m (1 ft) below land surface.

  12. Corrective Action Decision Document for Corrective Action Unit 516: Septic Systems and Discharge Points, Nevada Test Site, Nevada: Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2004-04-28

    This Corrective Action Decision Document (CADD) identifies and rationalizes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's selection of a recommended corrective action alternative appropriate to facilitate the closure of Corrective Action Unit (CAU) 516: Septic Systems and Discharge Points, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. Located in Areas 3, 6, and 22 on the NTS, CAU 516 includes six Corrective Action Sites (CASs) consisting of two septic systems, a sump and piping, a clean-out box and piping, dry wells, and a vehicle decontamination area. Corrective action investigation activities were performed from July 22 through August 14, 2003, with supplemental sampling conducted in late 2003 and early 2004. The potential exposure pathways for any contaminants of concern (COCs) identified during the development of the DQOs at CAU 516 gave rise to the following objectives: (1) prevent or mitigate exposure to media containing COCs at concentrations exceeding PALs as defined in the corrective action investigation plan; and (2) prevent the spread of COCs beyond each CAS. The following alternatives have been developed for consideration at CAU 516: Alternative 1 - No Further Action; Alternative 2 - Clean Closure; and Alternative 3 - Closure in Place with Administrative Controls. Alternative 1, No Further Action, is the preferred corrective action for two CASs (06-51-02 and 22-19-04). Alternative 2, Clean Closure, is the preferred corrective action for four CASs (03-59-01, 03-59-02, 06-51-01, and 06-51-03). The selected alternatives were judged to meet all requirements for the technical components evaluated, as well as meeting all applicable state and federal regulations for closure of the site and will further eliminate the contaminated media at CAU 516.

  13. Corrective Action Decision Document for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2008-02-01

    This Corrective Action Decision Document has been prepared for Corrective Action Unit (CAU) 563, Septic Systems, in accordance with the Federal Facility Agreement and Consent Order (FFACO, 1996; as amended January 2007). The corrective action sites (CASs) for CAU 563 are located in Areas 3 and 12 of the Nevada Test Site, Nevada, and are comprised of the following four sites: •03-04-02, Area 3 Subdock Septic Tank •03-59-05, Area 3 Subdock Cesspool •12-59-01, Drilling/Welding Shop Septic Tanks •12-60-01, Drilling/Welding Shop Outfalls The purpose of this Corrective Action Decision Document is to identify and provide the rationale for the recommendation of a corrective action alternative (CAA) for the four CASs within CAU 563. Corrective action investigation (CAI) activities were performed from July 17 through November 19, 2007, as set forth in the CAU 563 Corrective Action Investigation Plan (NNSA/NSO, 2007). Analytes detected during the CAI were evaluated against appropriate final action levels (FALs) to identify the contaminants of concern (COCs) for each CAS. The results of the CAI identified COCs at one of the four CASs in CAU 563 and required the evaluation of CAAs. Assessment of the data generated from investigation activities conducted at CAU 563 revealed the following: •CASs 03-04-02, 03-59-05, and 12-60-01 do not contain contamination at concentrations exceeding the FALs. •CAS 12-59-01 contains arsenic and chromium contamination above FALs in surface and near-surface soils surrounding a stained location within the site. Based on the evaluation of analytical data from the CAI, review of future and current operations at CAS 12-59-01, and the detailed and comparative analysis of the potential CAAs, the following corrective actions are recommended for CAU 563.

  14. Completion Report for Well ER-4-1 Corrective Action Unit 97: Yucca Flat/Climax Mine, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Wurtz, Jeffrey [Navarro, Las Vegas, NV (United States); Rehfeldt, Ken [Navarro, Las Vegas, NV (United States)

    2017-07-01

    Well ER-4-1 was drilled for the U.S. Department of Energy, Nevada National Security Administration Nevada Field Office in support of the Underground Test Area (UGTA) Activity. The well was drilled and completed from March 23 to April 13, 2016, as part of the Corrective Action Investigation Plan (CAIP) for Yucca Flat/Climax Mine Corrective Action Unit (CAU) 97. The primary purpose of the well was to collect hydrogeologic data to assist in validating concepts of the groundwater flow system within the Yucca Flat/Climax Mine CAU, and to test for potential radionuclides in groundwater from the STRAIT (U4a) underground test. The completed well includes one piezometer (p1), to a depth of 663.16 meters (m) (2,175.71 feet [ft]) below ground surface (bgs) and open from the Alluvial aquifer (AA3) to the Oak Spring Butte confining unit (OSBCU) hydrostratigraphic units; and a main completion (m1), which includes 6.625-inch (in.) casing with slotted interval (m1) installed to 906.80 m (2,975.05 ft) bgs in the Lower carbonate aquifer (LCA). A 13.375-in. diameter surface casing was installed from the surface to a depth of 809.00 m (2,654.21 ft) bgs. Well ER-4-1 experienced a number of technical issues during drilling, including borehole instability and sloughing conditions. An intermediate, 10.75-in./9.625-in. casing string was installed to 856.94 m (2,811.48 ft) bgs to control these issues. Borehole stability and erosion problems appear to be associated with the Tunnel Formation (Tn) and the Older tunnel beds (Ton). Overall efforts to stabilize the borehole were successful. Data collected during borehole construction include composite drill cutting samples collected every 3.0 m (10 ft), a partial suite of geophysical logs to a maximum depth of 766.57 m (2,515 ft) bgs, water-quality measurements (including tritium), water-level measurements, and two depth-discrete bailer samples collected at 538.89 m and 646.18 m (1,768 ft and 2,120 ft) bgs respectively. The well penetrated 187

  15. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey.

    Science.gov (United States)

    Fleming, Susan E; Donovan-Batson, Colleen; Burduli, Ekaterina; Barbosa-Leiker, Celestina; Hollins Martin, Caroline J; Martin, Colin R

    2016-10-01

    to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics ™ ). a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. 24 CFR 968.225 - Budget revisions.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

  17. Addendum to the Closure Report for Corrective Action Unit 403: Second Gas Station, Tonopah Test Range, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2009-05-01

    This document constitutes an addendum to the Closure Report for Corrective Action Unit 403: Second Gas Station, Tonopah Test Range, Nevada, September 1998 as described in the document Supplemental Investigation Report for FFACO Use Restrictions, Nevada Test Site, Nevada (SIR) dated November 2008. The SIR document was approved by NDEP on December 5, 2008. The approval of the SIR document constituted approval of each of the recommended UR removals. In conformance with the SIR document, this addendum consists of: • This page that refers the reader to the SIR document for additional information • The cover, title, and signature pages of the SIR document • The NDEP approval letter • The corresponding section of the SIR document This addendum provides the documentation justifying the cancellation of the UR for CAS 03-02-004-0360, Underground Storage Tanks. This UR was established as part of a Federal Facility Agreement and Consent Order (FFACO) corrective action and is based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996). Since this UR was established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, this UR was reevaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006). This re-evaluation consisted of comparing the original data (used to define the need for the UR) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove the UR because contamination is not present at the site above the risk-based FALs. Requirements for inspecting and maintaining this UR will be canceled, and the postings and signage at this site will be removed. Fencing and posting may be present at this site that are unrelated to the FFACO UR

  18. Phase II Documentation Overview of Corrective Action Unit 98: Frenchman Flat, Nevada Test Site, Nye County, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Greg Ruskauff

    2010-04-01

    The U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) initiated the Underground Test Area (UGTA) Subproject to assess and evaluate radiologic groundwater contamination resulting from underground nuclear testing at the NTS. These activities are overseen by the Federal Facility Agreement and Consent Order (FFACO) (1996, as amended March 2010). For Frenchman Flat, the UGTA Subproject addresses media contaminated by the underground nuclear tests, which is limited to geologic formations within the saturated zone or 100 meters (m) or less above the water table. Transport in groundwater is judged to be the primary mechanism of migration for the subsurface contamination away from the Frenchman Flat underground nuclear tests. The intent of the UGTA Subproject is to assess the risk to the public from the groundwater contamination produced as a result of nuclear testing. The primary method used to assess this risk is the development of models of flow and contaminant transport to forecast the extent of potentially contaminated groundwater for the next 1,000 years, establish restrictions to groundwater usage, and implement a monitoring program to verify protectiveness. For the UGTA Subproject, contaminated groundwater is that which exceeds the radiological standards of the Safe Drinking Water Act (CFR, 2009) the State of Nevada’s groundwater quality standard to protect human health and the environment. Contaminant forecasts are expected to be uncertain, and groundwater monitoring will be used in combination with land-use control to build confidence in model results and reduce risk to the public. Modeling forecasts of contaminant transport will provide the basis for negotiating a compliance boundary for the Frenchman Flat Corrective Action Unit (CAU). This compliance boundary represents a regulatory-based distinction between groundwater contaminated or not contaminated by underground testing. Transport modeling simulations

  19. Corrective Action Investigation Plan for Corrective Action Unit 557: Spills and Tank Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-07-01

    Corrective Action Unit (CAU) 557 is located in Areas 1, 3, 6, and 25 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada, and is comprised of the four corrective action sites (CASs) listed below: • 01-25-02, Fuel Spill • 03-02-02, Area 3 Subdock UST • 06-99-10, Tar Spills • 25-25-18, Train Maintenance Bldg 3901 Spill Site These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on April 3, 2008, by representatives of the Nevada Division of Environmental Protection (NDEP); U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 557. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to each CAS. The scope of the corrective action investigation for CAU 557 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling. • Conduct radiological survey at CAS 25-25-18. • Perform field screening. • Collect and submit environmental samples for laboratory analysis to determine whether contaminants of concern are present. • If contaminants of concern are present, collect additional step

  20. Corrective Action Decision Document/Closure Report for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2010-04-01

    Corrective Action Unit 560 comprises seven corrective action sites (CASs): •03-51-01, Leach Pit •06-04-02, Septic Tank •06-05-03, Leach Pit •06-05-04, Leach Bed •06-59-03, Building CP-400 Septic System •06-59-04, Office Trailer Complex Sewage Pond •06-59-05, Control Point Septic System The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure of CAU 560 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from October 7, 2008, through February 24, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada, and Record of Technical Change No. 1. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: •Determine whether contaminants of concern (COCs) are present. •If COCs are present, determine their nature and extent. •Provide sufficient information and data to complete appropriate corrective actions. The CAU 560 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. The following contaminants were determined to be present at concentrations exceeding their corresponding FALs: •No contamination exceeding the FALs was identified at CASs 03-51-01, 06-04-02, and 06-59-04. •The soil at the base of the leach pit chamber at CAS 06-05-03 contains arsenic above the FAL of 23 milligrams per kilogram (mg/kg) and polychlorinated biphenyl (PCBs) above the FAL of 0.74 mg/kg, confined vertically from a depth of approximately 5 to 20 feet (ft) below ground surface. The contamination is confined laterally to the walls of the

  1. Corrective Action Investigation Plan for Corrective Action Unit 550: Smoky Contamination Area Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2012-05-01

    Corrective Action Unit (CAU) 550 is located in Areas 7, 8, and 10 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. CAU 550, Smoky Contamination Area, comprises 19 corrective action sites (CASs). Based on process knowledge of the releases associated with the nuclear tests and radiological survey information about the location and shape of the resulting contamination plumes, it was determined that some of the CAS releases are co-located and will be investigated as study groups. This document describes the planned investigation of the following CASs (by study group): (1) Study Group 1, Atmospheric Test - CAS 08-23-04, Atmospheric Test Site T-2C; (2) Study Group 2, Safety Experiments - CAS 08-23-03, Atmospheric Test Site T-8B - CAS 08-23-06, Atmospheric Test Site T-8A - CAS 08-23-07, Atmospheric Test Site T-8C; (3) Study Group 3, Washes - Potential stormwater migration of contaminants from CASs; (4) Study Group 4, Debris - CAS 08-01-01, Storage Tank - CAS 08-22-05, Drum - CAS 08-22-07, Drum - CAS 08-22-08, Drums (3) - CAS 08-22-09, Drum - CAS 08-24-03, Battery - CAS 08-24-04, Battery - CAS 08-24-07, Batteries (3) - CAS 08-24-08, Batteries (3) - CAS 08-26-01, Lead Bricks (200) - CAS 10-22-17, Buckets (3) - CAS 10-22-18, Gas Block/Drum - CAS 10-22-19, Drum; Stains - CAS 10-22-20, Drum - CAS 10-24-10, Battery. These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each study group. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed

  2. Comparison of monitor units calculated by radiotherapy treatment planning system and an independent monitor unit verification software.

    Science.gov (United States)

    Sellakumar, P; Arun, C; Sanjay, S S; Ramesh, S B

    2011-01-01

    In radiation therapy, the monitor units (MU) needed to deliver a treatment plan are calculated by treatment planning systems (TPS). The essential part of quality assurance is to verify the MU with independent monitor unit calculation to correct any potential errors prior to the start of treatment. In this study, we have compared the MU calculated by TPS and by independent MU verification software. The MU verification software was commissioned and tested for the data integrity to ensure that the correct beam data was considered for MU calculations. The accuracy of the calculations was tested by creating a series of test plans and comparing them with ion chamber measurements. The results show that there is good agreement between the two. The MU difference (MUdiff) between the monitor unit calculations of TPS and independent MU verification system was calculated for 623 fields from 245 patients and was analyzed by treatment site for head & neck, thorax, breast, abdomen and pelvis. The mean MUdiff of -0.838% with a standard deviation of 3.04% was observed for all 623 fields. The site specific standard deviation of MUdiff was as follows: abdomen and pelvis (<1.75%), head & neck (2.5%), thorax (2.32%) and breast (6.01%). The disparities were analyzed and different correction methods were used to reduce the disparity. © 2010 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  3. Symptom profile as assessed on delirium rating scale-revised-98 of delirium in respiratory intensive care unit: A study from India

    Directory of Open Access Journals (Sweden)

    Akhilesh Sharma

    2017-01-01

    Full Text Available Aim: This study aimed to evaluate the phenomenology of delirium in patients admitted in a Respiratory Intensive Care Unit (RICU. Methods: Consecutive patients admitted to RICU were screened for delirium using Richmond Agitation-Sedation Scale (RASS, Confusion Assessment Method for ICU (CAM-ICU assessment tool and those found positive for delirium were evaluated by a psychiatrist to confirm the diagnosis. Those with a diagnosis of delirium as per the psychiatrist were evaluated on Delirium Rating Scale-Revised-98 (DRS-R-98 to study phenomenology. Results: All the 75 patients fulfilled the criteria of “acute onset of symptoms” and “presence of an underlying physical disorder” as per the DRS-R-98. Commonly seen symptoms of delirium included disturbances in attention (100%, thought process abnormality (100%, fluctuation in symptoms (97.33% disturbance in, sleep-wake cycle, language disturbance (94.7%, disorientation (81.33%, and short-term memory impairments (73.33%. No patient had delusions and very few (5.3% reported perceptual disturbances. According to RASS subtyping, hypoactive delirium was the most common subtype (n = 34; 45.33%, followed by hyperactive subtype (n = 28; 37.33% and a few patients had mixed subtype of delirium (n = 13; 17.33%. Factor structure of DRS-R-98 symptoms yielded 3 factors (Factor-1: cognitive factor; Factor-2: motoric factor; Factor-3; thought, language, and fluctuation factor. Conclusion: The phenomenology of delirium in ICU patients is similar to non-ICU patients, but hypoactive delirium is the most common subtype.

  4. ENEA`s mobile treatment units for specific waters; Impianti mobili ENEA di trattamento / smaltimento rifiuti

    Energy Technology Data Exchange (ETDEWEB)

    Beone, G.; Barni, E.; Coronidi, M. [ENEA, Centro Ricerche Casaccia, Rome (Italy). Dipt. Ambiente; Bortone, G.; Gambaro, L.; Zanetti, P. [ENEA, Centro Ricerche `Ezio Clementel, Bologna (Italy). Dipt. Ambiente; Liccione, G. [ENEA, Centro Ricerche Trisaia, Matera (Italy). Dipt. Ambiente; Zanin, E.

    1997-11-01

    Solid waste production in turistic places is characterized by a large increase, up to 80 % for few months during the year. Generally a waste treatment plant is designed for a mean production and can support increases that non exceed 10 %. Treatment plants with higher capacity are not economically convenient and the excedent production is landfilled. An answer to this problem are mobile treatment units that could be used to support resident plants when higher treatment capacity is requested. Mobile units are very useful for other uses like as treatment of specific wastes (agricultural plastic bags and sheets contaminated by antiparasitics and herbicides) infective wastes from hospital and laboratories and leaches from landfills. Mobile units flexibility is also important for environmental protection actions, either scheduled on in an emergency, like as reclamation of contaminated soils, asbestos contaminated site and every time when waste transport is characterized by high cost or safety and sanitary problems.

  5. Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan.

    Science.gov (United States)

    Shauver, Melissa J; Nishizuka, Takanobu; Hirata, Hitoshi; Chung, Kevin C

    2016-04-01

    Large geographic differences in procedure utilization draw into question its appropriate use. In Japan, replantation is frequent for even very distal finger amputations. In the United States, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences. The authors created a survey to assess experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter Study and to hand surgeons making podium presentations at the Thirty-Second Annual Meeting of the Central Japanese Society for Surgery of the Hand. One hundred percent of both groups responded. There were no significant differences in surgeon experience. Japanese surgeons were significantly more likely to recommend replantation in all scenarios, despite 62 percent ranking function 6 months after replantation as "poor." Japanese surgeons also rated the appearance of a hand with an amputated finger significantly poorer. Finally, Japanese surgeons were significantly more likely to report stigmatization against finger amputees. There is no study with a high level of evidence comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, such as that planned by the Finger Replantation and Amputation Multicenter Study, can provide evidence toward the appropriate use of replantation.

  6. Plutonium Finishing Plant (PFP) Treatment and Storage Unit Waste Analysis Plan

    International Nuclear Information System (INIS)

    PRIGNANO, A.L.

    2000-01-01

    The purpose of this waste analysis plan (WAP) is to document waste analysis activities associated with the Plutonium Finishing Plant Treatment and Storage Unit (PFP Treatment and Storage Unit) to comply with Washington Administrative Code (WAC) 173-303-300(1), (2), (4)(a) and (5). The PFP Treatment and Storage Unit is an interim status container management unit for plutonium bearing mixed waste radiologically managed as transuranic (TRU) waste. TRU mixed (TRUM) waste managed at the PFP Treatment and Storage Unit is destined for the Waste Isolation Pilot Plant (WIPP) and therefore is not subject to land disposal restrictions [WAC 173-303-140 and 40 CFR 268]. The PFP Treatment and Storage Unit is located in the 200 West Area of the Hanford Facility, Richland Washington (Figure 1). Because dangerous waste does not include source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of this documentation. The information on radionuclides is provided only for general knowledge

  7. Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

    Energy Technology Data Exchange (ETDEWEB)

    Vigil-Holterman, Luciana R. [Los Alamos National Laboratory

    2012-05-07

    This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of the open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.

  8. Withdrawing life-support treatment in the intensive care unit: The ...

    African Journals Online (AJOL)

    Critically ill patients admitted to the intensive care units (ICUs) require treatment methods to support their vital functions of respiration and circulation by means of modalities such as mechanical ventilation and inotropic support. However, when these treatment options are maximised and the patient's condition remains ...

  9. Evaluation of the effectiveness of an urban stormwater treatment unit in Madison, Wisconsin, 1996-97

    Science.gov (United States)

    Waschbusch, Robert J.

    1999-01-01

    An urban stormwater treatment unit was tested as part of an ongoing program of urban nonpoint- pollution research in Madison, Wis. Flow measurements were made and water samples were collected at the inlet to, outlet from, and bypass around the treatment chamber of the device that was installed to collect the runoff from a city maintenance yard.

  10. Phase I Hydrologic Data for the Groundwater Flow and Contaminant Transport Model of Corrective Action Unit 97: Yucca Flat/Climax Mine, Nevada Test Site, Nye County, Nevada, Revision 0

    International Nuclear Information System (INIS)

    John McCord

    2007-01-01

    This document, which makes changes to Phase I Hydrologic Data for the Groundwater Flow and Contaminant Transport Model of Corrective Action Unit 97: Yucca Flat/Climax Mine, Nevada Test Site, Nye County, Nevada, S-N/99205--077, Revision 0 (June 2006), was prepared to address review comments on this final document provided by the Nevada Division of Environmental Protection (NDEP) in a letter dated August 4, 2006. The document includes revised pages that address NDEP review comments and comments from other document users. Change bars are included on these pages to identify where the text was revised. In addition to the revised pages, the following clarifications are made for the two plates inserted in the back of the document: Plate 4: Disregard the repeat of legend text 'Drill Hole Name' and 'Drill Hole Location' in the lower left corner of the map. Plate 6: The symbol at the ER-16-1 location (white dot on the lower left side of the map) is not color-coded because no water level has been determined. The well location is included for reference. Plate 6: The symbol at the ER-12-1 location (upper left corner of the map), a yellow dot, represents the lower water level elevation. The higher water level elevation, represented by a red dot, was overprinted

  11. Clinical Usefulness of the 2010 Clinical and Laboratory Standards Institute Revised Breakpoints for Cephalosporin Use in the Treatment of Bacteremia Caused by Escherichia coli or Klebsiella spp.

    Science.gov (United States)

    Ku, Nam Su; Chung, Hae-Sun; Choi, Jun Yong; Yong, Dongeun; Lee, Kyungwon; Kim, June Myung; Chong, Yunsop

    2015-01-01

    We investigated the clinical usefulness of the revised 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints for Escherichia coli and Klebsiella spp. Of 2,623 patients with bacteremia caused by E. coli or Klebsiella spp., 573 who had been treated appropriately with cephalosporin based on the CLSI 2009 guidelines were enrolled. There were no differences in the rates of treatment failure or mortality between the appropriately and inappropriately treated groups according to the CLSI 2010 guidelines. Additionally, in the matched case-control analysis, the treatment failure rate was higher in bacteremic patients with extended-spectrum β-lactamase- (ESBL-) producing but cephalosporin-susceptible organisms than in those with ESBL-nonproducing isolates when patients with urinary tract infections were excluded (44% and 0%, resp., P = 0.026). In patients with bacteremia caused by E. coli or Klebsiella spp., the revised CLSI 2010 guidelines did not lead to poorer outcomes. However, ESBL production appeared to be associated with poor clinical outcomes in patients with bacteremia from sources other than the urinary tract. PMID:25793209

  12. Clinical usefulness of the 2010 clinical and laboratory standards institute revised breakpoints for cephalosporin use in the treatment of bacteremia caused by Escherichia coli or Klebsiella spp.

    Science.gov (United States)

    Ku, Nam Su; Chung, Hae-Sun; Choi, Jun Yong; Yong, Dongeun; Lee, Kyungwon; Kim, June Myung; Chong, Yunsop

    2015-01-01

    We investigated the clinical usefulness of the revised 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints for Escherichia coli and Klebsiella spp. Of 2,623 patients with bacteremia caused by E. coli or Klebsiella spp., 573 who had been treated appropriately with cephalosporin based on the CLSI 2009 guidelines were enrolled. There were no differences in the rates of treatment failure or mortality between the appropriately and inappropriately treated groups according to the CLSI 2010 guidelines. Additionally, in the matched case-control analysis, the treatment failure rate was higher in bacteremic patients with extended-spectrum β-lactamase- (ESBL-) producing but cephalosporin-susceptible organisms than in those with ESBL-nonproducing isolates when patients with urinary tract infections were excluded (44% and 0%, resp., P = 0.026). In patients with bacteremia caused by E. coli or Klebsiella spp., the revised CLSI 2010 guidelines did not lead to poorer outcomes. However, ESBL production appeared to be associated with poor clinical outcomes in patients with bacteremia from sources other than the urinary tract.

  13. Revision endoscopic sinonasal surgery.

    Science.gov (United States)

    Cantillano, Pablo; Rubio, Fabián; Naser, Alfredo; Nazar, Rodolfo

    Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  14. Plutonium Finishing Plant Treatment and Storage Unit Dangerous Waste Training Plan

    International Nuclear Information System (INIS)

    ENTROP, G.E.

    2000-01-01

    The training program for personnel performing waste management duties pertaining to the Plutonium Finishing Plant (PFP) Treatment and Storage Unit is governed by the general requirements established in the Plutonium Finishing Plant Dangerous Waste Training Plan (PFP DWTP). The PFP Treatment and Storage Unit DWTP presented below incorporates all of the components of the PFP DWTP by reference. The discussion presented in this document identifies aspects of the training program specific to the PFP Treatment and Storage Unit. The training program includes specifications for personnel instruction through both classroom and on-the-job training. Training is developed specific to waste management duties. Hanford Facility personnel directly involved with the PFP Treatment and Storage Unit will receive training to container management practices, spill response, and emergency response. These will include, for example, training in the cementation process and training pertaining to applicable elements of WAC 173-303-330(1)(d). Applicable elements from WAC 173-303-330(1)(d) for the PFP Treatment and Storage Unit include: procedures for inspecting, repairing, and replacing facility emergency and monitoring equipment; communications and alarm systems; response to fires or explosions; and shutdown of operations

  15. Addendum to the Closure Report for Corrective Action Unit 326: Areas 6 and 27 Release Sites, Nevada Test Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2009-05-01

    This document constitutes an addendum to the Closure Report for Corrective Action Unit 326: Areas 6 and 27 Release Sites, Nevada Test Site, Nevada (Revision 1), December 2002 as described in the document Supplemental Investigation Report for FFACO Use Restrictions, Nevada Test Site, Nevada (SIR) dated November 2008. The SIR document was approved by NDEP on December 5, 2008. The approval of the SIR document constituted approval of each of the recommended UR removals. In conformance with the SIR document, this addendum consists of: • This page that refers the reader to the SIR document for additional information • The cover, title, and signature pages of the SIR document • The NDEP approval letter • The corresponding section of the SIR document This addendum provides the documentation justifying the cancellation of the UR for CAS 06-25-01, CP-1 Heating Oil Release. This UR was established as part of a Federal Facility Agreement and Consent Order (FFACO) corrective action and is based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996). Since this UR was established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, this UR was reevaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006). This re-evaluation consisted of comparing the original data (used to define the need for the UR) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove the UR because contamination is not present at the site above the risk-based FALs. Requirements for inspecting and maintaining this UR will be canceled, and the postings and signage at this site will be removed. Fencing and posting may be present at this site that are unrelated to

  16. Tracking the inorganic suspended solids through biological treatment units of wastewater treatment plants.

    Science.gov (United States)

    Ekama, G A; Wentzel, M C; Sötemann, S W

    2006-11-01

    From an experimental and theoretical investigation of the continuity of influent inorganic suspended solids (ISS) along the links connecting the primary settling tank (PST), fully aerobic or N removal activated sludge (AS) and anaerobic and aerobic digestion (AerD) unit operations, it was found that (i) the influent wastewater (fixed) ISS concentration is conserved through primary sludge anaerobic digestion, and AS and AerD unit operations. However, the measured ISS flux at different stages through a series of WWTP unit operations is not equal to the influent ISS flux because the ordinary heterotrophic organisms (OHO) biomass contributes to the ISS flux by differing amounts depending on the OHO (active) fraction of the VSS solids at that stage.

  17. United States Nuclear Regulatory Commission staff practice and procedure digest. Commission, Appeal Board and Licensing Board decisions, July 1972-September 1985. Digest No. 4, Revision No. 1

    International Nuclear Information System (INIS)

    1986-04-01

    This Revision 1 of the fourth edition of the NRC Staff Practice and Procedure Digest contains a digest of a number of Commission, Atomic Safety and Licensing Appeal Board, and Atomic Safety and Licensing Board decisions issued during the period from July 1, 1972 to September 30, 1985 interpreting the NRC's Rules of Practice in 10 CFR Part 2. This Revision 1 replaces earlier editions and supplements and includes appropriate changes reflecting the admendments to the Rules of Practice effective through September 20, 1985

  18. United States Nuclear Regulatory Commission Staff Practice and Procedure Digest. Commission, Appeal Board and Licensing Board decisions, July 1972-December 1985. Digest No. 4, Revision No. 2

    International Nuclear Information System (INIS)

    1986-08-01

    This Revision 2 of the fourth edition of the NRC Staff Practice and Procedure Digest contains a digest of a number of Commission, Atomic Safety and Licensing Appeal Board, and Atomic Safety and Licensing Board decisions issued during the period July 1, 1972 to December 31, 1985, interpreting the NRC's Rules of Practice in 10 CFR Part 2. This Revision 2 replaces in part earlier editions and supplements and includes appropriate changes reflecting the amendment to the Rules of Practice effective December 31, 1985. Topics covered include prehearing and posthearing matters, herings, appeals, and general matters

  19. Long-term trends in restoration and associated land treatments in the southwestern United States

    Science.gov (United States)

    Copeland, Stella M.; Munson, Seth M.; Pilliod, David S.; Welty, Justin L.; Bradford, John B.; Butterfield, Bradley J.

    2018-01-01

    Restoration treatments, such as revegetation with seeding or invasive species removal, have been applied on U.S. public lands for decades. Temporal trends in these management actions have not been extensively summarized previously, particularly in the southwestern United States where invasive plant species, drought, and fire have altered dryland ecosystems. We assessed long-term (1940–2010) trends in restoration using approximately 4,000 vegetation treatments conducted on Bureau of Land Management lands across the southwestern United States. We found that since 1940, the proportions of seeding and vegetation/soil manipulation (e.g. vegetation removal or plowing) treatments have declined, while the proportions of prescribed burn and invasive species treatments have increased. Treatments in pinyon-juniper and big sagebrush communities declined in comparison to treatments in desert scrub, creosote bush, and riparian woodland communities. Restoration-focused treatment objectives increased relative to resource extraction objectives. Species richness and proportion of native species used in seeding treatments also increased. Inflation-adjusted costs per area rose 750% for vegetation/soil manipulation, 600% for seeding, and 400% for prescribed burn treatments in the decades from 1981 to 2010. Seeding treatments were implemented in warmer and drier years when compared to the climate conditions of the entire study period and warmer and wetter years relative to several years before and after the treatment. These results suggest that treatments over a 70-year period on public lands in the southwestern United States are shifting toward restoration practices that are increasingly large, expensive, and related to fire and invasive species control.

  20. Safety analysis report for the Mixed Waste Storage Facility and portable storage units at the Idaho National Engineering Laboratory. Revision 4

    International Nuclear Information System (INIS)

    Peatross, R.

    1997-01-01

    This revision contains Section 2 only which gives a description of the Mixed Waste Storage Facility (MWSF) and its operations. Described are the facility location, services and utilities, process description and operation, and safety support systems. The MWSF serves as a storage and repackaging facility for low-level mixed waste

  1. Characterization of suspended bacteria from processing units in an advanced drinking water treatment plant of China.

    Science.gov (United States)

    Wang, Feng; Li, Weiying; Zhang, Junpeng; Qi, Wanqi; Zhou, Yanyan; Xiang, Yuan; Shi, Nuo

    2017-05-01

    For the drinking water treatment plant (DWTP), the organic pollutant removal was the primary focus, while the suspended bacterial was always neglected. In this study, the suspended bacteria from each processing unit in a DWTP employing an ozone-biological activated carbon process was mainly characterized by using heterotrophic plate counts (HPCs), a flow cytometer, and 454-pyrosequencing methods. The results showed that an adverse changing tendency of HPC and total cell counts was observed in the sand filtration tank (SFT), where the cultivability of suspended bacteria increased to 34%. However, the cultivability level of other units stayed below 3% except for ozone contact tank (OCT, 13.5%) and activated carbon filtration tank (ACFT, 34.39%). It meant that filtration processes promoted the increase in cultivability of suspended bacteria remarkably, which indicated biodegrading capability. In the unit of OCT, microbial diversity indexes declined drastically, and the dominant bacteria were affiliated to Proteobacteria phylum (99.9%) and Betaproteobacteria class (86.3%), which were also the dominant bacteria in the effluent of other units. Besides, the primary genus was Limnohabitans in the effluents of SFT (17.4%) as well as ACFT (25.6%), which was inferred to be the crucial contributors for the biodegradable function in the filtration units. Overall, this paper provided an overview of community composition of each processing units in a DWTP as well as reference for better developing microbial function for drinking water treatment in the future.

  2. Plutonium Finishing Plan (PFP) Treatment and Storage Unit Interim Status Closure Plan

    International Nuclear Information System (INIS)

    PRIGNANO, A.L.

    2000-01-01

    This document describes the planned activities and performance standards for closing the Plutonium Finishing Plant (PFP) Treatment and Storage Unit. The PFP Treatment and Storage Unit is located within the 234-52 Building in the 200 West Area of the Hanford Facility. Although this document is prepared based upon Title 40 Code of Federal Regulations (CFR), Part 265, Subpart G requirements, closure of the unit will comply with Washington Administrative Code (WAC) 173-303-610 regulations pursuant to Section 5.3 of the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Action Plan (Ecology et al. 1996). Because the PFP Treatment and Storage Unit manages transuranic mixed (TRUM) waste, there are many controls placed on management of the waste. Based on the many controls placed on management of TRUM waste, releases of TRUM waste are not anticipated to occur in the PFP Treatment and Storage Unit. Because the intention is to clean close the PFP Treatment and Storage Unit, postclosure activities are not applicable to this closure plan. To clean close the unit, it will be demonstrated that dangerous waste has not been left onsite at levels above the closure performance standard for removal and decontamination. If it is determined that clean closure is not possible or is environmentally impractical, the closure plan will be modified to address required postclosure activities. The PFP Treatment and Storage Unit will be operated to immobilize and/or repackage plutonium-bearing waste in a glovebox process. The waste to be processed is in a solid physical state (chunks and coarse powder) and will be sealed into and out of the glovebox in closed containers. The containers of immobilized waste will be stored in the glovebox and in additional permitted storage locations at PFP. The waste will be managed to minimize the potential for spills outside the glovebox, and to preclude spills from reaching soil. Containment surfaces will be maintained to ensure

  3. Official Satire in Propaganda: The Treatment of the United States in the GDR's "Eulenspiegel."

    Science.gov (United States)

    Bytwerk, Randall L.

    1989-01-01

    Examines 102 issues (published in 1985 and 1986) of the "Eulenspiegel," the only magazine in the German Democratic Republic (GDR) devoted to humor and satire. Focuses on the "Eulenspiegel's" treatment of the United States to determine the nature of that satire, its purposes, and its effectiveness. (MM)

  4. Application for verification of monitor units of the treatment planning system

    International Nuclear Information System (INIS)

    Suero Rodrigo, M. A.; Marques Fraguela, E.

    2011-01-01

    Current estimates algorithms achieve acceptable degree of accuracy. However, operate on the basis of un intuitive models. It is therefore necessary to verify the calculation of monitor units of the treatment planning system (TPS) with those obtained by other independent formalisms. To this end, we have developed an application based on factorization formalism that automates the calculation of dose.

  5. The Interactive Seminar: An Educational Approach for Voluntary HIV Testing in a Drug Dependence Treatment Unit.

    Science.gov (United States)

    Sedhom, Laila; And Others

    1994-01-01

    A survey of 118 male patients in a drug dependence treatment unit before and after an interactive seminar with a nonjudgmental professional showed that seminar participants, especially intravenous drug users, had higher rates of voluntary HIV testing than nonparticipants. Drug users who completed detoxification and attended the seminar also had…

  6. Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study

    DEFF Research Database (Denmark)

    Jørgensen, H S; Kammersgaard, L P; Nakayama, H

    1999-01-01

    We have previously reported a marked reduction in mortality up to 1 year after treatment and rehabilitation on a stroke unit versus on general neurological and medical wards in unselected stroke patients. In the present study we wanted to test the hypothesis that this mortality-reducing effect...

  7. Checks for quality control of wedge dynamics in treatment units and the planning system

    International Nuclear Information System (INIS)

    Mateos Salvador, P.; Rodriguez Lopez, B.; Font Gelabert, J.; Hernandez Rodriguez, J.; Arino Gil, A.

    2013-01-01

    The objective of this study is to verify the implementation of enhanced dynamic wedge (EDW) vary in the Eclipse planning system and the experimental determination of the parameters that define the dosimetry characteristics of enhanced dynamic wedge of our treatment units. (Author)

  8. [Technical aspects of treatments with single- and multi-unit fixed dental prostheses

    NARCIS (Netherlands)

    Wiersema, E.J.; Kreulen, C.M.; Latzke, P.; Witter, D.J.; Creugers, N.H.J.

    2014-01-01

    For the manufacture of single- and multi-unit fixed dental prostheses, effective communication between dentist and dental technician is required. Mutual insight concerning the (im)possibilities of available treatments and technical options is prerequisitefor this communication. The manufacture of

  9. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States

    NARCIS (Netherlands)

    Perez, Marisol; Ohrt, Tara K.; Hoek, Hans W.

    2016-01-01

    Purpose of reviewWe reviewed the recent literature on prevalence rates, and application of evidence-based treatments for eating disorders among Hispanics/Latinos residing in the United States.Recent findingsLifetime prevalence rates of anorexia nervosa are lower among Hispanic/Latinos than

  10. One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection.

    Science.gov (United States)

    Capuano, Nicola; Logoluso, Nicola; Gallazzi, Enrico; Drago, Lorenzo; Romanò, Carlo Luca

    2018-03-16

    Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI). In this two-center case-control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating. At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6 days, respectively). Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections. III.

  11. The case for SAR as the major component of a hyperthermia treatment unit

    International Nuclear Information System (INIS)

    Scott, R.S.

    1985-01-01

    A major problem facing clinical hyperthermia is the lack of a useful unit of treatment. Most attempts at a treatment unit have utilized some function of temperature and time. Having accepted the validity of such a hypothetical units, one is faced with the formidable problem of obtaining a three dimensional temperature profile so that thermal dose can be determined. A corollary is the desirability of obtaining uniform temperature in the treatment volume. Various studies suggest that a uniform SAR is a more desirable goal when radiotherapy is to be used in combination with hyperthermia. The synergy between radiation and hyperthermia is maximized in low pH regions of tumor which are presumably also hypoxic. These regions are poorly perfused, likely to heat readily, and are resistant to the cytotoxic effects of radiation alone. On the other hand, well perfused regions of tumor are likely sensitive to radiation, and benefit less from the combination treatment. Other studies have definitely shown that tissue temperatures in the range normally associated with desirable hyperthermia treatment result in severe vascular damage. This damage could be expected to unnecessarily compromise the effectiveness of radiotherapy. Models in the literature can be combined to verify these observations

  12. Effects of Hydrogen Peroxide on Dental Unit Biofilms and Treatment Water Contamination

    Science.gov (United States)

    Lin, Shih-Ming; Svoboda, Kathy K.H.; Giletto, Anthony; Seibert, Jeff; Puttaiah, Raghunath

    2011-01-01

    Objectives: To study effects of various concentrations of hydrogen peroxide on mature waterline biofilms and in controlling planktonic (free-floating) organisms in simulated dental treatment water systems; and to study in vitro the effects of 2%, 3%, and 7% hydrogen peroxide on the removal of mature biofilms and inorganic compounds in dental waterlines. Methods: Four units of an automated dental unit water system simulation device was used for 12 weeks. All units were initially cleaned to control biofilms and inorganic deposits. H2O2 at concentrations of 1%, 2%, 3% was used weekly for periodic cleaning in three treatment group units (units 1, 2 & 3), with 0.05%, 0.15% and 0.25% H2O2 in municipal water used as irrigant respectively. The control unit (unit 4) did not have weekly cleanings and used municipal water as irrigant. Laser Scanning Confocal Microscopy and Scanning Electron Microscopy were used to study deposits on lines, and weekly heterotrophic plate counts done to study effluent water contamination. A 24 hour in vitro challenge test with 7%, 3% and 2% H2O2 on mature biofilms was conducted using harvested waterlines to study biofilm and inorganic deposit removal. Results: Heterotrophic plate counts of effluent water showed that the control unit reached contamination levels in excess of 400,000 CFU/mL while all treatment units showed contamination levels biofilm and inorganic deposit control in this short 12 week study. The in vitro challenge test showed although there was biofilm control, there was no eradication even when 7% H2O2 was used for 24 hours. Conclusions: 2% H2O2 used as a periodic cleaner, and diluted to 0.05% in municipal water for irrigation was beneficial in controlling biofilm and planktonic contamination in dental unit water systems. However, to remove well established biofilms, it may take more than 2 months when initial and multiple periodic cleanings are performed using H2O2. PMID:21228956

  13. Project C-018H, 242-A Evaporator/PUREX Plant Process Condensate Treatment Facility, functional design criteria. Revision 3

    International Nuclear Information System (INIS)

    Sullivan, N.

    1995-01-01

    This document provides the Functional Design Criteria (FDC) for Project C-018H, the 242-A Evaporator and Plutonium-Uranium Extraction (PUREX) Plant Condensate Treatment Facility (Also referred to as the 200 Area Effluent Treatment Facility [ETF]). The project will provide the facilities to treat and dispose of the 242-A Evaporator process condensate (PC), the Plutonium-Uranium Extraction (PUREX) Plant process condensate (PDD), and the PUREX Plant ammonia scrubber distillate (ASD)

  14. Project C-018H, 242-A Evaporator/PUREX Plant Process Condensate Treatment Facility, functional design criteria. Revision 3

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, N.

    1995-05-02

    This document provides the Functional Design Criteria (FDC) for Project C-018H, the 242-A Evaporator and Plutonium-Uranium Extraction (PUREX) Plant Condensate Treatment Facility (Also referred to as the 200 Area Effluent Treatment Facility [ETF]). The project will provide the facilities to treat and dispose of the 242-A Evaporator process condensate (PC), the Plutonium-Uranium Extraction (PUREX) Plant process condensate (PDD), and the PUREX Plant ammonia scrubber distillate (ASD).

  15. Treatment utilization among persons with opioid use disorder in the United States.

    Science.gov (United States)

    Wu, Li-Tzy; Zhu, He; Swartz, Marvin S

    2016-12-01

    The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts. We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n=6,125) in the 2005-2013 National Surveys on Drug Use and Health (N=503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment. Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD+HUD. Persons with Rx OUD+HUD tended to be white, adults aged 18-49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services. Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  16. Outcome of Tuberculosis Treatment in Patients with Diabetes Mellitus Treated in the Revised National Tuberculosis Control Programme in Malappuram District, Kerala, India

    Science.gov (United States)

    KV, Nandakumar; Duraisamy, Karthickeyan; Balakrishnan, Shibu; M, Sunilkumar; S, Jaya Sankar; Sagili, Karuna D.; Satyanarayana, Srinath; MV, Ajay Kumar; Enarson, Donald A.

    2013-01-01

    Settings Kerala State, India has reported the greatest dual burden of Tuberculosis (TB) and Diabetes Mellitus (DM). Malappuram district in Kerala has monitored and recorded DM status and its control from 2010 under Revised National Tuberculosis Control Program (RNTCP). Objectives To assess, under programme conditions, comprehensiveness of recording DM status among TB cases and the TB treatment outcomes among DM patients (disaggregated by glycemic control) and compare with-non DM patients. Design This retrospective record review included 3,116TB patients from April 2010 to September 2011.DM was defined as per international guidelines and TB treatment outcomes were categorized as favourable(cured and treatment completed) and unfavourable(death, default, failure and transfer out). Relative Risk (RR) and 95% confidence intervals(CI) were calculated to assess the risk of unfavourable outcomes. Results DM status was recorded in 90% of TB cases and 667 (24%) had DM. 17% of DM patients and 23% of patients with unknown DM status had unfavourable outcomes but this difference was not statistically significant. Unadjusted RR for poor glycemic control or unknown control status for unfavourable outcome were (2.00; 95% CI 0.97–4.13) and (2.14; 95% CI 1.11–4.13). Conclusion This study could not confirm an adverse association between DM or its control during treatment and the course of response to TB treatment.DM screening in TB cases and recording of DM care needs to be improved to enable more conclusive evidence. PMID:24155897

  17. Population-level differences in revascularization treatment and outcomes among various United States subpopulations.

    Science.gov (United States)

    Graham, Garth; Xiao, Yang-Yu Karen; Rappoport, Dan; Siddiqi, Saima

    2016-01-26

    Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to

  18. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies....... ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary...

  19. Radiological and chemical characterization report for the planned Quarry Construction Staging Area and Water Treatment Plant: Revision 1

    International Nuclear Information System (INIS)

    1989-03-01

    The Quarry Construction Staging Area and Water Treatment Plant (QCSA) will be used in the support of the bulk waste removal of the Weldon Spring Quarry. Radiological and chemical characterization was performed on a 12 acre site where the QCSA will be constructed. The characterization revealed approximately .5 acres of radiologically contaminated land. No chemical contamination was found. 8 refs., 5 figs., 7 tabs

  20. Revised National Tuberculosis Control Program regimens with and without directly observed treatment, short-course: A comparative study of therapeutic cure rate and adverse reactions

    Directory of Open Access Journals (Sweden)

    Rengaraj Sivaraj

    2014-01-01

    Full Text Available Objective: To compare the therapeutic cure rate and adverse reactions in the regimens of the Revised National Tuberculosis Control Program (RNTCP with directly observed treatment, short-course (DOTS and without DOTS. Materials and Methods: Fifty patients in the DOTS regimen and 50 patients in the non-DOTS regimen were enrolled in the study. All the participants were asked to come regularly for 3 consecutive days for sputum collection, and the sputum samples were examined for acid-fast bacilli. If tuberculosis (TB was confirmed, the disease status was confirmed through a chest X-ray (PA view. The participants were monitored for adverse events arising from the use of anti-TB drugs for the next 6 months. Results: The TB cure rates for RNTCP with DOTS and RNTCP with non-DOTS were 80% and 66%, respectively. The DOTS therapy had a better cure rate for radiologically positive, sputum-positive cases compared with the non-DOTS regimen group. The non-DOTS treatment regimen had significantly increased numbers of adverse events in the hepatic and hematinic systems. Conclusion: The DOTS regimen has higher cure rates and a lower incidence of adverse reactions compared with the non-DOTS regimen.

  1. Case report: treatment of medulloblastoma using a computer-controlled tracking cobalt unit

    International Nuclear Information System (INIS)

    Tate, T.; Brace, J.A.; Davy, T.J.; Morgan, H.M.; Skeggs, D.B.L.; Tookman, A.J.

    1985-01-01

    Radiation therapy of the length of the spinal column presents various clinical and physical problems. The completed plan may be complicated to set up, be time-consuming and require daily variation to achieve reasonable dose homogeneity. A case of medulloblastoma is used to illustrate the steps in producing a plan for dynamic treatment using a computer-controlled tracking cobalt unit. After definition by computed tomography, the target is considered in segments in order to develop a plan which keeps the spinal cord constantly positioned at the beam isocentre. The main computer is used to develop the patient treatment file and information is transferred to a second computer which controls and monitors the safe functioning of the cobalt unit. The cranial fields are treated separately in a conventional way. Good and consistent control of the dose distribution is achieved along the entire target volume. This technique is a marked improvement over all existing methods of treating the spinal axis. (author)

  2. Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

    Directory of Open Access Journals (Sweden)

    João Maurício Castaldelli-Maia

    2013-12-01

    Full Text Available Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018. Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%. Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.

  3. Tuberculosis Diagnosis Delaying Treatment of Cancer: Experience From a New Oncology Unit in Blantyre, Malawi.

    Science.gov (United States)

    Masamba, Leo Peter Lockie; Jere, Yankho; Brown, Ewan Russell Stewart; Gorman, Dermot Robert

    2016-02-01

    Malawi is a low-income country in sub-Saharan Africa with limited health care infrastructure and high prevalance of HIV and tuberculosis. This study aims to determine the characteristics of patients presenting to Queen Elizabeth Central Hospital Oncology Unit, Blantyre, Malawi, who had been treated for tuberculosis before they were diagnosed with cancer. Clinical data on all patients presenting to the oncology unit at Queen Elizabeth Central Hospital from 2010 to 2014 after a prior diagnosis of tuberculosis were prospectively recorded, and a descriptive analysis was undertaken. Thirty-four patients who had been treated for tuberculosis before being diagnosed with cancer were identified between 2010 and 2014, which represents approximately 1% of new referrals to the oncology unit. Forty-one percent of patients were HIV positive. Mean duration of tuberculosis treatment before presentation to the oncology unit was 3.6 months. The most common clinical presentation was a neck mass or generalized lymphadenopathy. Lymphoma was the most common malignancy that was subsequently diagnosed in 23 patients. Misdiagnosis of cancer as tuberculosis is a significant clinical problem in Malawi. This study underlines the importance of closely monitoring the response to tuberculosis treatment, being aware of the possibility of a cancer diagnosis, and seeking a biopsy early if cancer is suspected.

  4. Trends in the United States in the treatment of distal radial fractures in the elderly.

    Science.gov (United States)

    Chung, Kevin C; Shauver, Melissa J; Birkmeyer, John D

    2009-08-01

    Traditionally, distal radial fractures in the elderly have been treated nonoperatively with casting. However, since the introduction of the volar locking plating system in 2000, there has been an interest in the use of more aggressive treatment methods. The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States. We evaluated a 5% sample of Medicare data from 1996 to 1997 and a 20% sample from 1998 to 2005. Information on four treatment methods (closed treatment, percutaneous pin fixation, internal fixation, and external fixation) was extracted from the dataset. Other available data were diagnosis, physician specialty, and patient age, sex, and race. We calculated frequencies and rates to compare the utilization of different treatments over time. Over the ten-year time period examined, the rate of internal fixation of distal radial fractures in the elderly increased fivefold, from 3% in 1996 to 16% in 2005. Closed treatment, however, remained the predominant method (used for 82% of the fractures in 1996 and 70% in 2005). Fractures in patients with an age of eighty-five years or more were significantly more likely to be treated in a closed fashion (p < 0.0001). There was a large variation among physician specialties with regard to the fixation methods that were used. Orthopaedic surgeons were significantly more likely to use closed treatment than hand surgeons were, whereas hand surgeons were significantly more likely to use internal fixation than orthopaedic surgeons were. Since 2000, although the majority of distal radial fractures are still treated nonoperatively, there has been an increase in the use of internal fixation and a concurrent decrease in the rate of closed treatment of distal radial fractures in the elderly in the United States.

  5. Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States.

    Science.gov (United States)

    Burger, Charles D; Ozbay, A Burak; Lazarus, Howard M; Riehle, Ellen; Montejano, Leslie B; Lenhart, Gregory; White, R James

    2018-02-13

    -month post-index period with any inpatient admission decreased, 42% versus 30% (P employee of Gilead Sciences. At the time that this project and manuscript were developed, Lazarus was an employee of Gilead Sciences and may own stock/stock options. Riehle, Montejano, and Lenhart are employees of Truven Health Analytics, an IBM company, which received funding from Gilead Sciences to conduct this study. Burger and White do research with, and are paid consultants for, Gilead Sciences; they do not own equity and received no personal compensation for the work here. Burger also reports consultancy and advisory board work for Actelion Pharmaceuticals and grants from Gilead Sciences, Actelion Pharmaceuticals, Bayer, and United Therapeutics. Study concept and design were contributed by Ozbay, Riehle, and Montejano, along with the other authors. Riehle, Montejano, and Lenhart collected the data, and data interpretation was performed by Burger, Lazarus, and White, with assistance from the other authors. The manuscript was written by Riehle, Burger, Montejano, Osbay, and White and revised by Burger and White, along with Osbay, Lazarus, Riehle, and Montejano.

  6. CONCEPTUAL BASES OF THE ENERGY EFFICIENT SYSTEM OF MANAGEMENT OF COMBINED UNITS OF WASTEWATER TREATMENT

    Directory of Open Access Journals (Sweden)

    V. N. Shtepa

    2016-01-01

    Full Text Available A critical analysis of the shortcomings of the existing water purification systems is conducted. In order to ensure environmental safety and energy savings it is proposed to use the combined units, including physical, chemical, physical-and-chemical and biological methods. The attention is driven to the fact that the most effective way to maintain current water purification is an adaptive control system. The shortcomings of the management of water treatment units were revealed and it was proposed to produce their synthesis based on the mathematical apparatus of artificial intelligence systems. Taking into account the requirements of the environmental safety and the need in the energy savings, the energy efficiency criteria of combined system functioning has been developed. At an industrial plant (slaughterhouse wastewater treatment the compliance of the production conditions of the criterion has been undertaken that confirmed the criterion relevance and usefulness as applied to the synthesis of energy-efficient control systems. A synthetic control system combined the water treatment plants. Having based on the preliminary research and analysis of the current work in the subject area the architecture of a control system of combined water treatment units that use intelligent technology was developed. The key functional of the unit – information-analytical subsystem of the formation control actions including: multilayer perceptrons self-organization Kohonen network, fuzzy cognitive map. The basic difference between the developed design and its analogues is the ability to adjust the settings of equipment adaptively on the basis of processing sensor data, information on the price of consumables, volley discharges of pollutants, a sudden change in the flow and other force majeure. Adjustment of the parameters of the control system is carried out with the use of experimental and analytical data stored in the knowledge base of technological

  7. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States

    OpenAIRE

    Fryer, Gary; Morse, Christopher M; Johnson, Jane C

    2009-01-01

    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests w...

  8. Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada Test Site, Nevada, Revision 1

    International Nuclear Information System (INIS)

    2008-01-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for the closure of Corrective Action Unit (CAU) 116, Area 25 Test Cell C Facility. The Test Cell C (TCC) Facility is located in Area 25 of the Nevada Test Site (NTS) approximately 25 miles northwest of Mercury, Nevada (Figure 1). CAU 116 is currently listed in Appendix III of the Federal Facility Agreement and Consent Order (FFACO) of 1996 (as amended February 2008) and consists of two Corrective Action Sites (CASs): (1) CAS 25-23-20, Nuclear Furnace Piping; and (2) CAS 25-41-05, Test Cell C Facility. CAS 25-41-05 is described in the FFACO as the TCC Facility but actually includes Building 3210 and attached concrete shield wall only. CAU 116 will be closed by demolishing Building 3210, the attached concrete shield wall, and the nuclear furnace piping. In addition, as a best management practice (BMP), Building 3211 (moveable shed) will be demolished due to its close proximity to Building 3210. This will aid in demolition and disposal operations. Radiological surveys will be performed on the demolition debris to determine the proper disposal pathway. As much of the demolition debris as space allows will be placed into the Building 3210 basement structure. After filling to capacity with demolition debris, the basement structure will be mounded or capped and closed with administrative controls. Prior to beginning demolition activities and according to an approved Sampling and Analysis Plan (SAP), representative sampling of surface areas that are known, suspected, or have the potential to contain hazardous constituents such as lead or polychlorinated biphenyls (PCBs) will be performed throughout all buildings and structures. Sections 2.3.2, 4.2.2.2, 4.2.2.3, 4.3, and 6.2.6.1 address the methodologies employed that assure the solid debris placed in the basement structure will not contain contaminants of concern (COCs) above hazardous waste levels. The anticipated post

  9. Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada Test Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2008-12-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for the closure of Corrective Action Unit (CAU) 116, Area 25 Test Cell C Facility. The Test Cell C (TCC) Facility is located in Area 25 of the Nevada Test Site (NTS) approximately 25 miles northwest of Mercury, Nevada (Figure 1). CAU 116 is currently listed in Appendix III of the Federal Facility Agreement and Consent Order (FFACO) of 1996 (as amended February 2008) and consists of two Corrective Action Sites (CASs): (1) CAS 25-23-20, Nuclear Furnace Piping; and (2) CAS 25-41-05, Test Cell C Facility. CAS 25-41-05 is described in the FFACO as the TCC Facility but actually includes Building 3210 and attached concrete shield wall only. CAU 116 will be closed by demolishing Building 3210, the attached concrete shield wall, and the nuclear furnace piping. In addition, as a best management practice (BMP), Building 3211 (moveable shed) will be demolished due to its close proximity to Building 3210. This will aid in demolition and disposal operations. Radiological surveys will be performed on the demolition debris to determine the proper disposal pathway. As much of the demolition debris as space allows will be placed into the Building 3210 basement structure. After filling to capacity with demolition debris, the basement structure will be mounded or capped and closed with administrative controls. Prior to beginning demolition activities and according to an approved Sampling and Analysis Plan (SAP), representative sampling of surface areas that are known, suspected, or have the potential to contain hazardous constituents such as lead or polychlorinated biphenyls (PCBs) will be performed throughout all buildings and structures. Sections 2.3.2, 4.2.2.2, 4.2.2.3, 4.3, and 6.2.6.1 address the methodologies employed that assure the solid debris placed in the basement structure will not contain contaminants of concern (COCs) above hazardous waste levels. The anticipated post

  10. [Characteristics of Adolescents with Gender Dysphoria Referred to the Gender Identity Treatment Unit].

    Science.gov (United States)

    Fernández Rodríguez, María; Guerra Mora, Patricia; Martín Sánchez, Eloya

    2017-02-01

    The demand for treatment among people with gender dys-phoria has increased during the last years. The aim of the present research was to carry out an analysis of the demand of the teenagers that requested consultation at the UTIGPA (Gender Identity Treatment Unit of Principality of Asturias) as they presented complains of gender dysphoria. The sample included 20 minors that were treated between March 2007 and December 2015. The clinical history was made to collect informa-tion. It was made descriptive analysis and the reason sex/gender was used. The 20 teenagers represented the 14,6% of the whole sample (of 137 demands). The age average was 15,20 years (SD=1,473) and the range of years was between 12-17. The reason sex/gender was 1/1 (10 into the man to woman group and 10 into the woman to man group). At the arrival at the Treatment Unit, 100% of the individuals lived with their nuclear or extended family and in the 60% of the cases, their parents were separated. 70% of the cases were referred from mental health services. 10% hadn´t got any past medical history and 35% had never received any prescription for a psychopharmacological treatment. 95% hadn't done any hormonal self-treatment. 100% defined themselves as heterosexual. 25% requested exclusively for psychological interventions and 75% asked for medical treatments. The profile of the minor was a teenager of approximately 15 years old that was referred from mental health services. Contrary to the fin-dings of other national and international researches, the rate sex/gender was equated in our research. The minor had got a past medical history and their prio-rity request was for medical treatments, both hormonal and surgical therapies.

  11. Mixed Waste Focus Area Working Group: An Integrated Approach to Mercury Waste Treatment and Disposal. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Morris, M.I.; Conley, T.B.; Osborne-Lee, I.W.

    1997-09-08

    May 1996, the U.S. Department of Energy (DOE) Mixed Waste Focus Area (MWFA) initiated the Mercury Work Group (HgWG). The HgWG was established to address and resolve the issues associated with Mercury- contaminated mixed wastes (MWs). During the initial technical baseline development process of the MWFA, three of the top four technology deficiencies identified were related to (1) amalgamation, (2) stabilization, and (3) separation and removal for the treatment of mercury and mercury-contaminated mixed waste (MW). The HgWG is assisting the MWFA in soliciting, identifying, initiating, and managing efforts to address these needs.

  12. Mixed Waste Focus Area Working Group: An Integrated Approach to Mercury Waste Treatment and Disposal. Revision 1

    International Nuclear Information System (INIS)

    Morris, M.I.; Conley, T.B.; Osborne-Lee, I.W.

    1997-01-01

    May 1996, the U.S. Department of Energy (DOE) Mixed Waste Focus Area (MWFA) initiated the Mercury Work Group (HgWG). The HgWG was established to address and resolve the issues associated with Mercury- contaminated mixed wastes (MWs). During the initial technical baseline development process of the MWFA, three of the top four technology deficiencies identified were related to (1) amalgamation, (2) stabilization, and (3) separation and removal for the treatment of mercury and mercury-contaminated mixed waste (MW). The HgWG is assisting the MWFA in soliciting, identifying, initiating, and managing efforts to address these needs

  13. 40 CFR 60.4124 - Hg budget permit revisions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Hg budget permit revisions. 60.4124... Coal-Fired Electric Steam Generating Units Permits § 60.4124 Hg budget permit revisions. Except as provided in § 60.4123(b), the permitting authority will revise the Hg Budget permit, as necessary, in...

  14. Toward treatment with respect and dignity in the intensive care unit.

    Science.gov (United States)

    Sugarman, Jeremy

    2015-01-01

    Despite concern that patients in the intensive care unit (ICU) may not be treated with respect and dignity, there is not conceptual clarity regarding what constitutes such treatment. In addition, measures specific to treatment with respect and dignity in the ICU are unavailable. Accordingly, a multidisciplinary group developed a conceptual model for treatment with respect and dignity in the ICU and used mixed methods to gather data on this issue. This effort included interviews with patients and families, focus groups with health care professionals, and direct observations. These data were then compared and contrasted to synthesize what was learned. Finally, pilot quantitative patient and family survey data were collected and analyzed. Each of these approaches, which comprise the papers in this supplement to Narrative Inquiry in Bioethics, is briefly described in this article.

  15. Streptococcus equi Infections in Horses: Guidelines for Treatment, Control, and Prevention of Strangles—Revised Consensus Statement

    Science.gov (United States)

    Timoney, J.F.; Newton, J.R.; Hines, M.T.; Waller, A.S.; Buchanan, B.R.

    2018-01-01

    This consensus statement update reflects our current published knowledge and opinion about clinical signs, pathogenesis, epidemiology, treatment, complications, and control of strangles. This updated statement emphasizes varying presentations in the context of existing underlying immunity and carrier states of strangles in the transmission of disease. The statement redefines the “gold standard” for detection of possible infection and reviews the new technologies available in polymerase chain reaction diagnosis and serology and their use in outbreak control and prevention. We reiterate the importance of judicious use of antibiotics in horses with strangles. This updated consensus statement reviews current vaccine technology and the importance of linking vaccination with currently advocated disease control and prevention programs to facilitate the eradication of endemic infections while safely maintaining herd immunity. Differentiation between immune responses to primary and repeated exposure of subclinically infected animals and responses induced by vaccination is also addressed. PMID:29424487

  16. MOBIL CONTAINER UNIT FOR SEWAGE SLUDGE UTILIZATION FROM SMALL AND MEDIUM WASTWATER TREATMENT PLANTS

    Directory of Open Access Journals (Sweden)

    Stanisław Ledakowicz

    2016-06-01

    Full Text Available The most wastewater treatment plants in Poland are small and medium plants of flow capacity below 1000 m3/d. These plants are not able to build sludge incineration plants and the transportation costs to the nearest plants increase the total costs of wastewater treatment. Polish company Metal Expert together with the French company ETIA and Lodz University of Technology proposed mobile unit for integrated drying and pyrolysis of sewage sludge in a pilot bench scale with capacity of 100 kg/h of dewatered sludge. The pilot plant was mounted in a typical mobile container which could provide service to small and medium wastewater treatment plants offering thermal processing of sewage sludge. This unit consists of KENKI contact dryer and „Spirajoule”® pyrolyser supplied with electricity utilizing the Joule effect, and a boiler, wherein the pyrolysis gases and volatile products are burned producing steam sent to the contact dryer. The bio-char produced during sludge pyrolysis could be utilized for agriculture purposes. During preliminary experiments and short-term exploitation of the unit at Elbląg Wastewater Treatment Plant the obtained results allowed us to make a mass and energy balance depended on the process conditions in the pyrolysis temperature range of 400÷800 °C. Based on the obtained results a calculator was created in the Excel , which enables assessment of pyrolysis products content and making mass and energy balances depended on process parameters such as initial moisture of sludge, pyrolysis temperature and installation output.

  17. Design of chemical treatment unit for radioactive liquid wastes in Serpong nuclear facilities

    International Nuclear Information System (INIS)

    Salimin, Z.; Walman, E.; Santoso, P.; Purnomo, S.; Sugito; Suwardiyono; Wintono

    1996-01-01

    The chemical treatment unit for radioactive liquid wastes arising from nuclear fuel fabrication, radioisotopes production and radiometallurgy facility has been designed. The design of chemical processing unit is based on the characteristics of liquid wastes containing fluors from uranium fluoride conversion process to ammonium uranyl carbonate on the fuel fabrication. The chemical treatment has the following process steps: coagulation-precipitation of fluoride ion by calcium hydroxide coagulant, separation of supernatant solution from sludge, coagulation of remaining fluoride on the supernatant solution by alum, separation of supernatant from sludge, and than precipitation of fluors on the supernatant by polymer resin WWS 116. The processing unit is composed of 3 storage tanks for raw liquid wastes (capacity 1 m 3 per tank), 5 storage tanks for chemicals (capacity 0.5 m 3 per tank), 2 mixing reactors (capacity 0.5 m 3 per reactor), 1 storage tank for supernatant solution (capacity 1 m 3 ), and 1 storage tank for sludge (capacity 1 m 3 )

  18. Racial Variation in Treatment of Traumatic Finger/Thumb Amputation: A National Comparative Study of Replantation and Revision Amputation.

    Science.gov (United States)

    Mahmoudi, Elham; Swiatek, Peter R; Chung, Kevin C; Ayanian, John Z

    2016-03-01

    Traumatic finger/thumb amputations are some of the most prevalent traumatic injuries affecting Americans each year. Rates of replantation after traumatic finger/thumb amputation, however, have been declining steadily across U.S. hospitals, which may make these procedures less accessible to minorities and vulnerable populations. The specific aim of this study was to examine racial variation in finger replantation after traumatic finger/thumb amputation. Using a two-level hierarchical model, the authors retrospectively compared replantation rates for African American patients with those of whites, adjusting for patient and hospital characteristics. Patients younger than 65 years with traumatic finger/thumb amputation injuries who sought care at a U.S. trauma center between 2007 and 2012 were included in the study sample. The authors analyzed 13,129 patients younger than 65 years with traumatic finger/thumb amputation. Replantation rates declined over time from 19 percent to 14 percent (p = 0.004). Adjusting for patient and hospital characteristics, African Americans (OR, 0.81; 95 percent CI, 0.66 to 0.99; p = 0.049) were less likely to undergo replantation procedures than whites, and uninsured patients (OR, 0.73; 95 percent CI, 0.62 to 0.84; p amputation injuries. Regionalization of care for these injuries may not only provide a higher quality care but also reduce variations in treatment. Risk, III.

  19. Revision of documents guide to obtain the renovation of licence of the nuclear power plant of Laguna Verde, Units I and II; Revision de documentos guia para obtener la renovacion de licencia de la Central Nuclear Laguna Verde Unidades 1 and 2

    Energy Technology Data Exchange (ETDEWEB)

    Jarvio C, G. [ININ 52750 La Marquesa, Estado de Mexico (Mexico); Fernandez S, G. [CFE, Gerencia de Centrales Nucleoelectricas, Subgerencia de Ingenieria, Carretera Veracruz-Medellin s/n (Km. 7.5), Dos Bocas, 54270 Veracruz (Mexico)]. e-mail: giarvio@yahoo.com.mx

    2008-07-01

    Unquestionably the renovation of license of the nuclear power plants , it this converting in a promising option to be able to gather in sure, reliable form and economic those requests about future energy in the countries with facilities of this type. This work it analyzes four documents guide and their application for the determination of the renovation of it licenses in nuclear plants that will serve of base for their aplication in the Nuclear Power Plant of Laguna Verde Units I and 2. The four documents in question are: the one Inform Generic of Learned Lessons on the Aging (NUREG - 1801), the Standard Revision Plan for the Renovation of License (NUREG - 1800), the Regulatory Guide for Renovation of License (GR-1.188), and the NEI 95-10, developed by the Institute of Nuclear Energy that is an Industrial Guide to Implement the Requirements of the 1OCFR Part 54-the Rule of Renovation of It licenses. (Author)

  20. Contaminant Transport Parameters for the Groundwater Flow and Contaminant Transport Model of Corrective Action Units 101 and 102: Central and Western Pahute Mesa, Nye County, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Drici, Warda [International Technologies Corporation, Las Vegas, NV (United States)

    2003-08-01

    This report documents the analysis of the available transport parameter data conducted in support of the development of a Corrective Action Unit (CAU) groundwater flow model for Central and Western Pahute Mesa: CAUs 101 and 102.

  1. Hydrologic Data for the Groundwater Flow and Contaminant Transport Model of Corrective Action Units 101 and 102: Central and Western Pahute Mesa, Nye County, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Drici, Warda [Stoller-Navarro Joint Venture, Las Vegas, NV (United States)

    2004-02-01

    This report documents the analysis of the available hydrologic data conducted in support of the development of a Corrective Action Unit (CAU) groundwater flow model for Central and Western Pahute Mesa: CAUs 101 and 102.

  2. Current trends in endodontic treatment by general dental practitioners: report of a United States national survey.

    Science.gov (United States)

    Savani, Gina M; Sabbah, Wael; Sedgley, Christine M; Whitten, Brian

    2014-05-01

    In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols. A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE). Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P 20 years were more likely to perform retreatments (P retreatment or molar RCT (both P 5 hours of CE were more likely to use rotary instrumentation (P retreatment (P 20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  3. Design of Biochemical Oxidation Process Engineering Unit for Treatment of Organic Radioactive Liquid Waste

    International Nuclear Information System (INIS)

    Zainus Salimin; Endang Nuraeni; Mirawaty; Tarigan, Cerdas

    2010-01-01

    Organic radioactive liquid waste from nuclear industry consist of detergent waste from nuclear laundry, 30% TBP-kerosene solvent waste from purification or recovery of uranium from process failure of nuclear fuel fabrication, and solvent waste containing D 2 EHPA, TOPO, and kerosene from purification of phosphoric acid. The waste is dangerous and toxic matter having low pH, high COD and BOD, and also low radioactivity. Biochemical oxidation process is the effective method for detoxification of organic waste and decontamination of radionuclide by bio sorption. The result process are sludges and non radioactive supernatant. The existing treatment facilities radioactive waste in Serpong can not use for treatment of that’s organics waste. Dio chemical oxidation process engineering unit for continuous treatment of organic radioactive liquid waste on the capacity of 1.6 L/h has been designed and constructed the equipment of process unit consist of storage tank of 100 L capacity for nutrition solution, 2 storage tanks of 100 L capacity per each for liquid waste, reactor oxidation of 120 L, settling tank of 50 L capacity storage tank of 55 L capacity for sludge, storage tank of 50 capacity for supernatant. Solution on the reactor R-01 are added by bacteria, nutrition and aeration using two difference aerators until biochemical oxidation occurs. The sludge from reactor of R-01 are recirculated to the settling tank of R-02 and on the its reverse operation biological sludge will be settled, and supernatant will be overflow. (author)

  4. Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya.

    Science.gov (United States)

    Kawakatsu, Yoshito; Tanaka, Junichi; Ogawa, Kazuya; Ogendo, Kenneth; Honda, Sumihisa

    2017-02-16

    The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area's CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Factors significantly associated with a lower prevalence of diarrhea among children under five were the child's increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on

  5. Pre-treatment analysis of woody vegetation composition and structure on the hardwood ecosystem experiment research units

    Science.gov (United States)

    Michael R. Saunders; Justin E. Arseneault

    2013-01-01

    In long-term, large-scale forest management studies, documentation of pre-treatment differences among and variability within experimental units is critical for drawing the proper inferences from imposed treatments. We compared pre-treatment overstory and large shrub communities (diameters at breast height >1.5 cm) for the 9 research cores with the Hardwood Ecosystem...

  6. Enhancing the ecological and operational characteristics of water treatment units at TPPs based on baromembrane technologies

    Science.gov (United States)

    Chichirova, N. D.; Chichirov, A. A.; Filimonova, A. A.; Saitov, S. R.

    2017-12-01

    The innovative baromembrane technologies for water demineralization were introduced at Russian TPPs more than 25 years ago. While being used in the power engineering industry of Russia, these technologies demonstrated certain advantages over the traditional ion-exchange and thermal technologies of makeup water treatment for steam boilers. Water treatment units based on the baromembrane technology are compact, easy to operate, and highly automated. The experience gained from the use of these units shows that their reliability depends directly on preliminary water treatment. The popular water pretreatment technology with coagulation by aluminum oxychloride proved to be inefficient during the seasonal changes of source water quality that occurs at some stations. The use of aluminum coagulant at pH 8 and higher does not ensure the stable and qualitative pretreatment regime: soluble aluminum forms slip on membranes of the ultrafiltration unit, thereby causing pollution and intoxication as well as leading to structural damages or worsening of mechanical properties of the membranes. The problem of increased pH and seasonal changes of the source water quality can be solved by substitution of the traditional coagulant into a new one. To find the most successful coagulant for water pretreatment, experiments have been performed on both qualitative and quantitative analysis of the content of natural organic matters in the Volga water and their structure. We have developed a software program and measured the concentrations of soluble aluminum and iron salts at different pH values of the source water. The analysis of the obtained results has indicated that iron sulfate at pH 6.0-10.2, in contrast to aluminum oxychloride, is not characterized by increased solubility. Thus, the basic process diagrams of water pretreatment based on baromembrane technologies with pretreatment through coagulation by iron salts and wastewater amount reducing from 60-40 to 5-2% have been introduced for

  7. Resource Conservation and Recovery Act (RCRA) closure sumamry for the Uranium Treatment Unit

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    This closure summary has been prepared for the Uranium Treatment Unit (UTU) located at the Y-12 Plant in Oak Ridge, Tennessee. The actions required to achieve closure of the UTU area are outlined in the Closure Plan, submitted to and approved by the Tennessee Department of Environmental and Conservation staff, respectively. The UTU was used to store and treat waste materials that are regulated by the Resource Conservation and Recovery Act. This closure summary details all steps that were performed to close the UTU in accordance with the approved plan.

  8. Resource Conservation and Recovery Act (RCRA) closure sumamry for the Uranium Treatment Unit

    International Nuclear Information System (INIS)

    1996-05-01

    This closure summary has been prepared for the Uranium Treatment Unit (UTU) located at the Y-12 Plant in Oak Ridge, Tennessee. The actions required to achieve closure of the UTU area are outlined in the Closure Plan, submitted to and approved by the Tennessee Department of Environmental and Conservation staff, respectively. The UTU was used to store and treat waste materials that are regulated by the Resource Conservation and Recovery Act. This closure summary details all steps that were performed to close the UTU in accordance with the approved plan

  9. Study of the uses of Information and Communication Technologies by Pain Treatment Unit Physicians.

    Science.gov (United States)

    Muriel Fernandez, Jorge; Sánchez Ledesma, María José; López Millan, Manuel; García Cenador, María Begoña

    2017-05-01

    Adequate use of Information and Communication Technologies (ICTs) in health has been shown to save the patient and caregiver time, improve access to the health system, improve diagnosis and control of disease or treatment. All this results in cost savings, and more importantly, they help improve the quality of service and the lives of patients. The purpose of this study is to analyse the differences in the uses of this ICTs between those physicians that belong to Pain Treatment Units (PU) and other physicians that work in pain not linked to these PUs. An online survey, generated by Netquest online survey tool, was sent to both groups of professionals and the data collected was statistical analysed through a logistic regression methodology which is the Logit binomial model. Our results show that those physicians that belong to PUs use ICTs more frequently and consider it more relevant to their clinical practice.

  10. Treatment of skin and soft tissue infections in a pediatric observation unit.

    Science.gov (United States)

    Lane, Roni D; Sandweiss, David R; Corneli, Howard M

    2014-05-01

    To report the success rate of observation unit (OU) treatment of pediatric skin and soft tissue infections (SSTIs) and to see if we could identify variables at the time of initial evaluation that predicted successful OU treatment. A retrospective review of children less than 18 years of age admitted for SSTI treatment to our OU from the emergency department between January 2003 and June 2009. On records review, 853 patients matched eligibility criteria; median age was 5.2 years (interquartile range = 2.5-9 years). Of the 853 patients, 597 (70.0%) met the primary outcome criteria of successful OU discharge within 26 hours. Secondary analysis revealed that 82% of the patients achieved successful discharge from the OU within 48 hours. Although some laboratory variables demonstrated statistical association with success, none achieved a combination of high sensitivity and specificity to predict OU failure. OU success rates varied by location. Dental and face infections and those of the extremities or multiple sites demonstrated OU success rates higher than 65%, while infection of the groin, buttocks, trunk, or neck had success rates between 24% (neck) and 60% (groin). In multivariate analysis, only 3 variables remained significant. Unfavorable location was most strongly associated with OU failure, followed by C-reactive protein > 4 and then by erythrocyte sedimentation rate > 20. Our findings suggest that successful OU treatment is possible in a large group of patients needing hospitalization for SSTIs. Consideration of infection location may assist the emergency department clinician in determining the most appropriate unit for admission.

  11. Closure Report (CR) for Corrective Action Unit (CAU) 91: Area 3 U-3fi Injection Well with Errata Sheet and Certification, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Navarro Nevada Environmental Services

    2010-08-10

    The closure report for CAU 91 has no Use Restriction Form or drawing/map included in the document to describe the use restricted area, however, Section 3.3.3 states that the site will be fenced and signage placed indicating the area as a Resource Conservation and Recovery Act (RCRA) Unit. The drawing that was placed in the FFACO indicating the use restricted area lists the coordinates for the RCRA Unit in Nevada State Plan Coordinates - North American Datum of 1983. In the ensuing years the reporting of coordinates has been standardized so that all coordinates are reported in the same manner, which is: NAD 27 UTM Zone 11 N, meters. This Errata Sheet updates the coordinate reporting to the currently accepted method and includes an aerial photo showing the RCRA Unit with the coordinates listed showing the use restricted area.

  12. Corrective Action Decision Document/Closure Report for Corrective Action Unit 370: T-4 Atmospheric Test Site, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2009-05-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit (CAU) 370, T-4 Atmospheric Test Site, located in Area 4 at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 370 is comprised of Corrective Action Site (CAS) 04-23-01, Atmospheric Test Site T-4. The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 370 due to the implementation of the corrective action of closure in place with administrative controls. To achieve this, corrective action investigation (CAI) activities were performed from June 25, 2008, through April 2, 2009, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 370: T-4 Atmospheric Test Site and Record of Technical Change No. 1.

  13. Development and status of the AL Mixed Waste Treatment Plan or I love that mobile unit of mine

    International Nuclear Information System (INIS)

    Bounini, L.; Williams, M.; Zygmunt, S.

    1995-01-01

    Nine Department of Energy (DOE) sites reporting to the Albuquerque Office (AL) have mixed waste that is chemically hazardous and radioactive. The hazardous waste regulations require the chemical portion of mixed waste to be to be treated to certain standards. The total volume of low-level mixed waste at the nine sites is equivalent to 7,000 drums, with individual site volumes ranging from 1 gallon of waste at the Pinellas Plant to 4,500 drums at Los Alamos National Laboratory. Nearly all the sites have a diversity of wastes requiring a diversity of treatment processes. Treatment capacity does not exist for much of this waste, and it would be expensive for each site to build the diversity of treatment processes needed to treat its own wastes. DOE-AL assembled a team that developed the AL Mixed Waste Treatment Plan that uses the resources of the nine sites to treat the waste at the sites. Work on the plan started in October 1993, and the plan was finalized in March 1994. The plan uses commercial treatment, treatability studies, and mobile treatment units. The plan specifies treatment technologies that will be built as mobile treatment units to be moved from site to site. Mobile units include bench-top units for very small volumes and treatability studies, drum-size units that treat one drum per day, and skid-size units that handle multiple drum volumes. After the tools needed to treat the wastes were determined, the sites were assigned to provide part of the treatment capacity using their own resources and expertise. The sites are making progress on treatability studies, commercial treatment, and mobile treatment design and fabrication. To date, this is the only plan for treating waste that brings the resources of several DOE sites together to treat mixed waste. It is the only program actively planning to use mobile treatment coordinated between DOE sites

  14. Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

    Science.gov (United States)

    Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

    2013-01-01

    Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding

  15. Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States.

    Science.gov (United States)

    Tekle, Wondwossen G; Chaudhry, Saqib A; Hassan, Ameer E; Rodriguez, Gustavo J; Suri, M Fareed K; Qureshi, Adnan I

    2012-07-01

    To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm. Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; Pcare was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286). One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.

  16. Land Application of Treated Sewage Sludge in the United States: Regulatory Considerations for Risk Reduction and Determining Treatment Process Equivalency

    Science.gov (United States)

    In the United States, municipal wastewater includes discharges from households, commercial businesses and various industries. Microorganisms associated with these wastes can be concentrated in the solids (sludge) which are removed during treatment operations. Beneficial reuse a...

  17. High levels of multidrug resistant tuberculosis in new and treatment-failure patients from the Revised National Tuberculosis Control Programme in an urban metropolis (Mumbai in Western India

    Directory of Open Access Journals (Sweden)

    Nicol Mark

    2009-06-01

    Full Text Available Abstract Background India, China and Russia account for more than 62% of multidrug resistant tuberculosis (MDRTB globally. Within India, locations like urban metropolitan Mumbai with its burgeoning population and high incidence of TB are suspected to be a focus for MDRTB. However apart from sporadic surveys at watched sites in the country, there has been no systematic attempt by the Revised National Tuberculosis Control Programme (RNTCP of India to determine the extent of MDRTB in Mumbai that could feed into national estimates. Drug susceptibility testing (DST is not routinely performed as a part of programme policy and public health laboratory infrastructure, is limited and poorly equipped to cope with large scale testing. Methods From April 2004 to January 2007 we determined the extent of drug resistance in 724 {493 newly diagnosed, previously untreated and 231 first line treatment failures (sputum-smear positive at the fifth month after commencement of therapy} cases of pulmonary tuberculosis drawn from the RNTCP in four suboptimally performing municipal wards of Mumbai. The observations were obtained using a modified radiorespirometric Buddemeyer assay and validated by the Swedish Institute for Infectious Disease Control, Stockholm, a supranational reference laboratory. Data was analyzed utilizing SPSS 10.0 and Epi Info 2002. Results This study undertaken for the first time in RNTCP outpatients in Mumbai reveals a high proportion of MDRTB strains in both previously untreated (24% and treatment-failure cases (41%. Amongst new cases, resistance to 3 or 4 drug combinations (amplified drug resistance including isoniazid (H and rifampicin (R, was greater (20% than resistance to H and R alone (4% at any point in time during the study. The trend for monoresistance was similar in both groups remaining highest to H and lowest to R. External quality control revealed good agreement for H and R resistance (k = 0.77 and 0.76 respectively. Conclusion

  18. High levels of multidrug resistant tuberculosis in new and treatment-failure patients from the Revised National Tuberculosis Control Programme in an urban metropolis (Mumbai) in Western India.

    Science.gov (United States)

    D'souza, Desiree T B; Mistry, Nerges F; Vira, Tina S; Dholakia, Yatin; Hoffner, Sven; Pasvol, Geoffrey; Nicol, Mark; Wilkinson, Robert J

    2009-06-29

    India, China and Russia account for more than 62% of multidrug resistant tuberculosis (MDRTB) globally. Within India, locations like urban metropolitan Mumbai with its burgeoning population and high incidence of TB are suspected to be a focus for MDRTB. However apart from sporadic surveys at watched sites in the country, there has been no systematic attempt by the Revised National Tuberculosis Control Programme (RNTCP) of India to determine the extent of MDRTB in Mumbai that could feed into national estimates. Drug susceptibility testing (DST) is not routinely performed as a part of programme policy and public health laboratory infrastructure, is limited and poorly equipped to cope with large scale testing. From April 2004 to January 2007 we determined the extent of drug resistance in 724 {493 newly diagnosed, previously untreated and 231 first line treatment failures (sputum-smear positive at the fifth month after commencement of therapy)} cases of pulmonary tuberculosis drawn from the RNTCP in four suboptimally performing municipal wards of Mumbai. The observations were obtained using a modified radiorespirometric Buddemeyer assay and validated by the Swedish Institute for Infectious Disease Control, Stockholm, a supranational reference laboratory. Data was analyzed utilizing SPSS 10.0 and Epi Info 2002. This study undertaken for the first time in RNTCP outpatients in Mumbai reveals a high proportion of MDRTB strains in both previously untreated (24%) and treatment-failure cases (41%). Amongst new cases, resistance to 3 or 4 drug combinations (amplified drug resistance) including isoniazid (H) and rifampicin (R), was greater (20%) than resistance to H and R alone (4%) at any point in time during the study. The trend for monoresistance was similar in both groups remaining highest to H and lowest to R. External quality control revealed good agreement for H and R resistance (k = 0.77 and 0.76 respectively). Levels of MDRTB are much higher in both previously

  19. Surgical treatment using The Unit Rod in children with neuromuscular scoliosis.

    Science.gov (United States)

    Nedelcu, T; Georgescu, I; Leroux, J; Lechevallier, J; Barbilian, A; Tuhar, I

    2016-01-01

    The article represents a retrospective clinical and radiological study. Objective. To assess the safety and the stability in time of the Unit Rod instrumentation in the treatment of severe neuromuscular scoliosis in children and adolescents. Summary. The treatment of patients with neuromuscular scoliosis always represents a challenge. The patients are debilitated and usual interventions are very long with great loss of blood. Serious complications can compromise the result of the surgery. The technique we used (the Unit Rod) is worldwide recognized, is simple, and gives excellent stability with a low rate of complications. Methods. We conducted a clinical and radiological retrospective study with a follow-up of at least 4 years in 58 patients with serious neuromuscular conditions, most of them being non-walkers. They were surgically treated by using mostly the Unit Rod technique, in the department of Paediatric Orthopaedics of the Rouen University Hospital, France, between 2000 and 2008. The back fusion was generally from T2 to pelvis. We used the Galveston technique for the patients who needed a pelvic fixation. Results. The mean Cobb angle correction was of 67% immediately after surgery; the correction of the curve decreased in time only in 4% of the cases. Pelvic obliquity was also very well corrected: 73% immediately and 70% at the last radiological follow-up. The mean operative time was of 175 minutes compared to 269 minutes for screws and hooks instrumentation. The most common complication for our technique was the radiolucent halo that appeared around the pelvic inserts. There was no significant degradation in time of the correction obtained. Conclusions. The use of this technique is safe, gives excellent results, achieving significant improvements in the postoperative functional status of the patients. The intra- and postoperative complications were minor. The advantage of using this method is the low cost of the material and technical simplicity, the

  20. Multibeam tomotherapy: A new treatment unit devised for multileaf collimation, intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Achterberg, Nils; Mueller, Reinhold G.

    2007-01-01

    A fully integrated system for treatment planning, application, and verification for automated multileaf collimator (MLC) based, intensity-modulated, image-guided, and adaptive radiation therapy (IMRT, IGRT and ART, respectively) is proposed. Patient comfort, which was the major development goal, will be achieved through a new unit design and short treatment times. Our device for photon beam therapy will consist of a new dual energy linac with five fixed treatment heads positioned evenly along one plane but one electron beam generator only. A minimum of moving parts increases technical reliability and reduces motion times to a minimum. Motion is allowed solely for the MLCs, the robotic patient table, and the small angle gantry rotation of ±36 deg. . Besides sophisticated electron beam guidance, this compact setup can be built using existing modules. The flattening-filter-free treatment heads are characterized by reduced beam-on time and contain apertures restricted in one dimension to the area of maximum primary fluence output. In the case of longer targets, this leads to a topographic intensity modulation, thanks to the combination of ''step and shoot'' MLC delivery and discrete patient couch motion. Owing to the limited number of beam directions, this multislice cone beam serial tomotherapy is referred to as ''multibeam tomotherapy.'' Every patient slice is irradiated by one treatment head at any given moment but for one subfield only. The electron beam is then guided to the next head ready for delivery, while the other heads are preparing their leaves for the next segment. The ''Multifocal MLC-positioning'' algorithm was programmed to enable treatment planning and optimize treatment time. We developed an overlap strategy for the longitudinally adjacent fields of every beam direction, in doing so minimizing the field match problem and the effects of possible table step errors. Clinical case studies show for the same or better planning target volume coverage

  1. Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit

    Directory of Open Access Journals (Sweden)

    Bick Debra

    2012-06-01

    Full Text Available Abstract Background Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women’s views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated. Methods Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women’s views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression. Results Data were obtained on 741/1160 (64% women at 10 days post-birth and 616 (54% at 3 months post-birth pre-intervention, and 725/1153 (63% and 575 (50% respectively post-intervention. Post intervention there were statistically significant differences in the initiation (p = 0.050, duration of any breastfeeding (p = 0.020 and duration of exclusive breastfeeding to 10 days (p = 0.038 and duration of any breastfeeding to three months (p = 0.016. Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care. Conclusions It is possible to improve outcomes of routine in-patient care within current resources through continuous quality

  2. Independent calculation of the monitor units and times of treatment in radiotherapy

    International Nuclear Information System (INIS)

    Mueller, Marcio Rogerio

    2005-01-01

    In this work, an independent verification system of calculations in radiotherapy was developed and applied, using Visual Basic TM programming language. The computational program performs calculations of monitor units and treatment time, based on the algorithm of manual calculation. The calculations executed for the independent system had initially been compared with the manual calculations performed by the medical physicists of the Institute of Radiotherapy of the Hospital das Clinicas da Universidade de Sao Paulo. In this step, the results found for more than two hundred fields studied were similar to those found in the literature; deviations larger than +- 1% were found only in five cases involving errors in manual calculation. The application of the independent system, in this stage, could have identified errors up to +- 2,4%. Based on these data, the system was validated for use in clinical routine. In a second step, calculations were compared with calculations realized by the treatment computerized planning system CadPIan TM . When, again, the results were similar to those published in other works allowing to obtain levels of acceptance of the discrepancies between the calculations executed for the independent system and the calculations developed from the planning system, separated by anatomical region, as recommended according by the recent literature. For beams of 6 MV, the levels of acceptance for deviations between the calculations of monitor units, separated by treatment region were the following; breast +- 1.7%, head and neck +2%; hypophysis +- 2.2%; pelvis +- 4 . 1% and thorax +- 1.5%. For beams of 15 MV, the level suggested for pelvis was of +- 4.5%. (author)

  3. Corrective Action Investigation Plan for Corrective Action Unit 428: Area 3 Septic Waste Systems 1 and 5, Tonopah Test Range, Nevada, REVISION 0, march 1999

    Energy Technology Data Exchange (ETDEWEB)

    DOE/NV

    1999-03-26

    The Corrective Action Investigation Plan for Corrective Action Unit 428, Area 3 Septic Waste Systems 1 and 5, has been developed in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the U. S. Department of Energy, Nevada Operations Office; the State of Nevada Division of Environmental Protection; and the U. S. Department of Defense. Corrective Action Unit 428 consists of Corrective Action Sites 03- 05- 002- SW01 and 03- 05- 002- SW05, respectively known as Area 3 Septic Waste System 1 and Septic Waste System 5. This Corrective Action Investigation Plan is used in combination with the Work Plan for Leachfield Corrective Action Units: Nevada Test Site and Tonopah Test Range, Nevada , Rev. 1 (DOE/ NV, 1998c). The Leachfield Work Plan was developed to streamline investigations at leachfield Corrective Action Units by incorporating management, technical, quality assurance, health and safety, public involvement, field sampling, and waste management information common to a set of Corrective Action Units with similar site histories and characteristics into a single document that can be referenced. This Corrective Action Investigation Plan provides investigative details specific to Corrective Action Unit 428. A system of leachfields and associated collection systems was used for wastewater disposal at Area 3 of the Tonopah Test Range until a consolidated sewer system was installed in 1990 to replace the discrete septic waste systems. Operations within various buildings at Area 3 generated sanitary and industrial wastewaters potentially contaminated with contaminants of potential concern and disposed of in septic tanks and leachfields. Corrective Action Unit 428 is composed of two leachfield systems in the northern portion of Area 3. Based on site history collected to support the Data Quality Objectives process, contaminants of potential concern for the site include oil/ diesel range total petroleum hydrocarbons, and Resource Conservation

  4. Corrective Action Investigation Plan for Corrective Action Unit 556: Dry Wells and Surface Release Points Nevada Test Site, Nevada (Draft), Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2007-02-01

    Corrective Action Unit  (CAU) 556, Dry Wells and Surface Release Points, is located in Areas 6 and 25 of the Nevada Test Site, 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 556 is comprised of four corrective action sites (CASs) listed below: •06-20-04, National Cementers Dry Well •06-99-09, Birdwell Test Hole •25-60-03, E-MAD Stormwater Discharge and Piping •25-64-01, Vehicle Washdown and Drainage Pit These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document.

  5. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 124: Storage Tanks, Nevada Test Site, Nevada (Draft), Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2007-04-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses closure for Corrective Action Unit (CAU) 124, Areas 8, 15, and 16 Storage Tanks, identified in the Federal Facility Agreement and Consent Order. Corrective Action Unit 124 consists of five Corrective Action Sites (CASs) located in Areas 8, 15, and 16 of the Nevada Test Site as follows: • 08-02-01, Underground Storage Tank • 15-02-01, Irrigation Piping • 16-02-03, Underground Storage Tank • 16-02-04, Fuel Oil Piping • 16-99-04, Fuel Line (Buried) and UST This plan provides the methodology of field activities necessary to gather information to close each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 124 using the SAFER process.

  6. Corrective Action Decision Document/Closure Report for Corrective Action Unit 410: Waste Disposal Trenches, Tonopah Test Range, Nevada: Revision No. 0

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2003-12-22

    This Corrective Action Decision Document/Closure Report (CADD/CR) has been prepared for Corrective Action Unit (CAU) 410: Waste Disposal Trenches, Tonopah Test Range, Nevada, in accordance with the Federal Facility Agreement and Consent Order. Corrective Action Unit 410 consists of five Corrective Action Sites (CASs): TA-21-003-TANL; 09-21-001-TA09; TA-19-002-TAB2; TA-21-002-TAAL; and 03-19-001. The CADD and CR have been combined into one report because no further action is recommended for this CAU. The corrective action alternative recommended for CAU 410 is Clean Closure; therefore, no corrective action or corrective action plan is required. No use restrictions are required to be placed on this CAU because the investigation showed no evidence of remaining soil contamination or remaining debris/waste upon completion of all investigation activities.

  7. Study of the efficiency of some water treatment unit that present in houses in Erbil city-Iraq

    Science.gov (United States)

    Toma, Janan. Jabbar.; Hanna, Aveen. Matti.

    2017-09-01

    Many people in Erbil city started more than two decade to put special treatment units in their houses to purified water to become safer for drinking uses. The aim of this study was determine the efficiency of six kind water treatment units which include (two replicate of Crystal Water Purifier, So-Safe Water Filter, R O Water Purifier, Kontec Water Purified and Al-Kawther Purified Water). Water samples were collected in two sites one before and other after treatment unit. Each sample was collect with three replication during May to October-2016. Analyzed for Major cations concentration (calcium, magnesium, sodium and potassium), anions concentration (nitrate and chloride) and hydrogen ion concentration (pH), electrical conductivity (EC), total dissolved solids (TDS), alkalinity and total hardness by using standard methods. The water quality index values for all raw water sample befor and after treatment was good and excellent respectively for drinking purposes. Efficiency of So-Safe Water Filter was 66.32% it means was more efficiency than others special water treatment units while in RO Water Purifier was 27.14%, means less efficiency than other water purifier water under this study. Values for major cations, anions and others chemicals characteristics in the water samples after treatment became lower concentrations than befor treatment, likely an indication that these were removed by treatment. According to guideline of world health organization all of variables except total hardness befor treatment are safe and suitable for drinking purposes.

  8. Addendum to the Closure Report for Corrective Action Unit 411: Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Burmeister, Mark [Navarro, Las Vegas, NV (United States)

    2016-11-01

    The Corrective Action Unit (CAU) 411 Closure Report (CR) was published in June 2016 (NNSA/NFO, 2016). The purpose of this addendum is to clarify language in the CR relating to the field instrument for the detection of low-energy radiation (FIDLER), provide the waste disposal documentation for waste generated during the corrective action investigation (CAI), and reference a letter from the U.S. Air Force (USAF) regarding the closure of CAU 411.

  9. Addendum to the Corrective Action Investigation Plan for Corrective Action Unit 447, Project Shoal Area, Nevada Subsurface Site, Revision 1, April 1999

    International Nuclear Information System (INIS)

    1999-01-01

    The report is an addendum to Chapter 6.0, ''Field Investigation,'' of the Corrective Action Investigation Plan for Corrective Action Unit 447: Project Shoal Area, Nevada Subsurface Site, DOE/NV--513. Sections 6.0 and 6.1 in DOE/NV--513 continue to stand, with the sections below following after them. These new sections represent information that was not available at the time DOE/NV--513 was issued

  10. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 408: Bomblet Target Area Tonopah Test Range (TTR), Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-03-01

    This Streamlined Approach for Environmental Restoration Plan addresses the actions needed to achieve closure of Corrective Action Unit (CAU) 408, Bomblet Target Area (TTR). Corrective Action Unit 408 is located at the Tonopah Test Range and is currently listed in Appendix III of the Federal Facility Agreement and Consent Order. Corrective Action Unit 408 comprises Corrective Action Site TA-55-002-TAB2, Bomblet Target Areas. Clean closure of CAU 408 will be accomplished by removal of munitions and explosives of concern within seven target areas and potential disposal pits. The target areas were used to perform submunitions related tests for the U.S. Department of Energy (DOE). The scope of CAU 408 is limited to submunitions released from DOE activities. However, it is recognized that the presence of other types of unexploded ordnance and munitions may be present within the target areas due to the activities of other government organizations. The CAU 408 closure activities consist of: • Clearing bomblet target areas within the study area. • Identifying and remediating disposal pits. • Collecting verification samples. • Performing radiological screening of soil. • Removing soil containing contaminants at concentrations above the action levels. Based on existing information, contaminants of potential concern at CAU 408 include unexploded submunitions, explosives, Resource Conservation Recovery Act metals, and depleted uranium. Contaminants are not expected to be present in the soil at concentrations above the action levels; however, this will be determined by radiological surveys and verification sample results.

  11. Corrective Action Decision Document/Closure Report for Corrective Action Unit 557: Spills and Tank Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2009-05-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit (CAU) 557, Spills and Tank Sites, in Areas 1, 3, 6, and 25 of the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order. Corrective Action Unit 557 comprises the following corrective action sites (CASs): • 01-25-02, Fuel Spill • 03-02-02, Area 3 Subdock UST • 06-99-10, Tar Spills • 25-25-18, Train Maintenance Bldg 3901 Spill Site The purpose of this Corrective Action Decision Document/Closure Report is to identify and provide the justification and documentation that supports the recommendation for closure of the CAU 557 CASs with no further corrective action. To achieve this, a corrective action investigation (CAI) was conducted from May 5 through November 24, 2008. The CAI activities were performed as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 557: Spills and Tank Sites, Nevada Test Site, Nevada.

  12. Performance assessment of the BEBIG MultiSource® high dose rate brachytherapy treatment unit

    Science.gov (United States)

    Palmer, Antony; Mzenda, Bongile

    2009-12-01

    A comprehensive system characterisation was performed of the Eckert & Ziegler BEBIG GmbH MultiSource® High Dose Rate (HDR) brachytherapy treatment unit with an 192Ir source. The unit is relatively new to the UK market, with the first installation in the country having been made in the summer of 2009. A detailed commissioning programme was devised and is reported including checks of the fundamental parameters of source positioning, dwell timing, transit doses and absolute dosimetry of the source. Well chamber measurements, autoradiography and video camera analysis techniques were all employed. The absolute dosimetry was verified by the National Physical Laboratory, UK, and compared to a measurement based on a calibration from PTB, Germany, and the supplied source certificate, as well as an independent assessment by a visiting UK centre. The use of the 'Krieger' dosimetry phantom has also been evaluated. Users of the BEBIG HDR system should take care to avoid any significant bend in the transfer tube, as this will lead to positioning errors of the source, of up to 1.0 mm for slight bends, 2.0 mm for moderate bends and 5.0 mm for extreme curvature (depending on applicators and transfer tube used) for the situations reported in this study. The reason for these errors and the potential clinical impact are discussed. Users should also note the methodology employed by the system for correction of transit doses, and that no correction is made for the initial and final transit doses. The results of this investigation found that the uncorrected transit doses lead to small errors in the delivered dose at the first dwell position, of up to 2.5 cGy at 2 cm (5.6 cGy at 1 cm) from a 10 Ci source, but the transit dose correction for other dwells was accurate within 0.2 cGy. The unit has been mechanically reliable, and source positioning accuracy and dwell timing have been reproducible, with overall performance similar to other existing HDR equipment. The unit is capable of high

  13. Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey.

    Science.gov (United States)

    McCabe, Sean Esteban; West, Brady T; Hughes, Tonda L; Boyd, Carol J

    2013-01-01

    This study examined substance abuse treatment utilization across three dimensions of sexual orientation (identity, attraction, and behavior) in a large national sample of adults in the United States. Prevalence estimates were based on data collected from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions. The sample consisted of 34,653 adults 20 years and older, and represented a population that was 52% women, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% other race/ethnicities. An estimated 2% of the target population self-identified as lesbian, gay or bisexual; 4% reported same-sex sexual behavior, and 6% reported same-sex sexual attraction. Sexual minorities, especially women, had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The majority of respondents with substance use disorders were untreated and lifetime substance abuse treatment utilization differed based on sexual orientation. Sexual minorities were found to have more extensive family histories of substance abuse problems. The findings indicate the underutilization of substance abuse treatment among all adults, and highlight some important factors to consider when working with sexual minorities. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Sexual Orientation and Substance Abuse Treatment Utilization in the United States: Results from a National Survey

    Science.gov (United States)

    McCabe, Sean Esteban; West, Brady T.; Hughes, Tonda L.; Boyd, Carol J.

    2012-01-01

    This study examined substance abuse treatment utilization across three dimensions of sexual orientation (identity, attraction, behavior) in a large national sample of adults in the United States. Prevalence estimates were based on data collected from the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions. The sample consisted of 34,653 adults aged 20 years and older: 52% women, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% other race/ethnicities. Approximately 2% of the sample self-identified as lesbian, gay or bisexual; 4% reported same-sex sexual behavior, and 6% reported same-sex sexual attraction. Sexual minorities, especially women, had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The majority of respondents with substance use disorders were untreated and lifetime substance abuse treatment utilization differed based on sexual orientation. Sexual minorities were found to have more extensive family history of substance abuse problems. The findings indicate the underutilization of substance abuse treatment among all adults, and highlight some important factors to consider when working with sexual minorities. PMID:22444421

  15. Ceftaroline fosamil for the treatment of community-acquired bacterial pneumonia in the intensive care unit.

    Science.gov (United States)

    Maggiore, Christy; Vazquez, Jose A; Guervil, David J; Ramani, Ananthakrishnan; Jandourek, Alena; Cole, Phillip; Friedland, H David

    2015-01-01

    The Clinical Assessment Program and Teflaro(®) Utilization Registry (CAPTURE) is a multicenter study evaluating the clinical use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP) or acute bacterial skin and skin structure infection. Data were collected between August 2011 and February 2013, from 398 evaluable patients receiving treatment at 33 sites in the USA. This manuscript presents data collected from patients with CABP who received care in an intensive care unit (ICU) or in general medical wards (35% and 64% of evaluable patients, respectively). The majority of ICU and general medical ward patients had underlying comorbidities (78% and 74%, respectively), with structural lung disease being the most common (42% in the ICU and 40% in general medical wards). Patients admitted to the ICU had a longer duration of stay, a longer duration of symptoms before treatment, and a longer duration of ceftaroline fosamil therapy than did general medical ward patients. Most patients treated in the ICU and in general medical wards were given ceftaroline fosamil as second-line therapy (87% and 80%, respectively). The overall rate of clinical success for patients treated with ceftaroline fosamil was 68% in the ICU and 85% in the general medical wards. Clinical success for patients receiving ceftaroline fosamil as a second-line agent was 84% in the ICU and 86% in general medical wards. These findings indicate that ceftaroline fosamil is a viable treatment option for CABP, both in the ICU and in general medical wards.

  16. The management and treatment of children with Fabry disease: A United States-based perspective.

    Science.gov (United States)

    Hopkin, Robert J; Jefferies, John L; Laney, Dawn A; Lawson, Victoria H; Mauer, Michael; Taylor, Matthew R; Wilcox, William R

    2016-02-01

    Fabry disease is an inherited X-linked disorder that presents during childhood in male and female patients. Young patients may initially experience pain, hypohidrosis, and gastrointestinal symptoms. Other manifestations of Fabry disease, such as renal and cardiac disease, manifest later in adolescence or adulthood. In the pediatric population, renal damage is typically subclinical and identifiable only through biopsy. Specialists from the United States with expertise in Fabry disease convened during 2013-2014 in order to develop these consensus guidelines about the management and treatment of children with Fabry disease. The presence of symptoms in boys and girls of any age is an indication to begin therapy. Early treatment before the onset of potentially irreversible vital organ pathology is ideal. Asymptomatic children with Fabry mutations should be followed closely for the development of renal, cardiac, neurological, or gastrointestinal signs, symptoms, or laboratory changes, which would warrant treatment initiation. A comprehensive care plan should be implemented by the treating physicians to guide the management of children with Fabry disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment.

    Science.gov (United States)

    Strosberg, Jonathan; Casciano, Roman; Stern, Lee; Parikh, Rohan; Chulikavit, Maruit; Willet, Jacob; Liu, Zhimei; Wang, Xufang; Grzegorzewski, Krzysztof J

    2013-04-21

    To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States. United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g., surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites). Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared

  18. Attitudes of dermatologists in the southeastern United States regarding treatment of alopecia areata: a cross-sectional survey study

    Directory of Open Access Journals (Sweden)

    Stewart Paul W

    2009-11-01

    Full Text Available Abstract Background Little evidence exists to guide treatment of alopecia areata (AA. The current practices in treatment of children compared to adults and of progressive stages of hair loss are unknown. The objective of this study was to examine the current practices of southeastern United States dermatologists for the treatment of AA. Methods Dermatologists were sent anonymous questionnaires regarding their treatment practices by mail. Respondents' frequencies of treatment in children compared to adults and in patchy hair loss compared to widespread hair loss were compared with Wilcoxon signed-ranks tests and Friedman tests. As a secondary source, the National Alopecia Areata Registry (NAAR database was analyzed for patients' treatment histories. Results Survey results suggested that dermatologists recommend treatment less frequently for children than adults and for more advanced hair loss. NAAR data confirmed that offering no treatment for AA is relatively common. Conclusion Dermatologists' treatment of AA is inconsistent. A stronger evidence base will provide more consistent treatment options.

  19. Grand Junction projects office mixed-waste treatment program, VAC*TRAX mobile treatment unit process hazards analysis

    International Nuclear Information System (INIS)

    Bloom, R.R.

    1996-04-01

    The objective of this report is to demonstrate that a thorough assessment of the risks associated with the operation of the Rust Geotech patented VAC*TRAX mobile treatment unit (MTU) has been performed and documented. The MTU was developed to treat mixed wastes at the US Department of Energy (DOE) Albuquerque Operations Office sites. The MTU uses an indirectly heated, batch vacuum dryer to thermally desorb organic compounds from mixed wastes. This process hazards analysis evaluated 102 potential hazards. The three significant hazards identified involved the inclusion of oxygen in a process that also included an ignition source and fuel. Changes to the design of the MTU were made concurrent with the hazard identification and analysis; all hazards with initial risk rankings of 1 or 2 were reduced to acceptable risk rankings of 3 or 4. The overall risk to any population group from operation of the MTU was determined to be very low; the MTU is classified as a Radiological Facility with low hazards

  20. Copyright Revision in Canada

    Science.gov (United States)

    Keyes, A. A.

    1977-01-01

    The article discusses the history of copyright laws, the directions which copyright revision can take, and the rationale behind revision. Regulations for protecting various media such as sound recordings, performances, and cable television are discussed. (JAB)

  1. Revised draft environmental statement related to construction of Atlantic Generating Station Units 1 and 2 (Docket Nos. STN 50-477 and STN 50-478)

    International Nuclear Information System (INIS)

    1976-10-01

    The proposed action is the issuance of a construction permit to Public Service Electric and Gas Company (PDE and G) for the construction of the Atlantic Generating Station (AGS), Units 1 and 2. The AGS is the first nuclear power station in the United States proposed for construction in the offshore waters on the continental shelf. The AHS will be located in the Atlantic Ocean 2.8 miles offshore of Atlantic and Ocean countries. New Jersey, 11 miles northeast of Atlantic City, and will consist of two floating nuclear power plants enclosed in a protective rubble-mound breakwater. Both plants will be identical, of standardized design, and will employ pressurized water reactors to produce up to approximately 3425 megawatts thermal (MWt) each. Steam turbine generators will use this heat to produce up to approximately 1150 megawatts of electrical power (MWe) per unit. The main condensers will be cooled by the flow of seawater drawn from within the breakwater and discharged shoreward and external to the breakwater. This statement identifies various environmental aspects and potential adverse effects associated with the construction and operation of the AGS. Based upon an approximate two-year review period which included a multidisciplined assessment of extensive survey and modeling data, these effects are considered by the staff to be of a generally acceptable nature. Breakwater construction will result in the destruction of 100 acres of benthic infauna (burrowing animals) and the development of a reef-type community on the breakwater. The production of new biomass (standing crop) by the reef community is expected to compensate for the infaunal biomass destroyed by dredging and will contribute mainly to the local sport fishery. 93 figs., 110 tabs

  2. Corrective Action Decision Document/Closure Report for Corrective Action Unit 190: Contaminated Waste Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-03-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit (CAU) 190, Contaminated Waste Sites, Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy, Environmental Management; U.S. Department of Defense; and DOE, Legacy Management (1996, as amended January 2007). Corrective Action Unit 190 is comprised of the following four corrective action sites (CASs): • 11-02-01, Underground Centrifuge • 11-02-02, Drain Lines and Outfall • 11-59-01, Tweezer Facility Septic System • 14-23-01, LTU-6 Test Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation for closure of CAU 190 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from March 21 through June 26, 2007. All CAI activities were conducted as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 190: Contaminated Waste Sites, Nevada Test Site, Nevada (NNSA/NSO, 2006). The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective process: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent. • Provide sufficient information and data to complete appropriate corrective actions. The CAU 190 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the data quality objective data needs.

  3. Corrective Action Investigation Plan for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada (December 2002, Revision No.: 0), Including Record of Technical Change No. 1

    Energy Technology Data Exchange (ETDEWEB)

    NNSA/NSO

    2002-12-12

    The Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 204 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 204 is located on the Nevada Test Site approximately 65 miles northwest of Las Vegas, Nevada. This CAU is comprised of six Corrective Action Sites (CASs) which include: 01-34-01, Underground Instrument House Bunker; 02-34-01, Instrument Bunker; 03-34-01, Underground Bunker; 05-18-02, Chemical Explosives Storage; 05-33-01, Kay Blockhouse; 05-99-02, Explosive Storage Bunker. Based on site history, process knowledge, and previous field efforts, contaminants of potential concern for Corrective Action Unit 204 collectively include radionuclides, beryllium, high explosives, lead, polychlorinated biphenyls, total petroleum hydrocarbons, silver, warfarin, and zinc phosphide. The primary question for the investigation is: ''Are existing data sufficient to evaluate appropriate corrective actions?'' To address this question, resolution of two decision statements is required. Decision I is to ''Define the nature of contamination'' by identifying any contamination above preliminary action levels (PALs); Decision II is to ''Determine the extent of contamination identified above PALs. If PALs are not exceeded, the investigation is completed. If PALs are exceeded, then Decision II must be resolved. In addition, data will be obtained to support waste management decisions. Field activities will include radiological land area surveys, geophysical surveys to identify any subsurface metallic and nonmetallic debris, field screening for applicable contaminants of potential concern, collection and analysis of surface and subsurface soil samples from biased locations

  4. Corrective Action Decision Document/Closure Report for Corrective Action Unit 190: Contaminated Waste Sites, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Alfred Wickline

    2008-01-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit (CAU) 190, Contaminated Waste Sites, Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy, Environmental Management; U.S. Department of Defense; and DOE, Legacy Management (1996, as amended January 2007). Corrective Action Unit 190 is comprised of the following four corrective action sites (CASs): (1) 11-02-01, Underground Centrifuge; (2) 11-02-02, Drain Lines and Outfall; (3) 11-59-01, Tweezer Facility Septic System; (4) 14-23-01, LTU-6 Test Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation for closure of CAU 190 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from March 21 through June 26, 2007. All CAI activities were conducted as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 190: Contaminated Waste Sites, Nevada Test Site, Nevada (NNSA/NSO, 2006). The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective process: (1) Determine whether contaminants of concern (COCs) are present. (2) If COCs are present, determine their nature and extent. (3) Provide sufficient information and data to complete appropriate corrective actions. The CAU 190 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the data quality objective data needs

  5. United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet

    Science.gov (United States)

    Tomas-Rossello, Juana; Rawson, Richard A.; Zarza, Maria J.; Bellows, Anne; Busse, Anja; Saenz, Elizabeth; Freese, Thomas; Shawkey, Mansour; Carise, Deni; Ali, Robert; Ling, Walter

    2010-01-01

    Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created…

  6. Guide to fuel treatments in dry forests of the Western United States: assessing forest structure and fire hazard.

    Science.gov (United States)

    Morris C. Johnson; David L. Peterson; Crystal L. Raymond

    2007-01-01

    Guide to Fuel Treatments analyzes a range of fuel treatments for representative dry forest stands in the Western United States with overstories dominated by ponderosa pine (Pinus ponderosa), Douglas-fir (Pseudotsuga menziesii), and pinyon pine (Pinus edulis). Six silvicultural options (no thinning; thinning...

  7. Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

    Energy Technology Data Exchange (ETDEWEB)

    Farnham, Irene [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2016-08-01

    This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impacted groundwater

  8. Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2013-11-01

    This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.

  9. Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick

    2014-01-01

    The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

  10. Corrective Action Decision Document/Closure Report for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2010-07-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 371, Johnnie Boy Crater and Pin Stripe, located within Areas 11 and 18 at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit (CAU) 371 comprises two corrective action sites (CASs): • 11-23-05, Pin Stripe Contamination Area • 18-45-01, U-18j-2 Crater (Johnnie Boy) The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 371 based on the implementation of corrective actions. The corrective action of closure in place with administrative controls was implemented at both CASs. Corrective action investigation (CAI) activities were performed from January 8, 2009, through February 16, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 371 dataset of investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. Radiological doses exceeding the FAL of 25 millirem per year were not found to be present in the surface soil. However, it was assumed that radionuclides are present in subsurface media within the Johnnie Boy crater and the fissure at Pin Stripe. Due to the assumption of radiological dose exceeding the FAL, corrective actions were undertaken

  11. Revised Final Report - Independent Verification Survey Activities At The Separations Process Research Unit Sites, Niskayuna, New York - DCN 0496-SR-06-1

    International Nuclear Information System (INIS)

    Harpeneau, Evan

    2011-01-01

    The Separations Process Research Unit (SPRU) complex located on the Knolls Atomic Power Laboratory (KAPL) site in Niskayuna, New York, was constructed in the late 1940s to research the chemical separation of plutonium and uranium (Figure A-1). SPRU operated as a laboratory scale research facility between February 1950 and October 1953. The research activities ceased following the successful development of the reduction oxidation and plutonium/uranium extraction processes. The oxidation and extraction processes were subsequently developed for large scale use by the Hanford and Savannah River sites (aRc 2008a). Decommissioning of the SPRU facilities began in October 1953 and continued through the 1990s.

  12. Examination of the Regional Supply and Demand Balance for Renewable Electricity in the United States through 2015: Projecting from 2009 through 2015 (Revised)

    Energy Technology Data Exchange (ETDEWEB)

    Bird, L.; Hurlbut, D.; Donohoo, P.; Cory, K.; Kreycik, C.

    2010-06-01

    This report examines the balance between the demand and supply of new renewable electricity in the United States on a regional basis through 2015. It expands on a 2007 NREL study that assessed the supply and demand balance on a national basis. As with the earlier study, this analysis relies on estimates of renewable energy supplies compared to demand for renewable energy generation needed to meet existing state renewable portfolio standard (RPS) policies in 28 states, as well as demand by consumers who voluntarily purchase renewable energy. However, it does not address demand by utilities that may procure cost-effective renewables through an integrated resource planning process or otherwise.

  13. REVISED FINAL REPORT – INDEPENDENT VERIFICATION SURVEY ACTIVITIES AT THE SEPARATIONS PROCESS RESEARCH UNIT SITES, NISKAYUNA, NEW YORK – DCN 0496-SR-06-1

    Energy Technology Data Exchange (ETDEWEB)

    Evan Harpenau

    2011-10-10

    The Separations Process Research Unit (SPRU) complex located on the Knolls Atomic Power Laboratory (KAPL) site in Niskayuna, New York, was constructed in the late 1940s to research the chemical separation of plutonium and uranium (Figure A-1). SPRU operated as a laboratory scale research facility between February 1950 and October 1953. The research activities ceased following the successful development of the reduction oxidation and plutonium/uranium extraction processes. The oxidation and extraction processes were subsequently developed for large scale use by the Hanford and Savannah River sites (aRc 2008a). Decommissioning of the SPRU facilities began in October 1953 and continued through the 1990s.

  14. State Clean Energy Policies Analysis (SCEPA) Project: An Analysis of Renewable Energy Feed-in Tariffs in the United States (Revised)

    Energy Technology Data Exchange (ETDEWEB)

    Couture, T.; Cory, K.

    2009-06-01

    This report analyzes renewable energy feed-in tariff (FIT) policies and explores the different FIT policies currently implemented in the United States. It also discusses of a few proposed policies, the best practices in FIT policy design, and examines how FITs can be used to target state policy goals. The report covers current and potential future interactions between FITs and other state and federal energy policies while also providing an overview of the impacts FIT policies have in terms of renewable energy deployment, job creation, and economic development.

  15. Corrective Action Decision Document/Closure Report for Corrective Action Unit 546: Injection Well and Surface Releases Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-12-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 546, Injection Well and Surface Releases, at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO, 1996; as amended February 2008). Corrective Action Unit (CAU) 546 is comprised of two corrective action sites (CASs): • 06-23-02, U-6a/Russet Testing Area • 09-20-01, Injection Well The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation for closure of CAU 546. To achieve this, corrective action investigation (CAI) activities were performed from May 5 through May 28, 2008, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 546: Injection Well and Surface Releases, Nevada Test Site, Nevada (NNSA/NSO, 2008). The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: • Determine whether a contaminant of concern is present at a given CAS. • Determine whether sufficient information is available to evaluate potential corrective action alternatives at each CAS. The CAU 546 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the DQO data needs. Because DQO data needs were met, and corrective actions have been implemented, it has been determined that no further corrective action (based on risk to human receptors) is necessary for the CAU 546 CASs. The U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office provides the following recommendations: • No further corrective actions are needed for CAU 546 CASs. • No Corrective Action Plan is required. • A Notice of Completion to the U.S. Department of Energy, National Nuclear Security Administration Nevada Site

  16. Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

    International Nuclear Information System (INIS)

    Farnham, Irene

    2016-01-01

    This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impacted groundwater

  17. Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

    Directory of Open Access Journals (Sweden)

    William Rassman, MD

    2017-11-01

    Full Text Available Two relatively new modalities, follicular unit extraction (FUE and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5% and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination.

  18. Fuzzy dynamic modelling and predictive control of a coagulation chemical dosing unit for water treatment plants

    Directory of Open Access Journals (Sweden)

    Oladipupo Bello

    2014-09-01

    Full Text Available In this paper, a fuzzy model predictive control (FMPC strategy is proposed to regulate the output variables of a coagulation chemical dosing unit. A multiple-input, multiple-output (MIMO process model in form of a linearised Takagi–Sugeno (T–S fuzzy model is derived. The process model is obtained through subtractive clustering from the plant's data set. The MIMO model is described by a set of coupled multiple-input, single-output models (MISO. In the controller design, the T–S fuzzy model is applied in combination with the nonlinear model predictive control (MPC algorithm. The results show that the proposed controller has good set-point tracking when compared with nonlinear MPC and adequate disturbance rejection ability required for efficient coagulation control and process optimisation in water treatment operations.

  19. Case study: evaluation of the performance of water treatment units by the use of tracer techniques

    International Nuclear Information System (INIS)

    Sebastian, C.; Maghella, G.; Mamani, E.

    2000-12-01

    Very often, water treatment systems do not reach the expected performance due to disturbances of hydraulic order, which cause malfunctioning in the flow through such systems. Tracer techniques have proved to be very useful to obtain information on the system or a part of it, by means of observation of the released tracer or observation of the released tracer during its progress into the system or at the output of the same. This paper is a report of the behavior of a set of both sand settlement unit and hydraulic flocculators in a potable water plant, through the analysis of radiotracers response curves or residence time distribution curves. The tracers released into the system consists in an aqueous solution of Iodine-131 with very low activity, in order to get a dynamic behave similar to the one of the fluid under investigation

  20. Radionuclides release to three rivers by ore treatment unit at Caldas, Minas Gerais - Brazil

    International Nuclear Information System (INIS)

    Pereira, W.S.; Carmo, R.F. do; Py Junior, D.A.

    2013-01-01

    The Ore Treatment Unit (OTU) is a uranium mining and milling plant, situated at Caldas city, Minas Gerais, Brazil that was disabled in the mid 90's. This unit releases controlled effluents to three rivers: Ribeirao das Antas (at point 014, influenced by the waste pile), Ribeirao Soberbo (point 025, influenced by the waste pond) and Corrego da Consulta (at point 076, influenced by the open pit mine). Water samples collected at these points were analyzed for U nat , 226 Ra, 210 Pb, 232 Th and 228 Ra content in the particulate and soluble fractions, and the behavior of radionuclide releases and their fractions was investigated. U nat and 228 Ra showed identical behaviors at these three points. U nat at point 014 (waste pile) behaved different from described in recent literature data. The isotopes of Ra should exhibit the same behavior at each point, but this was not observed at point 025 (waste pond). 232 Th release showed equal activity concentration near the waste pile (point 014) and near the waste pond (point 025), whilst near the open pit mine (point 076) the soluble fraction showed a concentration of activity greater than the particulate fraction. Finally, 210 Pb showed a different behavior at each point. Due to the great differences in behaviors of each radionuclide, it was not possible to establish a temporal pattern of release which requires assessment over a longer period of time. (author)

  1. Prolonged glucocorticoid treatment in ARDS: impact on intensive care unit acquired weakness.

    Directory of Open Access Journals (Sweden)

    Gianfranco Umberto Meduri

    2016-08-01

    Full Text Available AbstractSystemic inflammation and duration of immobilization are strong independent risk factors for development of intensive care unit- acquired weakness (ICUAW. Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials (RCTs investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a re-analysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. Acknowledgements: The NHLBI ARDSnetwork graciously provided and assisted with the ARDSnet02 Dataset on the Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (LaSRS.

  2. Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002-2012.

    Science.gov (United States)

    Wysowski, Diane K; Greene, Patty

    2013-12-01

    Bisphosphonates have been widely prescribed to postmenopausal women for treatment and prevention of osteoporosis. Given a background of reports of recent safety problems, questions about optimal duration of use, and the patent expiration of Fosamax in February 2008, we accessed data from pharmaceutical marketing research databases to describe trends in dispensed prescriptions and sales of oral bisphosphonates, characteristics of patients and prescribers, and sales of intravenous bisphosphonates for osteoporosis treatment. An estimated 21.3million prescriptions for oral bisphosphonates were dispensed in U.S. retail pharmacies in 2002 that increased 46% to a peak of 31.0million in 2007 and 2008, and declined by 53% in a four year-period to 14.7million in 2012. Sales data (number of packages sold in all settings of care) showed parallel trends (66% increase from 2002 through 2007 and 51% decrease from 2007 through 2012). Similarly, intravenous bisphosphonate sales for osteoporosis treatment grew 3.8-fold from 149.5 thousand packages in 2007 to 561.6 thousand in 2010, followed by a 22% decrease in 2012. Data from an ongoing monthly office-based survey indicated physicians mentioned oral bisphosphonates primarily in visits of older aged Caucasian women with lower body mass for osteoporosis. Frequencies of oral bisphosphonate mentions increased between 2002 and 2012 in visits of Asians and for osteopenia diagnoses. These data indicate a substantial decline in prescriptions and sales of oral (since 2007-2008) and intravenous (since 2010) bisphosphonates for osteoporosis treatment in the United States. Reasons for, and implications of, the decline should be considered for future research. © 2013.

  3. Removal of trace organic chemicals in onsite wastewater soil treatment units: a laboratory experiment.

    Science.gov (United States)

    Teerlink, Jennifer; Martínez-Hernández, Virtudes; Higgins, Christopher P; Drewes, Jörg E

    2012-10-15

    Onsite wastewater treatment is used by 20% of residences in the United States. The ability of these systems, specifically soil treatment units (STUs), to attenuate trace organic chemicals (TOrCs) is not well understood. TOrCs released by STUs pose a potential risk to downstream groundwater and hydraulically-connected surface water that may be used as a drinking water source. A series of bench-scale experiments were conducted using sand columns to represent STUs and to evaluate the efficacy of TOrC attenuation as a function of hydraulic loading rate (1, 4, 8, 12, and 30 cm/day). Each hydraulic loading rate was examined using triplicate experimental columns. Columns were initially seeded with raw wastewater to establish a microbial community, after which they were fed with synthetic wastewater and spiked with 17 TOrCs, in four equal doses per day, to provide a consistent influent water quality. After an initial start-up phase, effluent from all columns consistently demonstrated >90% reductions in dissolved organic carbon and nearly complete (>85%) oxidation of ammonia to nitrate, comparable to the performance of field STUs. The results of this study suggest STUs are capable of attenuating many TOrCs present in domestic wastewater, but attenuation is compound-specific. A subset of TOrCs exhibited an inverse relationship with hydraulic loading rate and attenuation efficiency. Atenolol, cimetidine, and TCPP were more effectively attenuated over time in each experiment, suggesting that the microbial community evolved to a stage where these TOrCs were more effectively biotransformed. Aerobic conditions as compared to anaerobic conditions resulted in more efficient attenuation of acetaminophen and cimetidine. Copyright © 2012. Published by Elsevier Ltd.

  4. Corrective Action Decision Document/Closure Report for Corrective Action Unit 550: Smoky Contamination Area Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick K. [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2015-02-01

    This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 550: Smoky Contamination Area, Nevada National Security Site, Nevada. CAU 550 includes 19 corrective action sites (CASs), which consist of one weapons-related atmospheric test (Smoky), three safety experiments (Ceres, Oberon, Titania), and 15 debris sites (Table ES-1). The CASs were sorted into the following study groups based on release potential and technical similarities: • Study Group 1, Atmospheric Test • Study Group 2, Safety Experiments • Study Group 3, Washes • Study Group 4, Debris The purpose of this document is to provide justification and documentation supporting the conclusion that no further corrective action is needed for CAU 550 based on implementation of the corrective actions listed in Table ES-1. Corrective action investigation (CAI) activities were performed between August 2012 and October 2013 as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 550: Smoky Contamination Area; and in accordance with the Soils Activity Quality Assurance Plan. The approach for the CAI was to investigate and make data quality objective (DQO) decisions based on the types of releases present. The purpose of the CAI was to fulfill data needs as defined during the DQO process. The CAU 550 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs.

  5. Framework for a Risk-Informed Groundwater Compliance Strategy for Corrective Action Unit 98: Frenchman Flat, Nevada National Security Site, Nye County, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Marutzky, Sam

    2010-09-01

    Note: This document was prepared before the NTS was renamed the Nevada National Security Site (August 23, 2010); thus, all references to the site herein remain NTS. Corrective Action Unit (CAU) 98, Frenchman Flat, at the Nevada Test Site (NTS) was the location of ten underground nuclear tests between 1965 and 1971. As a result, radionuclides were released in the subsurface in the vicinity of the test cavities. Corrective Action Unit 98 and other CAUs at the NTS and offsite locations are being investigated. The Frenchman Flat CAU is one of five Underground Test Area (UGTA) CAUs at the NTS that are being evaluated as potential sources of local or regional impact to groundwater resources. For UGTA sites, including Frenchman Flat, contamination in and around the test cavities will not be remediated because it is technologically infeasible due to the depth of the test cavities (150 to 2,000 feet [ft] below ground surface) and the volume of contaminated groundwater at widely dispersed locations on the NTS. Instead, the compliance strategy for these sites is to model contaminant flow and transport, estimate the maximum spatial extent and volume of contaminated groundwater (over a period of 1,000 years), maintain institutional controls, and restrict access to potentially contaminated groundwater at areas where contaminants could migrate beyond the NTS boundaries.

  6. Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick

    2013-09-01

    This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 105 comprises the following five corrective action sites (CASs): -02-23-04 Atmospheric Test Site - Whitney Closure In Place -02-23-05 Atmospheric Test Site T-2A Closure In Place -02-23-06 Atmospheric Test Site T-2B Clean Closure -02-23-08 Atmospheric Test Site T-2 Closure In Place -02-23-09 Atmospheric Test Site - Turk Closure In Place The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

  7. Streamlined approach for environmental restoration work plan for Corrective Action Unit 126: Closure of aboveground storage tanks, Nevada Test Site, Nevada. Revision 1

    International Nuclear Information System (INIS)

    1998-07-01

    This plan addresses the closure of several aboveground storage tanks in Area 25 of the Nevada Test Site. The unit is currently identified as Corrective Action Unit 126 in the Federal Facility Agreement and Consent Order and is listed as having six Corrective Action Sites. This plan addresses the Streamlined Approach for Environmental Restoration closure for five of the six sites. Four of the CASs are located at the Engine Test Stand complex and one is located in the Central Support Area. The sites consist of aboveground tanks, two of which were used to store diesel fuel and one stored Nalcool (an antifreeze mixture). The remaining tanks were used as part of a water demineralization process and stored either sulfuric acid or sodium hydroxide, and one was used as a charcoal adsorption furnace. Closure will be completed by removal of the associated piping, tank supports and tanks using a front end loader, backhoe, and/or crane. When possible, the tanks will be salvaged as scrap metal. The piping that is not removed will be sealed using a cement grout

  8. CORRRECTIVE ACTION DECISION DOCUMENT FOR CORRECTIVE ACTION UNIT 427: AREA 3 SEPTIC WASTE SYSTEMS 2 AND 6, TONOPAH TEST RANGE, NEVADA, REVISION 0, JUNE 1998

    Energy Technology Data Exchange (ETDEWEB)

    DOE/NV

    1998-06-23

    This Corrective Action Decision Document has been prepared for the Area 3 Septic Waste Systems 2 and 6 (Corrective Action Unit 427) in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 427 is located at the Tonopah Test Range, Nevada, and is comprised of the following Corrective Action Sites, each an individual septic waste system (DOE/NV, 1996a): (1) Septic Waste System 2 is Corrective Action Site Number 03-05-002-SW02. (2) Septic Waste System 6 is Corrective Action Site Number 03-05-002-SW06. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended corrective action alternative for each Corrective Action Site. The scope of this Correction Action Decision Document consists of the following tasks: (1) Develop corrective action objectives. (2) Identify corrective action alternative screening criteria. (3) Develop corrective action alternatives. (4) Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria. (5) Recommend and justify a preferred corrective action alternative for each CAS. From November 1997 through January 1998, a corrective action investigation was performed as set forth in the Corrective Action Investigation Plan for Corrective Action Unit No. 427: Area 3 Septic Waste System Numbers 2 and 6, Tonopah Test Range, Nevada (DOE/NV, 1997b). Details can be found in Appendix A of this document. The results indicated that contamination is present in some portions of the CAU and not in others as described in Table ES-1 and shown in Figure A.2-2 of Appendix A. Based on the potential exposure pathways, the following corrective action objectives have been identified for Corrective Action Unit 427: (1) Prevent or mitigate human exposure to subsurface soils containing TPH at concentrations greater than 100 milligrams per kilogram (NAC

  9. ICEMENERG technologies of water treatment applied at Cernavoda NPP Unit 1

    International Nuclear Information System (INIS)

    Stanca, Angela; Bolma, Aurelia; Serbanescu, Agnes; Raducanu, Alice

    2002-01-01

    The paper presents the ICEMENERG technologies for water treatment applied at Cernavoda Unit 1, the treatment of the additional water for power steam generators and the chemical treatment of cooling system water. The requirements for quality of water totally demineralized as imposed by the AECL-ANSALDO consortium are as following: electrical conductivity, < 0.2 mS/cm; total silicon, <0.02 mg/L; ionic silicon, <0.01 mg/L; sodium, < 0.05 mg/L; TOC, <0.300 mg/L. These requirements raise rather difficult problems to be solved because the raw water source in case of Cernavoda NPP is Danube River which presents a raising trend of organic and inorganic contamination. Accordingly, experiments at laboratory scale reproducing the entire technological flow were conducted. The following operations were studied: pretreatment with limewash, ferric chloride (with and without coagulation additives); demineralization with ion exchangers of Purolite and Amberlite types. The system consisted of a cationic stage, formed of an strongly acid step with countercurrent recovery and an anionic stage formed of two steps, namely, a weakly basic step and a strongly basic step with recovery inserted; finishing on mixed bed. The paper presents also the chemical treatment/conditioning of the cooling loop of turbine condenser. The Cernavoda NPP cooling system is an open system with a single flow of cooling water comprising two systems, namely, the circulation water system ensuring the steam condenser cooling and the servicing water system ensuring the cooling of heat exchangers in the recirculated water circuit (RCWS), the turbine oil coolants, the coolants of auxiliary steam as well as the emergency core cooling system. Studies were conducted to ensure the chemical conditioning of the raw water from Danube River, particularly, to destroy and remove the shells, the algae and other components. Finally, the following four steps of conditioning the water of the cooling system are summarized: 1

  10. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States

    Science.gov (United States)

    Fryer, Gary; Morse, Christopher M; Johnson, Jane C

    2009-01-01

    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests. Results One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic

  11. Corrective Action Decision Document for Corrective Action Unit 536: Area 3 Release Site, Nevada Test Site, Nevada, Revision 0 with Errata

    Energy Technology Data Exchange (ETDEWEB)

    Boehlecke, Robert

    2004-11-01

    This Corrective Action Decision Document (CADD) has been prepared for Corrective Action Unit (CAU) 536: Area 3 Release Site, Nevada Test Site (NTS), Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada, the U.S. Department of Energy (DOE), and the U.S Department of Defense (FFACO, 1996). The NTS is approximately 65 miles (mi) northwest of Las Vegas, Nevada (Figure 1-1). Corrective Action Unit 536 is comprised of a single Corrective Action Site (CAS), 03-44-02, Steam Jenny Discharge, and is located in Area 3 of the NTS (Figure 1-2). The CAU was investigated in accordance with the Corrective Action Investigation Plan (CAIP) and Record of Technical Change (ROTC) No. 1 (NNSA/NV, 2003). The CADD provides or references the specific information necessary to support the recommended corrective action alternative selected to complete closure of the site. The CAU 536, Area 3 Release Site, includes the Steam Jenny Discharge (CAS 03-44-02) that was historically used for steam cleaning equipment in the Area 3 Camp. Concerns at this CAS include contaminants commonly associated with steam cleaning operations and Area 3 Camp activities that include total petroleum hydrocarbons (TPH), unspecified solvents, radionuclides, metals, and polychlorinated biphenyls (PCBs). The CAIP for Corrective Action Unit 536: Area 3 Release Site, Nevada Test Site, Nevada (NNSA/NV, 2003), provides additional information relating to the history, planning, and scope of the investigation; therefore, it will not be repeated in this CADD. This CADD identifies potential corrective action alternatives and provides a rationale for the selection of a recommended corrective action alternative for the CAS within CAU 536. The evaluation of corrective action alternatives is based on process knowledge and the results of the investigative activities conducted in accordance with the CAIP (NNSA/NV, 2003) that was approved prior to the start of the

  12. Corrective Action Decision Document/Closure Report for Corrective Action Unit 365: Baneberry Contamination Area, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2011-09-01

    Corrective Action Unit 365 comprises one corrective action site (CAS), CAS 08-23-02, U-8d Contamination Area. The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 365 based on the implementation of the corrective action of closure in place with a use restriction (UR). Corrective action investigation (CAI) activities were performed from January 18, 2011, through August 2, 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 365: Baneberry Contamination Area. The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 365 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in supporting the DQO decisions. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL of 25 millirem per year was established based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were found to be present to the southwest of the Baneberry crater. It was also assumed that radionuclide levels present within the crater and fissure exceed the FAL. Corrective actions were undertaken that consisted of establishing a UR and posting warning signs for the crater, fissure, and the area located to the southwest of the crater where soil concentrations exceeded the FAL. These URs were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: (1) No further corrective actions beyond what are described in this document are necessary for CAU 365. (2) A Notice of Completion to

  13. Corrective Action Decision Document/Closure Report for Corrective Action Unit 106: Area 5, 11 Frenchman Flat Atmospheric Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews and Dawn Peterson

    2011-09-01

    Corrective Action Unit 106 comprises four corrective action sites (CASs): (1) 05-20-02, Evaporation Pond; (2) 05-23-05, Atmospheric Test Site - Able; (3) 05-45-04, 306 GZ Rad Contaminated Area; (4) 05-45-05, 307 GZ Rad Contaminated Area. The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 106 based on the implementation of corrective actions. The corrective action of clean closure was implemented at CASs 05-45-04 and 05-45-05, while no corrective action was necessary at CASs 05-20-02 and 05-23-05. Corrective action investigation (CAI) activities were performed from October 20, 2010, through June 1, 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 106: Areas 5, 11 Frenchman Flat Atmospheric Sites. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of other releases (mechanical displacement and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 106 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL of 25 millirem per year was established based on the Industrial Area exposure scenario (2,250 hours of annual exposure). The only radiological dose exceeding the FAL was at CAS 05-45-05 and was associated with potential source material (PSM). It is also assumed that additional PSM in the form of depleted uranium (DU) and DU-contaminated debris at CASs 05-45-04 and 05-45-05 exceed the FAL. Therefore, corrective actions were undertaken at these CASs that consisted of removing PSM and collecting verification

  14. Corrective Action Decision Document for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada, Revision 0 with ROTC 1, 2, and Errata

    Energy Technology Data Exchange (ETDEWEB)

    Wickline, Alfred

    2004-04-01

    This Corrective Action Decision Document (CADD) has been prepared for Corrective Action Unit (CAU) 204 Storage Bunkers, Nevada Test Site (NTS), Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE); and the U.S. Department of Defense (FFACO, 1996). The NTS is approximately 65 miles (mi) north of Las Vegas, Nevada (Figure 1-1). The Corrective Action Sites (CASs) within CAU 204 are located in Areas 1, 2, 3, and 5 of the NTS, in Nye County, Nevada (Figure 1-2). Corrective Action Unit 204 is comprised of the six CASs identified in Table 1-1. As shown in Table 1-1, the FFACO describes four of these CASs as bunkers one as chemical exchange storage and one as a blockhouse. Subsequent investigations have identified four of these structures as instrumentation bunkers (CASs 01-34-01, 02-34-01, 03-34-01, 05-33-01), one as an explosives storage bunker (CAS 05-99-02), and one as both (CAS 05-18-02). The six bunkers included in CAU 204 were primarily used to monitor atmospheric testing or store munitions. The ''Corrective Action Investigation Plan (CAIP) for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada'' (NNSA/NV, 2002a) provides information relating to the history, planning, and scope of the investigation; therefore, it will not be repeated in this CADD. This CADD identifies potential corrective action alternatives and provides a rationale for the selection of a recommended corrective action alternative for each CAS within CAU 204. The evaluation of corrective action alternatives is based on process knowledge and the results of investigative activities conducted in accordance with the CAIP (NNSA/NV, 2002a) that was approved prior to the start of the Corrective Action Investigation (CAI). Record of Technical Change (ROTC) No. 1 to the CAIP (approval pending) documents changes to the preliminary action levels

  15. Corrective Action Investigation Plan for Corrective Action Unit 234: Mud Pits, Cellars, and Mud Spills, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Grant Evenson

    2007-01-01

    Corrective Action Unit 234, Mud Pits, Cellars, and Mud Spills, consists of 12 inactive sites located in the north and northeast section of the NTS. The 12 CAU 234 sites consist of mud pits, mud spills, mud sumps, and an open post-test cellar. The CAU 234 sites were all used to support nuclear testing conducted in the Yucca Flat and Rainier Mesa areas during the 1950s through the 1970s. The CASs in CAU 234 are being investigated because hazardous and/or radioactive constituents may be present in concentrations that could potentially pose a threat to human health and the environment. Existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives for the CASs. Additional information will be generated by conducting a CAI before evaluating and selecting appropriate corrective action alternatives

  16. Corrective Action Decision Document for Corrective Action Unit 366: Area 11 Plutonium Valley Dispersion Sites Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2012-09-01

    CAU 366 comprises six corrective action sites (CASs): • 11-08-01, Contaminated Waste Dump #1 • 11-08-02, Contaminated Waste Dump #2 • 11-23-01, Radioactively Contaminated Area A • 11-23-02, Radioactively Contaminated Area B • 11-23-03, Radioactively Contaminated Area C • 11-23-04, Radioactively Contaminated Area D The purpose of this CADD is to identify and provide the rationale for the recommendation of corrective action alternatives (CAA) for the six CASs within CAU 366. Corrective action investigation (CAI) activities were performed from October 12, 2011, to May 14, 2012, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 366: Area 11 Plutonium Valley Dispersion Sites.

  17. Corrective Action Decision Document/Closure Report for Corrective Action Unit 137: Waste Disposal Sites, Nevada Test Site, Nevada (Revision 0) with ROTC 1 and 2

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Mark J

    2007-03-01

    The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation for closure of CAU 137 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from February 28 through August 17, 2006, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 137: Waste Disposal Sites. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective process: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent. • Provide sufficient information and data to complete appropriate corrective actions. ROTC-1: Downgrade FFACO UR at CAU 137, CAS 07-23-02, Radioactive Waste Disposal Site to an Administrative UR. ROTC-2: Downgrade FFACO UR at CAU 137, CAS 01-08-01, Waste Disposal Site to an Administrative UR.

  18. Closure Report for Corrective Action Unit 415: Project 57 No. 1 Plutonium Dispersion (NTTR) Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

    Energy Technology Data Exchange (ETDEWEB)

    Sloop, Christina

    2017-12-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 415: Project 57 No. 1 Plutonium Dispersion, which is located on Range 4808A of the Nevada Test and Training Range (NTTR). This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. CAU 415 comprises one corrective action site (CAS): NAFR-23-02, Pu Contaminated Soil. The purpose of this CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 415 based on the implementation of the corrective action of Closure in Place.

  19. Modeling Approach/Strategy for Corrective Action Unit 99: Rainier Mesa and Shoshone Mountain, Nevada Test Site, Nye County, Nevada, Revision 1, with ROTC-1

    Energy Technology Data Exchange (ETDEWEB)

    Greg Ruskauff

    2008-06-01

    This document describes an approach for preliminary (Phase I) flow and transport modeling for the Rainier Mesa/Shoshone Mountain (RMSM) Corrective Action Unit (CAU). This modeling will take place before the planned Phase II round of data collection to better identify the remaining data gaps before the fieldwork begins. Because of the geologic complexity, limited number of borings, and large vertical gradients, there is considerable uncertainty in the conceptual model for flow; thus different conceptual models will be evaluated, in addition to different framework and recharge models. The transport simulations will not be used to formally calculate the Contaminant Boundary at this time. The modeling (Phase II) will occur only after the available data are considered sufficient in scope and quality.

  20. Revision of torrent mites (Parasitengona, Torrenticolidae, Torrenticola of the United States and Canada: 90 descriptions, molecular phylogenetics, and a key to species

    Directory of Open Access Journals (Sweden)

    J. Ray Fisher

    2017-09-01

    Full Text Available The descriptive biology of torrent mites (Parasitengona: Torrenticolidae: Torrenticola of North America (north of Mexico is investigated using integrative methods. Material examined includes approximately 2,300 specimens from nearly 500 localities across the United States and Canada, and a few collections in Mexico and Central America. Species hypotheses are derived from a phylogenetic analysis of the barcoding region of cytochrome c oxidase subunit 1 (COI for 476 specimens and supported with morphology and biogeography. Relationships between species are examined with a combined analysis of COI and two expansion regions (D2–3 of the large ribosomal subunit (28S rDNA for 57 specimens. All previously described species from the US and Canada are examined. Our results indicate the need to synonymize four species: T. mercedensis (Marshall, 1943 is a junior synonym of T. sierrensis (Marshall, 1943; T. rectiforma Habeeb, 1974 is a junior synonym of T. ellipsoidalis (Marshall, 1943; T. neoconnexa Habeeb, 1957 is a junior synonym of T. magnexa Habeeb, 1955; and T. esbelta Cramer, 1992 is a junior synonym of T. boettgeri KO Viets, 1977. We describe 66 new species and re-describe all previously described regional species. Our findings indicate that total diversity of Torrenticola in the United States and Canada comprises 90 species, 57 known from the east and 33 from the west. We organize these species into four species complexes that include 13 identification groups. An additional 13 species do not fit within an identification group. The southern Appalachians are suspected to contain the highest concentration of remaining undescribed diversity. A key is provided to all known species in the US and Canada.

  1. Revision of torrent mites (Parasitengona, Torrenticolidae,Torrenticola) of the United States and Canada: 90 descriptions, molecular phylogenetics, and a key to species.

    Science.gov (United States)

    Fisher, J Ray; Fisher, Danielle M; Skvarla, Michael J; Nelson, Whitney A; Dowling, Ashley P G

    2017-01-01

    The descriptive biology of torrent mites (Parasitengona: Torrenticolidae: Torrenticola ) of North America (north of Mexico) is investigated using integrative methods. Material examined includes approximately 2,300 specimens from nearly 500 localities across the United States and Canada, and a few collections in Mexico and Central America. Species hypotheses are derived from a phylogenetic analysis of the barcoding region of cytochrome c oxidase subunit 1 (COI) for 476 specimens and supported with morphology and biogeography. Relationships between species are examined with a combined analysis of COI and two expansion regions (D2-3) of the large ribosomal subunit (28S rDNA) for 57 specimens. All previously described species from the US and Canada are examined. Our results indicate the need to synonymize four species: T. mercedensis (Marshall, 1943) is a junior synonym of T. sierrensis (Marshall, 1943); T. rectiforma Habeeb, 1974 is a junior synonym of T. ellipsoidalis (Marshall, 1943); T. neoconnexa Habeeb, 1957 is a junior synonym of T. magnexa Habeeb, 1955; and T. esbelta Cramer, 1992 is a junior synonym of T. boettgeri KO Viets, 1977. We describe 66 new species and re-describe all previously described regional species. Our findings indicate that total diversity of Torrenticola in the United States and Canada comprises 90 species, 57 known from the east and 33 from the west. We organize these species into four species complexes that include 13 identification groups. An additional 13 species do not fit within an identification group. The southern Appalachians are suspected to contain the highest concentration of remaining undescribed diversity. A key is provided to all known species in the US and Canada.

  2. Corrective Action Investigation Plan for Corrective Action Unit 97: Yucca Flat/Climax Mine, Nevada Test Site, Nevada (Revision 0, September 2000); FINAL

    International Nuclear Information System (INIS)

    2000-01-01

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, Nevada Operations Office's (DOE/NV's) approach to collect the data necessary to evaluate Corrective Action Alternatives (CAAs) appropriate for the closure of Corrective Action Unit (CAU) 97 under the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 97, collectively known as the Yucca Flat/Climax Mine CAU, consists of 720 Corrective Action Sites (CASs). The Yucca Flat/Climax Mine CAU extends over several areas of the NTS and constitutes one of several areas used for underground nuclear testing in the past. The nuclear tests resulted in groundwater contamination in the vicinity as well as downgradient of the underground test areas. Based on site history, the Yucca Flat underground nuclear tests were conducted in alluvial, volcanic, and carbonate rocks; whereas, the Climax Mine tests were conducted in an igneous intrusion located in northern Yucca Flat. Particle-tracking simulations performed during the regional evaluation indicate that the local Climax Mine groundwater flow system merges into the much larger Yucca Flat groundwater flow systems during the 1,000-year time period of interest. Addressing these two areas jointly and simultaneously investigating them as a combined CAU has been determined the best way to proceed with corrective action investigation (CAI) activities. The purpose and scope of the CAI includes characterization activities and model development conducted in five major sequential steps designed to be consistent with FFACO Underground Test Area Project's strategy to predict the location of the contaminant boundary, develop and implement a corrective action, and close each CAU. The results of this field investigation will support a defensible evaluation of CAAs in the subsequent corrective action decision document

  3. Corrective Action Investigation Plan for Corrective Action Unit 370: T-4 Atmospheric Test Site, Nevada Test Site, Nevada with ROTC-1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Pat Matthews

    2008-04-01

    Corrective Action Unit (CAU) 370 is located in Area 4 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 370 is comprised of Corrective Action Site (CAS) 04-23-01, Atmospheric Test Site T-4. This site is being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and/or implement a corrective action. Additional information will be obtained by conducting a corrective action investigation (CAI) before evaluating corrective action alternatives and selecting the appropriate corrective action for this CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The investigation results may also be used to evaluate improvements in the Soils Project strategy to be implemented. The site will be investigated based on the data quality objectives (DQOs) developed on December 10, 2007, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Desert Research Institute; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 370. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to the CAS. The scope of the CAI for CAU 370 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling. • Conduct radiological surveys. • Perform field screening. • Collect and submit environmental samples for laboratory analysis to determine whether contaminants of concern are present. • If contaminants of concern are present, collect samples to define the extent of the

  4. Sorption-reagent treatment of brines produced by reverse osmosis unit for liquid radioactive waste management

    International Nuclear Information System (INIS)

    Avramenko, V. A.; Zheleznov, V. V.; Sergienko, V. I.; Chizhevsky, I. Yu

    2003-01-01

    The results of the pilot plant tests (2002-2003) of the sorption-reagent decontamination of high salinity radioactive waste (brines) remaining after the low-salinity liquid radioactive waste (LRW) treatment in the reverse-osmosis unit from long-lived radionuclides are presented. The sorption-reagent materials used in this work were developed in the Institute of Chemistry FEDRAS. They enable one to decontaminate brines with total salt content up to 50 g/l from long-lived radionuclides of Cs, Sr and Co. At joint application of the reverse-osmosis and sorption-reagent technologies total volume of solid radioactive waste (SRW) decreases up to 100-fold as compared to the technology of cementation of reverse osmosis brines. In this case total cost of LRW treatment and SRW disposal decreases more than 10-fold. Brines decontaminated from radionuclides are then diluted down to the ecologically safe total salts content in water to be disposed of. Tests were performed to compare the efficiency of technologies including evaporation of brines remaining after reverse osmosis process and their decontamination by means of the sorption-reagent method. It was shown that, as compared to evaporation, the sorption-reagent technology provides substantial advantages as in regard to radioactive waste total volume reduction as in view of total cost of the waste management

  5. Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

    Science.gov (United States)

    Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

    2017-01-01

    Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p financial loss for the operating department. PMID:28107366

  6. Investigation of Accelerated Partial Breast Patient Alignment and Treatment With Helical Tomotherapy Unit

    International Nuclear Information System (INIS)

    Langen, Katja M.; Buchholz, Daniel J.; Burch, Doug R. C.; Burkavage, Rob C.; Limaye, Arti U.; Meeks, Sanford L.; Kupelian, Patrick A.; Ruchala, Kenneth J.; Haimerl, Jason; Henderson, Doug; Olivera, Gustavo H.

    2008-01-01

    Purpose: To determine the precision of megavoltage computed tomography (MVCT)-based alignment of the seroma cavity for patients undergoing partial breast irradiation; and to determine whether accelerated partial breast irradiation (APBI) plans can be generated for TomoTherapy deliveries that meet the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol guidelines for target coverage and normal tissue dose limitations. Methods and Materials: We obtained 50 MVCT images from 10 patients. An interuser study was designed to assess the alignment precision. Using a standard helical and a fixed beam prototype ('topotherapy') optimizer, two APBI plans for each patient were developed. Results: The precision of the MVCT-based seroma cavity alignment was better than 2 mm if averaged over the patient population. Both treatment techniques could be used to generate acceptable APBI plans for patients that fulfilled the recommended NSABP B-39/RTOG-0413 selection criteria. For plans of comparable treatment time, the conformation of the prescription dose to the target was greater for helical deliveries, while the ipsilateral lung dose was significantly reduced for the topotherapy plans. Conclusions: The inherent volumetric imaging capabilities of a TomoTherapy Hi-Art unit allow for alignment of patients undergoing partial breast irradiation that is determined from the visibility of the seroma cavity on the MVCT image. The precision of the MVCT-based alignment was better than 2 mm (± standard deviation) when averaged over the patient population. Using the NSABP B-39/RTOG-0413 guidelines, acceptable APBI treatment plans can be generated using helical- or topotherapy-based delivery techniques

  7. Ceftaroline fosamil for the treatment of community-acquired bacterial pneumonia in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Maggiore C

    2015-04-01

    Full Text Available Christy Maggiore,1 Jose A Vazquez,2 David J Guervil,3 Ananthakrishnan Ramani,4 Alena Jandourek,5 Phillip Cole,5 H David Friedland5 1Gulf Coast Medical Center, Panama City, FL, USA; 2Medical College of Georgia, Georgia Regents University, Augusta, GA, USA; 3Memorial Hermann-Texas Medical Center, Houston, TX, USA; 4Mountain View Medical Practice (Columbia Memorial Hospital, Catskill, NY, USA; 5Cerexa, Inc., Oakland, CA, USA Abstract: The Clinical Assessment Program and Teflaro® Utilization Registry (CAPTURE is a multicenter study evaluating the clinical use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP or acute bacterial skin and skin structure infection. Data were collected between August 2011 and February 2013, from 398 evaluable patients receiving treatment at 33 sites in the USA. This manuscript presents data collected from patients with CABP who received care in an intensive care unit (ICU or in general medical wards (35% and 64% of evaluable patients, respectively. The majority of ICU and general medical ward patients had underlying comorbidities (78% and 74%, respectively, with structural lung disease being the most common (42% in the ICU and 40% in general medical wards. Patients admitted to the ICU had a longer duration of stay, a longer duration of symptoms before treatment, and a longer duration of ceftaroline fosamil therapy than did general medical ward patients. Most patients treated in the ICU and in general medical wards were given ceftaroline fosamil as second-line therapy (87% and 80%, respectively. The overall rate of clinical success for patients treated with ceftaroline fosamil was 68% in the ICU and 85% in the general medical wards. Clinical success for patients receiving ceftaroline fosamil as a second-line agent was 84% in the ICU and 86% in general medical wards. These findings indicate that ceftaroline fosamil is a viable treatment option for CABP, both in the ICU and in general

  8. Independent verification of monitor unit calculation for radiation treatment planning system.

    Science.gov (United States)

    Chen, Li; Chen, Li-Xin; Huang, Shao-Min; Sun, Wen-Zhao; Sun, Hong-Qiang; Deng, Xiao-Wu

    2010-02-01

    To ensure the accuracy of dose calculation for radiation treatment plans is an important part of quality assurance (QA) procedures for radiotherapy. This study evaluated the Monitor Units (MU) calculation accuracy of a third-party QA software and a 3-dimensional treatment planning system (3D TPS), to investigate the feasibility and reliability of independent verification for radiation treatment planning. Test plans in a homogenous phantom were designed with 3-D TPS, according to the International Atomic Energy Agency (IAEA) Technical Report No. 430, including open, blocked, wedge, and multileaf collimator (MLC) fields. Test plans were delivered and measured in the phantom. The delivered doses were input to the QA software and the independent calculated MUs were compared with delivery. All test plans were verified with independent calculation and phantom measurements separately, and the differences of the two kinds of verification were then compared. The deviation of the independent calculation to the measurements was (0.1 +/- 0.9)%, the biggest difference fell onto the plans that used block and wedge fields (2.0%). The mean MU difference between the TPS and the QA software was (0.6 +/- 1.0)%, ranging from -0.8% to 2.8%. The deviation in dose of the TPS calculation compared to the measurements was (-0.2 +/- 1.7)%, ranging from -3.9% to 2.9%. MU accuracy of the third-party QA software is clinically acceptable. Similar results were achieved with the independent calculations and the phantom measurements for all test plans. The tested independent calculation software can be used as an efficient tool for TPS plan verification.

  9. Revised SRAC code system

    International Nuclear Information System (INIS)

    Tsuchihashi, Keichiro; Ishiguro, Yukio; Kaneko, Kunio; Ido, Masaru.

    1986-09-01

    Since the publication of JAERI-1285 in 1983 for the preliminary version of the SRAC code system, a number of additions and modifications to the functions have been made to establish an overall neutronics code system. Major points are (1) addition of JENDL-2 version of data library, (2) a direct treatment of doubly heterogeneous effect on resonance absorption, (3) a generalized Dancoff factor, (4) a cell calculation based on the fixed boundary source problem, (5) the corresponding edit required for experimental analysis and reactor design, (6) a perturbation theory calculation for reactivity change, (7) an auxiliary code for core burnup and fuel management, etc. This report is a revision of the users manual which consists of the general description, input data requirements and their explanation, detailed information on usage, mathematics, contents of libraries and sample I/O. (author)

  10. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma

    Science.gov (United States)

    Asa, Sylvia L.; Dralle, Henning; Elisei, Rossella; Evans, Douglas B.; Gagel, Robert F.; Lee, Nancy; Machens, Andreas; Moley, Jeffrey F.; Pacini, Furio; Raue, Friedhelm; Frank-Raue, Karin; Robinson, Bruce; Rosenthal, M. Sara; Santoro, Massimo; Schlumberger, Martin; Shah, Manisha; Waguespack, Steven G.

    2015-01-01

    Introduction: The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. Methods: The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. Results: The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. Conclusions: The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice. PMID:25810047

  11. Corrective Action Investigation Plan for Corrective Action Unit 561: Waste Disposal Areas, Nevada Test Site, Nevada with ROTC 1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2008-07-01

    Corrective Action Unit (CAU) 561 is located in Areas 1, 2, 3, 5, 12, 22, 23, and 25 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 561 is comprised of the 10 corrective action sites (CASs) listed below: • 01-19-01, Waste Dump • 02-08-02, Waste Dump and Burn Area • 03-19-02, Debris Pile • 05-62-01, Radioactive Gravel Pile • 12-23-09, Radioactive Waste Dump • 22-19-06, Buried Waste Disposal Site • 23-21-04, Waste Disposal Trenches • 25-08-02, Waste Dump • 25-23-21, Radioactive Waste Dump • 25-25-19, Hydrocarbon Stains and Trench These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on April 28, 2008, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 561. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to each CAS. The scope of the Corrective Action Investigation for CAU 561 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling. • Conduct radiological surveys

  12. Corrective Action Investigation Plan for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2009-02-01

    Corrective Action Unit (CAU) 371 is located in Areas 11 and 18 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 371 is comprised of the two corrective action sites (CASs) listed below: • 11-23-05, Pin Stripe Contamination Area • 18-45-01, U-18j-2 Crater (Johnnie Boy) These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on November 19, 2008, by representatives of the Nevada Division of Environmental Protection; U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 371. Appendix A provides a detailed discussion of the DQO methodology and the DQOs specific to each CAS. The scope of the corrective action investigation for CAU 371 includes the following activities: • Move surface debris and/or materials, as needed, to facilitate sampling. • Conduct radiological surveys. • Measure in situ external dose rates using thermoluminescent dosimeters or other dose measurement devices. • Collect and submit environmental samples for laboratory analysis to determine internal dose rates. • Combine internal and external dose rates to determine whether total

  13. Corrective Action Investigation Plan for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada, Revision No. 1 (9/2001)

    Energy Technology Data Exchange (ETDEWEB)

    NNSA/NV

    2000-07-20

    This corrective action investigation plan contains the U.S. Department of Energy, Nevada Operations Office's approach to collect data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 262 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 262 consists of nine Corrective Action Sites (CASs): Underground Storage Tank (25-02-06), Septic Systems A and B (25-04-06), Septic System (25-04-07), Leachfield (25-05-03), Leachfield (25-05-05), Leachfield (25-05-06), Radioactive Leachfield (25-05-08), Leachfield (25-05-12), and Dry Well (25-51-01). Situated in Area 25 at the Nevada Test Site (NTS), sites addressed by CAU 262 are located at the Reactor-Maintenance, Assembly, and Disassembly (R-MAD); Test Cell C; and Engine-Maintenance, Assembly, and Disassembly (E-MAD) facilities. The R-MAD, Test Cell C, and E-MAD facilities supported nuclear rocket reactor and engine testing as part of the Nuclear Rocket Development Station. The activities associated with the testing program were conducted between 1958 and 1973. Based on site history collected to support the Data Quality Objectives process, contaminants of potential concern (COPCs) for the site include oil/diesel-range total petroleum hydrocarbons, volatile organic compounds, semivolatile organic compounds, polychlorinated biphenyls, Resource Conservation and Recovery Act metals, and gamma-emitting radionuclides, isotopic uranium, isotopic plutonium, strontium-90, and tritium. The scope of the corrective action field investigation at the CAU will include the inspection of portions of the collection systems, sampling the contents of collection system features in situ of leachfield logging materials, surface soil sampling, collection of samples of soil underlying the base of inlet and outfall ends of septic tanks and outfall ends of diversion structures and distribution boxes, collection of soil samples from biased or a combination of

  14. Corrective Action Decision Document for Corrective Action Unit 322: Areas 1 and 3 Release Sites and Injection Wells Nevada Test Site, Nevada, Revision 0 with ROTC 1

    Energy Technology Data Exchange (ETDEWEB)

    Boehlecke, Robert

    2004-12-01

    This Corrective Action Decision Document has been prepared for Corrective Action Unit (CAU) 322, Areas 1 and 3 Release Sites and Injection Wells, Nevada Test Site, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit 322 is comprised of the following corrective action sites (CASs): (1) 01-25-01 - AST Release Site; (2) 03-25-03 - Mud Plant and AST Diesel Release; and (3) 03-20-05 - Injection Wells and BOP Shop. The purpose of this Corrective Action Decision Document is to identify and provide the rationale for the recommendation of a corrective action alternative for each CAS within CAU 322. Corrective action investigation activities were performed from April 2004 through September 2004, as set forth in the Corrective Action Investigation Plan. The purposes of the activities as defined during the data quality objectives process were: (1) Determine if contaminants of concern (COCs) are present; (2) If COCs are present, determine their nature and extent; and (3) Provide sufficient information and data to recommend appropriate corrective actions for the CASs. Analytes detected during the corrective action investigation were evaluated against appropriate preliminary action levels to identify contaminants of concern for each corrective action site. Radiological field measurements were compared to unrestricted release criteria. Assessment of the data generated from investigation activities revealed the following: (1) CAS 01-25-01 contains an AST berm contaminated with total petroleum hydrocarbons (TPH) diesel-range organics (DRO). (2) CAS 03-25-03 includes two distinct areas: Area A where no contamination remains from a potential spill associated with an AST, and Area B where TPH-DRO contamination associated with various activities at the mud plant was identified. The Area B contamination was found at various locations and depths. (3) CAS 03-25-03 Area B contains TPH-DRO contamination at various

  15. Closure Report for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks Nevada National Security Site, Nevada with ROTC-1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Kauss

    2011-06-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 539: Areas 25 and 26 Railroad Tracks, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 539 are located within Areas 25 and 26 of the Nevada National Security Site. Corrective Action Unit 539 comprises the following CASs: • 25-99-21, Area 25 Railroad Tracks • 26-99-05, Area 26 Railroad Tracks The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 539 were met. To achieve this, the following actions were performed: • Reviewed documentation on historical and current site conditions, including the concentration and extent of contamination. • Conducted radiological walkover surveys of railroad tracks in both Areas 25 and 26. • Collected ballast and soil samples and calculated internal dose estimates for radiological releases. • Collected in situ thermoluminescent dosimeter measurements and calculated external dose estimates for radiological releases. • Removed lead bricks as potential source material (PSM) and collected verification samples. • Implemented corrective actions as necessary to protect human health and the environment. • Properly disposed of corrective action and investigation wastes. • Implemented an FFACO use restriction (UR) for radiological contamination at CAS 25-99-21. The approved UR form and map are provided in Appendix F and will be filed in the DOE, National Nuclear Security Administration Nevada Site Office (NNSA/NSO), Facility Information Management System; the FFACO database; and the NNSA/NSO CAU/CAS files. From November 29

  16. Corrective Action Investigation Plan for Corrective Action Unit 545: Dumps, Waste Disposal Sites, and Buried Radioactive Materials Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Wickline, Alfred

    2007-06-01

    Corrective Action Unit 545, Dumps, Waste Disposal Sites, and Buried Radioactive Materials, consists of seven inactive sites located in the Yucca Flat area and one inactive site in the Pahute Mesa area. The eight CAU 545 sites consist of craters used for mud disposal, surface or buried waste disposed within craters or potential crater areas, and sites where surface or buried waste was disposed. The CAU 545 sites were used to support nuclear testing conducted in the Yucca Flat area during the 1950s through the early 1990s, and in Area 20 in the mid-1970s. This Corrective Action Investigation Plan has been developed in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Under the Federal Facility Agreement and Consent Order, this Corrective Action Investigation Plan will be submitted to the Nevada Division of Environmental Protection for approval. Fieldwork will be conducted following approval.

  17. Addendum to the Corrective Action Decision Document/Closure Report for Corrective Action Unit 529: Area 25 Contaminated Materials, Nevada Test Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Mark J

    2013-10-01

    This document constitutes an addendum to the Corrective Action Decision Document/Closure Report for Corrective Action Unit 529: Area 25 Contaminated Materials, Nevada Test Site, Nevada as described in the document Recommendations and Justifications To Remove Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office Federal Facility Agreement and Consent Order dated September 2013. The Use Restriction (UR) Removal document was approved by the Nevada Division of Environmental Protection on October 16, 2013. The approval of the UR Removal document constituted approval of each of the recommended UR removals. In conformance with the UR Removal document, this addendum consists of: This page that refers the reader to the UR Removal document for additional information The cover, title, and signature pages of the UR Removal document The NDEP approval letter The corresponding section of the UR Removal document This addendum provides the documentation justifying the cancellation of the UR for CAS 25-23-17, Contaminated Wash (Parcel H). This UR was established as part of FFACO corrective actions and was based on the presence of total petroleum hydrocarbon diesel-range organics contamination at concentrations greater than the NDEP action level at the time of the initial investigation.

  18. Corrective Action Investigation Plan for Corrective Action Unit 576: Miscellaneous Radiological Sites and Debris Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro, Las Vegas, NV (United States)

    2016-12-01

    Corrective Action Unit (CAU) 576 is located in Areas 2, 3, 5, 8, and 9 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. CAU 576 is a grouping of sites where there has been a suspected release of contamination associated with nuclear testing. This document describes the planned investigation of CAU 576, which comprises the following corrective action sites (CASs): 00-99-01, Potential Source Material; 02-99-12, U-2af (Kennebec) Surface Rad-Chem Piping; 03-99-20, Area 3 Subsurface Rad-Chem Piping; 05-19-04, Frenchman Flat Rad Waste Dump ; 09-99-08, U-9x (Allegheny) Subsurface Rad-Chem Piping; 09-99-09, U-9its u24 (Avens-Alkermes) Surface Contaminated Flex Line These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document (CADD).

  19. Corrective Action Investigation Plan for Corrective Action Unit 414: Clean Slate III Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro, Las Vegas, NV (United States)

    2016-09-01

    Corrective Action Unit (CAU) 414 is located on the Tonopah Test Range, which is approximately 130 miles northwest of Las Vegas, Nevada, and approximately 40 miles southeast of Tonopah, Nevada. The CAU 414 site consists of the release of radionuclides to the surface and shallow subsurface from the conduct of the Clean Slate III (CSIII) storage–transportation test conducted on June 9, 1963. CAU 414 includes one corrective action site (CAS), TA-23-03CS (Pu Contaminated Soil). The known releases at CAU 414 are the result of the atmospheric dispersal of contamination from the 1963 CSIII test. The CSIII test was a nonnuclear detonation of a nuclear device located inside a reinforced concrete bunker covered with 8 feet of soil. This test dispersed radionuclides, primarily uranium and plutonium, on the ground surface. The presence and nature of contamination at CAU 414 will be evaluated based on information collected from a corrective action investigation (CAI). The investigation is based on the data quality objectives (DQOs) developed on June 7, 2016, by representatives of the Nevada Division of Environmental Protection; the U.S. Air Force; and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective action alternatives for CAU 414.

  20. Streamlined approach for environmental restoration (SAFER) plan for corrective action unit 412: clean slate I plutonium dispersion (TTR) tonopah test range, Nevada, revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick K.

    2015-04-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 412. CAU 412 is located on the Tonopah Test Range and consists of a single corrective action site (CAS), TA-23-01CS, Pu Contaminated Soil. There is sufficient information and historical documentation from previous investigations and the 1997 interim corrective action to recommend closure of CAU 412 using the SAFER process. Based on existing data, the presumed corrective action for CAU 412 is clean closure. However, additional data will be obtained during a field investigation to document and verify the adequacy of existing information and determine whether the CAU 412 closure objectives have been achieved. This SAFER Plan provides the methodology to gather the necessary information for closing the CAU.The following summarizes the SAFER activities that will support the closure of CAU 412:• Collect environmental samples from designated target populations to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information.• If no COCs are present, establish clean closure as the corrective action. • If COCs are present, the extent of contamination will be defined and further corrective actions will be evaluated with the stakeholders (NDEP, USAF).• Confirm the preferred closure option is sufficient to protect human health and the environment.

  1. Corrective Action Investigation Plan for Corrective Action Unit 414: Clean Slate III Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 1

    International Nuclear Information System (INIS)

    Matthews, Patrick

    2016-01-01

    Corrective Action Unit (CAU) 414 is located on the Tonopah Test Range, which is approximately 130 miles northwest of Las Vegas, Nevada, and approximately 40 miles southeast of Tonopah, Nevada. The CAU 414 site consists of the release of radionuclides to the surface and shallow subsurface from the conduct of the Clean Slate III (CSIII) storage transportation test conducted on June 9, 1963. CAU 414 includes one corrective action site (CAS), TA-23-03CS (Pu Contaminated Soil). The known releases at CAU 414 are the result of the atmospheric dispersal of contamination from the 1963 CSIII test. The CSIII test was a nonnuclear detonation of a nuclear device located inside a reinforced concrete bunker covered with 8 feet of soil. This test dispersed radionuclides, primarily uranium and plutonium, on the ground surface. The presence and nature of contamination at CAU 414 will be evaluated based on information collected from a corrective action investigation (CAI). The investigation is based on the data quality objectives (DQOs) developed on June 7, 2016, by representatives of the Nevada Division of Environmental Protection; the U.S. Air Force; and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective action alternatives for CAU 414.

  2. Corrective Action Decision Document/Closure Report for Corrective Action Unit 554: Area 23 Release Site Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Evenson, Grant

    2005-07-01

    This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 554, Area 23 Release Site, located in Mercury at the Nevada Test Site, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit (CAU) 554 is comprised of one corrective action site (CAS): (1) CAS 23-02-08, USTs 23-115-1, 2, 3/Spill 530-90-002. The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation for closure of CAU 554 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from January 18 through May 5, 2005, as set forth in the ''Corrective Action Investigation Plan for Corrective Action Unit 554: Area 23 Release Site'' (NNSA/NSO, 2004) and Records of Technical Change No. 1 and No. 2. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: (1) Determine whether contaminants of concern are present. (2) If contaminants of concern are present, determine their nature and extent. (3) Provide sufficient information and data to complete appropriate corrective actions. The CAU 554 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against preliminary action levels (PALs) established in the CAU 554 CAIP for total petroleum hydrocarbons (TPH) benzo(a)pyrene, dibenz(a,h)anthracene, and trichloroethene (TCE). Specifically: (1) The soil beneath and laterally outward from former underground storage tanks at CAS 23-02-08 contains TPH-diesel-range organics (DRO) above the PAL of 100 milligrams per kilogram, confined vertically from a depth of approximately 400

  3. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 415: Project 57 No. 1 Plutonium Dispersion (NTTR), Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick; Burmeister, Mark

    2014-04-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 415, Project 57 No. 1 Plutonium Dispersion (NTTR). CAU 415 is located on Range 4808A of the Nevada Test and Training Range (NTTR) and consists of one corrective action site: NAFR-23-02, Pu Contaminated Soil. The CAU 415 site consists of the atmospheric release of radiological contaminants to surface soil from the Project 57 safety experiment conducted in 1957. The safety experiment released plutonium (Pu), uranium (U), and americium (Am) to the surface soil over an area of approximately 1.9 square miles. This area is currently fenced and posted as a radiological contamination area. Vehicles and debris contaminated by the experiment were subsequently buried in a disposal trench within the surface-contaminated, fenced area and are assumed to have released radiological contamination to subsurface soils. Potential source materials in the form of pole-mounted electrical transformers were also identified at the site and will be removed as part of closure activities.

  4. Corrective Action Decision Document/ Closure Report for Corrective Action Unit 556: Dry Wells and Surface Release Points, Nevada Test Site, Nevada with Errata Sheet, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2008-09-01

    This Corrective Action Decision Document (CADD)/Closure Report (CR) has been prepared for Corrective Action Unit 556, Dry Wells and Surface Release Points, located at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO, 1996; as amended February 2008). Corrective Action Unit (CAU) 556 is comprised of four corrective action sites (CASs): • 06-20-04, National Cementers Dry Well • 06-99-09, Birdwell Test Hole • 25-60-03, E-MAD Stormwater Discharge and Piping • 25-64-01, Vehicle Washdown and Drainage Pit The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure of CAU 556 with no further corrective action. To achieve this, corrective action investigation (CAI) activities began on February 7 and were completed on June 19, 2008, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 556: Dry Wells and Surface Release Points, Nevada Test Site, Nevada (NNSA/NSO, 2007). The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent. • Provide sufficient information and data to complete appropriate corrective actions. The CAU 556 data were evaluated based on the data quality assessment process, which demonstrated the quality and acceptability of the data for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against appropriate final action levels (FALs) to identify the COCs for each CAS. The results of the CAI identified COCs at one of the four CASs in CAU 556 that required the completion of a corrective action. Assessment of the data generated from investigation activities conducted at CAU 556 revealed the following: • Corrective Action Sites 06-20-04, 06-99-09, and 25-64-01 do not contain contamination at

  5. Addendum to the Closure Report for Corrective Action Unit 165: Area 25 and 26 Dry Well and Washdown Areas, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Mark J

    2013-10-01

    This document constitutes an addendum to the Closure Report for Corrective Action Unit 165: Area 25 and 26 Dry Well and Washdown Areas, Nevada Test Site, Nevada as described in the document Recommendations and Justifications To Remove Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office Federal Facility Agreement and Consent Order dated September 2013. The Use Restriction Removal document was approved by the Nevada Division of Environmental Protection on October 16, 2013. The approval of the UR Removal document constituted approval of each of the recommended UR removals. In conformance with the UR Removal document, this addendum consists of: This page that refers the reader to the UR Removal document for additional information The cover, title, and signature pages of the UR Removal document The NDEP approval letter The corresponding section of the UR Removal document This addendum provides the documentation justifying the cancellation of the UR for CAS 25-20-01, Lab Drain Dry Well. This UR was established as part of FFACO corrective actions and was based on the presence of tetrachloroethene contamination at concentrations greater than the action level established at the time of the initial investigation. Although total petroleum hydrocarbon diesel-range organics contamination at concentrations greater than the NDEP action level was present at the site, no hazardous constituents of TPH-DRO exceeded the U.S. Environmental Protection Agency (EPA) Region 9 preliminary remediation goals established at the time of the initial investigation.

  6. Corrective Action Decision Document for Corrective Action Unit 140: Waste Dumps, Burn Pits, and Storage Area, Nevada Test Site, Nevada, Revision 1 with ROTC 1

    International Nuclear Information System (INIS)

    Boehlecke, Robert

    2004-01-01

    This Corrective Action Decision Document (CADD) has been prepared for Corrective Action Unit (CAU) 140: Waste Dumps, Burn Pits, and Storage Area, Nevada Test Site (NTS), Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit 140 is located within Areas 5, 22, and 23 of the NTS and is comprised of the following corrective action sites (CASs): 05-08-01, Detonation Pits; 05-08-02, Debris Pits; 05-17-01, Hazardous Waste Accumulation Site (Buried); 05-19-01, Waste Disposal Site; 05-23-01, Gravel Gertie; 05-35-01, Burn Pit; 05-99-04, Burn Pit; 22-99-04, Radioactive Waste Dump; and 23-17-01, Hazardous Waste Storage Area. The purpose of this CADD is to identify and provide a rationale for the recommendation of a corrective action alternative for each CAS within CAU 140. Corrective action investigation activities were performed from November 13 through December 11, 2002. Additional sampling to delineate the extent of contaminants of concern (COCs) was conducted on February 4 and March 18 and 19, 2003. Corrective action investigation activities were performed as set forth in the Corrective Action Investigation Plan for CAU 140. Analytes detected during the corrective action investigation were evaluated against appropriate preliminary action levels to identify COCs for each CAS. Assessment of the data generated from investigation activities revealed the following: (1) CAS 05-08-01 contains the COCs lead and the radioisotope thorium-234 in the surface soil at sample location A05. (2) CAS 05-23-01 did not have any COCs identified during the field investigation; however, based on historical knowledge of activities at this site, the interior of the Gravel Gertie is considered contaminated with uranium. (3) CAS 23-17-01 contains the COC total petroleum hydrocarbons (diesel-range organics) at location J20 at a depth of 9 to 10 feet below ground surface. (4) No COCs were identified at CASs 05-08-02, 05-17-01, 05-19-01, 05

  7. Corrective Action Investigation Plan for Corrective Action Unit 106: Areas 5, 11 Frenchman Flat Atmospheric Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2010-04-01

    Corrective Action Unit (CAU) 106 is located in Area 5 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 106 comprises the five corrective action sites (CASs) listed below: •05-23-02, GMX Alpha Contaminated Area •05-23-05, Atmospheric Test Site - Able •05-45-01, Atmospheric Test Site - Hamilton •05-45-04, 306 GZ Rad Contaminated Area •05-45-05, 307 GZ Rad Contaminated Area These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on January 19, 2010, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 106. The presence and nature of contamination at CAU 106 will be evaluated based on information collected from a field investigation. The CAU includes land areas impacted by the release of radionuclides from a weapons-effect tower test (CAS 05-45-01), a weapons-related airdrop test (CAS 05-23-05), “equation of state” experiments (CAS 05-23-02), and unknown support activities at two sites (CAS 05-45-04 and CAS 05-45-05). Surface-deposited radiological contamination will be evaluated based on a comparison of the total effective dose (TED) at sample plot locations to the dose

  8. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 114: Area 25 EMAD Facility Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burmeister

    2009-08-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 114, Area 25 EMAD Facility, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 114 comprises the following corrective action sites (CASs) located in Area 25 of the Nevada Test Site: • 25-41-03, EMAD Facility • 25-99-20, EMAD Facility Exterior Releases This plan provides the methodology for field activities needed to gather the necessary information for closing each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 114 using the SAFER process. Additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. It is anticipated that the results of the field investigation and implementation of a corrective action of clean closure will support a defensible recommendation that no further corrective action is necessary. If it is determined that complete clean closure cannot be accomplished during the SAFER, then a hold point will have been reached and the Nevada Division of Environmental Protection (NDEP) will be consulted to determine whether the remaining contamination will be closed under the alternative corrective action of closure in place. This will be presented in a closure report that will be prepared and submitted to NDEP for review and approval. The sites will be investigated based on the data quality objectives (DQOs) developed on April 30, 2009, by representatives of NDEP; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data

  9. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 465: Hydronuclear Nevada National Security Site, Nevada, with ROTC 1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2011-11-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 465, Hydronuclear, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 465 comprises the following four corrective action sites (CASs) located in Areas 6 and 27 of the Nevada National Security Site: (1) 00-23-01, Hydronuclear Experiment; (2) 00-23-02, Hydronuclear Experiment; (3) 00-23-03, Hydronuclear Experiment; (4) 06-99-01, Hydronuclear. The sites will be investigated based on the data quality objectives (DQOs) developed on July 6, 2011, by representatives of the Nevada Division of Environmental Protection (NDEP) and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for each CAS in CAU 465. For CAU 465, two potential release components have been identified. The subsurface release component includes potential releases of radiological and nonradiological contaminants from the subsurface hydronuclear experiments and disposal boreholes. The surface release component consists of other potential releases of radiological and nonradiological contaminants to surface soils that may have occurred during the pre- and post-test activities. This plan provides the methodology for collection of the necessary information for closing each CAS component. There is sufficient information and process knowledge from historical documentation, contaminant characteristics, existing regional and site groundwater models, and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 465 using the SAFER process. For potential subsurface releases, flow and transport models will be developed to integrate existing data into a conservative

  10. Corrective Action Investigation Plan for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews; Christy Sloop

    2012-02-01

    Corrective Action Unit (CAU) 569 is located in Area 3 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 569 comprises the nine numbered corrective action sites (CASs) and one newly identified site listed below: (1) 03-23-09, T-3 Contamination Area (hereafter referred to as Annie, Franklin, George, and Moth); (2) 03-23-10, T-3A Contamination Area (hereafter referred to as Harry and Hornet); (3) 03-23-11, T-3B Contamination Area (hereafter referred to as Fizeau); (4) 03-23-12, T-3S Contamination Area (hereafter referred to as Rio Arriba); (5) 03-23-13, T-3T Contamination Area (hereafter referred to as Catron); (6) 03-23-14, T-3V Contamination Area (hereafter referred to as Humboldt); (7) 03-23-15, S-3G Contamination Area (hereafter referred to as Coulomb-B); (8) 03-23-16, S-3H Contamination Area (hereafter referred to as Coulomb-A); (9) 03-23-21, Pike Contamination Area (hereafter referred to as Pike); and (10) Waste Consolidation Site 3A. Because CAU 569 is a complicated site containing many types of releases, it was agreed during the data quality objectives (DQO) process that these sites will be grouped. These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each study group. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the DQOs developed on September 26, 2011, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO

  11. Corrective Action Decision Document for Corrective Action Unit 568. Area 3 Plutonium Dispersion Sites, Nevada National Security Site, Nevada Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Nevada Field Ofice, Las Vegas, NV (United States). National Nuclear Security Administration

    2015-08-01

    The purpose of this Corrective Action Decision Document is to identify and provide the rationale for the recommendation of corrective action alternatives (CAAs) for the 14 CASs within CAU 568. Corrective action investigation (CAI) activities were performed from April 2014 through May 2015, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 568: Area 3 Plutonium Dispersion Sites, Nevada National Security Site, Nevada; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices. The purpose of the CAI was to fulfill data needs as defined during the DQO process. The CAU 568 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated that the dataset is complete and acceptable for use in fulfilling the DQO data needs. Based on the evaluation of analytical data from the CAI, review of future and current operations at the 14 CASs, and the detailed and comparative analysis of the potential CAAs, the following corrective actions are recommended for CAU 568: • No further action is the preferred corrective action for CASs 03-23-17, 03-23-22, 03-23-26. • Closure in place is the preferred corrective action for CAS 03-23-19; 03-45-01; the SE DCBs at CASs 03-23-20, 03-23-23, 03-23-31, 03-23-32, 03-23-33, and 03-23-34; and the Pascal-BHCA at CAS 03-23-31. • Clean closure is the preferred corrective action for CASs 03-08-04, 03-23-30, and 03-26-04; and the four well head covers at CASs 03-23-20, 03-23-23, 03-23-31, and 03-23-33.

  12. Corrective Action Decision Document for Corrective Action Unit 140: Waste Dumps, Burn Pits, and Storage Area, Nevada Test Site, Nevada: Revision No. 0

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2003-10-17

    This Corrective Action Decision Document identifies and rationalizes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's selection of a recommended corrective action alternative appropriate to facilitate the closure of Corrective Action Unit (CAU) 140: Waste Dumps, Burn Pits, and Storage Area, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. Located in Areas 5, 22, and 23 of the NTS, CAU 140 consists of nine corrective action sites (CASs). Investigation activities were performed from November 13 through December 11, 2002, with additional sampling to delineate the extent of contaminants of concern (COCs) conducted on February 4 and March 18 and 19, 2003. Results obtained from the investigation activities and sampling indicated that only 3 of the 9 CASs at CAU 140 had COCs identified. Following a review of existing data, future land use, and current operations at the NTS, the following preferred alternatives were developed for consideration: (1) No Further Action - six CASs (05-08-02, 05-17-01, 05-19-01, 05-35-01, 05-99-04, and 22-99-04); (2) Clean Closure - one CAS (05-08-01), and (3) Closure-in-Place - two CASs (05-23-01 and 23-17-01). These alternatives were judged to meet all requirements for the technical components evaluated. Additionally, the alternatives meet all applicable state and federal regulations for closure of the site and will eliminate potential future exposure pathways to the contaminated media at CAU 140.

  13. Groundwater Flow Model of Corrective Action Units 101 and 102: Central and Western Pahute Mesa, Nevada Test Site, Nye County, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Greg Ruskauff

    2006-06-01

    The Pahute Mesa groundwater flow model supports the FFACO UGTA corrective action strategy objective of providing an estimate of the vertical and horizontal extent of contaminant migration for each CAU in order to predict contaminant boundaries. A contaminant boundary is the model-predicted perimeter that defines the extent of radionuclide-contaminated groundwater from underground nuclear testing above background conditions exceeding Safe Drinking Water Act (SDWA) standards. The contaminant boundary will be composed of both a perimeter boundary and a lower hydrostratigraphic unit (HSU) boundary. Additional results showing contaminant concentrations and the location of the contaminant boundary at selected times will also be presented. These times may include the verification period, the end of the five-year proof-of-concept period, as well as other times that are of specific interest. The FFACO (1996) requires that the contaminant transport model predict the contaminant boundary at 1,000 years and “at a 95% level of confidence.” The Pahute Mesa Phase I flow model described in this report provides, through the flow fields derived from alternative hydrostratigraphic framework models (HFMs) and recharge models, one part of the data required to compute the contaminant boundary. Other components include the simplified source term model, which incorporates uncertainty and variability in the factors that control radionuclide release from an underground nuclear test (SNJV, 2004a), and the transport model with the concomitant parameter uncertainty as described in Shaw (2003). The uncertainty in all the above model components will be evaluated to produce the final contaminant boundary. This report documents the development of the groundwater flow model for the Central and Western Pahute Mesa CAUs.

  14. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 411. Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick K. [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2015-03-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 411, Double Tracks Plutonium Dispersion (Nellis). CAU 411 is located on the Nevada Test and Training Range and consists of a single corrective action site (CAS), NAFR-23-01, Pu Contaminated Soil. There is sufficient information and historical documentation from previous investigations and the 1996 interim corrective action to recommend closure of CAU 411 using the SAFER process. Based on existing data, the presumed corrective action for CAU 411 is clean closure. However, additional data will be obtained during a field investigation to document and verify the adequacy of existing information, and to determine whether the CAU 411 closure objectives have been achieved. This SAFER Plan provides the methodology to gather the necessary information for closing the CAU. The results of the field investigation will be presented in a closure report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The site will be investigated based on the data quality objectives (DQOs) developed on November 20, 2014, by representatives of NDEP, the U.S. Air Force (USAF), and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine whether CAU 411 closure objectives have been achieved. The following text summarizes the SAFER activities that will support the closure of CAU 411; Collect environmental samples from designated target populations to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information; If COCs are no longer present, establish clean closure as the corrective action; If COCs are present, the extent of contamination will be defined and further corrective actions

  15. Corrective Action Investigation Plan for Corrective Action Unit 413: Clean Slate II Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick; Burmeister, Mark; Gallo, Patricia

    2016-04-21

    Corrective Action Unit (CAU) 413 is located on the Tonopah Test Range, which is approximately 130 miles northwest of Las Vegas, Nevada, and approximately 40 miles southeast of Tonopah, Nevada. The CAU 413 site consists of the release of radionuclides to the surface and shallow subsurface from the conduct of the Clean Slate II (CSII) storage–transportation test conducted on May 31, 1963. CAU 413 includes one corrective action site (CAS), TA-23-02CS (Pu Contaminated Soil). The known releases at CAU 413 are the result of the atmospheric deposition of contamination from the 1963 CSII test. The CSII test was a non-nuclear detonation of a nuclear device located inside a reinforced concrete bunker covered with 2 feet of soil. This test dispersed radionuclides, primarily plutonium, on the ground surface. The presence and nature of contamination at CAU 413 will be evaluated based on information collected from a corrective action investigation (CAI). The investigation is based on the data quality objectives (DQOs) developed on June 17, 2015, by representatives of the Nevada Division of Environmental Protection; the U.S. Air Force; and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 413. The CAI will include radiological surveys, geophysical surveys, collection and analyses of soil samples, and assessment of investigation results. The collection of soil samples will be accomplished using both probabilistic and judgmental sampling approaches. To facilitate site investigation and the evaluation of DQO decisions, the releases at CAU 413 have been divided into seven study groups.

  16. Corrective Action Decision Document/Corrective Action Plan for Corrective Action Unit 97: Yucca Flat/Climax Mine Nevada National Security Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Farnham, Irene [Navarro, Las Vegas, NV (United States)

    2017-08-01

    This corrective action decision document (CADD)/corrective action plan (CAP) has been prepared for Corrective Action Unit (CAU) 97, Yucca Flat/Climax Mine, Nevada National Security Site (NNSS), Nevada. The Yucca Flat/Climax Mine CAU is located in the northeastern portion of the NNSS and comprises 720 corrective action sites. A total of 747 underground nuclear detonations took place within this CAU between 1957 and 1992 and resulted in the release of radionuclides (RNs) in the subsurface in the vicinity of the test cavities. The CADD portion describes the Yucca Flat/Climax Mine CAU data-collection and modeling activities completed during the corrective action investigation (CAI) stage, presents the corrective action objectives, and describes the actions recommended to meet the objectives. The CAP portion describes the corrective action implementation plan. The CAP presents CAU regulatory boundary objectives and initial use-restriction boundaries identified and negotiated by DOE and the Nevada Division of Environmental Protection (NDEP). The CAP also presents the model evaluation process designed to build confidence that the groundwater flow and contaminant transport modeling results can be used for the regulatory decisions required for CAU closure. The UGTA strategy assumes that active remediation of subsurface RN contamination is not feasible with current technology. As a result, the corrective action is based on a combination of characterization and modeling studies, monitoring, and institutional controls. The strategy is implemented through a four-stage approach that comprises the following: (1) corrective action investigation plan (CAIP), (2) CAI, (3) CADD/CAP, and (4) closure report (CR) stages.

  17. Closure Report for Corrective Action Unit 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada: Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2003-09-26

    This Closure Report (CR) presents information supporting a closure recommendation for Corrective Action Unit (CAU) 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada, in compliance with the requirements of the Federal Facility Agreement and Consent Order. This CAU contains six Corrective Action Sites (CASs): 12-25-04, UST 12-16-2 Waste Oil Release; 18-25-01, 18-25-02, 18-25-03, Oil Spills; 18-25-04, Spill (Diesel Fuel); and 29-44-01, Fuel Spill, located within Areas 12, 18, and 29 on the Nevada Test Site. The purpose of this CR is to provide documentation supporting recommendations of no further action or closure in place for CASs within CAU 394. Throughout late 2002 and early to mid 2003, closure activities were performed as set forth in the CAU 394 Streamlined Approach for Environmental Restoration Plan. The closure activities identified the nature and extent of contaminants of potential concern at the CASs, and provided sufficient information and data to complete appropriate corrective actions for the CASs. Soil in CASs 18-25-02 and 18-25-03 containing polychlorinated biphenyls exceeding the action levels established by the Nevada Administrative Code were removed for proper disposal. The soil remaining in these CASs containing petroleum hydrocarbons exceeding the action level were closed in place with use restrictions. Corrective Action Sites 18-25-04 required no further corrective action; closure in place is required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03, and 29-44-01; and use restrictions are required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03 and 29-44-01. In summary, no corrective action plan is required for CAU 394.

  18. Corrective Action Decision Document/Closure Report for Corrective Action Unit 545: Dumps, Waste Disposal Sites, and Buried Radioactive Materials Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Alfred Wickline

    2008-04-01

    This Corrective Action Decision Document (CADD)/Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 545, Dumps, Waste Disposal Sites, and Buried Radioactive Materials, in Areas 2, 3, 9, and 20 of the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management (1996, as amended February 2008). Corrective Action Unit 545 is comprised of the following eight Corrective Action Sites (CASs): • 02-09-01, Mud Disposal Area • 03-08-03, Mud Disposal Site • 03-17-01, Waste Consolidation Site 3B • 03-23-02, Waste Disposal Site • 03-23-05, Europium Disposal Site • 03-99-14, Radioactive Material Disposal Area • 09-23-02, U-9y Drilling Mud Disposal Crater • 20-19-01, Waste Disposal Site While all eight CASs are addressed in this CADD/CR, sufficient information was available for the following three CASs; therefore, a field investigation was not conducted at these sites: • For CAS 03-08-03, though the potential for subsidence of the craters was judged to be extremely unlikely, the data quality objective (DQO) meeting participants agreed that sufficient information existed about disposal and releases at the site and that a corrective action of close in place with a use restriction is recommended. Sampling in the craters was not considered necessary. • For CAS 03-23-02, there were no potential releases of hazardous or radioactive contaminants identified. Therefore, the Corrective Action Investigation Plan for CAU 545 concluded that: “Sufficient information exists to conclude that this CAS does not exist as originally identified. Therefore, there is no environmental concern associated with CAS 03-23-02.” This CAS is closed with no further action. • For CAS 03-23-05, existing information about the two buried sources and lead pig was considered to be

  19. Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States.

    Science.gov (United States)

    Zakrzewska, Joanna M; Wu, Ning; Lee, John Y K; Werneburg, Brian; Hoffman, Deborah; Liu, Ying

    2018-02-19

    Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN. Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year pre-index, with ≥3 years' follow-up post-index. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN. 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; mean[SD] age, 59 [15] years). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). Sixty-five percent of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN. In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps due to suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License

  20. Addendum 2 to the Streamlined Approach for Environmental Restoration Closure Report for Corrective Action Unit 454: Historical Underground Storage Tank Release Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2009-05-01

    This document constitutes an addendum to the Streamlined Approach for Environmental Restoration Closure Report for Corrective Action Unit 454: Historical Underground Storage Tank Release Sites, Nevada Test Site, Nevada, April 1998 as described in the document Supplemental Investigation Report for FFACO Use Restrictions, Nevada Test Site, Nevada (SIR) dated November 2008. The SIR document was approved by NDEP on December 5, 2008. The approval of the SIR document constituted approval of each of the recommended UR removals. In conformance with the SIR document, this addendum consists of: • This page that refers the reader to the SIR document for additional information • The cover, title, and signature pages of the SIR document • The NDEP approval letter • The corresponding section of the SIR document This addendum provides the documentation justifying the cancellation of the URs for CASs: • 12-25-08, Spill H950524F (from UST 12-B-1) • 12-25-10, Spill H950919A (from UST 12-COMM-1) These URs were established as part of Federal Facility Agreement and Consent Order (FFACO) corrective actions and were based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996). Since these URs were established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, these URs were re-evaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006). This re-evaluation consisted of comparing the original data (used to define the need for the URs) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove these URs because contamination is not present at these sites above the risk-based FALs. Requirements for inspecting and maintaining these URs will be

  1. Addendum to the Corrective Action Decision Document/Closure Report for Corrective Action Unit 321: Area 22 Weather Station Fuel Storage Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Lynn Kidman

    2008-10-01

    This document constitutes an addendum to the August 2001, Corrective Action Decision Document / Closure Report for Corrective Action Unit 321: Area 22 Weather Station Fuel Storage as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications. In conformance with the UR Modification document, this addendum consists of: • This cover page that refers the reader to the UR Modification document for additional information • The cover and signature pages of the UR Modification document • The NDEP approval letter • The corresponding section of the UR Modification document This addendum provides the documentation justifying the cancellation of the UR for CAS 22-99-05, Fuel Storage Area. This UR was established as part of a Federal Facility Agreement and Consent Order (FFACO) corrective action and is based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996; as amended August 2006). Since this UR was established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, this UR was re-evaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006c). This re-evaluation consisted of comparing the original data (used to define the need for the UR) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove the UR because

  2. Addendum to the Streamlined Approach for Environmental Restoration Closure Report for Corrective Action Unit 452: Historical Underground Storage Tank Release Sites, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Grant Evenson

    2009-05-01

    This document constitutes an addendum to the Streamlined Approach for Environmental Restoration Closure Report for Corrective Action Unit 452: Historical Underground Storage Tank Release Sites, Nevada Test Site, Nevada, April 1998 as described in the document Supplemental Investigation Report for FFACO Use Restrictions, Nevada Test Site, Nevada (SIR) dated November 2008. The SIR document was approved by NDEP on December 5, 2008. The approval of the SIR document constituted approval of each of the recommended UR removals. In conformance with the SIR document, this addendum consists of: • This page that refers the reader to the SIR document for additional information • The cover, title, and signature pages of the SIR document • The NDEP approval letter • The corresponding section of the SIR document This addendum provides the documentation justifying the cancellation of the URs for CASs: • 25-25-09, Spill H940825C (from UST 25-3101-1) • 25-25-14, Spill H940314E (from UST 25-3102-3) • 25-25-15, Spill H941020E (from UST 25-3152-1) These URs were established as part of Federal Facility Agreement and Consent Order (FFACO) corrective actions and were based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996). Since these URs were established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, these URs were re-evaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006). This re-evaluation consisted of comparing the original data (used to define the need for the URs) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove these URs because contamination is not present at these sites above the risk-based FALs

  3. Corrective Action Decision Document/Corrective Action Plan for Corrective Action Unit 413: Clean Slate II Plutonium Dispersion (TTR) Tonopah Test Range, Nevada. Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro, Las Vegas, NV (United States)

    2017-05-01

    This Corrective Action Decision Document/Corrective Action Plan provides the rationale and supporting information for the selection and implementation of corrective actions at Corrective Action Unit (CAU) 413, Clean Slate II Plutonium Dispersion (TTR). CAU 413 is located on the Tonopah Test Range and includes one corrective action site, TA-23-02CS. CAU 413 consists of the release of radionuclides to the surface and shallow subsurface from the Clean Slate II (CSII) storage–transportation test conducted on May 31, 1963. The CSII test was a non-nuclear detonation of a nuclear device located inside a concrete bunker covered with 2 feet of soil. To facilitate site investigation and the evaluation of data quality objectives decisions, the releases at CAU 413 were divided into seven study groups: 1 Undisturbed Areas 2 Disturbed Areas 3 Sedimentation Areas 4 Former Staging Area 5 Buried Debris 6 Potential Source Material 7 Soil Mounds Corrective action investigation (CAI) activities, as set forth in the CAU 413 Corrective Action Investigation Plan, were performed from June 2015 through May 2016. Radionuclides detected in samples collected during the CAI were used to estimate total effective dose using the Construction Worker exposure scenario. Corrective action was required for areas where total effective dose exceeded, or was assumed to exceed, the radiological final action level (FAL) of 25 millirem per year. The results of the CAI and the assumptions made in the data quality objectives resulted in the following conclusions: The FAL is exceeded in surface soil in SG1, Undisturbed Areas; The FAL is assumed to be exceeded in SG5, Buried Debris, where contaminated debris and soil were buried after the CSII test; The FAL is not exceeded at SG2, SG3, SG4, SG6, or SG7. Because the FAL is exceeded at CAU 413, corrective action is required and corrective action alternatives (CAAs) must be evaluated. For CAU 413, three CAAs were evaluated: no further action, clean closure, and

  4. Revised Backbone-Virtual-Bond-Angle Potentials to Treat the l- and d-Amino Acid Residues in the Coarse-Grained United Residue (UNRES) Force Field.

    Science.gov (United States)

    Sieradzan, Adam K; Niadzvedtski, Andrei; Scheraga, Harold A; Liwo, Adam

    2014-05-13

    Continuing our effort to introduce d-amino-acid residues in the united residue (UNRES) force field developed in our laboratory, in this work the C α ··· C α ··· C α backbone-virtual-bond-valence-angle (θ) potentials for systems containing d-amino-acid residues have been developed. The potentials were determined by integrating the combined energy surfaces of all possible triplets of terminally blocked glycine, alanine, and proline obtained with ab initio molecular quantum mechanics at the MP2/6-31G(d,p) level to calculate the corresponding potentials of mean force (PMFs). Subsequently, analytical expressions were fitted to the PMFs to give the virtual-bond-valence potentials to be used in UNRES. Alanine represented all types of amino-acid residues except glycine and proline. The blocking groups were either the N -acetyl and N ', N '-dimethyl or N -acetyl and pyrrolidyl group, depending on whether the residue next in sequence was an alanine-type or a proline residue. A total of 126 potentials (63 symmetry-unrelated potentials for each set of terminally blocking groups) were determined. Together with the torsional, double-torsional, and side-chain-rotamer potentials for polypeptide chains containing d-amino-acid residues determined in our earlier work (Sieradzan et al. J. Chem. Theory Comput. , 2012 , 8, 4746), the new virtual-bond-angle (θ) potentials now constitute the complete set of physics-based potentials with which to run coarse-grained simulations of systems containing d-amino-acid residues. The ability of the extended UNRES force field to reproduce thermodynamics of polypeptide systems with d-amino-acid residues was tested by comparing the experimentally measured and the calculated free energies of helix formation of model KLALKLALxxLKLALKLA peptides, where x denotes any d- or l- amino-acid residue. The obtained results demonstrate that the UNRES force field with the new potentials reproduce the changes of free energies of helix formation upon d

  5. Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions.

    Science.gov (United States)

    Levine, Alexander R; Meyer, Matthew J; Bittner, Edward A; Berg, Sheri; Kalman, Rebecca; Stanislaus, Anne B; Ryan, Cheryl; Ball, Stephanie A; Eikermann, Matthias

    2013-10-01

    Persistent low-level hypotension represents a barrier to discharging patients from the intensive care unit (ICU). Midodrine may be an effective adjunct to wean intravenous (IV) vasopressors and permit ICU discharge. We tested the hypothesis that midodrine, given to patients on IV vasopressors who otherwise met ICU discharge criteria, increased the magnitude of change in IV vasopressor rate. This was a prospective, observational study in 20 adult surgical ICU patients who met ICU discharge criteria except for an IV vasopressor requirement. We compared the change in phenylephrine equivalent rates during the day before midodrine to the change in phenylephrine equivalent rates after midodrine initiation and analyzed changes in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count during this period. Patients received 41.0±33.4 μg/min of phenylephrine equivalents and the change in IV vasopressor rate (slope) decreased significantly from -0.62 μg/min per hour of phenylephrine equivalents before midodrine to -2.20 μg/min per hour following the initiation of midodrine treatment (P=.012). Change in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count did not correlate with change in IV vasopressor rate. Midodrine treatment was associated with an increase in the magnitude of decline of the IV vasopressor rate. Oral midodrine may facilitate liberation of surgical ICU patients from an IV vasopressor infusion, and this may affect discharge readiness of patients from the ICU. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-07-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 544, Cellars, Mud Pits, and Oil Spills, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 544 comprises the following 20 corrective action sites (CASs) located in Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada Test Site (NTS): • 02-37-08, Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mud Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills This plan provides the methodology for field activities needed to gather the necessary information for closing each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 544 using the SAFER process. Using the approach approved for previous mud pit investigations (CAUs 530–535), 14 mud pits have been identified that • are either a single mud pit or a system of mud pits, • are not located in a radiologically posted area, and • have no evident biasing factors based on visual inspections. These 14 mud pits are recommended for no further action (NFA), and further field investigations will not be conducted. For the sites that do not meet the previously approved closure criteria, additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible

  7. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 356: Mud Pits and Disposal Sites, Nevada Test Site, Nevada (Revision No. 0, August 2001); FINAL

    International Nuclear Information System (INIS)

    2001-01-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions necessary for the characterization and closure of Corrective Action Unit (CAU) 356, Mud Pits and Disposal Sites, as identified in the Federal Facility Agreement and Consent Order (FFACO). The CAU, located on the Nevada Test Site in Nevada, consists of seven Corrective Action Sites (CASs): CAS 03-04-01, Area 3 Change House Septic System; CAS 03-09-01, Mud Pit Spill Over; CAS 03-09-03, Mud Pit; CAS 03-09-04, Mud Pit; CAS 03-09-05, Mud Pit; CAS 20-16-01, Landfill; CAS 20-22-21, Drums. Sufficient information and process knowledge from historical documentation and investigations are the basis for the development of the phased approach chosen to address the data collection activities prior to implementing the preferred closure alternative for each CAS. The Phase I investigation will determine through collection of environmental samples from targeted populations (i.e., mud/soil cuttings above textural discontinuity) if contaminants of potential concern (COPCs) are present in concentrations exceeding preliminary action levels (PALs) at each of the CASs. If COPCs are present above PALs, a Phase II investigation will be implemented to determine the extent of contamination to support the appropriate corrective action alternative to complete closure of the site. Groundwater impacts from potentially migrating contaminants are not expected due to the depths to groundwater and limiting hydrologic drivers of low precipitation and high evaporation rates. Future land-use scenarios limit future uses to industrial activities; therefore, future residential uses are not considered. Potential exposure routes to site workers from contaminants of concern in septage and soils include oral ingestion, inhalation, or dermal contact (absorption) through in-advertent disturbance of contaminated structures and/or soils. Diesel within drilling muds is expected to be the primary COPC based on process

  8. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 539: Area 25 and Area 26 Railroad Tracks, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-06-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 539, Areas 25 and 26 Railroad Tracks, as identified in the Federal Facility Agreement and Consent Order (FFACO). A modification to the FFACOwas approved in May 2010 to transfer the two Railroad Tracks corrective action sites (CASs) from CAU 114 into CAU539. The two CASs are located in Areas 25 and 26 of the Nevada Test Site: • 25-99-21, Area 25 Railroad Tracks • 26-99-05, Area 26 Railroad Tracks This plan provides the methodology for field activities needed to gather the necessary information for closing the two CASs. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of the CAU 539 Railroad Tracks CASs using the SAFER process. Additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. The results of the field investigation should support a defensible recommendation that no further corrective action is necessary. If it is determined that complete clean closure cannot be accomplished during the SAFER, then a hold point will have been reached and the Nevada Division of Environmental Protection (NDEP) will be consulted to determine whether the remaining contamination will be closed under the alternative corrective action of closure in place with use restrictions. This will be presented in a closure report that will be prepared and submitted to the NDEP for review and approval. The sites will be investigated based on the data quality objectives (DQOs) developed on December 14, 2009, by representatives of U.S.Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Navarro Nevada Environmental Services, LLC (NNES); and National Security Technologies

  9. Addendum to the Closure Report for Corrective Action Unit 404: Roller Coaster Sewage Lagoons and North Disposal Trench, Tonopah Test Range, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Lynn Kidman

    2009-02-01

    This document constitutes an addendum to the September 1998, Closure Report for Corrective Action Unit 404: Roller Coaster Lagoons and Trench, Tonopah Test Range, Nevada as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications. In conformance with the UR Modification document, this addendum consists of: • This cover page that refers the reader to the UR Modification document for additional information • The cover and signature pages of the UR Modification document • The NDEP approval letter • The corresponding section of the UR Modification document This addendum provides the documentation justifying the modification of the UR for CAS TA-03-001-TARC Roller Coaster Lagoons. This UR was established as part of Federal Facility Agreement and Consent Order (FFACO) corrective actions and was based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996; as amended August 2006). Since this UR was established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, this UR was re-evaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006c). This reevaluation consisted of comparing the original data (used to define the need for the UR) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to modify the UR for CAS TA-03

  10. Corrective Action Investigation Plan for Corrective Action Unit 567: Miscellaneous Soil Sites, Nevada National Security Site, Nevada, with ROTC 1 Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick K.

    2013-07-01

    Corrective Action Unit (CAU) 567 is located in Areas 1, 3, 5, 20, and 25 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. CAU 567 is a grouping of sites where there has been a suspected release of contamination associated with nuclear testing. This document describes the planned investigation of CAU 567, which comprises the following corrective action sites (CASs): • 01-23-03, Atmospheric Test Site T-1 • 03-23-25, Seaweed E Contamination Area • 05-23-07, A5b RMA • 20-23-08, Colby Mud Spill • 25-23-23, J-11 Soil RMA These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the investigation report. The sites will be investigated based on the data quality objectives (DQOs) developed on May 6, 2013, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 567. The site investigation process will also be conducted in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices to be applied to this activity. The potential contamination sources associated with CAU 567 releases are nuclear test operations and other NNSS operations. The DQO process resulted in an assumption that total effective dose (TED) within a default contamination boundary

  11. Corrective Action Decision Document/Corrective Action Plan for Corrective Action Unit 547: Miscellaneous Contaminated Waste Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2011-09-01

    The purpose of this CADD/CAP is to present the corrective action alternatives (CAAs) evaluated for CAU 547, provide justification for selection of the recommended alternative, and describe the plan for implementing the selected alternative. Corrective Action Unit 547 consists of the following three corrective action sites (CASs): (1) CAS 02-37-02, Gas Sampling Assembly; (2) CAS 03-99-19, Gas Sampling Assembly; and(3) CAS 09-99-06, Gas Sampling Assembly. The gas sampling assemblies consist of inactive process piping, equipment, and instrumentation that were left in place after completion of underground safety experiments. The purpose of these safety experiments was to confirm that a nuclear explosion would not occur in the case of an accidental detonation of the high-explosive component of the device. The gas sampling assemblies allowed for the direct sampling of the gases and particulates produced by the safety experiments. Corrective Action Site 02-37-02 is located in Area 2 of the Nevada National Security Site (NNSS) and is associated with the Mullet safety experiment conducted in emplacement borehole U2ag on October 17, 1963. Corrective Action Site 03-99-19 is located in Area 3 of the NNSS and is associated with the Tejon safety experiment conducted in emplacement borehole U3cg on May 17, 1963. Corrective Action Site 09-99-06 is located in Area 9 of the NNSS and is associated with the Player safety experiment conducted in emplacement borehole U9cc on August 27, 1964. The CAU 547 CASs were investigated in accordance with the data quality objectives (DQOs) developed by representatives of the Nevada Division of Environmental Protection (NDEP) and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for CAU 547. Existing radiological survey data and historical knowledge of

  12. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 356: Mud Pits and Disposal Sites, Nevada Test Site, Nevada (Revision No. 0, August 2001)

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office (NNSA/NV)

    2001-08-21

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions necessary for the characterization and closure of Corrective Action Unit (CAU) 356, Mud Pits and Disposal Sites, as identified in the Federal Facility Agreement and Consent Order (FFACO). The CAU, located on the Nevada Test Site in Nevada, consists of seven Corrective Action Sites (CASs): CAS 03-04-01, Area 3 Change House Septic System; CAS 03-09-01, Mud Pit Spill Over; CAS 03-09-03, Mud Pit; CAS 03-09-04, Mud Pit; CAS 03-09-05, Mud Pit; CAS 20-16-01, Landfill; CAS 20-22-21, Drums. Sufficient information and process knowledge from historical documentation and investigations are the basis for the development of the phased approach chosen to address the data collection activities prior to implementing the preferred closure alternative for each CAS. The Phase I investigation will determine through collection of environmental samples from targeted populations (i.e., mud/soil cuttings above textural discontinuity) if contaminants of potential concern (COPCs) are present in concentrations exceeding preliminary action levels (PALs) at each of the CASs. If COPCs are present above PALs, a Phase II investigation will be implemented to determine the extent of contamination to support the appropriate corrective action alternative to complete closure of the site. Groundwater impacts from potentially migrating contaminants are not expected due to the depths to groundwater and limiting hydrologic drivers of low precipitation and high evaporation rates. Future land-use scenarios limit future uses to industrial activities; therefore, future residential uses are not considered. Potential exposure routes to site workers from contaminants of concern in septage and soils include oral ingestion, inhalation, or dermal contact (absorption) through in-advertent disturbance of contaminated structures and/or soils. Diesel within drilling muds is expected to be the primary COPC based on process

  13. Corrective Action Investigation Plan for Corrective Action Unit 366: Area 11 Plutonium Valley Dispersion Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2011-09-01

    Corrective Action Unit 366 comprises the six corrective action sites (CASs) listed below: (1) 11-08-01, Contaminated Waste Dump No.1; (2) 11-08-02, Contaminated Waste Dump No.2; (3) 11-23-01, Radioactively Contaminated Area A; (4) 11-23-02, Radioactively Contaminated Area B; (5) 11-23-03, Radioactively Contaminated Area C; and (6) 11-23-04, Radioactively Contaminated Area D. These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed July 6, 2011, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 366. The presence and nature of contamination at CAU 366 will be evaluated based on information collected from a field investigation. Radiological contamination will be evaluated based on a comparison of the total effective dose (TED) at sample locations to the dose-based final action level (FAL). The TED will be calculated by summing the estimates of internal and external dose. Results from the analysis of soil samples collected from sample plots will be used to calculate internal radiological dose. Thermoluminescent dosimeters placed at each sample location will be used to measure external radiological dose. Based on historical documentation of the releases

  14. Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Patrick Matthews

    2012-09-01

    Corrective Action Unit (CAU) 105 is located in Area 2 of the Nevada National Security Site, which is approximately 65 miles northwest of Las Vegas, Nevada. CAU 105 is a geographical grouping of sites where there has been a suspected release of contamination associated with atmospheric nuclear testing. This document describes the planned investigation of CAU 105, which comprises the following corrective action sites (CASs): • 02-23-04, Atmospheric Test Site - Whitney • 02-23-05, Atmospheric Test Site T-2A • 02-23-06, Atmospheric Test Site T-2B • 02-23-08, Atmospheric Test Site T-2 • 02-23-09, Atmospheric Test Site - Turk These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives (CAAs). Additional information will be obtained by conducting a corrective action investigation before evaluating CAAs and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable CAAs that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on April 30, 2012, by representatives of the Nevada Division of Environmental Protection and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 105. The site investigation process will also be conducted in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices to be applied to this activity. The potential contamination sources associated with all CAU 105 CASs are from atmospheric nuclear testing activities. The presence and nature of contamination at CAU

  15. Firewater Storage, Treatment, Recycling and Management: New Perspectives Based on Experiences from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Miklas Scholz

    2014-02-01

    Full Text Available Smart firewater management and recycling helps reduce water use and protect the environment from pollution. However, contamination of recycled water may pose a health risk to fire fighters. This review assesses international literature to identify best practices, and to recommend new technologies and methods on firewater management and recycling. The literature assessment indicates that this is a new research area where insufficient findings have been published in Web of Science-referenced journals. Therefore, informally published materials (a.k.a. grey literature were also assessed. Findings indicate the need for practical decision support tools to estimate consumption rates, predict “bottlenecks” and bund capacity, assess water quality and determine pump requirements. This article recommends that cost-efficient and rapid on-site treatment methods, such as compact and mobile filtration units for firewater recycling should be researched in the future. The filters should be based on compartments with different media. The empty pore space should decrease from inflow to outflow. A light plastic media should be positioned near the inflow to retain large particles, such as a grid. Activated carbon media could be placed near the outlet to remove fine suspended solids and dissolved contaminants. This should address concerns by fire fighters dealing with contaminated water, spray and foam.

  16. Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit.

    Science.gov (United States)

    Lamb, Lucy Em; Cox, A T; Fletcher, T; McCourt, A L

    2017-02-01

    This paper describes the development of the UK military's Ebola Virus Disease Treatment Unit (EVD TU) that was deployed to Sierra Leone as part of the UK response to the West African Ebola virus disease (EVD) epidemic in 2014 and 2015. It highlights specific challenges faced within this unique Field Hospital environment. The military EVD TU was initially established to provide confidence to international healthcare workers coming to Sierra Leone to assist in the international response to the EVD epidemic and formed a key part of the action plan by the UK's Department for International Development. It was designed and staffed to provide a high level of care to those admitted with suspected or confirmed EVD and was prepared to admit the first patient within 6 weeks of the original activation order by the Ministry of Defence. This article outlines the main hazards perceived at the outset of the operation and the methods used to mitigate the risk to the healthcare workers at the EVD TU. The article examines the mechanisms that enabled the hospital to respond positively to challenges that emerged during the deployment, while simultaneously reducing the risk to the healthcare workers involved in care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    Science.gov (United States)

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia. © 2014 John Wiley & Sons Ltd.

  18. Responding to secondary traumatic stress: a pilot study of torture treatment programs in the United States.

    Science.gov (United States)

    Akinsulure-Smith, Adeyinka M; Keatley, Eva; Rasmussen, Andrew

    2012-04-01

    Providers who care for torture survivors may be at risk for secondary traumatic stress, yet there has been little documentation of the effects of repeated exposure to traumatic issues on their emotional health or exploration of the support systems and resources available to address their emotional needs. This study assessed the secondary stress experiences of service providers (N = 43) within the National Consortium of Torture Treatment Programs in the United States and examined the supports offered by their organizations. The study found a significant correlation between rates of anxiety and depression among providers, r(34) = .49, p = .003. Although these participants reported that their work with survivors of torture was stressful, 91% indicated that their organizations offered a variety of stress-reduction activities. Overall, participants reported that their own personal activities were the most-effective stress reducers. The results are discussed in light of challenges that professionals who work with this population face and the effectiveness of support systems available to support their work. Copyright © 2012 International Society for Traumatic Stress Studies.

  19. Dose in sensitive organs during the prostate treatment with a 60Co unit

    International Nuclear Information System (INIS)

    Vega C, H. R.; Navarro B, J. A.; Perez A, M. L.; Perez L, L. H.

    2012-10-01

    The absorbed dose by the bladder, the rectum and the gland thyroid was measured during a treatment applied for prostate cancer by means of a Cobalt 60 unit. The dose was measured using thermoluminescent dosimeters of the type TLD 100, with the values of the absorbed the values of the effective dose were calculated and was determined the probability of the development of a secondary cancer. Because these measurements cannot be made -in vivo- a phantom or mannequin was built with water that represents the hip and part of the torso of the human body and to represent the neck was used polyethylene. The study was carried out in the Instituto Zacatecano del Tumor that has a -cobalt bomb- which is used to treat oncology patients, during the phantom irradiation a dose of 200 c Gy was applied of this dose the bladder received 96.7%, the rectum 100.8% and the gland thyroid 0.3%. The dose received by the rectum and the bladder is due to the therapeutic beam while the dose received by the thyroid is due to the dispersed radiation by the phantom. The probability that in these organs a new neoplasm is developed is of 0.033% for the bladder, 0.157% for the rectum and 7.8 x 10 -5 % for the thyroid case. (Author)

  20. Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

    Directory of Open Access Journals (Sweden)

    Michele Stornello

    2013-04-01

    Full Text Available Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

  1. State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation.

    Science.gov (United States)

    Wen, Hefei; Cummings, Janet R; Hockenberry, Jason M; Gaydos, Laura M; Druss, Benjamin G

    2013-12-01

    The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. State-level SUD parity laws during the study period. State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. The implementation of any SUD parity law increased the treatment rate by 9% (P legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.

  2. Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

    OpenAIRE

    Bhattacharjee, Sandipan; Goldstone, Lisa; Ip, Queeny; Warholak, Terri

    2017-01-01

    Background. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). Objectives. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. Methods. A cross-sectional study was conducted by pooling multiple years (2005–2011) of National Ambulatory Medical Care Survey and the outpa...

  3. Corrective Action Decision Document/Closure Report for Corrective Action Unit 561: Waste Disposal Areas, Nevada National Security Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Krauss, Mark

    2011-01-01

    and counterweights (PSM) have been removed, and the COCs of arsenic and PCBs in soil have been removed; (4) No further corrective action at CAS 25-08-02, as the COC of arsenic in soil has been removed, and the lead-acid batteries have been removed; (5) No further corrective action at CAS 25-23-21, as the COCs of Cs-137 and PCBs in soil have been removed, and the cast-iron pipes have been removed and disposed of; (6) No further corrective action at CAS 25-25-19, as the lead bricks (PSM) been removed; (7) A Notice of Completion to the NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 561; and (8) Corrective Action Unit 561 should be moved from Appendix III to Appendix IV of the FFACO.

  4. Corrective Action Decision Document/Closure Report for Corrective Action Unit 561: Waste Disposal Areas, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2011-08-01

    and counterweights (PSM) have been removed, and the COCs of arsenic and PCBs in soil have been removed; (4) No further corrective action at CAS 25-08-02, as the COC of arsenic in soil has been removed, and the lead-acid batteries have been removed; (5) No further corrective action at CAS 25-23-21, as the COCs of Cs-137 and PCBs in soil have been removed, and the cast-iron pipes have been removed and disposed of; (6) No further corrective action at CAS 25-25-19, as the lead bricks (PSM) been removed; (7) A Notice of Completion to the NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 561; and (8) Corrective Action Unit 561 should be moved from Appendix III to Appendix IV of the FFACO.

  5. Processes for CO2 capture. Context of thermal waste treatment units. State of the art. Extended abstract

    International Nuclear Information System (INIS)

    Lopez, A.; Roizard, D.; Favre, E.; Dufour, A.

    2013-01-01

    For most of industrial sectors, Greenhouse Gases (GHG) such as carbon dioxide (CO 2 ) are considered as serious pollutants and have to be controlled and treated. The thermal waste treatment units are part of industrial CO 2 emitters, even if they represent a small part of emissions (2,5 % of GHG emissions in France) compared to power plants (13 % of GHG emissions in France, one third of worldwide GHG emissions) or shaper industries (20 % of GHG emissions in France). Carbon Capture and Storage (CCS) can be a solution to reduce CO 2 emissions from industries (power plants, steel and cement industries...). The issues of CCS applied to thermal waste treatment units are quite similar to those related to power plants (CO 2 flow, flue gas temperature and pressure conditions). The problem is to know if the CO 2 produced by waste treatment plants can be captured thanks to the processes already available on the market or that should be available by 2020. It seems technically possible to adapt CCS post-combustion methods to the waste treatment sector. But on the whole, CCS is complex and costly for a waste treatment unit offering small economies of scale. However, regulations concerning impurities for CO 2 transport and storage are not clearly defined at the moment. Consequently, specific studies must be achieved in order to check the technical feasibility of CCS in waste treatment context and clearly define its cost. (authors)

  6. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Science.gov (United States)

    2010-03-01

    ... Medical Care and Treatment Furnished by the United States; Delegation of Authority AGENCY: Department of... responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the... furnishing of hospital, medical, surgical, or dental care. During the intervening period, the cost of medical...

  7. An Analysis of the Treatment of Corporate Influence on Government by United States History and American Government High School Textbooks

    Science.gov (United States)

    Neumann, Richard

    2014-01-01

    This article reports on an investigation to explore the possibility that ideology might be expressed in the treatment of corporate influence on federal government by social studies textbooks. Two textbooks were examined in the study--United States history and American government. Corporate influence involves activities that affect election and…

  8. Supply of essential drugs in units specialized in the treatment of chronic diseases in Mexico in 2012

    Directory of Open Access Journals (Sweden)

    David Contreras-Loya

    2013-11-01

    Full Text Available Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.

  9. Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States.

    Science.gov (United States)

    Kerridge, Bradley T; Mauro, Pia M; Chou, S Patricia; Saha, Tulshi D; Pickering, Roger P; Fan, Amy Z; Grant, Bridget F; Hasin, Deborah S

    2017-12-01

    To present information on predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime DSM-5 cannabis use disorder (CUD). Face-to-face survey of a representative sample of the adult US general population (n=36,309). Treatment rates for CUD were low in this general population survey (13.7%). Severity of CUD and comorbidity of other lifetime drug use disorders were significant predictors of lifetime treatment utilization for CUD. Preference for self-reliance, minimizing problems, fear of stigma, and financial and structural issues were among the most frequently endorsed reasons for respondents not seeking treatment when they perceived the need for treatment among individuals with lifetime CUD, regardless of whether they eventually utilized treatment at some time in their lives. Given the rising prevalence of CUD in the US over the past decade and currently low treatment rates for CUD, increased provision for services for CUD appears critically needed, especially those that screen for and treat, when present, other drug use disorders. Programs to reduce stigma and financial barriers are needed, as well as programs to increase awareness among the general public, health care professionals about the nature and seriousness of CUD, and the availability and effectiveness of treatment for this disorder. Copyright © 2017. Published by Elsevier B.V.

  10. Study of technical and economical feasibility for implementation of a movable unit for treatment of industrial effluents with electron beam

    International Nuclear Information System (INIS)

    Rela, Carolina Sciamarelli

    2006-01-01

    The treatment of industrial effluents is a practice that is disseminating in accelerated rhythm, of contributing to reinforce the public image, through the combat of the pollution, it brings economical advantages allowing the companies the reuse of the treated water in their own processes. The liquid effluent treatment technique studied in the present work is the one that uses the chemical oxidation/reduction standing out the use of the electron beam (e.b.) radiation. This technique uses an advanced oxidation process, generating radicals highly reagents that provoke the oxidation, reduction, dissociation and degradation in composed organic and exercising lethal effect in general in the microorganisms and parasites. In this work a conceptual and basic project of a movable unit of effluents treatment using electron beam radiation process was developed, in order that the unit moves until the treatment point, where the effluent is produced, facilitating the logistics. A technical and economical feasibility study was also elaborated allowing data on the capacity and cost of effluents processing to consolidate the values of the necessary investments to be presented to foundations organs for the construction of a movable unit. The results of the studies demonstrated that it is technically viable attending the pertinent legislation of Brazil, in the aspects of Radiation Protection and transport limit capacity. The unitary cost of the e.b. radiation processing in the movable unit was shown more expensive than in the fixed unit, the reason is the decrease of the efficiency of the interaction of the incident electrons in the effluent, due to the reduction of electron energy operation time of the unit. (author)

  11. Treatment of Young People With Antipsychotic Medications in the United States.

    Science.gov (United States)

    Olfson, Mark; King, Marissa; Schoenbaum, Michael

    2015-09-01

    Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States. To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex. A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765,829), 2008 (n = 858,216), and 2010 (n = 851,874), including a subset from calendar year 2009 with service claims data (n = 53,896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined. The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of

  12. Surface interactions between nanoscale iron and organic material: Potential uses in water treatment process units

    Science.gov (United States)

    Storms, Max

    Membrane systems are among the primary emergent technologies in water treatment process units due to their ease of use, small physical footprint, and high physical rejection. Membrane fouling, the phenomena by which membranes become clogged or generally soiled, is an inhibitor to optimal efficiency in membrane systems. Novel, composite, and modified surface materials must be investigated to determine their efficacy in improving fouling behavior. Ceramic membranes derived from iron oxide nanoparticles called ferroxanes were coated with a superhydrophillic, zwitterionic polymer called poly (sulfobetaine methacrylate) (polySBMA) to form a composite ceramic-polymeric membrane. Membrane samples with and without polySBMA coating were subjected to fouling with a bovine serum albumin solution and fouling was observed by measuring permeate flux at 10 mL intervals. Loss of polySBMA was measured using total organic carbon analysis, and membrane samples were characterized using x-ray diffraction, scanning electron microscopy, and optical profilometry. The coated membrane samples decreased initial fouling rate by 27% and secondary fouling rate by 24%. Similarly, they displayed a 30% decrease in irreversible fouling during the initial fouling stage, and a 27% decrease in irreversible fouling in the secondary fouling stage; however, retention of polySBMA sufficient for improved performance was not conclusive. The addition of chemical disinfectants into drinking water treatment processes results in the formation of compounds called disinfection by-products (DBPs). The formation of DBPs occurs when common chemical disinfectants (i.e. chlorine) react with organic material. The harmful effects of DBP exposure require that they be monitored and controlled for public safety. This work investigated the ability of nanostructured hematite derived from ferroxane nanoparticles to remove organic precursors to DBPs in the form of humic acid via adsorption processes. The results show that p

  13. Corrective Action Decision Document/Closure Report for Corrective Action Unit 374: Area 20 Schooner Unit Crater, Nevada National Security Site, Nevada with ROTC 1 and 2, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick

    2011-07-01

    Corrective Action Unit 374 comprises five corrective action sites (CASs): • 18-22-05, Drum • 18-22-06, Drums (20) • 18-22-08, Drum • 18-23-01, Danny Boy Contamination Area • 20-45-03, U-20u Crater (Schooner) The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 374 based on the implementation of corrective actions. The corrective action of closure in place with administrative controls was implemented at CASs 18-23-01 and 20-45-03, and a corrective action of removing potential source material (PSM) was conducted at CAS 20-45-03. The other CASs require no further action; however, best management practices of removing PSM and drums at CAS 18-22-06, and removing drums at CAS 18-22-08 were performed. Corrective action investigation (CAI) activities were performed from May 4 through October 6, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 374: Area 20 Schooner Unit Crater, Nevada Test Site, Nevada. The approach for the CAI was divided into two facets: investigating the primary release of radionuclides and investigating other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 374 dataset of investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. Radiological doses exceeding the FAL of 25 millirem per year were found to be present in the surface soil that was sampled. It is assumed that radionuclide levels present in subsurface media within the craters and ejecta fields (default contamination boundaries) at the Danny Boy and

  14. Revision of migrated pelvic acetabular components in THA with or without vascular involvement

    Directory of Open Access Journals (Sweden)

    Ștefan Cristea

    2016-05-01

    Full Text Available Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8 total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4 of these cases. Two (2 cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views, CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6 units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

  15. Developing an efficient scheduling template of a chemotherapy treatment unit: A case study.

    Science.gov (United States)

    Ahmed, Z; Elmekkawy, Ty; Bates, S

    2011-01-01

    This study was undertaken to improve the performance of a Chemotherapy Treatment Unit by increasing the throughput and reducing the average patient's waiting time. In order to achieve this objective, a scheduling template has been built. The scheduling template is a simple tool that can be used to schedule patients' arrival to the clinic. A simulation model of this system was built and several scenarios, that target match the arrival pattern of the patients and resources availability, were designed and evaluated. After performing detailed analysis, one scenario provide the best system's performance. A scheduling template has been developed based on this scenario. After implementing the new scheduling template, 22.5% more patients can be served. 1. CancerCare Manitoba is a provincially mandated cancer care agency. It is dedicated to provide quality care to those who have been diagnosed and are living with cancer. MacCharles Chemotherapy unit is specially built to provide chemotherapy treatment to the cancer patients of Winnipeg. In order to maintain an excellent service, it tries to ensure that patients get their treatment in a timely manner. It is challenging to maintain that goal because of the lack of a proper roster, the workload distribution and inefficient resource allotment. In order to maintain the satisfaction of the patients and the healthcare providers, by serving the maximum number of patients in a timely manner, it is necessary to develop an efficient scheduling template that matches the required demand with the availability of resources. This goal can be reached using simulation modelling. Simulation has proven to be an excellent modelling tool. It can be defined as building computer models that represent real world or hypothetical systems, and hence experimenting with these models to study system behaviour under different scenarios.1, 2 A study was undertaken at the Children's Hospital of Eastern Ontario to identify the issues behind the long waiting

  16. Short-term effects of fuel reduction treatments on herpetofauna from the southeastern United States

    Science.gov (United States)

    Eran S. Kilpatrick; Thomas A. Waldrop; Joseph D. Lanham; Cathryn H. Greenberg; Tom H. Contreras

    2010-01-01

    Path analysis of fuel reduction treatments on herpetofauna across four southeastern sites of the National Fire and Fire Surrogate Study provided quantitative evidence relating changes in vegetation and fuels to herpetofauna response. Fuel reduction treatments included prescribed burning (B), a mechanical treatment (M), mechanical treatment followed by prescribed...

  17. Emergency War Surgery: Third United States Revision

    Science.gov (United States)

    2004-01-01

    mobilization. ◊ Psoas hitch (Fig. 18-4). ◊ Boare flap. 18.7 Genitourinary Tract Injuries Fig. 18-4. The psoas hitch. a b Fig. 18-5. Ureteroureterostomy...the fascial covering of the psoas muscle using permanent suture such as 2.0 or 3.0 Prolene. A transverse cystotomy assists in elongating the bladder...available) should be done to evaluate the technical adequacy of the repair, visualize the runoff, and detect any missed distal clot. ο Full strength

  18. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

    Science.gov (United States)

    DiGiulio, Anne; Jump, Zach; Yu, Annie; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Yembra, Debbie; Armour, Brian S

    2018-04-06

    Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications † in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).

  19. Upgrading of Alum Preparation and Dosing Unit for Sharq Dijla Water Treatment Plant by Using Programmable Logic Controller System

    Directory of Open Access Journals (Sweden)

    Aumar Al-Nakeeb

    2018-02-01

    Full Text Available One of the important units in Sharq Dijla Water Treatment Plant (WTP first and second extensions are the alum solution preparation and dosing unit. The existing operation of this unit accomplished manually starting from unloading the powder alum in the preparation basin and ending by controlling the alum dosage addition through the dosing pumps to the flash mix chambers. Because of the modern trend of monitoring and control the automatic operation of WTPs due to the great benefits that could be gain from optimum equipment operation, reducing the operating costs and human errors. This study deals with how to transform the conventional operation to an automatic monitoring and controlling system depending on a Programmable Logic Controller (PLC and online sensors for alum preparation and dosing unit in Sharq Dijla WTP. PLC system will receive, analyze transmitting data, compare them with preset points then automatically orders the operational equipment (such as pumps, valves, and mixers in a way that guarantees the safe and appropriate operation of the unit. As a result of Process and Instrumentation Diagrams (PID that were prepared in this study, these units can be fully operating and manage by using Supervisory Control and Data Acquisition (SCADA system.

  20. The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

    Science.gov (United States)

    Boone, M. Dustin; Massa, Jennifer; Mueller, Ariel; Jinadasa, Sayuri P; Lee, Joon; Kothari, Rishi; Scott, Daniel J.; Callahan, Julie; Celi, Leo Anthony; Hacker, Michele R.

    2016-01-01

    Purpose Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing. Methods Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episode(s) were categorized according to the staffing level, defined as high during weekday daytime (7am–7pm) and low during weekends or nighttime (7pm–7am). Results Patients with a hypotensive event on a weekend were less likely to be treated compared to those that occurred during the weekday daytime (p=0.02). No association between weekday daytime versus weekday nighttime staffing levels and treatment of hypotension was found (RR 1.02; 95% CI 0.98–1.07). Conclusion Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels. PMID:26975737

  1. The Treatment of the Architectural Unit above Openings of the Mamluk and Ottoman Facades in Cairo

    Directory of Open Access Journals (Sweden)

    Heba Mahmoud Saad Abdel Naby

    2014-09-01

    Full Text Available The facades of the Mamluk buildings have a common characteristic feature which is the use of lintels, nafis and relieving arches above doors and windows. The three elements together formed a unit with an important architectural function on the façades. This unit was also treated as a focal point of the façade. Therefore, it was richly decorated with floral and geometric decorations and was usually made of colored marble, joggles voussoirs or carved stones. As a result, that unit attracted the attention of pedestrians and added to the beauty of the façade. During the Ottoman period the same unit was used on facades, however, due to financial and political reasons, the materials used differed and the decorations became modest. Nonetheless, the decoration of the lintel, nafis and relieving arch managed to mark the Ottoman facades with a different identity.

  2. Neglected infections of poverty in Texas and the rest of the United States: management and treatment options.

    Science.gov (United States)

    Barry, M A; Bezek, S; Serpa, J A; Hotez, P J; Woc-Colburn, L

    2012-08-01

    In the poorest regions of the United States, especially along the Gulf Coast and in South Texas, are a group of endemic parasitic and related infections known as the neglected infections of poverty. Such infections are characterized by their chronicity, disabling features, and disproportionate impact on the estimated 46 million people who live below the U.S. poverty line. Today more Americans live in poverty than ever before in the half-century that the Census Bureau has been recording poverty rates. In association with that poverty, a group of major neglected infections of poverty have emerged in the United States. Here we describe the major neglected infections of poverty in the United States, with a brief overview of their significant epidemiological features, their links with poverty, and our approaches to their diagnosis, management, and treatment.

  3. Psychological Distress among Ebola Survivors Discharged from an Ebola Treatment Unit in Monrovia, Liberia ? A Qualitative Study

    OpenAIRE

    Rabelo, Ionara; Lee, Virginia; Fallah, Mosoka P.; Massaquoi, Moses; Evlampidou, Iro; Crestani, Rosa; Decroo, Tom; Van den Bergh, Rafael; Severy, Nathalie

    2016-01-01

    Introduction A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community. Methods Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited t...

  4. Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States.

    Science.gov (United States)

    Leggett, Amanda; Pepin, Renee; Sonnega, Amanda; Assari, Shervin

    2016-07-01

    Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor's recommendation. Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor's recommendation in 2010. New sleep medication prescriptions were started by 7.68%, 12.62% started using a new sleep treatment, and 31.93% were using the treatment outside of their doctor's recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol. Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual's awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Integrated Waste Treatment Unit (IWTU) Input Coal Analyses and Off-Gass Filter (OGF) Content Analyses

    Energy Technology Data Exchange (ETDEWEB)

    Jantzen, Carol M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Missimer, David M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Guenther, Chris P. [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Shekhawat, Dushyant [National Energy Technology Lab. (NETL), Morgantown, WV (United States); VanEssendelft, Dirk T. [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Means, Nicholas C. [AECOM Technology Corp., Oak Ridge, TN (United States)

    2015-04-23

    A full engineering scale Fluidized Bed Steam Reformer (FBSR) system is being used at the Idaho Nuclear Technology and Engineering Center (INTEC) to stabilize acidic Low Activity Waste (LAW) known as Sodium Bearing Waste (SBW). The INTEC facility, known as the Integrated Waste Treatment Unit (IWTU), underwent an Operational Readiness Review (ORR) and a Technology Readiness Assessment (TRA) in March 2014. The IWTU began non-radioactive simulant processing in late 2014 and by January, 2015 ; the IWTU had processed 62,000 gallons of simulant. The facility is currently in a planned outage for inspection of the equipment and will resume processing simulated waste feed before commencing to process 900,000 gallons of radioactive SBW. The SBW acidic waste will be made into a granular FBSR product (carbonate based) for disposal in the Waste Isolation Pilot Plant (WIPP). In the FBSR process calcined coal is used to create a CO2 fugacity to force the waste species to convert to carbonate species. The quality of the coal, which is a feed input, is important because the reactivity, moisture, and volatiles (C,H,N,O, and S) in the coal impact the reactions and control of the mineralizing process in the primary steam reforming vessel, the Denitration and Mineralizing Reformer (DMR). Too much moisture in the coal can require that additional coal be used. However since moisture in the coal is only a small fraction of the moisture from the fluidizing steam this can be self-correcting. If the coal reactivity or heating value is too low then the coal feedrate needs to be adjusted to achieve the desired heat generation. Too little coal and autothermal heat generation in the DMR cannot be sustained and/or the carbon dioxide fugacity will be too low to create the desired carbonate mineral species. Too much coal and excess S and hydroxide species can form. Excess sulfur from coal that (1) is too rich in sulfur or (2) from overfeeding coal can promote wall scale and contribute to corrosion

  6. Letter of Map Revision

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The National Flood Hazard Layer (NFHL) data incorporates all Digital Flood Insurance Rate Map(DFIRM) databases published by FEMA, and any Letters Of Map Revision...

  7. Katz's revisability paradox dissolved

    NARCIS (Netherlands)

    Tamminga, Allard; Verhaegh, Sander

    2013-01-01

    Quine's holistic empiricist account of scientific inquiry can be characterized by three constitutive principles: noncontradiction, universal revisability and pragmatic ordering. We show that these constitutive principles cannot be regarded as statements within a holistic empiricist's scientific

  8. The Economic Model of Retinopathy of Prematurity (EcROP) Screening and Treatment: Mexico and the United States.

    Science.gov (United States)

    Rothschild, Michael I; Russ, Rebecca; Brennan, Kathryn A; Williams, Christopher J; Berrones, David; Patel, Bhavesh; Martinez-Castellanos, Maria Ana; Fernandes, Alcides; Hubbard, G Baker; Chan, R V Paul; Yang, Zhou; Olsen, Timothy W

    2016-08-01

    To describe an economic (Ec) model for estimating the impact of screening and treatment for retinopathy of prematurity (ROP). EcROP is a cost-effectiveness, cost-utility, and cost-benefit analysis. We surveyed caregivers of 52 children at schools for the blind or pediatric eye clinics in Atlanta, Georgia and 43 in Mexico City. A decision analytic model with sensitivity analysis determined the incremental cost-effectiveness (primary outcome) and incremental monetary benefit (secondary outcome) of an ideal (100% screening) national ROP program as compared to estimates of current practice. Direct costs included screening and treatment expenditures. Indirect costs estimated lost productivity of caretaker(s) and blind individuals as determined by face-to-face surveys. Utility and effectiveness were measured in quality-adjusted life years and benefit in US dollars. EcROP includes a sensitivity analysis to assesses the incremental cost-effectiveness and societal impact of ROP screening and treatment within a country or economic region. Estimates are based on evidence-based clinical data and region-specific economic data acquired from direct field survey. In both Mexico and the United States, an ideal national ROP screening and treatment program was highly cost-saving. The incremental net benefit of an ideal ROP program over current practice is $5556 per child ($206 574 333 annually) and $3628 per child ($205 906 959 annually) in Mexico and the United States, respectively. EcROP demonstrates that ROP screening and treatment is highly beneficial for quality of life, cost saving, and cost-effectiveness in the United States and Mexico. EcROP can be applied to any country or region to provide data for informed allocation of limited health care resources. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Revision of the DELFIC Particle Activity Module

    Energy Technology Data Exchange (ETDEWEB)

    Hooper, David A [ORNL; Jodoin, Vincent J [ORNL

    2010-09-01

    The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.

  10. Alternative national guidelines for treating attention and depression problems in children: comparison of treatment approaches and prescribing rates in the United Kingdom and United States.

    Science.gov (United States)

    Murphy, J Michael; McCarthy, Alyssa E; Baer, Lee; Zima, Bonnie T; Jellinek, Michael S

    2014-01-01

    The use of psychotropic medications for children and adolescents with attention and depression problems continues to generate both attention in the news media and controversy within the field. Given that the United Kingdom has recently issued guidelines for its national health service that differ substantially from those in the United States, the time is ripe to reexamine the evidence. The purpose of this article is to describe the UK's new "stepped care" guidelines for treating attention and depression problems in children and to compare them to the US guidelines issued by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Our findings are that, despite many similarities, the UK guidelines are generally more conservative in their recommendations for medication use, especially for children experiencing only moderate impairment. Our article also compares prescription and diagnosis rates in the UK and the US, and reports evidence for lower rates of prescribing in the UK, despite some evidence that the rates of problems may not differ substantially. We conclude by noting that the existence of an alternative standard provides validation for clinicians or families who prefer to take a more conservative approach to medication use. The two different approaches to care also provide a valuable opportunity for research to determine whether the approaches result in different treatment outcomes.

  11. Effects of forest fuel-reduction treatments in the United States

    Science.gov (United States)

    Scott L. Stephens; James D. McIver; Ralph E.J. Boerner; Christopher J. Fettig; Joseph B. Fontaine; Bruce R. Hartsough; Patricia L. Kennedy; Dylan W. Schwilk

    2012-01-01

    The current conditions of many seasonally dry forests in the western and southern United States, especially those that once experienced low- to moderate-intensity fire regimes, leave them uncharacteristically susceptible to high-severity wildfire. Both prescribed fire and its mechanical surrogates are generally successful in meeting short-term fuel-reduction objectives...

  12. Greywater turns to gold: Treatment units to help low-income ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2011-02-08

    Feb 8, 2011 ... With no new sources to tap, Jordanians must find ways to reduce their demand and make better use of existing supplies. One of option ... At the Ministry of Planning and International Cooperation, officials approved the installation of greywater units in more than 700 households in 90 metropolitan areas.

  13. Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States

    Directory of Open Access Journals (Sweden)

    Diette GB

    2015-02-01

    Full Text Available Gregory B Diette,1 Anand A Dalal,2 Anna O D’Souza,3 Orsolya E Lunacsek,3 Saurabh P Nagar2 1Johns Hopkins University, Baltimore, MD, 2GlaxoSmithKline, Research Triangle Park, NC, 3Xcenda, Palm Harbor, FL, USA Background: This study evaluated patterns of pharmacotherapy in chronic obstructive pulmonary disease (COPD as they relate to recommended guidelines in a prevalent COPD patient population with employer-sponsored health insurance in the US.Methods: Health care claims data from 2007 and 2008 were retrospectively analyzed for the study population defined as patients aged 40 years and older, continuously enrolled during the study period, and having at least one inpatient or one emergency department (ED visit, or at least two outpatient claims coded with COPD (International Classification of Diseases, 9th Revision, Clinical Modification code 491.xx, 492.xx, 496.xx. Rates of any pharmacotherapy (both maintenance and reliever, long-acting maintenance pharmacotherapy in patients with an exacerbation history, and short-term treatment of acute exacerbations of COPD were evaluated in the overall population, newly diagnosed, and previously diagnosed patients (including maintenance-naïve and maintenance-experienced. Stratified analyses were also conducted by age group (40–64 years, ≥65 years and physician specialty.Results: A total of 55,361 patients met study criteria of whom 39% were newly diagnosed. The mean age was 66 years, and 46% were male. Three-fourths (74% of all COPD patients had some pharmacotherapy (maintenance or reliever with less than half (45% being treated with maintenance medications. The combination of an inhaled corticosteroid and a long-acting beta-agonist was the most prevalent drug class for maintenance treatment followed by tiotropium. Only 64% of patients with an exacerbation history had a prescription for a long-acting maintenance medication, and short-term treatment with oral corticosteroids or antibiotics was

  14. Thermal treatment of solid residues from WtE units: A review

    International Nuclear Information System (INIS)

    Lindberg, Daniel; Molin, Camilla; Hupa, Mikko

    2015-01-01

    Highlights: • We review the thermal treatment methods for ashes and residues from WtE plants. • We review the results from extensive laboratory work on vitrification, melting and vaporization of ash. • We analyze the results from the extensive patent literature on thermal treatment. • We review industrial concepts for thermal treatment of ash. - Abstract: Thermal treatment methods of bottom ash, fly ash and various types of APC (air pollution control) residues from waste-to-energy plants can be used to obtain environmentally stable material. The thermal treatment processes are meant to reduce the leachability of harmful residue constituents, destroy toxic organic compounds, reduce residue volume, and produce material suitable for utilization. Fly ash and APC residues often have high levels of soluble salts, particularly chlorides, metals such as cadmium, lead, copper and zinc, and trace levels of organic pollutants such as dioxins and furans. Different thermal treatment methods can be used to either decompose or stabilize harmful elements and compounds in the ash, or separate them from the ash to get a material that can be safely stored or used as products or raw materials. In the present paper, thermal treatment methods, such as sintering, vitrification, and melting have been reviewed. In addition to a review of the scientific literature, a survey has been made of the extensive patent literature in the field

  15. Thermal treatment of solid residues from WtE units: A review

    Energy Technology Data Exchange (ETDEWEB)

    Lindberg, Daniel, E-mail: daniel.lindberg@abo.fi; Molin, Camilla, E-mail: camilla.molin@abo.fi; Hupa, Mikko, E-mail: mikko.hupa@abo.fi

    2015-03-15

    Highlights: • We review the thermal treatment methods for ashes and residues from WtE plants. • We review the results from extensive laboratory work on vitrification, melting and vaporization of ash. • We analyze the results from the extensive patent literature on thermal treatment. • We review industrial concepts for thermal treatment of ash. - Abstract: Thermal treatment methods of bottom ash, fly ash and various types of APC (air pollution control) residues from waste-to-energy plants can be used to obtain environmentally stable material. The thermal treatment processes are meant to reduce the leachability of harmful residue constituents, destroy toxic organic compounds, reduce residue volume, and produce material suitable for utilization. Fly ash and APC residues often have high levels of soluble salts, particularly chlorides, metals such as cadmium, lead, copper and zinc, and trace levels of organic pollutants such as dioxins and furans. Different thermal treatment methods can be used to either decompose or stabilize harmful elements and compounds in the ash, or separate them from the ash to get a material that can be safely stored or used as products or raw materials. In the present paper, thermal treatment methods, such as sintering, vitrification, and melting have been reviewed. In addition to a review of the scientific literature, a survey has been made of the extensive patent literature in the field.

  16. Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States.

    Science.gov (United States)

    Wu, Li-Tzy; Zhu, He; Mannelli, Paolo; Swartz, Marvin S

    2017-08-01

    The increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD. We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD. The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment. This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  17. Mobile unit for treatment of oil emulsions (taladrines); Unidad movil de tratamiento de taladrinas

    Energy Technology Data Exchange (ETDEWEB)

    Ortiz, S.

    1995-06-01

    The environmental problems of water in oil emulsions (taladrines), produced because of an uncontrolled pouring in the sewage system, is the problem caused for the sewage sludge water treatment plants because they have oils, emulgents and heavy metals. (Author)

  18. Current Status of Treatment of Radiation Injury in the United States

    National Research Council Canada - National Science Library

    Jarrett, D. G; Sedlak, R. G; Dickerson, W. E

    2005-01-01

    ... on i) historical data, ii) animal research, and iii) human results derived from present medical treatment such as the care provided to cancer patients undergoing radiation therapy or chemotherapy...

  19. An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States.

    Science.gov (United States)

    Albert, David A; Begg, Melissa D; Andrews, Howard F; Williams, Sharifa Z; Ward, Angela; Conicella, Mary Lee; Rauh, Virginia; Thomson, Janet L; Papapanou, Panos N

    2011-01-01

    We examined whether periodontal treatment or other dental care is associated with adverse birth outcomes within a medical and dental insurance database. In a retrospective cohort study, we examined the records of 23,441 women enrolled in a national insurance plan who delivered live births from singleton pregnancies in the United States between January 1, 2003, and September 30, 2006, for adverse birth outcomes on the basis of dental treatment received. We compared rates of low birthweight and preterm birth among 5 groups, specifying the relative timing and type of dental treatment received. We used logistic regression analysis to compare outcome rates across treatment groups while adjusting for duration of continuous dental coverage, maternal age, pregnancy complications, neighborhood-level income, and race/ethnicity. Analyses showed that women who received preventive dental care had better birth outcomes than did those who received no treatment (P periodontal treatment. For women with medical and dental insurance, preventive care is associated with a lower incidence of adverse birth outcomes.

  20. Analysis and relevant treatment of diametral tolerance of exciter shaft in unit 2

    International Nuclear Information System (INIS)

    Liu Qiang

    2012-01-01

    The generator and exciter unit has three support in Qinshan Nuclear Power Plant Phase Ⅱ, there are two bearings for the generator rotor and one for the exciter, this structure results in that it is difficult to achieve the standard when checking the exciter bearing's diametral tolerance. In the fifth outage of unit 2 in Qinshan Nuclear Power Plant Phase Ⅱ, the diametral tolerance failed to achieve the standard, there were several reasons for this, such as the alignment of generator and exciter coupling, the angular moment of generator and exciter coupling bolt. the end surface condition of generator and exciter coupling, the fitting dimension of the coupling bolt hole and the sleeve in it. After the analysis of all reasons one by one, it was confirmed that the radical reason was the abnormal condition of the generator coupling end surface, the problem was solved by machining it. (author)

  1. Tuberculosis Treatment Completion in a United States/Mexico Binational Context

    Directory of Open Access Journals (Sweden)

    Celina I. Valencia

    2017-05-01

    Full Text Available BackgroundTuberculosis (TB remains a salient public health issue along the U.S./Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region.MethodsRetrospective study of data extracted from medical charts (n = 439 from Yuma County Health Department (YCHD (n = 160 and Centro de Salud San Luis Río Colorado (n = 279. Patients currently accessing TB treatment at either facility were excluded from the study. Chi-square, unadjusted odds ratios, and logistic regression were utilized to identify characteristics associated with successful TB treatment in this population.FindingsThe study population was predominantly male (n = 327. Females were more likely to complete TB treatment (OR = 3.71. The absence of drug use and/or the absence of an HIV positive diagnosis were found to be predictors of TB treatment completion across both clinical sites. Forty-four percent (43.59% (n = 85 TB patients treated at CDS San Luis did not complete treatment versus 40.35% (n = 49 of TB patients who did not complete treatment at YCHD. Moving from the area or being deported was the highest category (20.78% for incomplete TB treatment in the population (n = 64 across both clinical sites.

  2. Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland.

    Science.gov (United States)

    Kahila, K; Kilkku, N; Kaltiala-Heino, R

    2004-04-01

    Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.

  3. Revision and Implementation of "Clinical Guideline for Tuberculosis and HIV in Prisons", Great Tehran Prison, Iran.

    Science.gov (United States)

    Farhoudi, Behnam; SeyedAlinaghi, SeyedAhmad; Tabarsi, Payam; Mohraz, Minoo; Golrokhy, Raheleh; Farnia, Marzieh; Shahbazi, Mohammad; Alasvand, Ramin; Ebrahimi, Bahman; Esfehani, Jafar; Tashakoriyan, Mehrzad

    2018-01-01

    To evaluate the feasibility of the revised "Clinical Guideline for HIV and TB" in the Great Tehran Prison during October 2013 to June 2014. The guideline includes all aspects of HIV/TB diagnosis based on active case finding (ACF), treatment and care services. Before the implementation, a focus group discussion was conducted, and attended by experts on prison health. The objective was to identify defects and limitations of the guideline. After the discussion, the guideline was revised. The Great Tehran Prison contains three separate units; all prisoners are taken first to "reception and identification unit (quarantine)" and then send to two housing units according to their legal status. An HIV ACF strategy was employed in the quarantine, and two units through a voluntary provider-initiated HIV testing. Three staff of the triangular clinic trained the prisoners about common routes of HIV transmission and the symptoms of TB in the units. In the quarantine, all prisoners were examined for all HIV-risk factors, HIV testing and symptoms of TB. In unit one, healthcare staff continued the ACF process, while in unit two, the peers of prisoners were assigned as the healthcare communicators to proceed with the strategy. At this caring process, when the test result was positive, then the process of care, treatment and follow ups was initiated. Moreover, the use of directly observed therapy (DOT) for antiretroviral therapy (ART) and TB was applied to the sick prisoners. There was also a follow-up caring for released prisoner to refer them to care and treatment services outside the prison. The guideline was implemented in the prison successfully. Regarding feasibility of the guideline, the investigators of this study suggest that the guideline should be implemented in other prisons across the country. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers.

    Science.gov (United States)

    Taylor, Elaina C; O'Neill, Mark; Hughes, Lyndsay D; Moss-Morris, Rona

    2018-04-01

    This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent atrial fibrillation (AF). Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n = 198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory factor analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test-retest and internal reliability were examined. Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated three factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity. The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.

  5. The Effects of Silvicultural Treatment on Sirex noctilio Attacks and Tree Health in Northeastern United States

    Directory of Open Access Journals (Sweden)

    Kevin J. Dodds

    2014-11-01

    Full Text Available The invasive woodwasp Sirex noctilio (Hymenoptera: Siricidae is established in east-central North America. A replicated case study testing the effectiveness of silvicultural treatments for reducing the number of S. noctilio attacked trees in a stand was conducted in New York, USA. Silvicultural treatments reduced S. noctilio attacked trees by approximately 75% over the course of the study. There was no tree growth response to silvicultural treatments in the four years after thinning, but targeted removal of weakened trees removed potential S. noctilio habitat from treated stands. Two spectral vegetation indices were used to determine tree health in each treatment and potentially provide guidance for detection efforts. Silvicultural treatment significantly influenced the Red Edge Inflection Point, a strong indicator of chlorophyll content, and the Moisture Stress Index, a reflectance measurement sensitive to changes in foliar leaf water content, with the greatest differences occurring between control and treated blocks. Vegetation indices showed promise as a tool for aiding in stand prioritization for S. noctilio surveys or management activities.

  6. The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis.

    Science.gov (United States)

    Guy, Gery P; Zhang, Yuanhui; Ekwueme, Donatus U; Rim, Sun Hee; Watson, Meg

    2017-02-01

    Indoor tanning is associated with an increased risk of melanoma. The US Food and Drug Administration proposed prohibiting indoor tanning among minors younger than 18 years. We sought to estimate the health and economic benefits of reducing indoor tanning in the United States. We used a Markov model to estimate the expected number of melanoma cases and deaths averted, life-years saved, and melanoma treatment costs saved by reducing indoor tanning. We examined 5 scenarios: restricting indoor tanning among minors younger than 18 years, and reducing the prevalence by 20%, 50%, 80%, and 100%. Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 million youth age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced. Limitations include the reliance on available data and not examining compliance to indoor tanning laws. Reducing indoor tanning has the potential to reduce melanoma incidence, mortality, and treatment costs. These findings help quantify and underscore the importance of continued efforts to reduce indoor tanning and prevent melanoma. Published by Elsevier Inc.

  7. TITRATION: A Randomized Study to Assess 2 Treatment Algorithms with New Insulin Glargine 300 units/mL.

    Science.gov (United States)

    Yale, Jean-François; Berard, Lori; Groleau, Mélanie; Javadi, Pasha; Stewart, John; Harris, Stewart B

    2017-10-01

    It was uncertain whether an algorithm that involves increasing insulin dosages by 1 unit/day may cause more hypoglycemia with the longer-acting insulin glargine 300 units/mL (GLA-300). The objective of this study was to compare safety and efficacy of 2 titration algorithms, INSIGHT and EDITION, for GLA-300 in people with uncontrolled type 2 diabetes mellitus, mainly in a primary care setting. This was a 12-week, open-label, randomized, multicentre pilot study. Participants were randomly assigned to 1 of 2 algorithms: they either increased their dosage by 1 unit/day (INSIGHT, n=108) or the dose was adjusted by the investigator at least once weekly, but no more often than every 3 days (EDITION, n=104). The target fasting self-monitored blood glucose was in the range of 4.4 to 5.6 mmol/L. The percentages of participants reaching the primary endpoint of fasting self-monitored blood glucose ≤5.6 mmol/L without nocturnal hypoglycemia were 19.4% (INSIGHT) and 18.3% (EDITION). At week 12, 26.9% (INSIGHT) and 28.8% (EDITION) of participants achieved a glycated hemoglobin value of ≤7%. No differences in the incidence of hypoglycemia of any category were noted between algorithms. Participants in both arms of the study were much more satisfied with their new treatment as assessed by the Diabetes Treatment Satisfaction Questionnaire. Most health-care professionals (86%) preferred the INSIGHT over the EDITION algorithm. The frequency of adverse events was similar between algorithms. A patient-driven titration algorithm of 1 unit/day with GLA-300 is effective and comparable to the previously tested EDITION algorithm and is preferred by health-care professionals. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  8. Cancer Treatment Disparities in HIV-Infected Individuals in the United States

    Science.gov (United States)

    Suneja, Gita; Shiels, Meredith S.; Angulo, Rory; Copeland, Glenn E.; Gonsalves, Lou; Hakenewerth, Anne M.; Macomber, Kathryn E.; Melville, Sharon K.; Engels, Eric A.

    2014-01-01

    Purpose HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this. Patients and Methods We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin's lymphoma, Hodgkin's lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer. Results We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin's lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non–small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage. Conclusion HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival

  9. Fuzzy dynamic modelling and predictive control of a coagulation chemical dosing unit for water treatment plants

    OpenAIRE

    Oladipupo Bello; Yskandar Hamam; Karim Djouani

    2014-01-01

    In this paper, a fuzzy model predictive control (FMPC) strategy is proposed to regulate the output variables of a coagulation chemical dosing unit. A multiple-input, multiple-output (MIMO) process model in form of a linearised Takagi–Sugeno (T–S) fuzzy model is derived. The process model is obtained through subtractive clustering from the plant's data set. The MIMO model is described by a set of coupled multiple-input, single-output models (MISO). In the controller design, the T–S fuzzy model...

  10. Use of Transnational Services to Prevent Treatment Interruption in Tuberculosis-Infected Persons Who Leave the United States.

    Science.gov (United States)

    Tschampl, Cynthia A; Garnick, Deborah W; Zuroweste, Edward; Razavi, Moaven; Shepard, Donald S

    2016-03-01

    A major problem resulting from interrupted tuberculosis (TB) treatment is the development of drug-resistant TB, including multidrug-resistant TB (MDR TB), a more deadly and costly-to-treat form of the disease. Global health systems are not equipped to diagnose and treat the current burden of MDR TB. TB-infected foreign visitors and temporary US residents who leave the country during treatment can experience treatment interruption and, thus, are at greater risk for drug-resistant TB. Using epidemiologic and demographic data, we estimated TB incidence among this group, as well as the proportion of patients referred to transnational care-continuity and management services during relocation; each year, ≈2,827 visitors and temporary residents are at risk for TB treatment interruption, 222 (8%) of whom are referred for transnational services. Scale up of transnational services for persons at high risk for treatment interruption is possible and encouraged because of potential health gains and reductions in healthcare costs for the United States and receiving countries.

  11. ASSESSMENT OF ESTROGENIC ACTIVITY IN EFFLUENTS FROM SEWAGE TREATMENT PLANTS IN THE UNITED STATES

    Science.gov (United States)

    Newly developed molecular biology methods have been used for the measurement of estrogenic activity in source-biased studies of sewage treatment plants. Studies in Texas and New Mexico have shown the utility of the measurement of changes in vitellogenin gene expression in fathea...

  12. Predictors of Retention in Smoking Cessation Treatment among Latino Smokers in the Northeast United States

    Science.gov (United States)

    Lee, Christina S.; Hayes, Rashelle B.; McQuaid, Elizabeth L.; Borrelli, Belinda

    2010-01-01

    Introduction. Only one previous study on minority retention in smoking cessation treatment has been conducted (Nevid JS, Javier RA, Moulton JL III. "Factors predicting participant attrition in a community-based, culturally specific smoking cessation program for Hispanic smokers." "Health Psychol" 1996; 15: 226-29). We investigated predictors of…

  13. State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004.

    Science.gov (United States)

    Armour, Brian S; Campbell, Vincent A; Crews, John E; Malarcher, Ann; Maurice, Emmanuel; Richard, Roland A

    2007-10-01

    To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers. We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers. We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available. Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service's clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.

  14. Quantities, Units, and Symbols.

    Science.gov (United States)

    Royal Society, London (England).

    This booklet provides a reference to the quantities, units, and their symbols which are used in physical science. It is a revision of a 1969 report and takes account of the progress which has been made in obtaining international agreement on the definitions, names, and symbols for units and on the rules for the expression of relations involving…

  15. Exchange Transfusion in the Treatment of Neonatal Septic Shock: A Ten-Year Experience in a Neonatal Intensive Care Unit

    OpenAIRE

    Pugni, Lorenza; Ronchi, Andrea; Bizzarri, Bianca; Consonni, Dario; Pietrasanta, Carlo; Ghirardi, Beatrice; Fumagalli, Monica; Ghirardello, Stefano; Mosca, Fabio

    2016-01-01

    Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU), is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group) with the mortality rate of those treated w...

  16. House hold unit for the treatment of fluoride, iron, arsenic and microorganism contaminated drinking water.

    Science.gov (United States)

    Dhadge, Vijaykumar L; Medhi, Chitta Ranjan; Changmai, Murchana; Purkait, Mihir Kumar

    2018-05-01

    A first of its kind hybrid electrocoagulation-filtration prototype unit was fabricated for the removal of fluoride, iron, arsenic and microorganisms contaminated drinking water. The unit comprised of 3 chambers, chamber A consisting of an inlet for the water to be treated and an outlet for the treated water along with one block of aluminum electrodes. Chamber B consisted of ceramic membrane filtration assembly at the bottom over a metallic support which filters the flocs so produced in chamber A and chamber C consisting of space to collect the treated water. Operating parameters were maintained as current density of 625 A m -2 and an electrode distance of 0.005 m. Contaminated drinking water containing mixture of fluoride (10 mg L -1 ), iron (25 mg L -1 ), arsenic (200 μg L -1 ) and microorganisms (35 CFU ml -1 ) was used for the experiment. A removal of 98.74%, 95.65%, 93.2% and 100% were obtained for iron, arsenic, fluoride and microorganisms, respectively. The apparatus and method made it possible to efficiently treat contaminated drinking water to produce drinkable water as per WHO specification. By-products obtained from the electrocoagulation bath were analyzed using SEM, EDX and XRD and explained. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.

    Science.gov (United States)

    Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam

    2016-08-01

    The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  18. Irradiation as a quarantine treatment and the status in the United States and Hawaii

    Energy Technology Data Exchange (ETDEWEB)

    Moy, J.H. [Dept. of Food Science and Human Nutrition, Univ. of Hawaii, Honolulu, HI (United States)

    1998-12-31

    Finding an efficient and effective method to control fruit flies and other insect pests on tropical fruits is the prerequisite to sending fruits to international markets where fruit flies are unwanted. After ethylene dibromide was banned as a fumigant in the U.S. in 1984, papaya exports in Hawaii have been using two similar thermal treatments, either the vapor heat, or the high-temperature forced-air, as the disinfestation method. Time required for these thermal treatments is 5 to 6 hours and fruit quality problems are sometimes encountered. Other fruits would require different time-temperature regimes; yet not many fruits can tolerate the heat treatment. Irradiation, emerging as an alternative, efficacious disinfestation method, requires 15-20 min. in a commercial irradiator, and the quality of irradiated fruits is well preserved. Since April, 1995, more than 100,000 kg of untreated tropical fruits, mainly papaya, litchi, and starfruit, have been sent from Hawaii to the U.S. continent with a special permit by the Animal Plant Health Inspection Service (APHIS) of the U.S. Department of Agriculture (USDA), and irradiated at an irradiator near Chicago with a generic dose of 0.25 kGy. These fruits were test marketed with proper labeling in various supermarkets in the Midwest and other cities. Consumer acceptance of irradiated tropical fruits has been very favorable. In May, 1996, APHIS published a document describing policies, procedures, and regulations specifically related to irradiation as a phytosanitary treatment. In early July, 1998, USDA proposed a rule to allow more types of Hawaii-grown fruits to be shipped to the U.S. continent for radiation treatment. These include abiu, atemoya, longan, rambutan, sapodilla, green banana, and durian. To improve the export market potential, the Country of Hawaii is planning to build a small commercial irradiator in 1999 to treat various tropical fruits and possibly other products. (author)

  19. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

    Science.gov (United States)

    Bhadra, Arup K.; Altman, Roy; Dasa, Vinod; Myrick, Karen; Rosen, Jeffrey; Vad, Vijay; Vitanzo, Peter; Bruno, Michelle; Kleiner, Hillary; Just, Caryn

    2016-01-01

    Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA. PMID:28618868

  20. [Nurses' knowledge of alcohol-related problems and their treatment: a comparison of nurses in general hospital and alcoholism treatment units].

    Science.gov (United States)

    Hisatomi, N; Ito, K; Nagashima, Y; Fujiwara, K; Yasuda, K; Ashizawa, T; Sato, M; Higuchi, S

    1998-12-01

    Nurses have the most contact with patients in the clinical settings, and they play an important role in the guidance and education of patients. Nurses' basic knowledge of alcohol-related problems greatly influences early discovery of and early intervention against alcohol-related problems in general units (GU). In a study undertaken mainly to understand the status of nurses' knowledge in GU, a survey was performed to compare the knowledge and attitude of nurses working in GU and those with working in units specializing in the treatment of alcoholism (AU). For reference, we used the results of separate surveys performed previously on the general population. The results showed that, compared with nurses in AU, nurses in GU (1) were more tolerant of drinking, but (2) were more stigmatic concerning alcoholism, and (3) had little knowledge concerning alcohol-related problems. Nurses in GU tended to have less knowledge about alcohol-related problems than the general population. Moreover, the knowledge of nurses in AU could not be considered sufficient. This study suggested the need for basic education concerning alcohol-related problems and their treatment aimed at nurses.

  1. [Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit].

    Science.gov (United States)

    Cai, Xiao-Fang; Zhang, Fu-Rong; Zhang, Long; Sun, Ji-Min; Li, Wen-Bin

    2017-11-01

    To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU). Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events. Satisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (Pventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (Pmechanical ventilation, and length of PICU stay than the midazolam group (Padverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (Pmechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.

  2. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE, IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT, HANFORD SITE

    International Nuclear Information System (INIS)

    BYRNES ME

    2008-01-01

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU

  3. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    BYRNES ME

    2008-06-05

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU.

  4. [Laser treatment for retinopathy of prematurity in neonatal intensive care units. Premature Eye Rescue Program].

    Science.gov (United States)

    Maka, Erika; Imre, László; Somogyvári, Zsolt; Németh, János

    2015-02-01

    Retinopathy of prematurity is a leading cause of childhood blindness around the world. The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.

  5. Characterization and constructive utilization of sludge produced in clari-flocculation unit of water treatment plant

    Science.gov (United States)

    Ahmad, Tarique; Ahmad, Kafeel; Alam, Mehtab

    2018-03-01

    All water treatment plants produce waste/residue amid the treatment of raw water. This study selectively investigates the clariflocculator sludge for its physicochemical characteristics and potential reuse options. Sieve analysis, XRF, SEM, XRD, FTIR, and TG-DTA instrumental techniques have been used to characterize the sludge sample. Results show that clariflocculator sludge contains about 78% fine sand having grain size range 150-75 μm. SiO2, Al2O3, Fe2O3 and CaO constitute the maximum percentage of chemical compounds present in the sludge and quartz is the main crystalline phase of the sludge. Recycling and reuse of this sludge, especially, as fine sand in preparing mortar, concrete mix and other civil engineering products would pave the way for constructive utilization with safe and sustainable sludge management strategies.

  6. 76 FR 5157 - Public Water Supply Supervision Program; Program Revision for the State of Alaska

    Science.gov (United States)

    2011-01-28

    ... AGENCY Public Water Supply Supervision Program; Program Revision for the State of Alaska AGENCY... that the State of Alaska has revised its approved State Public Water Supply Supervision Primacy Program...; Long Term 2 Enhanced Surface Water Treatment Rule; and Lead and Copper Short-Term Regulatory Revisions...

  7. Physician perceptions of pharmacologic treatment options for chorea associated with Huntington disease in the United States.

    Science.gov (United States)

    Sung, Victor W; Iyer, Ravi G; Gandhi, Sanjay K; Shah-Manek, Bijal; DiBonaventura, Marco; Abler, Victor; Claassen, Daniel O

    2018-04-01

    To survey neurologists and obtain clinical perceptions of tetrabenazine for the treatment of chorea in patients with Huntington disease (HD). Board-certified/board-eligible neurologists, in practice for ≥5 years, who had treated treat ≥3 HD patients in the past 2 years, were recruited from an online physician panel to participate in a cross-sectional, web-based survey. Respondents provided information about themselves, their practice, approaches to HD chorea management and perceptions of available treatments. Two hundred neurologists responded to the survey. Based on clinician responses, the most common reasons to treat chorea are impairment in activities of daily living (54%) and quality of life (41%). Although tetrabenazine was the only approved treatment for chorea in HD patients at the time of this analysis, it was only prescribed to ∼50% of patients with HD-related chorea. More than half of physicians perceive tetrabenazine as having minimal or no effectiveness in improving chorea. More than 40% of physicians consider tetrabenazine to be a non-optimal treatment, and 51% of physicians agree that they are unable to titrate to efficacious doses due to adverse side effects or tolerability concerns. Physicians report that side effects leading to dose interruptions (33%) and reductions (30%) occur in their patients "often" or "almost always". The most common side effects that led to insufficient dosing and disruptions in titration were sedation and somnolence (41%), depression (24%) and anxiety (22%). Many physicians who treat HD-related chorea report that tolerability issues with tetrabenazine impact their ability to effectively use tetrabenazine in their clinical practice.

  8. Pentobarbital withdrawal and treatment in an infant in the pediatric cardiac intensive care unit.

    Science.gov (United States)

    Weber, Garret M; Smerling, Arthur J; Saroyan, John M

    2013-02-01

    Withdrawal syndromes following administration of sedative and analgesic infusions represent a significant morbidity that is described increasingly in the pediatric critical care literature. However, there are few descriptions of pentobarbital withdrawal symptoms and their treatment in the pediatric population. We describe an infant receiving multiple sedative and analgesic medications, including pentobarbital, who was resistant to our institution's standard weaning protocol, but whose severe withdrawal symptoms responded dramatically to phenobarbital loading and maintenance. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States.

    Science.gov (United States)

    Cadier, Benjamin; Bulsei, Julie; Nahon, Pierre; Seror, Olivier; Laurent, Alexis; Rosa, Isabelle; Layese, Richard; Costentin, Charlotte; Cagnot, Carole; Durand-Zaleski, Isabelle; Chevreul, Karine

    2017-04-01

    Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation. Transition probabilities were derived mainly from two French cohorts, CIRVIR and CHANGH. Costs were computed using French and U.S. tariffs. Effectiveness was measured in life years gained (LYG). An incremental cost-effectiveness ratio (ICER) was calculated for a 10-year horizon and tested with one-way and probabilistic sensitivity analyses. The cost difference between the two groups was $648 ($87,476 in the gold-standard monitoring group vs. $86,829 in the real-life monitoring group) in France and $11,965 ($93,795 vs. $81,829) in the United States. Survival increased by 0.37 years (7.18 vs. 6.81 years). The ICER was $1,754 per LYG in France and $32,415 per LYG in the United States. The health gain resulted from earlier diagnosis and access to first-line curative treatments, among which RFA provided the best value for money. Our results indicate that gold-standard monitoring for patients with cirrhosis is cost-effective, attributed to a higher probability of benefiting from a curative treatment and so a higher survival probability. (Hepatology 2017;65:1237-1248). © 2017 by the American Association for the Study of Liver Diseases.

  10. The biology, prevention, diagnosis and treatment of dental caries: scientific advances in the United States.

    Science.gov (United States)

    Zero, Domenick T; Fontana, Margherita; Martínez-Mier, E Angeles; Ferreira-Zandoná, Andréa; Ando, Masatoshi; González-Cabezas, Carlos; Bayne, Stephen

    2009-09-01

    Scientific advances in cariology in the past 150 years have led to the understanding that dental caries is a chronic, dietomicrobial, site-specific disease caused by a shift from protective factors favoring tooth remineralization to destructive factors leading to demineralization. Epidemiologic data indicate that caries has changed in the last century; it now is distributed unequally in the U.S. population. People who are minorities, homeless, migrants, children with disabilities and of lower socioeconomic status suffer from the highest prevalence and severity of dental caries. Scientific advances have led to improvements in the prevention, diagnosis and treatment of dental caries, but there is a need for new diagnostic tools and treatment methods. and Future management of dental caries requires early detection and risk assessment if the profession is to achieve timely and cost-effective prevention and treatment for those who need it most. Dental professionals look forward to the day when people of all ages and backgrounds view dental caries as a disease of the past.

  11. Treatment of chronic hepatitis C virus infection in the United States: some remaining obstacles.

    Science.gov (United States)

    Searson, Gloria; Engelson, Ellen S; Carriero, Damaris; Kotler, Donald P

    2014-05-01

    Hepatitis C infection is an important problem in inner city neighbourhoods, which suffer from multiple health disparities. Important factors in this population include alcoholism and substance abuse, mental illness and homelessness, which may be combined with mistrust, poor health literacy, limited access to healthcare and outright discrimination. Systemic barriers to effective care include a lack of capacity to provide comprehensive care, insufficient insurance coverage, poor coordination among caregivers and between caregivers and hospitals, as well as third party payers. These barriers affect real world treatment effectiveness as opposed to treatment efficacy, the latter reflecting the world of clinical trials. The components of effectiveness include efficacious medications, appropriate diagnosis and evaluation, recommendation for therapy, access to therapy, acceptance of the diagnosis and its implications by the patient and adherence to the recommended therapy. Very little attention has been given to assisting the patient to accept the diagnosis and adhere to therapy, i.e. care coordination. For this reason, care coordination is an area in which greater availability could lead to greater acceptance/adherence and greater treatment effectiveness. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Revision of the Failed Thumb Carpometacarpal Arthroplasty.

    Science.gov (United States)

    Papatheodorou, Loukia K; Winston, Jonathan D; Bielicka, Deidre L; Rogozinski, Benjamin J; Lourie, Gary M; Sotereanos, Dean G

    2017-12-01

    To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Successful resection of hepatocellular cancer not amenable to Milan criteria and durable complete remission induced by systemic polichemotherapy after development of metastases - should we think about revising the current treatment guidelines in selected patients?

    Science.gov (United States)

    Rados, Ivana; Badzek, Sasa; Golem, Hilda; Prejac, Juraj; Gorsic, Irma; Kekez, Domina; Librenjak, Niksa; Plestina, Stjepko

    2013-09-22

    To refresh clinical diagnostic and therapeutic dilemmas in patients presenting with hepatocellular cancer (HCC) and to report a rare success of systemic polichemotherapy in metastatic HCC. Case report of a patient with successfully resected HCC although initially deemed inoperable according to current guidelines, and who was successfully treated by systemic polichemotherapy after development of metastatic disease, resulting in a sustained complete remission. We describe a 71-year-old female with HCC initially treated by atypical liver resection, although not amenable to initial surgery according to current treatment guidelines, which resulted in 6 months disease-free interval. After development of pulmonary metastases, the patient was treated by systemic polichemotherapy, due to local unavailability of novel biologic agents. After 3 months of chemotherapy biochemical remission was confirmed, and after 10 months of active treatment complete radiological remission was verified according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, now exceeding 9 months in duration. There is an increasing body of evidence that criteria for surgical interventions in HCC should be revised and expanded, and our case is an example of such an approach. Although novel biologic therapies are not widely available in all regions of the world due to their cost, currently there are no hard recommendations for use of chemotherapy in such areas. Since this is a large problem in clinical practice, we conclude that chemotherapy should be offered to selected patients of good performance status if novel agents are unavailable.

  14. Revised Safety Instruction 41 (IS41 REV.)

    CERN Multimedia

    SC Secretariat

    2005-01-01

    Please note that the Revised Safety Instruction No. 41 (IS41 REV.), entitled 'The use of plastic and other non-metallic materials at CERN with respect to fire safety and radiation resistance' is available on the web at the following url: https://edms.cern.ch/document/335806/LAST_RELEASED Paper copies can also be obtained from the SC Unit Secretariat, e-mail: sc.secretariat@cern.ch SC Secretariat

  15. Clinical and Economic Burden of Revision Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mohit Bhandari

    2012-01-01

    Full Text Available Surgery is indicated for symptomatic knee osteoarthritis (OA when conservative measures are unsuccessful. High tibial osteotomy (HTO, unicompartmental knee arthroplasty (UKA, and total knee arthroplasty (TKA are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.

  16. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014.

    Science.gov (United States)

    Zhang, Yiyi; Moran, Andrew E

    2017-10-01

    Overall hypertension prevalence has not changed in the United States in recent decades although awareness, treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition Examination Surveys (1999-2014) and estimated temporal trends of hypertension, awareness, treatment, and control among young adults (age, 18-39 years) compared with middle-age (age, 40-59 years) and older adults (age, ≥60 years). In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4% for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in control. These findings suggest that improved access to and engagement in medical care might improve hypertension control in young adults, particularly young adult men, and reduce life-time cardiovascular risk. © 2017 American Heart Association, Inc.

  17. Full Monte Carlo-Based Biologic Treatment Plan Optimization System for Intensity Modulated Carbon Ion Therapy on Graphics Processing Unit.

    Science.gov (United States)

    Qin, Nan; Shen, Chenyang; Tsai, Min-Yu; Pinto, Marco; Tian, Zhen; Dedes, Georgios; Pompos, Arnold; Jiang, Steve B; Parodi, Katia; Jia, Xun

    2018-01-01

    One of the major benefits of carbon ion therapy is enhanced biological effectiveness at the Bragg peak region. For intensity modulated carbon ion therapy (IMCT), it is desirable to use Monte Carlo (MC) methods to compute the properties of each pencil beam spot for treatment planning, because of their accuracy in modeling physics processes and estimating biological effects. We previously developed goCMC, a graphics processing unit (GPU)-oriented MC engine for carbon ion therapy. The purpose of the present study was to build a biological treatment plan optimization system using goCMC. The repair-misrepair-fixation model was implemented to compute the spatial distribution of linear-quadratic model parameters for each spot. A treatment plan optimization module was developed to minimize the difference between the prescribed and actual biological effect. We used a gradient-based algorithm to solve the optimization problem. The system was embedded in the Varian Eclipse treatment planning system under a client-server architecture to achieve a user-friendly planning environment. We tested the system with a 1-dimensional homogeneous water case and 3 3-dimensional patient cases. Our system generated treatment plans with biological spread-out Bragg peaks covering the targeted regions and sparing critical structures. Using 4 NVidia GTX 1080 GPUs, the total computation time, including spot simulation, optimization, and final dose calculation, was 0.6 hour for the prostate case (8282 spots), 0.2 hour for the pancreas case (3795 spots), and 0.3 hour for the brain case (6724 spots). The computation time was dominated by MC spot simulation. We built a biological treatment plan optimization system for IMCT that performs simulations using a fast MC engine, goCMC. To the best of our knowledge, this is the first time that full MC-based IMCT inverse planning has been achieved in a clinically viable time frame. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older.

    Science.gov (United States)

    Ortuño, Noèlia; Cobo, Jesús; González, Espe; García, Imma; Ferrer, María-Dolores; Campos, Carmen; Planet, Núria; Oliva, Joan-Carles; Suárez, Mónica; Iglesias-Lepine, María-Luisa; García-Parés, Gemma

    There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population. Copyright © 2014 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Effect on treatment planning based on properties of Cobalt-60 stereotactic radiosurgery units

    International Nuclear Information System (INIS)

    Nakazawa, Hisato; Komori, Masataka; Uchiyama, Yukio; Hagiwara, Masahiro; Hayashi, Naoki

    2014-01-01

    The brand-new version of gamma knife, Perfexion, is equipped with an automatic collimator arrangement system that does not require manual collimator exchange and a couch-traveling system that is approximately ten times faster than Model C, so treatment time with multiple shots is assumed to remain within a clinically acceptable range. In this study, the treatment plans for Model C and Perfexion were compared from the viewpoint of number of shots, coverage, selectivity, conformity, and gradient in planning target volume (PTV) coverage. We enrolled 187 and 89 patients with vestibular schwannomas treated by Model C and Perfexion in the study. Treatment planning was created on a Leksell GammaPlan workstation. The mean PTV was 5.2 ml (range 0.1-18.4 ml) in Model C and 4.1 ml (range 0.1-32.1 ml) in Perfexion. The mean shot number for Model C and Perfexion was 11 (range 2-27) and 16 (range 1-41) at the isodose contour of 40-60%, respectively. The mean PTV coverage was 94% (range 73-100%) and 98% (range 91-100%), and the mean PTV selectivity was 83% (range 46-98%) and 87% (range 63-97%) for Model C and Perfexion, respectively. The mean conformity index was 1.15 (range 0.81-2.02) and 1.14 (range 0.97-1.57), and the mean gradient index was 2.82 (range 2.37-3.35) and 2.91 (range 2.55-4.48) for Model C and Perfexion, respectively. In Perfexion, better PTV coverage and selectivity were achieved by using an excessively large number of shots. In addition, the use of a small collimator in Perfexion produced a steeper dose gradient. Our comparative research demonstrated the greater clinical usefulness of Perfexion. (author)

  20. Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians.

    Science.gov (United States)

    de Ferranti, Sarah D; Rodday, Angie Mae; Parsons, Susan K; Cull, William L; O'Connor, Karen G; Daniels, Stephen R; Leslie, Laurel K

    2017-06-01

    To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?Pediatricians uniformly provided lifestyle counseling but access to healthy food (81%), exercise (83%), and adherence to lifestyle recommendations (96%) were reported barriers. One-half of pediatricians (55%) reported a lack of local subspecialists. Although 62% and 89% believed statins were appropriate for children and adolescents with high low-density lipoprotein cholesterol (200?mg/dL) unresponsive to lifestyle, a minority initiated statins (8%, 21%). US pediatricians report lipid screening and treatment practices that are largely at odds with existing recommendations, likely because of lack of knowledge and conflicts among national guidelines, and concern about treatment efficacy and harms. Education regarding pediatric lipid disorders could promote guideline implementation. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. National trends in the treatment of diabetic nephropathy in the United States.

    Science.gov (United States)

    Ajiboye, O; Segal, J B

    2017-06-01

    The prevalence of diabetic nephropathy continues to rise and it remains a strong predictor of morbidity and mortality in diabetic patients. Patients diagnosed with diabetic nephropathy are actively excluded from most trials involving diabetic medications and it is important to understand the prescription patterns in this subset of patients with diabetes. Using the IMS Health's National Disease and Therapeutic Index, we analysed the medication prescription patterns for six classes of medications from 2010 to 2014 among patients, 35 years or older, with diabetic nephropathy. Annual office visits increased from 772 860 (95% confidence interval (CI), 755, 470-790, 249) in 2010 to 1 868 618 (95% CI, 1 834 422-1 902 814) in 2013 and declined to 830 596 (95% CI, 809 167-852 025) in 2014. Sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were the most frequently used of the four classes of diabetic medications included in this study. DPP-4 inhibitors use increased gradually and was used in 54% (95% CI 49-58) of treatment visits by the last quarter of 2014. Across these years, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEIs and ARBs) were prescribed in the majority of treatment visits with peaks above 90%. However, there were some periods when utilization of these antihypertensives was low. Significant increases occurred in the uptake of new diabetic medications; DPP-4 inhibitors and SGLT-2 inhibitors and in the utilization of ACEIs and ARBs compared to the findings reported in other studies with increased complexity in the treatment of patients with diabetic nephropathy. Improved and continued used of these medications may be beneficial in improving patient outcomes. © 2017 John Wiley & Sons Ltd.

  2. Revision of Pachycentria (Melastomataceae)

    NARCIS (Netherlands)

    Clausing, Gudrun

    2000-01-01

    A revision of Pachycentria Blume, which includes the monotypic Pogonanthera Blume, is presented. Pachycentria comprises eight species and one subspecies. Two species, P. vogelkopensis and P. hanseniana, are newly described. The genus is distinguished from other genera in the Medinillinae by a small

  3. Revising China's Environmental Law

    NARCIS (Netherlands)

    He, G.; Zhang, L.; Mol, A.P.J.; Lu, Y.; Liu, Wenling; Liu, J.

    2013-01-01

    China's Environmental Protection Law (EPL) is the main national environmental legislative framework. Yet the environmental legal system is incomplete, and implementation and enforcement of environmental laws have shown major shortcomings (1–3). A controversial attempt to revise the EPL could have

  4. Revision of the Sarcospermataceae

    NARCIS (Netherlands)

    Lam, H.J.; Varossieau, W.W.

    1938-01-01

    The genus Sarcosperma was excluded from the Sapotaceae by the first-named writer in 1925, the group being considered as of family rank. In 1926 the same author published a concise and fragmentary revision of the monotypic order, in which two new Malaysian species were described. The continental

  5. Revision of Oxandra (Annonaceae)

    NARCIS (Netherlands)

    Junikka, L.; Maas, P.J.M.; Maas-van de Kamer, H.; Westra, L.Y.Th.

    2016-01-01

    A taxonomic revision is given of the Neotropical genus Oxandra (Annonaceae). Within the genus 27 species are recognized, 4 of which are new to science. Most of the species are occurring in tropical South America, whereas a few (6) are found in Mexico and Central America and two in the West Indies

  6. Revision without ordinals

    NARCIS (Netherlands)

    Rivello, Edoardo

    2013-01-01

    We show that Herzberger’s and Gupta’s revision theories of truth can be recast in purely inductive terms, without any appeal neither to the transfinite ordinal numbers nor to the axiom of Choice. The result is presented in an abstract and general setting, emphasising both its validity for a wide

  7. Revising Russian History.

    Science.gov (United States)

    Wertsch, James V.

    1999-01-01

    Examines the production of new history textbooks that appeared after the breakup of the Soviet Union. Argues that the radical revisions in official history in this context are shaped by the Bakhtinian process of "hidden dialogicality." Suggests that the importance of hidden dialogicality between narrative forms must be considered. (SC)

  8. Belief and Its Revision

    NARCIS (Netherlands)

    Bewersdorf, Benjamin

    2013-01-01

    The role of experience for belief revision is seldom explicitly discussed. This is surprising as it seems obvious that experiences play a major role for most of our belief changes. In this work, the two most plausible views on the role of experience for belief change are investigated: the view that

  9. Revising and editing for translators

    CERN Document Server

    Mossop, Brian

    2014-01-01

    Revising and Editing for Translators provides guidance and learning materials for translation students learning to edit texts written by others, and professional translators wishing to improve their self-revision ability or learning to revise the work of others. Editing is understood as making corrections and improvements to texts, with particular attention to tailoring them to the given readership. Revising is this same task applied to draft translations. The linguistic work of editors and revisers is related to the professional situations in which they work. Mossop offers in-depth coverage of a wide range of topics, including copyediting, style editing, structural editing, checking for consistency, revising procedures and principles, and translation quality assessment. This third edition provides extended coverage of computer aids for revisers, and of the different degrees of revision suited to different texts. The inclusion of suggested activities and exercises, numerous real-world examples, a proposed gra...

  10. Treatment and Survival of Small-bowel Adenocarcinoma in the United States: A Comparison With Colon Cancer.

    Science.gov (United States)

    Young, John I; Mongoue-Tchokote, Solange; Wieghard, Nicole; Mori, Motomi; Vaccaro, Gina M; Sheppard, Brett C; Tsikitis, Vassilki L

    2016-04-01

    Small-bowel adenocarcinoma is rare and fatal. Because of data paucity, there is a tendency to extrapolate treatment from colon cancer, particularly in the adjuvant stetting. The purpose of this study was to evaluate the current surgical and adjuvant treatments of small-bowel adenocarcinoma and compare with colon cancer. This was a retrospective cohort study. The linked Surveillance, Epidemiology, and End Results and Medicare database was used at a tertiary referral hospital. Patients with small-bowel adenocarcinoma and colon cancer identified from 1992 to 2010, using International Classification of Diseases for Oncology, 3 Revision, site, behavior, and histology codes were included. Overall survival and cancer-specific survival were estimated using the Kaplan-Meier method and competing risk analysis. A total of 2123 patients with small-bowel adenocarcinoma and 248,862 patients with colon cancer were identified. Five-year overall survival rates for patients with small-bowel adenocarcinoma and colon cancer were 34.9% and 51.5% (p bowel adenocarcinoma (73.0%) underwent surgery, compared with 177,017 patients with colon cancer (71.1%). The proportion of patients who received chemotherapy was similar, at 21.3% for small bowel and 20.0% for colon. In contrast to colon cancer, chemotherapy did not improve overall or cancer-specific survival for patients with small-bowel adenocarcinoma, regardless of stage. Predictors of poor survival for small-bowel adenocarcinoma on multivariate analysis included advanced age, black race, advanced stage, poor tumor differentiation, high comorbidity index, and distal location. Chemotherapy did not confer additional survival benefit compared with surgery alone (HR, 1.04 (95% CI, 0.90-1.22)). This was a retrospective review. The reliance on Medicare data limited granularity and may have affected the generalizability of the results. The prognosis for small-bowel adenocarcinoma is worse than that for colon cancer, and only surgery improves

  11. Growth hormone treatment in the United States: demographic and diagnostic features of 2331 children.

    Science.gov (United States)

    August, G P; Lippe, B M; Blethen, S L; Rosenfeld, R G; Seelig, S A; Johanson, A J; Compton, P G; Frane, J W; McClellan, B H; Sherman, B M

    1990-06-01

    Demographic, diagnostic, and baseline clinical data were collected for a large cohort (N = 2331) of children who started treatment with biosynthetic human growth hormone (GH) between October 1985 and October 1987. Eighty-one percent met classic criteria for GH deficiency and were classified as having idiopathic GH deficiency (59%), organic GH deficiency (18%), or septo-optic dysplasia (4%). The remaining 19.8% had short stature of varied causes. Height standard deviation score at diagnosis, maximum GH response to stimulation, and heights of parents were examined according to gender, race, age at diagnosis, and previous treatment history. The predominance of boys in all subgroups except septooptic dysplasia, and the observation that girls with idiopathic GH deficiency were comparatively shorter than boys at diagnosis, suggest ascertainment bias. Black children with idiopathic GH deficiency were shorter than white children at diagnosis, and their low overall representation (6.0%) compared with their percentage in the at-risk population (12.9%) also suggest ascertainment bias among races. These data provide a profile of GH deficiency as it is currently defined and expose possible inherent biases in the diagnostic process. Now that GH supply is no longer limited, criteria for its use should be formulated to avoid apparent underascertainment or late diagnosis of GH deficiency in girls and black children.

  12. ALTERNATIVE REMEDIATION TECHNOLOGY STUDY FOR GROUNDWATER TREATMENT AT 200-PO-1 OPERABLE UNIT AT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    DADO MA

    2008-07-31

    This study focuses on the remediation methods and technologies applicable for use at 200-PO-I Groundwater Operable Unit (OU) at the Hanford Site. The 200-PO-I Groundwater au requires groundwater remediation because of the existence of contaminants of potential concern (COPC). A screening was conducted on alternative technologies and methods of remediation to determine which show the most potential for remediation of groundwater contaminants. The possible technologies were screened to determine which would be suggested for further study and which were not applicable for groundwater remediation. COPCs determined by the Hanford Site groundwater monitoring were grouped into categories based on properties linking them by remediation methods applicable to each COPC group. The screening considered the following criteria. (1) Determine if the suggested method or technology can be used for the specific contaminants found in groundwater and if the technology can be applied at the 200-PO-I Groundwater au, based on physical characteristics such as geology and depth to groundwater. (2) Evaluate screened technologies based on testing and development stages, effectiveness, implementability, cost, and time. This report documents the results of an intern research project conducted by Mathew Dado for Central Plateau Remediation in the Soil and Groundwater Remediation Project. The study was conducted under the technical supervision of Gloria Cummins and management supervision of Theresa Bergman and Becky Austin.

  13. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

    Science.gov (United States)

    Martínez Vieira, A; Docobo Durántez, F; Mena Robles, J; Durán Ferreras, I; Vázquez Monchul, J; López Bernal, F; Romero Vargas, E

    2004-07-01

    Analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service) from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). Outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

  14. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

    Directory of Open Access Journals (Sweden)

    A. Martínez Vieira

    Full Text Available Objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Results: group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017, inability to tolerate oral diet (p = 0.002, and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003. Conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

  15. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  16. Review of treatments for improvement the nutritional properties of the cereal straw; Revision de los tratamientos para mejorar el valor nutritivo de la paja de cereal

    Energy Technology Data Exchange (ETDEWEB)

    Mateos, E.; Elias, A.; Ibarra, G. [Universidad del Pais Vasco (Spain)

    1999-08-01

    The objective of this work is to carry out a review of the nutritional properties of the cereal straw, and of the existent methods that contribute to improve its nutritious value, the digestibilidad and ingestion. After the selected treatment, this lignocellulosic by-product will be been able to use like food of quality for the animals with a cost of assailable conditioning. (Author) 18 refs.

  17. Monte Carlo calculations and measurements of absorbed dose per monitor unit for the treatment of uveal melanoma with proton therapy

    Energy Technology Data Exchange (ETDEWEB)

    Koch, Nicholas; Newhauser, Wayne D; Titt, Uwe; Starkschall, George [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (United States); Gombos, Dan [Section of Ophthalmology, Department of Head and Neck Surgery MDACC Unit 441 (United States); Coombes, Kevin [Graduate School of Biomedical Sciences, University of Texas Health Science Center, 6767 Bertner Avenue, Houston, TX 77030 (United States)], E-mail: kochn@musc.edu

    2008-03-21

    The treatment of uveal melanoma with proton radiotherapy has provided excellent clinical outcomes. However, contemporary treatment planning systems use simplistic dose algorithms that limit the accuracy of relative dose distributions. Further, absolute predictions of absorbed dose per monitor unit are not yet available in these systems. The purpose of this study was to determine if Monte Carlo methods could predict dose per monitor unit (D/MU) value at the center of a proton spread-out Bragg peak (SOBP) to within 1% on measured values for a variety of treatment fields relevant to ocular proton therapy. The MCNPX Monte Carlo transport code, in combination with realistic models for the ocular beam delivery apparatus and a water phantom, was used to calculate dose distributions and D/MU values, which were verified by the measurements. Measured proton beam data included central-axis depth dose profiles, relative cross-field profiles and absolute D/MU measurements under several combinations of beam penetration ranges and range-modulation widths. The Monte Carlo method predicted D/MU values that agreed with measurement to within 1% and dose profiles that agreed with measurement to within 3% of peak dose or within 0.5 mm distance-to-agreement. Lastly, a demonstration of the clinical utility of this technique included calculations of dose distributions and D/MU values in a realistic model of the human eye. It is possible to predict D/MU values accurately for clinical relevant range-modulated proton beams for ocular therapy using the Monte Carlo method. It is thus feasible to use the Monte Carlo method as a routine absolute dose algorithm for ocular proton therapy.

  18. Microalgae cultivation as tertiary unit operation for treatment of pharmaceutical wastewater associated with lipid production.

    Science.gov (United States)

    Hemalatha, Manupati; Venkata Mohan, S

    2016-09-01

    Microalgae based treatment was studied to polish sequential batch reactor (SBR) treated pharmaceutical wastewater under mixotrophic mode of operation with simultaneous biomass/lipid production. At the end of biomass growth phase (BGP), carbon removal efficiency was observed to be 73% along with good removal of nitrates (62%). Since microalgae assimilate nutrients from wastewater for growth, an increment in total biomass productivity (2.8g/l) was observed. Subjecting to nutrient stress phase (NSP), total lipid content of 17.2% with neutral lipids of 6.2% was observed under light condition. Contrarily, dark condition depicted total lipid content of 15.8% with neutral lipids constituting 6.5%. The nutrient stress in combination with light showed marked influence on the profile of saturated and unsaturated fatty acids. Integration of microalgae cultivation improves environmental sustainability and enables greener routes of biofuels and value added products synthesis in a biorefinery approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. The importance of early recognition and timely treatment of delirium in intensive care units

    Directory of Open Access Journals (Sweden)

    Stašević-Karličić Ivana

    2016-01-01

    Full Text Available Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia. The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A - Delirium as a sign of system infection, B - Therapy - Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C - An inconspicuous onset of delirium is overlooked, D - Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F - Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H - The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30 -40% of cases (50. An etiological treatment would help avoid complicating delirium's clinical picture and would very much

  20. Unacceptable treatment outcomes and associated factors among India's initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007-2011): Evidence leading to policy enhancement.

    Science.gov (United States)

    Parmar, Malik M; Sachdeva, Kuldeep Singh; Dewan, Puneet K; Rade, Kiran; Nair, Sreenivas A; Pant, Rashmi; Khaparde, Sunil D

    2018-01-01

    Globally, India has the world's highest burden of multidrug-resistant tuberculosis (MDR-TB). Programmatic Management of Drug Resistant TB (PMDT) in India began in 2007 and nationwide coverage was achieved in early 2013. Poor initial microbiological outcomes under the Revised National Tuberculosis Control Programme (RNTCP) prompted detailed analysis. This is the first study on factors significantly associated with poor outcomes in MDR-TB patients treated under the RNTCP. To evaluate initial sputum culture conversion, culture reversion and final treatment outcomes among MDR-TB patients registered in India from 2007 to early 2011 who were treated with a standard 24-month regimen under daily-observed treatment. This is a retrospective cohort study. Clinical and microbiological data were abstracted from PMDT records. Initial sputum culture conversion, culture reversion and treatment outcomes were defined by country adaptation of the standard WHO definitions (2008). Cox proportional hazards modeling with logistic regression, multinomial logistic regression and adjusted odds ratio was used to evaluate factors associated with interim and final outcomes respectively, controlling for demographic and clinical characteristics. In the cohort of 3712 MDR-TB patients, 2735 (73.6%) had initial sputum culture conversion at 100 median days (IQR 92-125), of which 506 (18.5%) had culture reversion at 279 median days (IQR 202-381). Treatment outcomes were available for 2264 (60.9%) patients while 1448 (39.0%) patients were still on treatment or yet to have a definite outcome at the time of analysis. Of 2264 patients, 781 (34.5%) had treatment success, 644 (28.4%) died, 670 (29.6%) were lost to follow up, 169 (7.5%) experienced treatment failure or were changed to XDR-TB treatment. Factors significantly associated with either culture non-conversion, culture reversion and/or unfavorable treatment outcomes were baseline BMI TB patients, 62 (59.6%) had Ofloxacin resistance among whom only