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Sample records for treatment units revision

  1. 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

  2. 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.

  3. Malaria Treatment (United States)

    Science.gov (United States)

    ... Providers, Emergency Consultations, and General Public. Contact Us Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  4. Revised Mulliken Electronegativities I. Calculation and Conversion to Pauling Units.

    Science.gov (United States)

    Bratsch, Steven G.

    1988-01-01

    Discusses a revision and extension of the Mulliken electronegativity scale to consider 50 elements. Describes the calculation of valence-state promotion energies and Mulliken atomic electronegativities and the conversion of Mulliken electronegativities to Pauling units. (CW)

  5. 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

  6. 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...

  7. 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.

  8. 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...

  9. 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

  10. Financing the Business. PACE Revised. Level 3. Unit 8. Research & Development Series No. 240CB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on financing businesses, the eighth of 18 modules, is on the third level of the revised Program for Acquiring Competence in Entrepreneurship (PACE). Intended for the advanced secondary and postsecondary levels and for adults wanting training or retraining, this unit, together with the other materials at…

  11. Quality measurement in the shunt treatment of hydrocephalus: analysis and risk adjustment of the Revision Quotient.

    Science.gov (United States)

    Piatt, Joseph H; Freibott, Christina E

    2014-07-01

    OBJECT.: The Revision Quotient (RQ) has been defined as the ratio of the number of CSF shunt revisions to the number of new shunt insertions for a particular neurosurgical practice in a unit of time. The RQ has been proposed as a quality measure in the treatment of childhood hydrocephalus. The authors examined the construct validity of the RQ and explored the feasibility of risk stratification under this metric. The Kids' Inpatient Database for 1997, 2000, 2003, 2006, and 2009 was queried for admissions with diagnostic codes for hydrocephalus and procedural codes for CSF shunt insertion or revision. Revision quotients were calculated for hospitals that performed 12 or more shunt insertions annually. The univariate associations of hospital RQs with a variety of institutional descriptors were analyzed, and a generalized linear model of the RQ was constructed. There were 12,244 admissions (34%) during which new shunts were inserted, and there were 23,349 admissions (66%) for shunt revision. Three hundred thirty-four annual RQs were calculated for 152 different hospitals. Analysis of variance in hospital RQs over the 5 years of study data supports the construct validity of the metric. The following factors were incorporated into a generalized linear model that accounted for 41% of the variance of the measured RQs: degree of pediatric specialization, proportion of initial case mix in the infant age group, and proportion with neoplastic hydrocephalus. The RQ has construct validity. Risk adjustment is feasible, but the risk factors that were identified relate predominantly to patterns of patient flow through the health care system. Possible advantages of an alternative metric, the Surgical Activity Ratio, are discussed.

  12. 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.

  13. 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

  14. Financing the Business. PACE Revised. Level 2. Unit 8. Research & Development Series No. 240BB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on financing a small business, the eighth in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about and try out…

  15. 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.

  16. 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

  17. History of United States Energy. A Basic Teaching Unit on Energy. Revised.

    Science.gov (United States)

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

    Intended as a supplement to the units "Oil: Fuel of the Past" and "Coal: Fuel of the Past, Hope of the Future," this 3-4 day unit contains three activities which briefly explain the chronological development of energy resources and the formation and development of the Organization of Petroleum Exporting Countries (OPEC). The…

  18. Determining Your Potential as an Entrepreneur. PACE Revised. Level 3. Unit 2. Research & Development Series No. 240CB2.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on determining one's potential as an entrepreneur, the second of 18 modules, is on the third level of the revised Program for Acquiring Competence in Entrepreneurship (PACE). Intended for the advanced secondary and postsecondary levels and for adults wanting training or retraining, this unit, together…

  19. Planning the Marketing Strategy. PACE Revised. Level 3. Unit 6. Research & Development Series No. 240CB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on planning marketing strategy, the sixth of 18 modules, is on the third level of the revised Program for Acquiring Competence in Entrepreneurship (PACE). Intended for the advanced secondary and postsecondary levels and for adults wanting training or retraining, this unit, together with the other…

  20. 40 CFR Appendix A to Subpart III... - States With Approved State Implementation Plan Revisions Concerning CAIR SO2 Opt-In Units

    Science.gov (United States)

    2010-07-01

    ... Implementation Plan Revisions Concerning CAIR SO2 Opt-In Units A Appendix A to Subpart III of Part 97 Protection... BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS CAIR SO2 Opt-in Units Pt. 97, Subpt. III... Concerning CAIR SO2 Opt-In Units 1. The following States have State Implementation Plan revisions under § 51...

  1. Early treatment using fractional CO2 laser before skin suture during scar revision surgery in Asians.

    Science.gov (United States)

    Du, Feiya; Yu, Yusheng; Zhou, Zhiqin; Wang, Liujia; Zheng, Shusen

    2018-04-01

    Fractional CO 2 laser is one of the most effective treatment options used to resurface scars. However, most previous studies have been performed on mature scars at least 2 months after surgery. Recent studies have emphasized the importance of early treatment to reduce scar formation. In the present study, we described our experience with fractional CO 2 laser intervention before skin suture during scar revision surgery in Asians, and found the treatment was safe and effective.

  2. 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

  3. 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

  4. 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.

  5. Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

    Science.gov (United States)

    Zeinali-Rafsanjani, B; Faghihi, R; Mosleh-Shirazi, M A; Mosalaei, A; Hadad, K

    2017-01-01

    Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest

  6. 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,…

  7. Determining Your Potential as an Entrepreneur. PACE Revised. Level 2. Unit 2. Research & Development Series No. 240BB2.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on determining one's potential as an entrepreneur, the second in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about…

  8. Planning the Marketing Strategy. PACE Revised. Level 2. Unit 6. Research & Development Series No. 240BB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on planning marketing strategy for a small business, the sixth in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about…

  9. Nevada Test Site Site Treatment Plan. Revision 2

    International Nuclear Information System (INIS)

    1996-03-01

    Treatment Plans (STPS) are required for facilities at which the US Department of Energy (DOE) or stores mixed waste, defined by the Federal Facility Compliance Act (FFCAct) as waste containing both a hazardous waste subject to the Resource Conservation and Recovery Act and a radioactive material subject to the Atomic Energy Act. On April 6, 1993, DOE published a Federal Register notice (58 FR 17875) describing its proposed process for developing the STPs in three phases including a Conceptual, a Draft, and a Proposed Site Treatment Plan (PSTP). All of the DOE Nevada Operations Office STP iterations have been developed with the state of Nevada's input. The options and schedules reflect a ''bottoms-up'' approach and have been evaluated for impacts on other DOE sites, as well as impacts to the overall DOE program. Changes may have occurred in the preferred option and associated schedules between the PSTP, which was submitted to the state of Nevada and US Environmental Protection Agency April 1995, and the Final STP (hereafter referred to as the STP) as treatment evaluations progressed. The STP includes changes that have occurred since the submittal of the PSTP as a result of state-to-state and DOE-to-state discussions

  10. 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.

  11. A revised annotated checklist of the Chironomidae (Insecta: Diptera) of the southeastern United States

    Science.gov (United States)

    Caldwell, Broughton A.; Hudson, Patrick L.; Lenat, David R.; Smith, David

    1997-01-01

    A revised annotated checklist for the chironomid midges (Diptera: Chironomidae) of the southeastern United States is presented that includes the states of Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee. Much of the information concerns occurrence and habitat preference records based upon the authors' data, as well as published and unpublished data. Some information is also presented that includes aspects of biology, habitat preference, bibliographic sources, and nomenclatorial changes. Based upon the present work, the chironomid fauna of the southeastern states is comprised of 189 genera (172 described, 17 informally or unofficially described) and 754 species (505 described, 17 informally or unofficially described, 33 that are assumed for generic or subgeneric presence only, 197 estimated species, and 2 species groups). Several new species synonyms and generic placements are recognized. Thirty-eight genera known from the Nearctic region remain unknown from the southeastern states. Diversity of species was greatest in the subfamily Chironominae, considering named as well as unnamed and estimated species. There were no significant changes in overall regional distribution patterns of subfamilies or habitat preferences form that which has been previously reported. The greatest totals for regional records, habitat types, and state occurrences were the Coastal Plain (378), streams (271), and North Carolina (373), respectively.

  12. 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.

  13. Revised feed-in tariff for solar photovoltaic in the United Kingdom: A cloudy future ahead?

    International Nuclear Information System (INIS)

    Muhammad-Sukki, Firdaus; Ramirez-Iniguez, Roberto; Munir, Abu Bakar; Mohd Yasin, Siti Hajar; Abu-Bakar, Siti Hawa; McMeekin, Scott G.; Stewart, Brian G.

    2013-01-01

    The United Kingdom (UK) started implementing a national Feed-In Tariff (FiT) mechanism on the 1 April 2010, which included specific payment tariffs for solar photovoltaic (PV) installations. However, a revised FiT rate has been put in place starting from 1 April 2012, applicable to any installations with an eligibility date of on or after 3 March 2012. This paper presents, first, an overview of solar PV installation in the UK. This followed by a general concept of the FiT in the UK before analyzing the financial impact of the new FiT rate on the consumers. Similar financial analysis is conducted with selected countries in Europe. The financial analysis investigates the total profit, the average rate of return and the payback period. It is found that the new FiT rate generates very low profit, minimum rate of return and a longer payback period, suggesting a downward trend of solar PV uptake in the future. - Highlight: ► Overview of solar PV installation in the UK until present time is discussed. ► Financial analysis is presented using previous, new and degression FiT tariff. ► Comparative analysis with other European countries is evaluated. ► The new FiT rate in the UK generates very low return than other countries. ► This could suggest a downward trend of UK's solar PV uptake in the future

  14. Adaptive remediation using portable treatment units

    International Nuclear Information System (INIS)

    Bahowick, S.; Folsom, E.; Pico, T.

    1996-01-01

    Lawrence Livermore National Laboratory (LLNL) is using adaptive remediation to optimize their environmental restoration strategy. Adaptive remediation uses hydrostratigraphic analysis to gain a better understanding of the subsurface characteristics, hydraulic tests to optimize contaminant transport models, and Portable Treatment Units (PTUs) as an alternative to fixed facilities. Hydrostratigraphic analysis is an optimization tool that improves the ability to identify and target contaminant migration pathways, identify the relationship between plumes and source areas, and better define hydraulic capture areas. Hydraulic tests, performed with PTUs, provide valuable data about subsurface characteristics. As clean up progresses, PTUs can be moved to the appropriate extraction wells to optimize contaminant mass removal. PTUs can also be placed to support innovative treatment technologies such as steam injection and microbial filters. Construction of PTUs will reduce by one-half the capital costs of building the rest of the fixed treatment system planned in the Record of Decision. Regulatory agencies are receptive to the use of the PTUs because the same treatment technology is being used and the PTUs will be able to clean up the plume cheaper and faster. Using adaptive remediation, LLNL is more effectively implementing remediation plans, improving cleanup time, and reducing project costs

  15. Unit-specific contingency plan for the 183-H solar evaporation basins. Revision 1

    International Nuclear Information System (INIS)

    Zoric, J.P.

    1996-03-01

    This document is a supplement to the Hanford Facility Contingency Plan. It provides the unit-specific information needed to fully comply with the Washington Administrative Code, Chapter 173-303, ''Dangerous Waste Regulations,'' for contingency plans. General emergency and response information is contained in the Hanford Facility Contingency Plan and is not repeated in this supplement. The 183-H solar evaporation basins are four concrete internal surfaces which contained radiologically- and hazardous-contaminated waste. The 183-H basins are currently empty, inactive and designated as a Resource Conservation and Recovery Act interim-status treatment, storage, and disposal unit undergoing closure. There is no dangerous waste management actively occurring. There is very little likelihood of any incidents that would present hazards to public health or the environment occurring at the 183-H basins

  16. Unit-specific contingency plan for the 183-H Solar Evaporation Basins. Revision 2

    International Nuclear Information System (INIS)

    Zoric, J.P.

    1997-01-01

    This document is a supplement to the Hanford Facility Contingency Plan. It provides the unit-specific information needed to fully comply with the Washington Administrative Code, Chapter 173-303, ''Dangerous Waste Regulations,'' for contingency plans. General emergency and response information is contained in the Hanford Facility Contingency Plan and is not repeated in this supplement. The 183-H Solar Evaporation Basins are four concrete internal surfaces which contained radiologically- and hazardous-contaminated waste. The 183-H basins are currently empty, inactive and designated as a Resource Conservation and Recovery Act interim-status treatment, storage, and disposal unit undergoing closure. There is no dangerous waste management actively occurring. There is very little likelihood of any incidents that would present hazards to public health or the environment occurring at the 183-H basins

  17. 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

    .7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor...... pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while...

  18. Safety analysis on Non-LOCA events for the revision of Wolsong NPP unit 2,3,4 sar

    International Nuclear Information System (INIS)

    Kim, Jong Hyun; Jin, Dong Sik; Ryu, Eui Seung; Kho, Dong Wook; Kim, Sung Min

    2015-01-01

    Korean Wolsong Nuclear Power Plant Units 2,3,4 (CANDU-6 Type) has prepared the revision of safety analysis report (Final Safety Analysis Report (FSAR) chapter 15) from the original performed in the year of 1990s, using the updated and state-of-the-art methodology and tools including IST safety analysis codes and more detail modelling. Compared with the original FSAR15, the revised FSAR15 has significant improvement in both the scope and the depth of safety analysis, which has demonstrated the safety analysis results have complied with the safety requirements(acceptance criteria). This paper will present the analysis scope for Non-LOCA events re-analyzed or added for the FSAR15 revision, methodologies applied such as codes and modelling and some important analysis results will be demonstrated with comparison to acceptance criteria. Application of more detail and near-realistic assumptions and method including Dev-PDO options and uncertainty related to the CHF correlations has altogether brought about more safety margin compared with the original FSAR15 with respect to SDS trip effectiveness etc. (author)

  19. Design parameters for waste effluent treatment unit from beverages production

    OpenAIRE

    Mona A. Abdel-Fatah; H.O. Sherif; S.I. Hawash

    2017-01-01

    Based on a successful experimental result from laboratory and bench scale for treatment of wastewater from beverages industry, an industrial and efficient treatment unit is designed and constructed. The broad goal of this study was to design and construct effluent, cost effective and high quality treatment unit. The used technology is the activated sludge process of extended aeration type followed by rapid sand filters and chlorination as tertiary treatment. Experimental results have been con...

  20. 77 FR 71129 - Revisions to the California State Implementation Plan, San Joaquin Valley United Air Pollution...

    Science.gov (United States)

    2012-11-29

    ...EPA is finalizing approval of revisions to the SJVUAPCD and SCAQMD portion of the California State Implementation Plan (SIP). This action was proposed in the Federal Register on June 21, 2012 and concerns volatile organic compound (VOC) emissions from chipping and grinding activities, and composting operations. We are approving local rules that regulate these emission sources under the Clean Air Act (CAA or the Act).

  1. Revised surveillance case definition for HIV infection--United States, 2014.

    Science.gov (United States)

    2014-04-11

    Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

  2. 76 FR 3077 - Notice of Decision To Revise a Heat Treatment Schedule for Emerald Ash Borer

    Science.gov (United States)

    2011-01-19

    ... plants, fruits, vegetables, and other articles must be treated before they may be moved into the United... of 7 CFR chapter III for fruits, vegetables, and other articles. In Sec. 305.2, paragraph (b) states... would have resulted in some additional drying of the firewood before the treatment. Although the extra...

  3. 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

  4. 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

  5. 78 FR 59817 - Revision to United States Marshals Service Fees for Services

    Science.gov (United States)

    2013-09-30

    .... 4(b). When a statute does not address issues of how to calculate fees or what costs to include in..., investment, productivity, innovation, or on the ability of United States-based enterprises to compete with...

  6. 77 FR 32645 - Revision of Performance Standards for State Medicaid Fraud Control Units

    Science.gov (United States)

    2012-06-01

    ... familiar with, and adhere to, policies and procedures. To determine whether a Unit meets this standard, OIG... provide training on the elements of successful fraud referrals and receive training on the role and...

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

    Science.gov (United States)

    2011-10-06

    ... familiar with, and adhere to, policies and procedures. In meeting this standard, the following performance... funding permits. E. Through cross-training or by other means, Unit staff receive training on the role and...

  8. 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

  9. 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

  10. 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

  11. Financing the Business. PACE Revised. Level 1. Unit 8. Research & Development Series No. 240AB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This lesson on financing a business, the eighth in a series of 18 units, is part of the first level of a comprehensive entrepreneurship curriculum entitled: A Program for Acquiring Competence in Entrepreneurship (PACE). (Designed for use with secondary students, the first level of PACE introduces students to the concepts involved in…

  12. Biomedical Mathematics, Unit VII: Exponential and Logarithmic Functions. Student Text. Revised Version, 1977.

    Science.gov (United States)

    Biomedical Interdisciplinary Curriculum Project, Berkeley, CA.

    This collection of lessons, exercises, and experiments deals with exponential and logarithmic mathematical functions in the context of biomedical situations. Typical units in this collection provide discussion of the biomedical problem or setting, discussion of the mathematical concept, several example problems and solutions, and a set of problems…

  13. 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.

  14. Design parameters for waste effluent treatment unit from beverages production

    Directory of Open Access Journals (Sweden)

    Mona A. Abdel-Fatah

    2017-09-01

    Full Text Available Based on a successful experimental result from laboratory and bench scale for treatment of wastewater from beverages industry, an industrial and efficient treatment unit is designed and constructed. The broad goal of this study was to design and construct effluent, cost effective and high quality treatment unit. The used technology is the activated sludge process of extended aeration type followed by rapid sand filters and chlorination as tertiary treatment. Experimental results have been considered as the basis for full scale design of the industrial capacity of 1600 m3/day treatment plant. Final effluent characteristics after treatment comply with Egyptian legalizations after reducing COD and BOD5 by about 97% and 95% respectively. So it is recommended to reuse treated effluent in textile industry in dyeing process.

  15. Site-specific waste management instruction for the 100-KR-4 Operable Unit drilling. Revision 1

    International Nuclear Information System (INIS)

    Hadley, J.T.

    1996-08-01

    This site-specific waste management instruction provides guidance for the management of waste generated as a result of groundwater well installations in the 100-KR-4 Operable Unit (OU). The well installations are necessary to implement the Remedial Action (RA) option (pump-and-treat using ion exchange) to prevent discharge of hexavalent chromium at levels above those considered protective of aquatic life in the Columbia River and riverbed sediments

  16. Midwife-attended births in the United States, 1990-2012: results from revised birth certificate data.

    Science.gov (United States)

    Declercq, Eugene

    2015-01-01

    Data on attendance at birth by midwives in the United States have been available on the national level since 1989, allowing for the documentation of long-term trends. New items on payer source and prepregnancy body mass index (BMI) from a 2003 revision of the birth certificate provide an opportunity to examine additional aspects of US midwifery practice. The data in this report are based on records on birth attendant gathered as part of the US National Standard Certificate of Live Birth from a public use Web site, Vital Stats (http://www.cdc.gov/nchs/VitalStats.htm), which allows users to create and download specialized tables. Analysis of new items on prepregnancy BMI and birth payer source are limited to the 38 states (86% of US births) that adopted the revised birth certificate by 2012. Between 1989 and 2012, the proportion of all births attended by certified nurse-midwives (CNMs) increased from 3.3% to 7.9%. The proportion of vaginal births attended by CNMs reached an all-time high of 11.9%. Births attended by "other midwives" (typically certified professional midwives) rose to a peak of 28,343, or 0.7% of all US births. The distribution of payer source for CNM-attended births (44% Medicaid; 44% private insurance; 6% self-pay) is very similar to the national distribution, whereas the majority (53%) of births attended by other midwives are self-pay. Women whose births are attended by other midwives are less likely (13%) to have a prepregnancy BMI in the obese range than women attended by CNMs (19%) or overall (24%). The total number of births attended by CNMs and other midwives has remained steady or grown at a time when total US births have declined, resulting in the largest proportions of midwife-attended births in the quarter century that such data have been collected. © 2015 by the American College of Nurse-Midwives.

  17. Proposed plan for interim remedial measures at the 100-KR-1 Operable Unit. Revision 1

    International Nuclear Information System (INIS)

    1995-09-01

    This proposed plan identifies the preferred alternative for interim remedial measures for remedial action of radioactive liquid waste disposal sites that include contaminated soils and structures at the 100-KR-1 Operable Unit, located at the Hanford Site. It also summarizes other remedial alternatives evaluated for interim remedial measures in this Operable Unit. The intent of interim remedial measures is to speed up actions to address contaminated areas that pose potential threats to human health and the environment. This proposed plan is being issued by the US Environmental Protection Agency (EPA), the lead regulatory agency; the Washington State Department of Ecology (Ecology), the support regulatory agency; and the US Department of Energy (DOE), the responsible agency. The EPA, Ecology, and the DOE are issuing this proposed plan as part of their public participation responsibilities under Section 117(a) of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), commonly known as the ''Superfund Law.'' This proposed plan is intended to be a fact sheet for public review which briefly describes the remedial alternatives analyzed, identifies a preferred alternative, and summarizes the information relied upon to recommend the preferred alternative

  18. Risk-based decision analysis for the 200-BP-5 groundwater operable unit. Revision 2

    International Nuclear Information System (INIS)

    Chiaramonte, G.R.

    1996-02-01

    This document presents data from a risk analysis that was performed on three groundwater contaminant plumes within the 200-BP-5 Operable Unit. Hypothetical exposure scenarios were assessed based on current and future plume conditions. For current conditions, a hypothetical industrial groundwater scenarios were assumed. The industrial ingestion scenario, which is derived from HSRAM, was not used for drinking water and should not be implied by this risk analysis that the DOE is advocating use of this groundwater for direct human ingestion. Risk was calculated at each monitoring well using the observed radionuclide concentrations in groundwater from that well. The calculated values represent total radiological incremental lifetime cancer risk. Computer models were used to show the analytical flow and transport of contaminants of concern

  19. Data acquisition and treatment unit for use in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Annaix, C; Prieur, G; Vilayleck, S; Jallet, P [C.H.R., Angers (France)

    1981-01-01

    Here is below a one-channel data acquisition unit piloted through a minicomputer programmed by means of an advanced language of the Basic type. This unit allows, especially in nuclear medicine, pulse counts from a spectrometer according to a programmed sequence. Moreover, it provides treatment of measures as well as printing and filing of interpreted results. The acquisition unit is linked to the minicomputer through a RS 232 C serial mode, which ensures both easy operation and universal use of the system here described. Accuracy of measurement is also examined.

  20. 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

  1. 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.

  2. 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...

  3. 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).

  4. 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....

  5. Accessibility of hypertensive users to health units and treatment adherence

    Directory of Open Access Journals (Sweden)

    Natasha Marques Frota

    2013-09-01

    Full Text Available We aimed to analyze the accessibility of hypertensive users to the health system with focus on treatment adherence. A cross-sectional study with quantitative approach was conducted in four Family Health Basic Units of Fortaleza-CE, Brazil. The sample consisted of 400 users. Data collection happened through a form applied from May to August 2011. About 97.5% of users were older than 40 years, and 67.2% were female. The accessibility to the referral service occurred in 47.2% of users to secondary care, of which 101 (25.2% were referred to Emergency Units, and 88 (22.0% were admitted to Inpatient Units. Most hypertensive patients adhered to healthy habits, except the use of dietetic sweeteners (36.0% and physical exercise (35.0%. The hypertensive patients had good treatment adherence and difficulty in accessibility regarding counter-referral services to secondary and tertiary care services.

  6. 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.

  7. 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.

  8. Beyond Ebola treatment units: severe infection temporary treatment units as an essential element of Ebola case management during an outbreak.

    Science.gov (United States)

    Janke, Christian; Heim, Katrin Moira; Steiner, Florian; Massaquoi, Moses; Gbanya, Miatta Zenabu; Frey, Claudia; Froeschl, Guenter

    2017-02-06

    In the course of the Ebola outbreak in West Africa that was witnessed since early 2014, the response mechanisms showed deficits in terms of timeliness, volume and adequacy. The authors were deployed in the Ebola campaign in the West African country Liberia, where by September 2014 the changing epidemiological pattern made reconsiderations of guidelines and adopted procedures necessary. A temporary facility set up as a conventional Ebola Treatment Unit in the Liberian capital Monrovia was re-dedicated into a Severe Infections Temporary Treatment Unit. This facility allowed for stratification based on the nosocomial risk of exposure to Ebola virus for a growing subgroup of admitted patients that in the end would turn out as Ebola negative cases. At the same time, adequate diagnostic measures and treatment for the non-Ebola conditions of these patients could be provided without compromising work safety of the employed staff. The key elements of the new unit comprised a Suspect Cases Area similar to that of conventional Ebola treatment units for newly arriving patients, an Unlikely Cases Area for patients with a first negative Ebola PCR result, and a Confirmed Negative Cases Area for patients in whom Ebola could be ruled out. The authors, comprising representatives of the Liberian Ministry of Health and Social Welfare, as well as infectious disease specialists from the German Ebola Task Force are presenting key features of the adapted concept, and are highlighting its relevance in raising acceptance for outbreak counter-measures within the population at stake.

  9. 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.

  10. Automated system for review of radiotherapy treatment sheets; Sistema automatizado pra la revision de hojas de tratamiento en radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Collado Chamorro, P.; Sanz Freire, C. J.; Vazquez Galinanes, A.; Diaz Pascual, V.; Gomez amez, J.; Martinez Sanchez, S.; Ossola Lentati, G. A.

    2011-07-01

    In many modern radiotherapy services begins to leaf treatment implemented in electronic form. In our department has developed an automated reporting system, that check the following parameters: treatment completed correctly, number of sessions and cumulative dose administered. Likewise treatments are verified in the allocated separate unit, and over-writing table parameters.

  11. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'

    Directory of Open Access Journals (Sweden)

    Merlin Tracy

    2009-06-01

    Full Text Available Abstract Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely

  12. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'

    Science.gov (United States)

    2009-01-01

    Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely used and provides a common

  13. 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

  14. [Results of revision after failed surgical treatment for traumatic anterior shoulder instability].

    Science.gov (United States)

    Lópiz-Morales, Y; Alcobe-Bonilla, J; García-Fernández, C; Francés-Borrego, A; Otero-Fernández, R; Marco-Martínez, F

    2013-01-01

    Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques). Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  15. B Plant treatment, storage, and disposal (TSD) units inspection plan

    International Nuclear Information System (INIS)

    Beam, T.G.

    1996-01-01

    This inspection plan is written to meet the requirements of WAC 173-303 for operations of a TSD facility. Owners/operators of TSD facilities are required to inspection their facility and active waste management units to prevent and/or detect malfunctions, discharges and other conditions potentially hazardous to human health and the environment. A written plan detailing these inspection efforts must be maintained at the facility in accordance with Washington Administrative Code (WAC), Chapter 173-303, ''Dangerous Waste Regulations'' (WAC 173-303), a written inspection plan is required for the operation of a treatment, storage and disposal (TSD) facility and individual TSD units. B Plant is a permitted TSD facility currently operating under interim status with an approved Part A Permit. Various operational systems and locations within or under the control of B Plant have been permitted for waste management activities. Included are the following TSD units: Cell 4 Container Storage Area; B Plant Containment Building; Low Level Waste Tank System; Organic Waste Tank System; Neutralized Current Acid Waste (NCAW) Tank System; Low Level Waste Concentrator Tank System. This inspection plan complies with the requirements of WAC 173-303. It addresses both general TSD facility and TSD unit-specific inspection requirements. Sections on each of the TSD units provide a brief description of the system configuration and the permitted waste management activity, a summary of the inspection requirements, and details on the activities B Plant uses to maintain compliance with those requirements

  16. 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

  17. 76 FR 34147 - Land Disposal Restrictions: Revision of the Treatment Standards for Carbamate Wastes

    Science.gov (United States)

    2011-06-13

    ... numeric concentration limits or methods of treatment that substantially diminish the hazardous waste's... methods), reinstated the LDR treatment standards expressed as numerical concentration limits for 32... treatment methods and numeric concentration limits provides maximum flexibility in the choice of treatment...

  18. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: an analysis of 3863 patients.

    Science.gov (United States)

    Degen, Ryan M; Cancienne, Jourdan M; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

    2017-04-01

    This study was conducted to identify the rate of failure of operative treatment of lateral epicondylitis, defined as progression to ipsilateral revision surgery, and associated patient-specific risk factors for failure. A national database was used to identify patients undergoing surgical treatment of lateral epicondylitis from 2005 to 2012. Patients undergoing concomitant procedures were excluded. Patients who then required subsequent ipsilateral extensor carpi radialis brevis débridement or release within 2 years were identified using similar methods. A multivariate binomial logistic regression analysis was used to evaluate patient-related risk factors for revision surgery. In addition, the number of preoperative injections (1, 2, or ≥3) in the ipsilateral elbow was identified and included in the regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor. Of 3863 patients who underwent operative treatment of lateral epicondylitis, 58 (1.5%) required ipsilateral revision surgery. Risk factors for revision surgery included age lateral epicondylitis in the studied population is low (1.5%). Risk factors for revision surgery include younger age, male gender, morbid obesity, tobacco use, and inflammatory arthritis. The most significant risk factor for revision surgery is having ≥3 ipsilateral preoperative injections. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

    Directory of Open Access Journals (Sweden)

    Georgios K Matis

    2013-01-01

    Full Text Available Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

  20. 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

    Introduction Bisphosphonates have been proposed to delay or prevent loosening of joint replacement implants by reducing bone resorption. It is known, however, that implant motion prevents the bone anchorage necessary to maintain secure implant fixation. Methods We used our experimental implant...... 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...... administration alone to rescue implants that are already loose. In implants that have not progressed to loosening, alendronate may increase bone density at the border with the sclerotic shell, but the effect of this bone in delaying eventual loosening is not known. Udgivelsesdato: 2007-Dec...

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

    OpenAIRE

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

    2016-01-01

    Objective:\\ud 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).\\ud Study design:\\ud a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected...

  2. 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

  3. 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. 

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

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sung-ho; Seo, Hana; Lee, Chansuh; Kim, Jong-sook [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

    2015-10-15

    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.

  5. 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

  6. Could a revision of the current guidelines for cancer drug use improve the quality of cancer treatment?

    Science.gov (United States)

    Lippert, Theodor H; Ruoff, Hans-Jörg; Volm, Manfred

    2014-01-01

    Clinical practice guidelines are indispensable for such a variable disease as malignant solid tumors, with the complex possibilities of drug treatment. The current guidelines may be criticized on several points, however. First, there is a lack of information on the outcome of treatment, such as the expected success and failure rates. Treating not only drug responders but also nonresponders, that is, patients with drug resistance, must result in failures. There is no mention of the possibility of excluding the drug nonresponders, identifiable by special laboratory tests and no consideration is given to the different side effects of the recommended drug regimens. Nor are there any instructions concerning tumor cases for which anticancer drug treatment is futile. In such cases, early palliative care may lead to significant improvements in both life quality and life expectancy. Not least, there is no transparency concerning the preparation of the guidelines: persons cannot be identified who could give a statement of conflicts of interest, and responsibility is assumed only by anonymous medical associations. A revision of the current guidelines could considerably improve cancer treatment.

  7. Could a revision of the current guidelines for cancer drug use improve the quality of cancer treatment?

    Directory of Open Access Journals (Sweden)

    Lippert TH

    2014-01-01

    Full Text Available Theodor H Lippert,1 Hans-Jörg Ruoff,1 Manfred Volm2 1Medical Faculty, University of Tübingen, Tübingen, Germany; 2Medical Faculty, University of Heidelberg, Heidelberg, Germany Abstract: Clinical practice guidelines are indispensable for such a variable disease as malignant solid tumors, with the complex possibilities of drug treatment. The current guidelines may be criticized on several points, however. First, there is a lack of information on the outcome of treatment, such as the expected success and failure rates. Treating not only drug responders but also nonresponders, that is, patients with drug resistance, must result in failures. There is no mention of the possibility of excluding the drug nonresponders, identifiable by special laboratory tests and no consideration is given to the different side effects of the recommended drug regimens. Nor are there any instructions concerning tumor cases for which anticancer drug treatment is futile. In such cases, early palliative care may lead to significant improvements in both life quality and life expectancy. Not least, there is no transparency concerning the preparation of the guidelines: persons cannot be identified who could give a statement of conflicts of interest, and responsibility is assumed only by anonymous medical associations. A revision of the current guidelines could considerably improve cancer treatment. Keywords: anticancer drugs, quality of guidelines, critical remarks

  8. 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

  9. Radiological emergency response in a medical waste treatment unit

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L. [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil)

    2000-07-01

    Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

  10. Radiological emergency response in a medical waste treatment unit

    International Nuclear Information System (INIS)

    Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L.

    2000-01-01

    Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

  11. 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

  12. 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…

  13. 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…

  14. Selecting Effective Treatments: A Comprehensive, Systematic Guide to Treating Mental Disorders. Revised Edition.

    Science.gov (United States)

    Seligman, Linda

    This book presents an overview of the major types of mental disorders, accompanied by treatment models that are structured, comprehensive, grounded in research, and likely to be effective. Chapter topics are: (1) "Introduction to Effective Treatment Planning"; (2) "Mental Disorders in Infants, Children, and Adolescents"; (3) "Situationally…

  15. Treatment and disposal of petroleum contaminated soil (June 1996) : revised May 1998

    International Nuclear Information System (INIS)

    1998-05-01

    Leaking petroleum storage tanks and petroleum contaminated sites can pose significant environmental and public safety hazards. Proper mitigation is required to remove this threat. These guidelines are intended to assist environmental consultants, petroleum service contractors, waste disposal ground operators and petroleum storage tank owners in the management of petroleum contaminated soil (PCS). The procedures that should be used for disposal and treatment of PCS at licensed soil treatment facilities, municipal waste disposal grounds, and at single-use soil treatment sites approved by Manitoba Environment are described. The treatment should control excessive emission of volatile organic compounds to the atmosphere. Losses of petroleum compounds by leaching should also be controlled. The main treatment method at government-approved sites is land farming. Other remedial options include enhanced bioremediation, asphalt incorporation, soil washing, and thermal treatment. Permitting and licensing procedures, guidelines for the design and operations at PCS treatment and disposal sites, procedures for the removal and re-use of treated soil and procedures for the decommissioning of PCS treatment sites are also outlined. A list of other associated regulations and guidelines is included. 2 tabs

  16. 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)

  17. CE: Inside an Ebola Treatment Unit: A Nurse's Report.

    Science.gov (United States)

    Wilson, Deborah

    2015-12-01

    In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it's like to work during an Ebola outbreak and to put a human face on this devastating epidemic.

  18. 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.

  19. Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.

    Science.gov (United States)

    Carvalho, Bettina; Ballin, Annelyse Cristine; Becker, Renata Vecentin; Ribeiro, Talita Beithum; Cavichiolo, Juliana Benthien; Ballin, Carlos Roberto; Mocellin, Marcos

    2012-04-01

     Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment.  The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center.  We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center.  Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy.  Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids.  Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

  20. Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR

    Directory of Open Access Journals (Sweden)

    Carvalho, Bettina

    2012-01-01

    Full Text Available Introduction: Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment. Objective: The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT surgeries at our service center. Method: We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center. Results: Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy. Discussion: Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids. Conclusion: Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

  1. Oak Ridge National Laboratory West End Treatment Facility simulated sludge vitrification demonstration, Revision 1

    International Nuclear Information System (INIS)

    Cicero, C.A.; Bickford, D.F.; Bennert, D.M.; Overcamp, T.J.

    1994-01-01

    Technologies are being developed by the US Department of Energy's (DOE) Nuclear Facility sites to convert hazardous and mixed wastes to a form suitable for permanent disposal. Vitrification, which has been declared the Best Demonstrated Available Technology for high-level radioactive waste disposal by the EPA, is capable of producing a highly durable wasteform that minimizes disposal volumes through organic destruction, moisture evaporation, and porosity reduction. However, this technology must be demonstrated over a range of waste characteristics, including compositions, chemistries, moistures, and physical characteristics to ensure that it is suitable for hazardous and mixed waste treatment. These wastes are typically wastewater treatment sludges that are categorized as listed wastes due to the process origin or organic solvent content, and usually contain only small amounts of hazardous constituents. The Oak Ridge National Laboratory's (ORNL) West End Treatment Facility's (WETF) sludge is considered on of these representative wastes. The WETF is a liquid waste processing plant that generates sludge from the biodenitrification and precipitation processes. An alternative wasteform is needed since the waste is currently stored in epoxy coated carbon steel tanks, which have a limited life. Since this waste has characteristics that make it suitable for vitrification with a high likelihood of success, it was identified as a suitable candidate by the Mixed Waste Integrated Program (MWIP) for testing at CU. The areas of special interest with this sludge are (1) minimum nitrates, (2) organic destruction, and (3) waste water treatment sludges containing little or no filter aid

  2. Proposed site treatment plan (PSTP) Volumes I ampersand II ampersand reference document, Revision 3

    International Nuclear Information System (INIS)

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

    1995-01-01

    The Federal Facility Compliance Act requires the Department of Energy to undertake a national effort to develop Site Treatment Plans for each of its sites generating or storing mixed waste. Mixed waste contains both a hazardous waste subject to the Resource Conservation and Recovery Act and radioactive material subject to the Atomic Energy Act of 1954. The Site Treatment Plan for the Savannah River Site proposes how SRS will treat mixed waste that is now stored on the site and mixed waste that Will be generated in the future. Also, the Site Treatment Plan identifies Savannah River Site mixed wastes that other Department of Energy facilities could treat and mixed waste from other facilities that the Savannah River Site could treat. The Site Treatment Plan has been approved by the State of South Carolina. The Department of Energy Will enter into a consent order with the State of South Carolina by October 6, 1995. The consent order will contain enforceable commitments to treat mixed waste

  3. 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

  4. 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;}

  5. 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

  6. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-04-14

    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.

  8. 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 febrile neutropenia was completed; reference lists from identified articles also were used. In all, 10 trials were included in the analysis, which showed no significant difference in clinical failure rates and mortality for ambulatory regimens and standard hospital-based therapy. Subgroup analysis...... treatment failure (P febrile neutropenia is safe, effective, and comparable to standard hospital-based therapy. Patients at low risk are outpatients and are hemodynamically...

  9. Use of basic and specific pre-treatments for the biogas production. Revision and analysis

    International Nuclear Information System (INIS)

    Martínez Hernández, Carlos M.; García López, Yaser

    2016-01-01

    Keeping in mind the importance that has today the use of national and international biogas plants, which use as raw material animal manure; as well as agricultural and agroindustrial residuals for the energy production and biofertilizers, minimizing the aspects of environmental contamination. This work is presented in three parts, in those which: firstly the technologies and the methods are described to apply the basic and special pre-treatments to the different biomass in order to obtain their maximum potential of methane. A second part where it is approached the particularities to do that. Finally, a third part where their possible use is analyzed in the Cuban case. As a result of the same one, the state of the art is shown in the use of basic and special pre-treatments, with the objective of to potentialize the increase of the methane production in agricultural or animal biomasses. (author)

  10. Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.

    Science.gov (United States)

    Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

    2016-04-22

    Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  11. WASH activities at two Ebola treatment units in Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Michaela Mallow

    Full Text Available The 2014 outbreak of Ebola virus disease (EVD in West Africa was the largest in history. Starting in September 2014, International Medical Corps (IMC operated five Ebola treatment units (ETUs in Sierra Leone and Liberia. This paper explores how future infectious disease outbreak facilities in resource-limited settings can be planned, organized, and managed by analyzing data collected on water, sanitation, and hygiene (WASH and infection prevention control (IPC protocols.We conducted a retrospective cohort study by analyzing WASH/IPC activity data routinely recorded on paper forms or white boards at ETUs during the outbreak and later merged into a database from two IMC-run ETUs in Sierra Leone between December 2014 and December 2015.The IMC WASH/IPC database contains data from over 369 days. Our results highlight parameters key to designing and maintaining an ETU. High concentration chlorine solution usage was highly correlated with both daily patient occupancy and high-risk zone staff entries; low concentration chlorine usage was less well explained by these measures. There is high demand for laundering and disinfecting of personal protective equipment (PPE on a daily basis and approximately 1 (0-4 piece of PPE is damaged each day.Lack of standardization in the type and format of data collected at ETUs made constructing the WASH/IPC database difficult. However, the data presented here may help inform humanitarian response operations in future epidemics.

  12. 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.

  13. 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.

  14. A pilot application of risk-informed methods to establish inservice inspection priorities for nuclear components at Surry Unit 1 Nuclear Power Station. Revision 1

    International Nuclear Information System (INIS)

    Vo, T.V.; Phan, H.K.; Gore, B.F.; Simonen, F.A.; Doctor, S.R.

    1997-02-01

    As part of the Nondestructive Evaluation Reliability Program sponsored by the US Nuclear Regulatory Commission, the Pacific Northwest National Laboratory has developed risk-informed approaches for inservice inspection plans of nuclear power plants. This method uses probabilistic risk assessment (PRA) results to identify and prioritize the most risk-important components for inspection. The Surry Nuclear Power Station Unit 1 was selected for pilot application of this methodology. This report, which incorporates more recent plant-specific information and improved risk-informed methodology and tools, is Revision 1 of the earlier report (NUREG/CR-6181). The methodology discussed in the original report is no longer current and a preferred methodology is presented in this Revision. This report, NUREG/CR-6181, Rev. 1, therefore supersedes the earlier NUREG/CR-6181 published in August 1994. The specific systems addressed in this report are the auxiliary feedwater, the low-pressure injection, and the reactor coolant systems. The results provide a risk-informed ranking of components within these systems

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-27

    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.

  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. Performance and treatment outcome of tuberculosis among patients on Revised National Tuberculosis Control Programme in Urban and Tribal areas of a district in Maharashtra

    Directory of Open Access Journals (Sweden)

    Shivshakti Dattatray Pawar

    2017-01-01

    Full Text Available Background: Revised National Tuberculosis Control Programme (RNTCP was introduced in the country as a pilot project since 1993 in a phased manner and expanded throughout the country by the year 2005. Although studies have shown the success of RNTCP, data pertaining to the indicators of programme performance in urban and tribal set up are rare. Objectives: The objective of this study was to assess and compare the RNTCP in urban and tribal areas of Maharashtra through the indicators of performance and outcome of the patients. Patients and Methods: A retrospective comparative record-based study was conducted in selected urban and tribal areas' tuberculosis (TB units. Records of patients enrolled newly for TB treatment and those already undergoing treatment under RNTCP from April 2015 to September 2015 (6 months were considered for analysis. Chi-square test and Z-test (test of significance are applied where required by using Epi Info 7 and Microsoft Excel 2010.Results: Sputum smear collection was significantly higher in urban areas (P = 0.001. In urban areas, new TB case detection was 35%, while in tribal areas, it was 42% as per the RNTCP norms. Sputum positivity was marginally more in tribal (5.87% than urban (3.28% areas. Cure rate was more in urban areas than tribal (P = 0.001 areas. There were statistically significantly high default cases in tribal areas. Conclusions: Sputum collection and sputum positivity rate were low in urban and tribal areas, but TB screening, especially in tribal areas, was significantly low. Sputum positivity was significantly higher in tribal areas. Significantly low cure rate and high default rate in tribal area warrant the need for strengthening of RNTCP activities in tribal areas.

  19. 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)

  20. Clinical treatment planning optimization by Powell's method for gamma unit treatment system

    International Nuclear Information System (INIS)

    Yan Yulong; Shu Huazhong; Bao Xudong; Luo Limin; Bai Yi

    1997-01-01

    Purpose: This article presents a new optimization method for stereotactic radiosurgery treatment planning for gamma unit treatment system. Methods and Materials: The gamma unit has been utilized in stereotactic radiosurgery for about 30 years, but the usual procedure for a physician-physicist team to design a treatment plan is a trial-and-error approach. Isodose curves are viewed on two-dimensional computed tomography (CT) or magnetic resonance (MR) image planes, which is not only time consuming but also seldom achieves the optimal treatment plan, especially when the isocenter weights are regarded. We developed a treatment-planning system on a computer workstation in which Powell's optimization method is realized. The optimization process starts with the initial parameters (the number of iso centers as well as corresponding 3D iso centers' coordinates, collimator sizes, and weight factors) roughly determined by the physician-physicist team. The objective function can be changed to consider protection of sensitive tissues. Results: We use the plan parameters given by a well-trained physician-physicist team, or ones that the author give roughly as the initial parameters for the optimization procedure. Dosimetric results of optimization show a better high dose-volume conformation to the target volume compared to the doctor's plan. Conclusion: This method converges quickly and is not sensitive to the initial parameters. It achieves an excellent conformation of the estimated isodose curves with the contours of the target volume. If the initial parameters are varied, there will be a little difference in parameters' configuration, but the dosimetric results proved almost to be the same

  1. 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

  2. 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

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

    International Nuclear Information System (INIS)

    Skaggs, B.E.

    1993-11-01

    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 herein 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. Engineering evaluation/conceptual plan for the 200-UP-1 Groundwater Operable Unit interim remedial measure. Revision 2

    International Nuclear Information System (INIS)

    1996-03-01

    This report presents an engineering evaluation and conceptual plan for an interim remedial measure (IRM) to address a uranium and technetium-99 groundwater plume in the 200-UP-1 Groundwater Operable Unit located in the 200 West Area of the Hanford Site. This report provides information regarding the need for an IRM and its potentially achievable objectives and goals. The report also evaluates alternatives to contain elevated concentrations of uranium and technetium-99 and to obtain information necessary to develop final remedial actions for the operable unit

  7. Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox.

    Science.gov (United States)

    Schmidt, Frank P; Schmitt, Claus; Hochadel, Matthias; Giannitsis, Evangelos; Darius, Harald; Maier, Lars S; Schmitt, Claus; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Gori, Tommaso; Senges, Jochen; Münzel, Thomas

    2018-03-15

    Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (pGerman Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Planning the Marketing Strategy. PACE Revised. Level 1. Unit 6. Research & Development Series No. 240AB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This lesson on planning a marketing strategy, the sixth in a series of 18 units, is part of the first level of a comprehensive entrepreneurship curriculum entitled: A Program for Acquiring Competence in Entrepreneurship (PACE). (Designed for use with secondary students, the first level of PACE introduces students to the concepts involved in…

  9. Nuclear safety inspection in treatment process for SG heat exchange tubes deficiency of unit 1, TNPS

    International Nuclear Information System (INIS)

    Zhang Chunming; Song Chenxiu; Zhao Pengyu; Hou Wei

    2006-01-01

    This paper describes treatment process for SG heat exchange tubes deficiency of Unit 1, TNPS, nuclear safety inspection of Northern Regional Office during treatment process for deficiency and further inspection after deficiency had been treated. (authors)

  10. 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

    PURPOSE: The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant...... 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...

  11. 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.

  12. Revising Translations

    DEFF Research Database (Denmark)

    Rasmussen, Kirsten Wølch; Schjoldager, Anne

    2011-01-01

    The paper explains the theoretical background and findings of an empirical study of revision policies, using Denmark as a case in point. After an overview of important definitions, types and parameters, the paper explains the methods and data gathered from a questionnaire survey and an interview...... survey. Results clearly show that most translation companies regard both unilingual and comparative revisions as essential components of professional quality assurance. Data indicate that revision is rarely fully comparative, as the preferred procedure seems to be a unilingual revision followed by a more...... or less comparative rereading. Though questionnaire data seem to indicate that translation companies use linguistic correctness and presentation as the only revision parameters, interview data reveal that textual and communicative aspects are also considered. Generally speaking, revision is not carried...

  13. 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

  14. An Economic Evaluation of Tofacitinib Treatment in Rheumatoid Arthritis: Modeling the Cost of Treatment Strategies in the United States.

    Science.gov (United States)

    Claxton, Lindsay; Jenks, Michelle; Taylor, Matthew; Wallenstein, Gene; Mendelsohn, Alan M; Bourret, Jeffrey A; Singh, Amitabh; Moynagh, Dermot; Gerber, Robert A

    2016-09-01

    Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). Tofacitinib is approved in the United States for use in adults with moderately to severely active RA and an inadequate response or intolerance to methotrexate. To (a) evaluate, using an economic model, the treatment costs of an RA strategy including tofacitinib, compared with adalimumab, etanercept, certolizumab and tocilizumab biologic RA treatment strategies, which are commonly prescribed in the United States, and (b) assess the economic impact of monotherapy and combination therapy in patients who had an inadequate response to methotrexate therapy (MTX-IR analysis) and to combination therapy in patients who had an inadequate response to a tumor necrosis factor inhibitor (TNF-IR analysis). A transparent, Excel-based economic model with a decision-tree approach was developed to evaluate costs over a 1- and 2-year time horizon. The model compared tofacitinib 5 mg twice a day (BID) either as monotherapy or in combination with MTX with similarly labeled biologic therapies. Response to treatment was modeled as American College of Rheumatology (ACR) 20/50/70 response. ACR20 represented clinical response and determined whether patients continued therapy. ACR response rates at 6-month intervals were sourced from prescribing information and safety event rates from a published meta-analysis. Following an adverse event or a lack of response to treatment, it was assumed that 75% of patients switched to the next line of treatment (first to abatacept and then to rituximab). The perspective was that of a U.S. payer. Costs were reported in 2015 U.S. dollars and included drug wholesale acquisition costs, monitoring, drug administration, and treatment for minor and serious adverse events. The patient population eligible for treatment was based on the total number of members (i.e., RA and non-RA) in a payer organization; members with RA treated with biologic therapies were estimated using

  15. Revision muduloblastoma and treatment of posterior fossa ependinoma analysis of new therapeutic strategies; Revision de tratamiento de meduloblastoma y ependinoma de fosa posterior analisis de nuevas estrategias terapeuticas

    Energy Technology Data Exchange (ETDEWEB)

    Mara, C.; Rodríguez, R.; Torres, M.; Roldán, G.; Ferreira, V. [Depto. de Oncologia del Hospital de Clínicas, Facultad de Medicina, Universidad de la Republica, Montevideo (Uruguay); Instituto Nacional de Oncología, Ministerio de Salud Pública, Montevideo (Uruguay)

    2010-12-15

    Fulltext: In general the primary tumors of S.n.c. required at some stage in their treatment, use of radiotherapy, usually as postoperative treatment or exclusively in the case that the surgery is not possible, in turn for treatment of some of these tumors association with chemotherapy has shown to be beneficial. In the case of medulloblastomas, ependymomas of the posterior fossa tumors of the choroid plexus and the pineal gland, irradiation technique that used for their particular spread is the total craniospinal irradiation. In this paper a review of the treatment techniques are performed, the overall survival and disease-free survival and complications treatments, in patients with medulloblastoma and ependymomas treated in the Department. Oncology Hospital and Clinics in INDO period of approximately 30 years. Results were compared with the international literature and analysis was performed new perspectives on the therapeutic radiation treatment (radiotherapy 3D shaped for example) and its association with chemotherapy. The results will be analyzed in Congress.

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

    Energy Technology Data Exchange (ETDEWEB)

    USDOE/NV

    1999-05-01

    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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

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

    International Nuclear Information System (INIS)

    Alfred Wickline

    2008-01-01

    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

  2. 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

  3. 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

  4. Sampling and analysis plan for remediation of Operable Unit 100-IU-3 waste site 600-104. Revision 1

    International Nuclear Information System (INIS)

    1997-08-01

    This sampling and analysis plan presents the rationale and strategy for the sampling and analysis activities to support remediation of 100-IU-3 Operable Unit waste site 600-104. The purpose of the proposed sampling and analysis activities is to demonstrate that time-critical remediation of the waste site for soil containing 2,4-Dichlorophenoxyacetic acid salts and esters (2,4-D) and dioxin/furan isomers at concentrations that exceed cleanup levels has been effective. This shall be accomplished by sampling various locations of the waste site before and after remediation, analyzing the samples, and comparing the results to action levels set by the Washington State Department of Ecology

  5. Data validation summary report for the 100-BC-5 Operable Unit Round 9 Groundwater Sampling. Revision 0

    International Nuclear Information System (INIS)

    Kearney, A.T.

    1996-03-01

    The information provided in this validation summary report includes chemical analyses of samples from 100-BC-5 Operable Unit Round 9 Groundwater sampling data. Data from this sampling event and their related quality assurance (QA) samples were reviewed and validated in accordance with Westinghouse Hanford Company (WHC) guidelines at the requested level. Sample analyses included metals, general chemistry, and radiochemistry. Sixty metals samples were analyzed by Quanterra Environmental Services (QES) and Lockheed Analytical Services (LAS). The metals samples were validated using WHC protocols specified in Data Validation Procedures for Chemical Analyses. All qualifiers assigned to the metals data were based on this guidance. The Table 1.1 lists the metals sample delivery group (SDG) that were validated for this sampling event

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. Effluent treatment plant for pharmaceutical unit at Bahipheru - case study

    International Nuclear Information System (INIS)

    Hayat, A.

    1997-01-01

    This project has been awarded to environ (Pvt) Ltd., on turnkey basis, and is an integrated waste treatment facility for pharmaceuticals companies, manufacturing paracetamole, aspirin and various pharmaceuticals intermediates, from phenol as basic raw material. A highly toxic waste water, containing high concentrations of phenolics and sulfate ions is generated at this plant and has to be treatment before final disposal into an irrigation channel. (author)

  18. 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

  19. Corrective Action Decision Document for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada: Revision 0, Including Errata Sheet

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-01

    This Corrective Action Decision Document identifies the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's corrective action alternative recommendation for each of the corrective action sites (CASs) within Corrective Action Unit (CAU) 204: Storage Bunkers, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. An evaluation of analytical data from the corrective action investigation, review of current and future operations at each CAS, and a detailed comparative analysis of potential corrective action alternatives were used to determine the appropriate corrective action for each CAS. There are six CASs in CAU 204, which are all located between Areas 1, 2, 3, and 5 on the NTS. The No Further Action alternative was recommended for CASs 01-34-01, 02-34-01, 03-34-01, and 05-99-02; and a Closure in Place with Administrative Controls recommendation was the preferred corrective action for CASs 05-18-02 and 05-33-01. These alternatives were judged to meet all requirements for the technical components evaluated as well as applicable state and federal regulations for closure of the sites and will eliminate potential future exposure pathways to the contaminated media at CAU 204.

  20. 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.

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

    International Nuclear Information System (INIS)

    1997-01-01

    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

  2. Corrective Action Investigation Plan for Corrective Action Unit 552: Area 12 Muckpile and Ponds, Nevada Test Site, Nevada: Revision 0

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-06

    This Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office's approach for collecting the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 552: Area 12 Muckpile and Ponds, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. Located in Area 12 on the NTS, CAU 552 consists of two Corrective Action Sites (CASs): 12-06-04, Muckpile; 12-23-05, Ponds. Corrective Action Site 12-06-04 in Area 12 consists of the G-Tunnel muckpile, which is the result of tunneling activities. Corrective Action Site 12-23-05 consists of three dry ponds adjacent to the muckpile. The toe of the muckpile extends into one of the ponds creating an overlap of two CASs. The purpose of the investigation is to ensure that adequate data are collected to provide sufficient and reliable information to identify, evaluate, and select technic ally viable corrective actions. The results of the field investigation will support a defensible evaluation of corrective action alternatives in the corrective action decision document.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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...

  13. 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

  14. 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

  15. 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

  16. 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.

  17. Acetabular Cup Revision.

    Science.gov (United States)

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  18. 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.

  19. 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.

  20. Technical specifications: Callaway Plant, Unit No. 1 (Docket No. STN 50-483). Appendix A to License No. NPF-30. Revision 1

    International Nuclear Information System (INIS)

    1984-10-01

    Revised specifications are presented concerning limiting safety system settings for control systems, power distribution, instrumentation, coolant system, emergency core cooling system, containment systems, plant systems, electrical systems, refueling operations, radioactive effluents, and radiation environmental monitoring

  1. 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

  2. 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.

  3. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion.

    Science.gov (United States)

    2015-11-01

    In the United States, economic, racial, ethnic, geographic, and other disparities exist in access to fertility treatment and in treatment outcomes. This opinion examines the factors that contribute to these disparities and proposes actions to address them. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Improvement of Oil-Vapor Treatment Facility for Wolsong Unit 3,4

    International Nuclear Information System (INIS)

    Kim, Jeong Guk; Kwon, S. W.; Lee, H. S.

    2009-11-01

    With the purpose to minimize an oil-vapor discharge to the atmosphere and to be an environmentally friendly nuclear power plant by an improvement of mist eliminator for turbine lubricant system at Wolsong Nuclear Power Plant Unit 3,4, this project - project name : Improvement of Oil-vapor Treatment Facility for Wolsong Unit 3,4 - was conducted for six months (from Apr. 15, 2009 to Oct. 14, 2009). This Project contains Oil-vapor Source and Environmental Regulation, Analysis on the Present Oil-vapor Treatment Facility, Improvement of Oil-vapor Treatment Facility, Test Facility Design, Fabrication, Installation, Test Operation, Evaluation of the Facility

  5. 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

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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

  11. SensInDenT-Noncontact Sensors Integrated Into Dental Treatment Units.

    Science.gov (United States)

    Teichmann, Daniel; Teichmann, Maren; Weitz, Philippe; Wolfart, Stefan; Leonhardt, Steffen; Walter, Marian

    2017-02-01

    This paper presents the first system design (SensInDenT) for noncontact cardiorespiratory monitoring during dental treatment. The system is integrated into a dental treatment unit, and combines sensors based on electromagnetic, optical, and mechanical coupling at different sensor locations. The measurement principles and circuits are described and a system overview is presented. Furthermore, a first proof of concept is provided by taking measurements in healthy volunteers under laboratory conditions.

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

    OpenAIRE

    Stanisław Ledakowicz; Paweł Stolarek; A. Malinowski

    2016-01-01

    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 ...

  13. 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.

  14. 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

  15. 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.

  16. 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...

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

    NARCIS (Netherlands)

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

    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

  18. 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)

  19. [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

  20. 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

  1. 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

  2. Home Hemodialysis (HHD Treatment as an Effective yet Underutilized Treatment Modality in the United States

    Directory of Open Access Journals (Sweden)

    Jihane J. Hajj

    2017-11-01

    Full Text Available End-stage renal disease (ESRD is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized due to many contributing factors. The purpose of this review paper is to analyze the advantages and disadvantages of HHD and the reasons for its low utilization with a special focus on its socioeconomic impact as compared to facility hemodialysis. Key factors contributing to HHD underutilization are related to the reimbursement system of the facility and nephrologists as well as the underutilization of the pre-dialysis educational benefit. Based on this comprehensive review of the literature, we propose several suggestions which may contribute to the expansion of HHD treatment modality.

  3. 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)

  4. Septage unit treatment by sludge treatment reed beds for easy management and reuse: performance and design considerations.

    Science.gov (United States)

    Kim, Boram; Bel, Thomas; Bourdoncle, Pascal; Dimare, Jocelyne; Troesch, Stéphane; Molle, Pascal

    2018-01-01

    Sustainable treatment and management of fecal sludge in rural areas require adapted solutions. Rustic and simple operating processes such as sludge treatment reed beds (STRB) have been increasingly considered for this purpose. The biggest full scale (2,600 m 2 of STRB) septage treatment unit in France had been built in Nègrepelisse with the final objectives of reusing treated sludge and leachates for agriculture spreading and tree irrigation, respectively. The aim of this investigation was to validate the treatment chain of this installation. The obtained field data showed firstly that the overall removal efficiencies of STRB were satisfactory and stable. Removal rates higher than 98% for chemical oxygen demand and suspended solids and a 95% for Kjeldahl nitrogen represented so far a beneficial septage treatment by STRB. The highlighted necessity of a suitable complementary leachate treatment (before tree irrigation) justified the presence of the second stage of vertical flow constructed wetland. The sludge deposit drying and mineralization efficiencies were on the right track. According to hydrotextural diagram analysis, surface deposit was however found to have high deformability probably due to the youth of the installation. An in-depth understanding of STRB system needs continuous long-term studies.

  5. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

    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

  7. 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

  8. Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

    Science.gov (United States)

    Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M; Koss, Kari; Perera, Kanchana U; Rowan, Anderson; VanSickle, Marcus R; Novak, Laura A; Trieu, Theresa H

    2018-04-23

    Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines ( N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines ( N = 40) was matched to a non-treatment-seeking sample of Marines ( N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls ( p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

  9. 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.

  10. Doses in sensitive organs during prostate treatment with a 60Co unit

    International Nuclear Information System (INIS)

    Vega-Carrillo, H.R.; Navarro Becerra, J.A.; Pérez Arrieta, M.L.; Pérez-Landeros, L.H.

    2014-01-01

    Using thermoluminiscent dosimeters the absorbed dose in the bladder, rectum and thyroid have been evaluated when 200 cGy was applied to the prostate. The treatment was applied with a 60 Co unit. A water phantom was built and thermoluminiscent dosimeters were located in the position where the prostate, bladder, rectum and thyroid are located. The therapeutic beam was applied in 4 irradiations at 0, 90, 180 and 270° with the prostate at the isocenter. The TLDs readouts were used to evaluate the absorbed dose in each organ. The absorbed doses were used to estimate the effective doses and the probability of developing secondary malignacies in thyroid, rectum and bladder. - Highlights: • The absorbed doses in the bladder, rectum and thyroid were measured. • Measurements were done during prostate treatment with a 60 Co unit. • TLD100s in a water phantom were used. • The effective doses were also estimated

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

    Science.gov (United States)

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

    2016-11-01

    We reviewed the recent literature on prevalence rates, and application of evidence-based treatments for eating disorders among Hispanics/Latinos residing in the United States. Lifetime prevalence rates of anorexia nervosa are lower among Hispanic/Latinos than non-Hispanic Whites. There are comparable rates of bulimia nervosa and binge eating disorder (BED) among Hispanic/Latinos and non-Hispanic Whites. BED is the most common eating disorder among Hispanic/Latinos. Evidence-based treatments have begun to be implemented with Hispanics/Latinos. The core concepts of cognitive behavioral therapy for bulimia nervosa and BED apply to this population. Culture-specific adaptations include strengthening the collectivistic framework within an individualistic treatment, psychoeducation of immediate and extended family, and adjustment of meal plans that incorporated cultural foods. There are more similarities than differences in the prevalence of eating disorders across Hispanics/Latinos and non-Hispanic Whites. However, the social context such as immigration status and acculturation is important to consider in the development of eating disorders. In addition, the Westernization of Latin America may change the future relationship of immigration status and development of eating disorder within the United States. Overall, cultural adaptations of evidence-based treatments involved the inclusion of family within treatment, acculturation-related issues, and managing family conflicts that arise because of the changes in eating patterns.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. Closed cooling water chemistry guidelines revision

    International Nuclear Information System (INIS)

    McElrath, Joel; Breckenridge, Richard

    2014-01-01

    This second revision of the Closed Cooling Water Chemistry Guideline addresses the use of chemicals and monitoring methods to mitigate corrosion, fouling, and microbiological growth in the closed cooling-water (CCW) systems of nuclear and fossil-fueled power plants. This revision has been endorsed by the utility chemistry community and represents another step in developing a more proactive chemistry program to limit or control closed cooling system degradation with increased consideration of corporate resources and plant-specific design and operating concerns. These guidelines were developed using laboratory data, operating experience, and input from organizations and utilities within and outside of the United States of America. It is the intent of the Revision Committee that these guidelines are applicable to all nuclear and fossil-fueled generating stations around the world. A committee of industry experts—including utility specialists, Institute of Nuclear Power Operations representatives, water-treatment service-company representatives, consultants, a primary contractor, and EPRI staff—collaborated in reviewing available data on closed cooling-water system corrosion and microbiological issues. Recognizing that each plant owner has a unique set of design, operating, and corporate concerns, the Guidelines Committee developed a methodology for plant-specific optimization. The guideline provides the technical basis for a reasonable but conservative set of chemical treatment and monitoring programs. The use of operating ranges for the various treatment chemicals discussed in this guideline will allow a power plant to limit corrosion, fouling, and microbiological growth in CCW systems to acceptable levels. The guideline now includes closed cooling chemistry regimes proven successful in use in the international community. The guideline provides chemistry constraints for the use of phosphates control, as well as pure water with pH control. (author)

  17. Cone beam computed tomography image guidance system for a dedicated intracranial radiosurgery treatment unit.

    Science.gov (United States)

    Ruschin, Mark; Komljenovic, Philip T; Ansell, Steve; Ménard, Cynthia; Bootsma, Gregory; Cho, Young-Bin; Chung, Caroline; Jaffray, David

    2013-01-01

    Image guidance has improved the precision of fractionated radiation treatment delivery on linear accelerators. Precise radiation delivery is particularly critical when high doses are delivered to complex shapes with steep dose gradients near critical structures, as is the case for intracranial radiosurgery. To reduce potential geometric uncertainties, a cone beam computed tomography (CT) image guidance system was developed in-house to generate high-resolution images of the head at the time of treatment, using a dedicated radiosurgery unit. The performance and initial clinical use of this imaging system are described. A kilovoltage cone beam CT system was integrated with a Leksell Gamma Knife Perfexion radiosurgery unit. The X-ray tube and flat-panel detector are mounted on a translational arm, which is parked above the treatment unit when not in use. Upon descent, a rotational axis provides 210° of rotation for cone beam CT scans. Mechanical integrity of the system was evaluated over a 6-month period. Subsequent clinical commissioning included end-to-end testing of targeting performance and subjective image quality performance in phantoms. The system has been used to image 2 patients, 1 of whom received single-fraction radiosurgery and 1 who received 3 fractions, using a relocatable head frame. Images of phantoms demonstrated soft tissue contrast visibility and submillimeter spatial resolution. A contrast difference of 35 HU was easily detected at a calibration dose of 1.2 cGy (center of head phantom). The shape of the mechanical flex vs scan angle was highly reproducible and exhibited cone beam CT image guidance system was successfully adapted to a radiosurgery unit. The system is capable of producing high-resolution images of bone and soft tissue. The system is in clinical use and provides excellent image guidance without invasive frames. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. 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...

  19. Increasing incidence of penicillin- and cefotaxime-resistant Streptococcus pneumoniae causing meningitis in India: Time for revision of treatment guidelines?

    Science.gov (United States)

    Verghese, Valsan Philip; Veeraraghavan, Balaji; Jayaraman, Ranjith; Varghese, Rosemol; Neeravi, Ayyanraj; Jayaraman, Yuvaraj; Thomas, Kurien; Mehendale, Sanjay M

    2017-01-01

    Pneumococcal meningitis is a life-threatening infection, requiring prompt diagnosis and effective treatment. Penicillin resistance in pneumococcal infections is a concern. Here, we present the antibiotic susceptibility profile of pneumococcal meningeal isolates from January 2008 to August 2016 to elucidate treatment guidelines for pneumococcal meningitis. Invasive pneumococcal isolates from all age groups, were included in this study. Minimum inhibitory concentrations for the isolates were identified by agar dilution technique and VITEK System 2. Serotyping of isolates was done by co-agglutination technique. Out of 830 invasive pneumococcal isolates, 167 (20.1%) isolates were from meningeal infections. Cumulative penicillin resistance in pneumococcal meningitis was 43.7% and cefotaxime non-susceptibility was 14.9%. Penicillin resistance amongst meningeal isolates in those younger than 5 years, 5-16 years of age and those aged 16 years and older was 59.7%, 50% and 27.3%, respectively, with non-susceptibility to cefotaxime in the same age groups being 18%, 22.2% and 10.4%. Penicillin resistance amongst pneumococcal meningeal isolates increased from 9.5% in 2008 to 42.8% in 2016, whereas cefotaxime non-susceptibility increased from 4.7% in 2008 to 28.5% in 2016. Serotypes 14, 19F, 6B, 6A, 23F, 9V and 5 were the most common serotypes causing meningitis, with the first five accounting for over 75% of resistant isolates. The present study reports increasing penicillin resistance and cefotaxime non-susceptibility to pneumococcal meningitis in our setting. This highlights the need for empiric therapy with third-generation cephalosporins and vancomycin for all patients with meningitis while awaiting results of culture and susceptibility testing.

  20. 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.

  1. Comparing Guidelines for Statin Treatment in Canada and the United States.

    Science.gov (United States)

    Hennessy, Deirdre A; Bushnik, Tracey; Manuel, Douglas G; Anderson, Todd J

    2015-07-14

    New guidelines for cardiovascular disease risk assessment and statin eligibility have recently been published in the United States by the American College of Cardiology and the American Heart Association (ACC-AHA). It is unknown how these guidelines compare with the Canadian Cardiovascular Society (CCS) recommendations. Using data from the Canadian Health Measures Survey 2007-2011, we estimated the cardiovascular disease risk and proportion of the Canadian population, aged 40 to 75 years without cardiovascular disease, who would theoretically be eligible for statin treatment under both the CCS and ACC-AHA guidelines. The survey sample used (n=1975) represented 13.1 million community dwelling Canadians between the ages of 40 and 75 years. In comparing the CVD risk assessment methods, we found that calculated CVD risk was higher based on the CCS guidelines compared with the ACC-AHA guidelines. Despite this, a similar proportion and number of Canadians would be eligible for statin treatment under the 2 sets of recommendations. Some discordance in recommendations was found within subgroups of the population, with the CCS guidelines recommending more treatment for individuals who are younger, with a family history of CVD, or with chronic kidney disease. The ACC-AHA recommend more treatment for people who are older (age 60+ years). These results likely overestimate the treatment rate under both guidelines because, in primary prevention, a clinician-patient discussion must occur before treatment and determines uptake. Implementing the ACC-AHA lipid treatment guidelines in Canada would not result in an increase in individuals eligible for statin treatment. In fact, the proportion of the population recommended for statin treatment would decrease slightly and be targeted at different subgroups of the population. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Independent dose per monitor unit review of eight U.S.A. proton treatment facilities

    International Nuclear Information System (INIS)

    Moyers, M. F.; Ibbott, G. S.; Grant, R. L.; Summers, P. A.; Followill, D. S.

    2014-01-01

    Purpose: Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods. Methods: Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values. Results: Agreement between the measured and reported doses was similar using any of the three dosimetry methods. Use of the ICRU 59 N D,w based method gave results approximately 3% higher than both the ICRU 59 N X and ICRU 78 (TRS-398) N D,w based methods. Conclusions: Any single dosimetry method could be used for multi-institution trials with similar conformity between facilities. A multi-institutional trial could support facilities using both the ICRU 59 N X based and ICRU 78 (TRS-398) N D,w based methods but use of the ICRU 59 N D,w based method should not be allowed simultaneously with the other two until the difference is resolved

  3. 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 )

  4. 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 5 hours of CE were more likely to use rotary instrumentation (P irrigant activation devices (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.

  5. 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)

  6. Use of solidification/stabilization treatment technology for environmental remediation in the United States and Canada

    International Nuclear Information System (INIS)

    Wilk, C.M.

    2002-01-01

    In the United States (U.S.) Solidification/Stabilization (S/S) treatment is used to treat hazardous wastes for disposal, and in the remediation/site restoration of contaminated land. S/S is also an increasingly popular technology for Brownfields (industrial property) redevelopment since treated wastes can often be left on-site and to actually improve the site's soil for subsequent construction. The U.S. Environmental Protection Agency (EPA) considers S/S to be an established treatment technology. EPA has identified S/S treatment as Best Demonstrated Available Treatment Technology (BDAT) for at least 57 commonly produced industrial wastes (Resource Conservation and Recovery Act (RCRA)-listed hazardous wastes) and has selected S/S treatment for 25% of its Superfund (abandoned or uncontrolled) site remediation projects. S/S treatment involves mixing a binding reagent into the contaminated media or waste. Successful treatment is accomplished through physical changes to the waste form, and often, chemical changes to the hazardous constituents themselves. Commonly used S/S binding reagents in include portland cement, cement kiln dust, lime, lime kiln dust and fly ash. These materials are used alone or in combination. Proprietary reagents are also beginning to be marketed and used in the U.S. and Canada. This paper will discuss: (a) applicability of the technology to various wastes, (b) basic cement chemistry relating to S/S, (c) tests used to design treatability studies and to verify treatment, (d) basics on implementation of the technology in the field, and (e) examples of actual projects. (author)

  7. 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

  8. 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)

  9. 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.

  10. 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.

  11. Increased trends in the use of treatment-limiting decisions in a regional neurosurgical unit.

    Science.gov (United States)

    Wilson, William T; McMillan, Tristan; Young, Adam M H; White, Mark A J

    2017-04-01

    Treatment-limiting decisions (TLDs) are employed to actively withhold treatment from patients whom clinicians feel would derive no benefit or suffer detrimental effects from further intervention. The use of such decisions has been heavily discussed in the media and clinicians in the past have been reluctant to institute them, even though it is in the best interests of the patients. Their use is influenced by several ethical, religious and social factors all of which have changed significantly over time. This study reports the trends in use of TLDs in a regional neurosurgical unit over 23 years. Patient archives were reviewed to identify the number of admissions and procedures performed at the Institute of Neurological Sciences, Glasgow, in the years 1988, 1997 and 2011. Death certificate records were used to identify mortality in the unit in the year 2011. Patient records were used to obtain details of diagnosis, time from admission to death, and the presence and timing of a TLD. The results show an increase in the use of TLDs, with decisions made for 89% of those who died in 2011, compared to 68% in 1997 and 51% in 1988. The number of admissions has increased substantially since 1988 as has the percentage of patients undergoing surgery (46, 67 and 72% in 1988, 1997 and 2011, respectively). There is a trending increase in the number of patients who have a TLD in our regional neurosurgical unit. This demonstrates an increased willingness of clinicians to recognise poor prognosis and to withdraw or withhold treatment in these cases. Continued appropriate use of the TLD is recommended but it is to only ever reflect the best interests of the patient.

  12. 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

  13. Experience of the posterior lip augmentation device in a regional hip arthroplasty unit as a treatment for recurrent dislocation.

    Science.gov (United States)

    Hoggett, L; Cross, C; Helm, T

    2017-12-01

    Dislocation after total hip arthroplasty (THA) remains a significant complication of the procedure and is the third leading cause for revision THA. One technique for treatment of this complication is the use of the posterior lip augmentation device (PLAD). We describe our experience using the PLAD including complication rates. A retrospective review of 55 PLADs (54 patients) was carried out following identification from electronic theatre records. Basic patient demographics, operative records and radiographs were collected and reviewed and data was analysed using Microsoft Excel. Failure of the PLAD was defined as further operative intervention after PLAD insertion and included: dislocation, implant breakage, infection and revision of the THA for loosening of either component. 55 PLADs were implanted in 54 patients with an average age of 77 years. There was a significant preponderance of females and a variety of surgical approaches had been used for the original hip replacement, including trochanteric osteotomy, posterior and antero-lateral. 9 (16%) patients had recurrent dislocations,1 (2%) failed secondary to screw breakage, 3 (5%) had and infection requiring intervention and 2 (4%) underwent further revision for aseptic loosening of the femoral component. The overall failure rate was 25% with 14 patients requiring intervention post PLAD. Our results are inferior to other published results and indicate that the PLAD should be used with caution for recurrent dislocations of the Charnley hip replacement.

  14. 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

  15. Hot News: Impact of Low-level Viremia on Treatment Outcomes During ART - Is it Time to Revise the Definition of Virological Failure?

    Science.gov (United States)

    Poveda, Eva; Crespo, Manuel

    2018-01-01

    The level of HIV-RNA in plasma (HIV viral load) is the main marker used to monitor the virological response to antiretroviral therapy (ART) in HIV-infected patients. The threshold used to define virological suppression has historically been dictated by the limits of detection of the commercial assays used to quantify the plasma viral load. Thus, as more sensitive assays have proliferated and become more widely available, the definition has shifted from ART is to maintain virological suppression below 200 cop/mL, or even > 1000 cop/mL according to the WHO guidelines for low-income and middle-income countries. Several studies have evaluated the impact of low-level viremia as intermittent episodes (blips) or persistent detectable low-level viremia (50-1000 cop/mL) on treatment outcomes during ART. Some of these studies have suggested a potential role for low-level viremia as a predictor of virological failure, although up to now the data have been insufficient and controversial to guide clinical management. Hermans et al. have recently published the results of a large (n = 70.930 HIV-infected patients) multicenter study (57 clinical sites in South Africa) with a median follow-up for more than 2 years, to evaluate the incidence and impact of low-level viremia (defined as HIV-RNA viral load of 51-999 cop/mL) and its association with virological failure (Hermans et al., Lancet Infect Dis 2018;18:188-97). This large cohort study concludes that overall, patients with low-level viremia are predisposed to subsequent virological failure. The risk of virological failure was 5 times higher for patients with low-level viremia ranging 400-999 cop/mL, and 2 times higher for those with viremia ranging 51-199 cop/mL, compared with patients maintaining viral load suppression (ART should be recognized and considered in clinical decision-making. Furthermore, current WHO guidelines for low-income and middleincome countries should be revised and updated. Although substantial differences

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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

  4. Grey water treatment by a continuous process of an electrocoagulation unit and a submerged membrane bioreactor system

    KAUST Repository

    Bani-Melhem, Khalid; Smith, Edward

    2012-01-01

    This paper presents the performance of an integrated process consisting of an electro-coagulation (EC) unit and a submerged membrane bioreactor (SMBR) technology for grey water treatment. For comparison purposes, another SMBR process without

  5. Treatment patterns in disease-modifying therapy for patients with multiple sclerosis in the United States.

    Science.gov (United States)

    Bonafede, Machaon M; Johnson, Barbara H; Wenten, Madé; Watson, Crystal

    2013-10-01

    Patients with multiple sclerosis (MS) whose disease activity is inadequately controlled with a platform therapy (interferon beta or glatiramer acetate [GA]) may switch to another platform therapy or escalate therapy to natalizumab or fingolimod, which were approved in the US in 2006 and 2010, respectively. The objective of this study was to describe treatment patterns in patients with multiple sclerosis (MS) in the United States who were followed for 2 years after initiating a disease-modifying therapy (DMT). A retrospective observational cohort study was conducted to examine treatment patterns of initial DMT use (on initial therapy for 2 years with and without gaps of ≥ 60 days, medication switching, and discontinuation) among patients with MS who initiated a platform therapy (interferon-β or glatiramer acetate) or natalizumab between January 1, 2007, and September 30, 2009; the first DMT claim was the index. Eligible patients were identified in the MarketScan Commercial and Medicare Supplemental databases based on continuous enrollment for 6 months before (preindex period) and 24 months after their index date, with a diagnosis of MS and no claim for a previous DMT in the 6-month preindex period. Demographics at index and clinical characteristics during the preindex period were also analyzed. A total of 6181 MS patients were included, with 5735 (92.8%) starting on platform therapy. Natalizumab initiators were more likely to stay on index therapy (32.3% vs 16.9%, P treatment gaps of ≥ 60 days (44.8% vs 55.3%, P treatment (13.9% vs 19.1%, P = 0.007) and took longer to switch (400.9 days vs 330.7 days, P treatment gaps, and switch less than platform initiators in the 2 years after treatment initiation. Switching between platform therapies is common despite evidence that MS patients on platform therapy may benefit from switching to natalizumab. © 2013 Elsevier HS Journals, Inc. All rights reserved.

  6. SU-E-P-45: An Analytical Formula for Deriving Mechanical Iso-Center of Rotational Gantry Treatment Unit Rotational Gantry Treatment Unit

    International Nuclear Information System (INIS)

    Ding, X; Bues, M

    2015-01-01

    Purpose: To present an analytical formula for deriving mechanical isocenter (MIC) of a rotational gantry treatment unit. The input data to the formula is obtained by a custom-made device. The formula has been implemented and used in an operational proton therapy facility since 2005. Methods: The custom made device consisted of 3 mutually perpendicular dial indicators and 5 clinometers, to obtain displacement data and gantry angle data simultaneously. During measurement, a steel sphere was affixed to the patient couch, and the device was attached to the snout rotating with the gantry. The displacement data and angle data were obtained simultaneously at angular increments of less than 1 degree. The analytical formula took the displacement and angle as input and derived the positions of dial indicator tips (DIT) position in room-fixed coordinate system. The formula derivation presupposes trigonometry and 3-dimentional coordinate transformations. Due to the symmetry properties of the defining equations, the DIT position can be solved for analytically without using mathematical approximations. We define the mean of all points in the DIT trajectory as the MIC. The formula was implemented in computer code, which has been employed during acceptance test, commissioning, as well as routine QA practice in an operational proton facility since 2005. Results: It took one minute for the custom-made device to acquire the measurement data for a full gantry rotation. The DIT trajectory and MIS are instantaneously available after the measurement. The MIC Result agrees well with vendor’s Result, which came from a different measurement setup, as well as different data analysis algorithm. Conclusion: An analytical formula for deriving mechanical isocenter was developed and validated. The formula is considered to be absolutely accurate mathematically. Be analyzing measured data of radial displacements as function of gantry angle, the formula calculates the MI position in room

  7. topics revised

    African Journals Online (AJOL)

    Chantel

    ment of episodes involving drug overdose ... adults present special difficulties and any ... cal dependence, underlying pathology or ... taking a benzodiazepine regularly. .... Note: Over-treatment with atropine may induce atropine poisoning ..... appropriate dose should be used in order to prevent violent withdrawal symptoms.

  8. 40 CFR Appendix A to Subpart II of... - States With Approved State Implementation Plan Revisions Concerning CAIR NOX Opt-In Units

    Science.gov (United States)

    2010-07-01

    ... under § 97.188(b): Indiana Michigan North Carolina Ohio South Carolina Tennessee 2. The following States... allocation of CAIR NOX allowances to such units under § 97.188(c): Indiana Michigan Ohio North Carolina South Carolina Tennessee [65 FR 2727, Jan. 18, 2000, as amended at 72 FR 46394, Aug. 20, 2007; 72 FR 56920, Oct...

  9. 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

  10. Process engineering design of pathological waste incinerator with an integrated combustion gases treatment unit.

    Science.gov (United States)

    Shaaban, A F

    2007-06-25

    Management of medical wastes generated at different hospitals in Egypt is considered a highly serious problem. The sources and quantities of regulated medical wastes have been thoroughly surveyed and estimated (75t/day from governmental hospitals in Cairo). From the collected data it was concluded that the most appropriate incinerator capacity is 150kg/h. The objective of this work is to develop the process engineering design of an integrated unit, which is technically and economically capable for incinerating medical wastes and treatment of combustion gases. Such unit consists of (i) an incineration unit (INC-1) having an operating temperature of 1100 degrees C at 300% excess air, (ii) combustion-gases cooler (HE-1) generating 35m(3)/h hot water at 75 degrees C, (iii) dust filter (DF-1) capable of reducing particulates to 10-20mg/Nm(3), (iv) gas scrubbers (GS-1,2) for removing acidic gases, (v) a multi-tube fixed bed catalytic converter (CC-1) to maintain the level of dioxins and furans below 0.1ng/Nm(3), and (vi) an induced-draft suction fan system (SF-1) that can handle 6500Nm(3)/h at 250 degrees C. The residence time of combustion gases in the ignition, mixing and combustion chambers was found to be 2s, 0.25s and 0.75s, respectively. This will ensure both thorough homogenization of combustion gases and complete destruction of harmful constituents of the refuse. The adequate engineering design of individual process equipment results in competitive fixed and operating investments. The incineration unit has proved its high operating efficiency through the measurements of different pollutant-levels vented to the open atmosphere, which was found to be in conformity with the maximum allowable limits as specified in the law number 4/1994 issued by the Egyptian Environmental Affairs Agency (EEAA) and the European standards.

  11. The potential impact of increased treatment rates for alcohol dependence in the United Kingdom in 2004.

    Science.gov (United States)

    Shield, Kevin D; Rehm, Jürgen; Rehm, Maximilien X; Gmel, Gerrit; Drummond, Colin

    2014-02-05

    Alcohol consumption has been linked to a considerable burden of disease in the United Kingdom (UK), with most of this burden due to heavy drinking and Alcohol Dependence (AD). However, AD is undertreated in the UK, with only 8% of those individuals with AD being treated in England and only 6% of those individuals with AD being treated in Scotland. Thus, the objective of this paper is to quantify the deaths that would have been avoided in the UK in 2004 if the treatment rate for AD had been increased. Data on the prevalence of AD, alcohol consumption, and mortality were obtained from the Adult Psychiatric Morbidity Survey, the Global Information System on Alcohol and Health, and the 2004 Global Burden of Disease study respectively. Data on the effectiveness of pharmacological treatment and Motivational Interviewing/Cognitive Behavioural Therapy were obtained from Cochrane reviews and meta-analyses. Simulations were used to model the number of deaths under different treatment scenarios. Sensitivity analyses were performed to model the effects of Brief Interventions and to examine the effect of using AD prevalence data obtained from the National Institute for Health and Clinical Excellence. In the UK, 320 female and 1,385 male deaths would have been avoided if treatment coverage of pharmacological treatment had been increased to 20%. This decrease in the number of deaths represents 7.9% of all alcohol-attributable deaths (7.0% of all alcohol-attributable deaths for women and 8.1% of all alcohol-attributable deaths for men). If we used lower AD prevalence rates obtained from the National Institute for Health and Clinical Excellence, then treatment coverage of pharmacological treatment in hospitals for 20% of the population with AD would have resulted in the avoidance of 529 deaths in 2004 (99 deaths avoided for women and 430 deaths avoided for men). Increasing AD treatment in the UK would have led to a large number of deaths being avoided in 2004. Increased AD

  12. 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 < 0.001). In addition, PAH-related inpatient admissions decreased in the 6-month post-index period from 7% to 3% (P < 0.001). After treatment initiation, patients' nonpharmacy medical costs decreased from $48,200 (SD = $117,686) to $33,962 (SD = $90,294; P < 0.001), mainly attributable to reduced inpatient costs. However, total average medical costs including pharmacy costs remained comparable after treatment initiation (pre-index period = $51,455 vs. post-index period = $53,923; P = 0.213). This study found that while patients' PAH-related pharmacy costs increased after treatment initiation, the increase was offset by reduced inpatient utilization; therefore, total health care costs remained constant. While the majority of patients in this study were treated with monotherapy, the recently completed AMBITION study indicated that initial combination therapy with ambrisentan plus tadalafil reduced PAH-related hospitalizations compared with initial monotherapy with either of these agents. Future cost analyses of patients treated with combination therapy will be required to determine the economic effect of initial combination therapy. This study was sponsored and funded by Gilead Sciences. Ozbay is an 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

  13. 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

  14. 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)

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Yoshito Kawakatsu

    2017-02-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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

  17. 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.

  18. 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.

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

    International Nuclear Information System (INIS)

    Krauss, Mark

    2010-01-01

    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: (1) Clearing bomblet target areas within the study area. (2) Identifying and remediating disposal pits. (3) Collecting verification samples. (4) Performing radiological screening of soil. (5) 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.

  20. Impact of coronary intensive care unit in treatment of myocardial infarction

    Directory of Open Access Journals (Sweden)

    Marcia Cristina Todo

    Full Text Available Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU. The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group and between 2000 and 2002, before CICU implementation (before group. Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850, but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

  1. Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

    Science.gov (United States)

    Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn

    2015-06-01

    Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. © 2014 Australian College of Mental Health Nurses Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. 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

  4. Statistical Power and Optimum Sample Allocation Ratio for Treatment and Control Having Unequal Costs Per Unit of Randomization

    Science.gov (United States)

    Liu, Xiaofeng

    2003-01-01

    This article considers optimal sample allocation between the treatment and control condition in multilevel designs when the costs per sampling unit vary due to treatment assignment. Optimal unequal allocation may reduce the cost from that of a balanced design without sacrificing any power. The optimum sample allocation ratio depends only on the…

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, W.S.; Carmo, R.F. do; Py Junior, D.A., E-mail: pereiraws@gmail.com [Industrias Nucleares do Brasil (INB), Pocos de Caldas, MG (Brazil). Unidade de Tratamento de Minerio. Grupo Multidisciplinar de Radioprotecao; Kelecom, A., E-mail: akelecom@id.uff.br [Universidade Federal Fluminense (LARARA-PLS/GETA/UFF), Niteroi, RJ (Brazil). Laboratorio de Radiobiologia e Radiometria Pedro Lopes dos Santos. Grupo de Estudos em Temas Ambientais; Pereira, J.R.S., E-mail: pereirarsj@gmail.com [Universidade Federal de Alfenas (UNIFAL), Pocos de Caldas, MG (Brazil)

    2013-07-01

    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{sub nat}, {sup 226}Ra, {sup 210}Pb, {sup 232}Th and {sup 228}Ra content in the particulate and soluble fractions, and the behavior of radionuclide releases and their fractions was investigated. U{sub nat} and {sup 228}Ra showed identical behaviors at these three points. U{sub 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). {sup 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, {sup 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)

  18. 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)

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. An investigation of the air dispersion characteristics of refinery land treatment units

    International Nuclear Information System (INIS)

    Brewer, K.R.; Zaizhong Wang; Lupo, M.J.

    1991-01-01

    Numerical simulations of air emission and dispersion of volatile organic waste constituents from the land treatment units (LTU's) of four refineries were performed using the ISCST model. Particular attention was given to benzene. In order to realistically model the area pollutant source, each LTU had to be subdivided into smaller cells and the cell concentrations summed. The emission rate of the waste from the LTU's, one of the key inputs to the dispersion model, was periodically adjusted to reflect the rapid decay in rate following waste application. Meteorological conditions were found to be significant in determining boundary concentrations. The specific meteorological conditions most favorable for dispersion were investigated. The results of these simulations showed that mixing height is only minimally important in the dispersion of wastes from LTU's as currently regulated by EPA. Wind speed and variation of wind direction were both more important in atmospheric mixing of the volatile waste. It was found that care should be exercised in attempting to correlate any single meteorological parameter with favorable periods for land treatment. In comparisons of the cases, the results suggest that differences in LTU geometry may also be important in the modeling of long-term pollutant concentrations. Model simulations were performed to ascertain the impact of LTU geometry on boundary concentration

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. New Conceptual Model for Soil Treatment Units: Formation of Multiple Hydraulic Zones during Unsaturated Wastewater Infiltration.

    Science.gov (United States)

    Geza, Mengistu; Lowe, Kathryn S; Huntzinger, Deborah N; McCray, John E

    2013-07-01

    Onsite wastewater treatment systems are commonly used in the United States to reclaim domestic wastewater. A distinct biomat forms at the infiltrative surface, causing resistance to flow and decreasing soil moisture below the biomat. To simulate these conditions, previous modeling studies have used a two-layer approach: a thin biomat layer (1-5 cm thick) and the native soil layer below the biomat. However, the effect of wastewater application extends below the biomat layer. We used numerical modeling supported by experimental data to justify a new conceptual model that includes an intermediate zone (IZ) below the biomat. The conceptual model was set up using Hydrus 2D and calibrated against soil moisture and water flux measurements. The estimated hydraulic conductivity value for the IZ was between biomat and the native soil. The IZ has important implications for wastewater treatment. When the IZ was not considered, a loading rate of 5 cm d resulted in an 8.5-cm ponding. With the IZ, the same loading rate resulted in a 9.5-cm ponding. Without the IZ, up to 3.1 cm d of wastewater could be applied without ponding; with the IZ, only up to 2.8 cm d could be applied without ponding. The IZ also plays a significant role in soil moisture distribution. Without the IZ, near-saturation conditions were observed only within the biomat, whereas near-saturation conditions extended below the biomat with the IZ. Accurate prediction of ponding is important to prevent surfacing of wastewater. The degree of water and air saturation influences pollutant treatment efficiency through residence time, volatility, and biochemical reactions. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  17. 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

  18. Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea - STD Surveillance Network, United States, 2016.

    Science.gov (United States)

    Weston, Emily J; Workowski, Kimberly; Torrone, Elizabeth; Weinstock, Hillard; Stenger, Mark R

    2018-04-27

    Gonorrhea, the sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, is the second most common notifiable disease in the United States after chlamydia; 468,514 cases were reported to state and local health departments in 2016, an increase of 18.5% from 2015 (1). N. gonorrhoeae has progressively developed resistance to most antimicrobials used to treat the infection (2). As a result, CDC recommends two antimicrobials (250 mg of ceftriaxone [IM] plus 1 g of azithromycin [PO]) for treating uncomplicated gonorrhea to improve treatment efficacy and, potentially, to slow the emergence and spread of antimicrobial resistance. To monitor adherence to the current CDC-recommended regimen for uncomplicated gonorrhea, CDC reviewed enhanced data collected on a random sample of reported cases of gonorrhea in seven jurisdictions participating in the STD Surveillance Network (SSuN) and estimated the proportion of patients who received the CDC-recommended regimen for uncomplicated gonorrhea, by patient characteristics and diagnosing facility type. In 2016, the majority of reported patients with gonorrhea (81%) received the recommended regimen. There were no differences in the proportion of patients receiving the recommended regimen by age or race/ethnicity; however, patients diagnosed with gonorrhea in STD (91%) or family planning/reproductive health (94%) clinics were more likely to receive this regimen than were patients diagnosed in other provider settings (80%). These data document high provider adherence to CDC gonorrhea treatment recommendations in specialty STD clinics, indicating high quality of care provided in those settings. Local and state health departments should monitor adherence with recommendations in their jurisdictions and consider implementing interventions to improve provider and patient compliance with gonorrhea treatment recommendations where indicated.

  19. Screening and treatment for short cervical length in pregnancy: a physician survey in the United States.

    Science.gov (United States)

    Martell, Bridget; DiBenedetti, Dana B; Weiss, Herman; Zhou, Xiaolei; Reynolds, Maria; Berghella, Vincenzo; Hassan, Sonia S

    2018-03-01

    To evaluate how physicians in the United States (US) screen for, define, and treat a short cervix to prevent preterm birth. This was a cross-sectional, web-based survey of 500 physicians treating pregnant patients with a short cervix in the US. Respondents' geographic region was monitored to ensure balance across the nine US Census divisions. Respondents were predominantly obstetrician/gynecologists (86%, 429/500; mean age 49 years). Physicians reported that a median of 90% of their pregnant patients undergo cervical length screening; 81% (407/500) use transvaginal ultrasound. Physicians consult multiple evidence sources to inform their patient care, most commonly clinical guidelines (83%; 413/500) and published research (70%; 349/500). Most physicians (98%; 490/500) reported treating pregnant patients with a short cervix; 95% (474/500) use synthetic and/or natural progestogen, alone or in combination with other treatment modalities. If reimbursement was not a concern, 47% of physicians (230/500) would choose vaginal progesterone as their preferred treatment to prevent preterm birth in all patients with a short cervix, and 45% (218/500) would choose a synthetic progestogen. US guidelines recommend transvaginal ultrasound for cervical length screening; 81% of physicians in this study reported using this method. Most physicians surveyed use progestogens to treat a short cervix, with approximately half choosing a synthetic progestin (45%) and half choosing natural progesterone (47%) as their preferred treatment, despite national guidelines recommending only vaginal natural progesterone for this indication. Additional physician education is required to implement current and best practices.

  20. 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)

  1. 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

  2. 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)

    International Nuclear Information System (INIS)

    2000-01-01

    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

  3. Corrective Action Investigation Plan for Corrective Action Unit 410: Waste Disposal Trenches, Tonopah Test Range, Nevada, Revision 0 (includes ROTCs 1, 2, and 3)

    Energy Technology Data Exchange (ETDEWEB)

    NNSA/NV

    2002-07-16

    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

  4. 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

  5. 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.

  6. 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

    International Nuclear Information System (INIS)

    Boehlecke, Robert

    2004-01-01

    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 locations and

  7. 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.

  8. 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).

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. World Concerns and the United Nations: Model Teaching Units for Primary, Secondary, and Teacher Education Based on the Work of Participants in the UN Fellowship Programme for Educators and the UNESCO Associated Schools Project. Second Revised Edition.

    Science.gov (United States)

    Arkin, Linda, Ed.

    Today's educators face the daunting challenge of preparing new generations of young people for life in a world undergoing economic, political, and cultural changes on a scale unmatched in history. After five decades, the United Nations remains at the center of the global effort to ensure peace and the equitable enjoyment of the planet's resources.…

  14. 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

  15. 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

  16. 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

  17. Real-World Characteristics and Treatment Patterns in Patients with Urticaria Initiating Omalizumab in the United States.

    Science.gov (United States)

    Ke, Xuehua; Kavati, Abhishek; Wertz, Debra; Huang, Qing; Wang, Liya; Willey, Vincent J; Stephenson, Judith J; Ortiz, Benjamin; Paknis, Brandee; Bernstein, Jonathan A; Beck, Lisa A

    2017-12-19

    Omalizumab is indicated for the management of chronic idiopathic urticaria (CIU) in patients aged 12 years or older with persistent hives that are not adequately controlled by H1 antihistamines. While its safety and efficacy in CIU patients have been evaluated in multiple clinical trials, real-world use of omalizaumab in CIU has not been well characterized. To assess demographics, clinical characteristics, and treatment patterns of CIU patients who initiated omalizumab to better understand the usage of this agent in CIU management in the real world. This retrospective cohort study used medical and pharmacy claims data in the United States from the HealthCore Integrated Database to identify patients with CIU newly treated with omalizumab (≥ 4 omalizumab claims within 6 months of the initial claim) between March 21, 2014, and October 31, 2015 (study intake period). The index date was defined as the date of the first claim for omalizumab during the study intake period. Demographic and clinical characteristics were described for patients treated with omalizumab, as were treatment patterns associated with omalizumab and concomitant medications associated with CIU treatment. Descriptive and inferential statistics were reported. The Kaplan-Meier method was used to examine omalizumab treatment patterns. This study included 298 omalizumab-treated patients (mean [SD] age of 43.5 [13.64] years; 70.8% female); approximately 84% were seen by an allergist/immunologist. All patients had ≥ 12 months of continuous enrolment and a subset of 138 patients had ≥ 18 months of follow-up. For patients with ≥ 12 months of post-index follow-up, 12.1% (n = 36), 28.5% (n = 85), and 32.9% (n = 98) discontinued omalizumab within the 6-month, 12-month, and the entire post-index periods (mean 530 days), respectively; the mean number of days patients were continuously treated with omalizumab was 443.1 (95% CI = 425.0-461.3); the probabilities of continuous treatment (95% CI) were 0.879 (0

  18. 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

  19. 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.

  20. Addendum to the Closure Report for Corrective Action Unit 484: Surface Debris, Waste Sites, and Burn Area, Tonopah Test Range, Nevada (Revision 0)

    International Nuclear Information System (INIS)

    Burmeister, Mark

    2011-01-01

    Corrective Action Unit (CAU) 484 Streamlined Approach for Environmental Restoration (SAFER) activities called for the identification and remediation of surface hot spot depleted uranium (DU) with some excavation to determine the vertical extent of contamination (NNSA/NSO, 2004). During the CAU 484 SAFER investigation (conducted November 2003 through August 2007), approximately 50 locations containing DU were identified on Antelope Lake. All but four locations (CA-1, SA-5-9, SA-12-15, and SA-4) were remediated. Figure 1-1 shows locations of the four use restriction (UR) sites. The four locations were determined to have failed the SAFER conceptual site model assumption of a small volume hot spot. Two of the locations (CA-1 and SA-5-9) were excavated to depths of 3.5 to 7 feet (ft) below ground surface (bgs), and a third location (SA-12-15) with a footprint of 30 by 60 ft was excavated to a depth of 0.5 ft. At the fourth site (SA-4), the discovery of unexploded ordnance (UXO) halted the excavation due to potential safety concerns. Remediation activities on Antelope Lake resulted in the removal of approximately 246 cubic yards (yd3) of DU-impacted soil from the four UR sites; however, Kiwi surveys confirmed that residual DU contamination remained at each of the four sites. (The Kiwi was a Remote Sensing Laboratory [RSL] vehicle equipped with a data-acquisition system and four sodium iodide gamma detectors. Surveys were conducted with the vehicle moving at a rate of approximately 10 miles per hour with the gamma detectors positioned 14 to 28 inches [in.] above the ground surface [NNSA/NSO, 2004]).

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. Closure plan for the Test Area North-726 chromate water storage and Test Area North-726A chromate treatment units

    International Nuclear Information System (INIS)

    Smith, P.J.; Van Brunt, K.M.

    1992-11-01

    This document describes the proposed plan for closure of the Test Area North-726 chromate water storage and Test Area North-726A chromate treatment units at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act interim status closure requirements. The location, size, capacity, and history of the units are described, and their current status is discussed. The units will be closed by treating remaining waste in storage, followed by thorough decontamination of the systems. Sufficient sampling and analysis, and documentation of all activities will be performed to demonstrate clean closure

  7. Needle Revision With 5-fluorouracil for the Treatment of Ahmed Glaucoma Valve Filtering Blebs: 5-Fluoruracil Needling Revision can be a Useful and Safe Tool in the Management of Failing Ahmed Glaucoma Valve Filtering Blebs.

    Science.gov (United States)

    Quaranta, Luciano; Floriani, Irene; Hollander, Lital; Poli, Davide; Katsanos, Andreas; Konstas, Anastasios G P

    2016-04-01

    To determine the outcome of needling with adjunctive 5-fluorouracil (5-FU) in patients with a failing Ahmed glaucoma valve (AGV) implant, and to identify predictors of long-term intraocular pressure (IOP) control. A prospective observational study was performed on consecutive patients with medically uncontrolled primary open-angle glaucoma (POAG) with AGV encapsulation or fibrosis and inadequate IOP control. Bleb needling with 5-FU injection (0.1 mL of 50 mg/mL) was performed at the slit-lamp. Patients were examined 1 week following the needling, and then at months 1, 3, and 6. Subsequent follow-up visits were scheduled at 6-month intervals for at least 2 years. Needling with 5-FU was repeated no more than twice during the first 3 months of the follow-up. Procedure outcome was determined on the basis of the recorded IOP levels. Thirty-six patients with an encapsulated or fibrotic AGV underwent 67procedures (mean 1.86 ± 0.83). Complete success, defined as IOP ≤ 18 mm Hg without medications, was obtained in 25% at 24 months of observation. The cumulative proportion of cases achieving either qualified (ie, IOP ≤ 18 mm Hg with medications) or complete success at 24 months of observation was 72.2%. In a univariate Cox proportional hazards model, age was the only variable that independently influenced the risk of failing 5-FU needling revision. Fourteen eyes (38.8%) had a documented complication. Needling over the plate of an AGV supplemented with 5-FU is an effective and safe choice in a significant proportion of POAG patients with elevated IOP due to encapsulation or fibrosis.

  8. Evaluation of eleven years of area monitoring in ore treatment unit: I external exposure

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, W.S.; Py Junior, D.A.; Oliveira, S.Q. de; Dantas, M.V.A., E-mail: pereiraws@gmail.com [Industrias Nucleares do Brasil (INB), Pocos de Caldas, MG (Brazil). Unidade de Tratamento de Minerio. Grupo Multidisciplinar de Radioprotecao; Kelecom, A., E-mail: akelecom@id.uff.br [Universidade Federal Fluminense (LARARA-PLS/GETA/UFF), Niteroi, RJ (Brazil). Laboratorio de Radiobiologia e Radiometria Pedro Lopes dos Santos. Grupo de Estudos em Temas Ambientais; Pereira, J.R.S., E-mail: pereirarsj@gmail.com [Universidade Federal de Alfenas (UNIFAL), Pocos de Caldas, MG (Brazil)

    2013-07-01

    The Ore Treatment Unit (OTU) is an uranium mining and milling complex deactivated in 1995 that operated monazite during the years 2004 and 2005 in a plant used especially for that purpose called Chemical Treatment of Monazite (CTM). This study aims to analyze the monitoring of area to exposure rate from 2002 to 2012, comparing periods of suspended operation of OTU and identifying the influences of CTM and of the radioactive waste deposit, from other facilities of OTU. A total of 22,294 samples were analyzed for area dose rates; average values were obtained of 6.74 μSv h{sup -1} with an amplitude from 0 to 420 μSv h{sup -1}. 92% of the monitoring were below the derivative limit for workers, and 1,702 monitoring samples showed values above this limit. Ignoring the monitoring that was realized at CTM and at the deposit of radioactive waste, the number of monitoring samples were reduced to 1,341. In this case, the average reduces to 0.96 μSv h{sup -1}, going from 0 to 25 μSv h{sup -1}, only 15 samples remained above the threshold for workers and 675 samples were below the limit for individual public. It can be concluded that the OTU is an installation with nearly 99% of monitoring area safe for workers and 50% for individual public. The inclusion of new practices (CTM) and the deposit of radioactive waste coming from other facilities alter this picture dramatically, increased the dose rates. (author)

  9. Closure Report for Corrective Action Unit 404: Roller Coaster Sewage Lagoons and North Disposal Trench, Tonopah Test Range, Nevada with ROTC 1, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Lynn Kidman

    1998-09-01

    This Closure Report provides the documentation for closure of the Roller Coaster Sewage Lagoons and North Disposal Trench Comective Action Unit (CAU) 404. CAU 404 consists of the Roller Coaster Sewage Lagoons (Corrective Action Site [CAS] TA-03-O01-TA-RC) and the North Disposal Trench (CAS TA-21-001-TA-RC). The site is located on the Tonopah Test Range, approximately 225 kilometers (km) (140 miles [mi]) northwest ofLas Vegas, Nevada. . The sewage lagoons received ~quid sanitary waste horn the Operation Roller Coaster Man Camp in 1963 and debris from subsequent range and construction cleanup activities. The debris and ordnance was subsequently removed and properly dispos~, however, pesticides were detected in soil samples born the bottom of the lagoons above the U,S. Environmental Protection Agency Region IX Prelimimuy Remediation Goals (EPA 1996). . The North Disposal Trench was excavated in 1963. Debris from the man camp and subsequent range and construction cleanup activities was placed in the trench. Investigation results indicated that no constituents of concern were detected in soil samples collected from the trench. Remedial alternative proposed in the Comctive Action Decision Document (CADD) fm the site was “Covering” (DOE, 1997a). The Nevada Division of”Enviromnental Protection (NDEP)-approved Correction Action Plan (CAP) proposed the “Covering” niethodology (1997b). The closure activities were completed in accorhce with the approwil CAP and consisted of baclctllling the sewage lagoons and disposal trench, constructing/planting an engineered/vegetative cover in the area of the sewage lagoons and dikposal trencQ installing a perimeter fence and signs, implementing restrictions on fi~e use, and preparing a Post-Closure Monitoring Plan. “ Since closure activities. for CAU 404 have been completed in accordance with the Nevada Division of Environmental Protection-approved CAP (DOE, 1997b) as documented in this Closure Report, the U.S. Department of

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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)

  15. 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.

  16. 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...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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 costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p cost drivers were the cost of the implant and

  5. 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.

  6. 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.

  7. 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)

  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. The economic impact of revision otologic surgery.

    Science.gov (United States)

    Nadimi, Sahar; Leonetti, John P; Pontikis, George

    2016-03-01

    Revision otologic surgery places a significant economic burden on patients and the healthcare system. We conducted a retrospective chart analysis to estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy. We reviewed the medical records of all 189 adults who had undergone CWD mastoidectomy performed by the senior author between June 2006 and August 2011 at Loyola University Medical Center in Maywood, Ill. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery in Illinois and at the national level. Of the 189 CWD mastoidectomies, 89 were primary and 100 were revision procedures. The total charge for the revision cases was $2,783,700, and the net reimbursement (collections) was $846,289 (30.4%). Using Illinois Hospital Association data, we estimated that reimbursement for 387 revision CWD mastoidectomies that had been performed in fiscal year 2011 was nearly $3.3 million. By extrapolating our data to the national level, we estimated that 9,214 patients underwent revision CWD mastoidectomy in the United States during 2011, which cost the national healthcare system roughly $76 million, not including lost wages and productivity. Known causes of failed CWD mastoidectomies that often result in revision surgery include an inadequate meatoplasty, a facial ridge that is too high, residual diseased air cells, and recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, which could have a positive impact on the economic strain related to this procedure at the local, state, and national levels.

  10. 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.

  11. 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)

  12. 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

  13. 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

  14. Effectiveness of Ebola treatment units and community care centers - Liberia, September 23-October 31, 2014.

    Science.gov (United States)

    Washington, Michael L; Meltzer, Martin L

    2015-01-30

    Previous reports have shown that an Ebola outbreak can be slowed, and eventually stopped, by placing Ebola patients into settings where there is reduced risk for onward Ebola transmission, such as Ebola treatment units (ETUs) and community care centers (CCCs) or equivalent community settings that encourage changes in human behaviors to reduce transmission risk, such as making burials safe and reducing contact with Ebola patients. Using cumulative case count data from Liberia up to August 28, 2014, the EbolaResponse model previously estimated that without any additional interventions or further changes in human behavior, there would have been approximately 23,000 reported Ebola cases by October 31, 2014. In actuality, there were 6,525 reported cases by that date. To estimate the effectiveness of ETUs and CCCs or equivalent community settings in preventing greater Ebola transmission, CDC applied the EbolaResponse model to the period September 23-October 31, 2014, in Liberia. The results showed that admitting Ebola patients to ETUs alone prevented an estimated 2,244 Ebola cases. Having patients receive care in CCCs or equivalent community settings with a reduced risk for Ebola transmission prevented an estimated 4,487 cases. Having patients receive care in either ETUs or CCCs or in equivalent community settings, prevented an estimated 9,100 cases, apparently as the result of a synergistic effect in which the impact of the combined interventions was greater than the sum of the two interventions. Caring for patients in ETUs, CCCs, or in equivalent community settings with reduced risk for transmission can be important components of a successful public health response to an Ebola epidemic.

  15. 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

  16. 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

  17. Effects of lyric analysis interventions on treatment motivation in patients on a detoxification unit: a randomized effectiveness study.

    Science.gov (United States)

    Silverman, Michael J

    2015-01-01

    Treatment motivation is a key component in the early rehabilitative stages for people with substance use disorders. To date, no music therapy researcher has studied how lyric analysis interventions might affect motivation in a randomized controlled design. The primary purpose of this study was to determine the effect of lyric analysis interventions on treatment motivation in patients on a detoxification unit using a single-session wait-list control design. A secondary purpose was to determine if there were between-group differences concerning two contrasting songs used for the lyric analyses. Participants (N=104) were cluster randomized to a group lyric analysis condition or a wait-list control condition. Participants received either a "Hurt" or a "How to Save a Life" lyric analysis treatment. The Texas Christian University Treatment Motivation Scale-Client Evaluation of Self at Intake (CESI) (Simpson, 2008[2005]) was used to measure aspects of treatment motivation: problem recognition, desire for help, treatment readiness, pressures for treatment, and total motivation. Results indicated significant between-group differences in measures of problem recognition, desire for help, treatment readiness, and total motivation, with experimental participants having higher treatment motivation means than control participants. There was no difference between the two lyric analysis interventions. Although the song used for lyric analysis interventions did not affect outcome, a single group-based music therapy lyric analysis session can be an effective psychosocial treatment intervention to enhance treatment motivation in patients on a detoxification unit. Limitations, implications for clinical practice, and suggestions for future research are provided. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. 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.

  19. Bibliocable. Revised Edition.

    Science.gov (United States)

    Cable Television Information Center, Washington, DC.

    This selective, annotated bibliography is a revision of the original published in 1972 (ED 071 402). Some 104 books, articles, and reports included here deal with access, applications, franchising, regulation, technology, and other aspects of cable television. The listings are of two types in each category. First are revisions of the original…

  20. Emergency War Surgery: Third United States Revision

    Science.gov (United States)

    2004-01-01

    hospitals in the rear. Though one can hope that major strides in these and other areas of trauma resuscitation will be reflected in a future edition, our...more fervent hope is for mankind’s dream of peace and the exercise of his better Angels, … whereby this Handbook becomes altogether unnecessary. Dave... Ostomy Patients: Vent collection bags to avoid excess gas dislodging the bag from the stoma wafer. Use a straight pin to put two holes in the bag

  1. Treatment of severe insulin resistance in pregnancy with 500 units per milliliter of concentrated insulin.

    Science.gov (United States)

    Mendez-Figueroa, Hector; Maggio, Lindsay; Dahlke, Joshua D; Daley, Julie; Lopes, Vrishali V; Coustan, Donald R; Rouse, Dwight J

    2013-07-01

    To evaluate glycemic control and pregnancy outcomes among pregnant women with severe insulin resistance treated with 500 units/mL concentrated insulin. Retrospective analysis of gravid women with severe insulin resistance (need for greater than 100 units of insulin per injection or greater than 200 units/d) treated with either 500 units/mL concentrated insulin or conventional insulin therapy. We performed a two-part analysis: 1) between gravid women treated with and without 500 units/mL concentrated insulin; and 2) among gravid women treated with 500 units/mL concentrated insulin, comparing glycemic control before and after its initiation. Seventy-three pregnant women with severe insulin resistance were treated with 500 units/mL concentrated insulin and 78 with conventional insulin regimens. Patients treated with 500 units/mL concentrated insulin were older and more likely to have type 2 diabetes mellitus. Average body mass index was comparable between both groups (38.6 compared with 40.4, P=.11) as were obstetric and perinatal outcomes and glycemic control during the last week of gestation. Within the 500 units/mL concentrated insulin cohort, after initiation of this medication, fasting and postprandial blood glucose concentrations improved. However, the rates of blood glucose values less than 60 mg/dL and less than 50 mg/dL were higher in the 500 units/mL concentrated insulin group after initiation than before, 4.8% compared with 2.0% (Pinsulin in severely obese insulin-resistant pregnant women confers similar glycemic control compared with traditional insulin regimens but may increase the risk of hypoglycemia. II.

  2. 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).

  3. Revision of Dorstenia sect. Nothodorstenia (Moraceae)

    NARCIS (Netherlands)

    Berg, C.C.

    1978-01-01

    The African genus Craterogyne Lanjouw has to be united with Dorstenia L. Most species of Craterogyne can be included in Dorstenia sect. Nothodorstenia Engl. A revision of this section is presented. 5 species have been accepted, viz. D. elliptica Bureau, D. djettii J. L. Guillaumet, D. oligogyna

  4. 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

  5. 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.

  6. Intravenous dextrose administration reduces postoperative antiemetic rescue treatment requirements and postanesthesia care unit length of stay.

    Science.gov (United States)

    Dabu-Bondoc, Susan; Vadivelu, Nalini; Shimono, Chantelle; English, Annette; Kosarussavadi, Boonsri; Dai, Feng; Shelley, Kirk; Feinleib, Jessica

    2013-09-01

    Postoperative nausea and vomiting (PONV) remains the most common postoperative complication, and causes decreased patient satisfaction, prolonged postoperative hospital stays, and unanticipated admission. There are limited data that indicate that dextrose may reduce nausea and vomiting. In this trial, we attempted to determine whether the rate of PONV can be decreased by postoperative administration of IV dextrose bolus. To test the effect of postoperative dextrose administration on PONV rates, we conducted a double-blind, randomized, placebo-controlled trial. We enrolled 62 nondiabetic, ASA class I or II nonsmoking outpatients scheduled for gynecologic laparoscopic and hysteroscopic procedures. Patients were randomized into 2 groups: the treatment group received dextrose 5% in Ringer lactate solution, and the control (placebo) group received Ringer lactate solution given immediately after surgery. All patients underwent a standardized general anesthesia and received 1 dose of antiemetic a half hour before emergence from anesthesia. PONV scores, antiemetic rescue medications, narcotic consumption, and discharge time were recorded in the postanesthesia care unit (PACU) in half-hour intervals. The 2 groups were similar with regard to age, weight, anxiety scores, prior PONV, non per os status, presurgical glucose, anesthetic duration, intraoperative narcotic use, and total weight-based fluid volume received. Postoperative nausea scores were not significantly different in the dextrose group compared with the control group (P > 0.05) after Bonferroni correction for repeated measurements over time. However, patients who received dextrose 5% in Ringer lactate solution consumed less rescue antiemetic medications (ratio mean difference, 0.56; 95% confidence interval, 0.39-0.82; P = 0.02), and had a shorter length of stay in the PACU (ratio mean difference, 0.80; 95% confidence interval, 0.66-0.97; P = 0.03) compared with patients in the control group. In this trial

  7. Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States

    OpenAIRE

    Gubner, Noah R.; Andrews, K. Blakely; Mohammad-Zadeh, Ana; Lisha, Nadra E.; Guydish, Joseph

    2016-01-01

    Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N=1,113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-ciga...

  8. Verification of Monitor unit calculations for eclipse Treatment Planning System by in- house developed spreadsheet

    Directory of Open Access Journals (Sweden)

    Hemalatha Athiyaman

    2018-04-01

    Conclusion: The spreadsheet was tested for most of the routine treatment sites and geometries. It has good agreement with the Eclipse TPS version 13.8 for homogenous treatment sites such as head &and neck and carcinoma cervix.

  9. 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.

  10. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States.

    Science.gov (United States)

    Chhatwal, Jagpreet; Kanwal, Fasiha; Roberts, Mark S; Dunn, Michael A

    2015-03-17

    Sofosbuvir and ledipasvir, which have recently been approved for treatment of chronic hepatitis C virus (HCV) infection, are more efficacious and safer than the old standard of care (oSOC) but are substantially more expensive. Whether and in which patients their improved efficacy justifies their increased cost is unclear. To evaluate the cost-effectiveness and budget impact of sofosbuvir and ledipasvir. Microsimulation model of the natural history of HCV infection. Published literature. Treatment-naive and treatment-experienced HCV population defined on the basis of HCV genotype, age, and fibrosis distribution in the United States. Lifetime. Third-party payer. Simulation of sofosbuvir-ledipasvir compared with the oSOC (interferon-based therapies). Quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and 5-year spending on antiviral drugs. Sofosbuvir-based therapies added 0.56 QALY relative to the oSOC at an ICER of $55 400 per additional QALY. The ICERs ranged from $9700 to $284 300 per QALY depending on the patient's status with respect to treatment history, HCV genotype, and presence of cirrhosis. At a willingness-to-pay threshold of $100 000 per QALY, sofosbuvir-based therapies were cost-effective in 83% of treatment-naive and 81% of treatment-experienced patients. Compared with the oSOC, treating eligible HCV-infected persons in the United States with the new drugs would cost an additional $65 billion in the next 5 years, whereas the resulting cost offsets would be $16 billion. Results were sensitive to drug price, drug efficacy, and quality of life after successful treatment. Data on real-world effectiveness of new antivirals are lacking. Treatment of HCV is cost-effective in most patients, but additional resources and value-based patient prioritization are needed to manage patients with HCV. National Institutes of Health.

  11. Cryptococcal Meningitis Treatment Strategies Affected by the Explosive Cost of Flucytosine in the United States: A Cost-effectiveness Analysis.

    Science.gov (United States)

    Merry, Matthew; Boulware, David R

    2016-06-15

    In the United States, cryptococcal meningitis causes approximately 3400 hospitalizations and approximately 330 deaths annually. The US guidelines recommend treatment with amphotericin B plus flucytosine for at least 2 weeks, followed by fluconazole for a minimum of 8 weeks. Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22. Cost-effectiveness analysis was performed to determine the value of flucytosine relative to alternative regimens. We estimated the incremental cost-effectiveness ratio (ICER) of 3 cryptococcal induction regimens: (1) amphotericin B deoxycholate for 4 weeks; (2) amphotericin and flucytosine (100 mg/kg/day) for 2 weeks; and (3) amphotericin and fluconazole (800 mg/day) for 2 weeks. Costs of care were calculated using 2015 US prices and the medication costs. Survival estimates were derived from a randomized trial and scaled relative to published US survival data. Cost estimates were $83 227 for amphotericin monotherapy, $75 121 for amphotericin plus flucytosine, and $44 605 for amphotericin plus fluconazole. The ICER of amphotericin plus flucytosine was $23 842 per quality-adjusted life-year. Flucytosine is currently cost-effective in the United States despite a dramatic increase in price in recent years. Combination therapy with amphotericin and flucytosine is the most attractive treatment strategy for cryptococcal meningitis, though the rising price may be creating access issues that will exacerbate if the trend of profiteering continues. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  12. Difference in clinical presentation, immunology profile and treatment response of type 1 autoimmune hepatitis between United Kingdom and Singapore patients

    OpenAIRE

    Than, Nwe Ni; Ching, Doreen Koay Siew; Hodson, James; McDowell, Patrick; Mann, Jake; Gupta, Ravi; Salazar, Ennaliza; Ngu, Jing Hieng; Oo, Ye Htun

    2016-01-01

    Background Autoimmune hepatitis (AIH) is an immune-mediated liver disease of unknown etiology. Increasing incidence of AIH in Asian patients has been reported. However, the phenotypic difference of Asian patients in Europe and Asia has still not been explored. Aim To evaluate the clinical presentation, biochemical and immunological profiles, treatment response and survival outcome of type 1 AIH from two tertiary liver transplant centres (United Kingdom and Singapore). Method Patients who fulf...

  13. Effects of organ motion on IMRT treatments with segments of few monitor units

    International Nuclear Information System (INIS)

    Seco, J.; Sharp, G. C.; Turcotte, J.; Gierga, D.; Bortfeld, T.; Paganetti, H.

    2007-01-01

    Interplay between organ (breathing) motion and leaf motion has been shown in the literature to have a small dosimetric impact for clinical conditions (over a 30 fraction treatment). However, previous studies did not consider the case of treatment beams made up of many few-monitor-unit (MU) segments, where the segment delivery time (1-2 s) is of the order of the breathing period (3-5 s). In this study we assess if breathing compromises the radiotherapy treatment with IMRT segments of low number of MUs. We assess (i) how delivered dose varies, from patient to patient, with the number of MU per segment, (ii) if this delivered dose is identical to the average dose calculated without motion over the path of the motion, and (iii) the impact of the daily variation of the delivered dose as a function of MU per segment. The organ motion was studied along two orthogonal directions, representing the left-right and cranial-caudal directions of organ movement for a patient setup in the supine position. Breathing motion was modeled as sin(x), sin 4 (x), and sin 6 (x), based on functions used in the literature to represent organ motion. Measurements were performed with an ionization chamber and films. For a systematic study of motion effects, a MATLAB simulation was written to model organ movement and dose delivery. In the case of a single beam made up of one single segment, the dose delivered to point in a moving target over 30 fractions can vary up to 20% and 10% for segments of 10 MU and 20 MU, respectively. This dose error occurs because the tumor spends most of the time near the edges of the radiation beam. In the case of a single beam made of multiple segments with low MU, we observed 2.4%, 3.3%, and 4.3% differences, respectively, for sin(x), sin 4 (x), and sin 6 (x) motion, between delivered dose and motion-averaged dose for points in the penumbra region of the beam and over 30 fractions. In approximately 5-10% of the cases, differences between the motion-averaged dose

  14. A clinical-economic study of caspofungin use in the treatment of invasive candidiasis in intensive care units

    Directory of Open Access Journals (Sweden)

    A. S. Kolbin

    2010-01-01

    Full Text Available Candida spp. are the fourth on the list of sepsis pathogens in patients in intensive care units. Currently the physician’s armamentarium includes a whole range of antifungal medicines that have demonstrated high clinicalmycological effectiveness in clinical trials. The aim of this study to evaluate the clinical-economic usefulness of caspofungin therapy in the treatment of invasive candidiasis versus standard and alternative treatments in patients inintensive care units. The first time in the Russian clinical-economic analysis for targeted IC treatment in non-neutropenic patients in intensive care units who have not received primary prophylaxis with azole antimycotics, as well as in those with low (< 20% occurrence of in vitro Candida spp. resistance to fluconazole according to national or local study results, yielded the following findings: the best strategy is initial amphotericin B therapy with subsequent switching to caspofungin in patients with ineffective initial amphotericin B therapy or those with severe adverse events.

  15. Commercial waste treatment R and D needs in the United States

    International Nuclear Information System (INIS)

    Burkholder, H.C.

    1982-05-01

    The mission of the commercial waste treatment program is to establish treatment technology for safe and efficient management of high-level and transuranic wastes from reprocessing and fuel fabrication and special wastes from other fuel cycle activities. The four functional objectives that must be achieved to fulfill the mission are: (1) define waste product and treatment process performance requirements; (2) specify adequately safe waste products and verify their performance; (3) specify adequately efficient treatment processes and equipment and verify their performance; (4) solve existing waste treatment problems using verified products and processes. Although commercial waste treatment technology is in many respects highly advanced, there remains a number of areas where significant research and development is needed. These are: (1) technically-based performance requirements for both waste products and treatment processes; (2) pilot-scale radioactive demonstration of liquid-fed ceramic melting process and equipment for borosilicate glass; (3) non-glass TRU waste product and treatment process development; (4) waste product performance testing and predictive modeling; (5) quality verification for treatment processes

  16. 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

  17. Publishing and Revising Content

    Science.gov (United States)

    Editors and Webmasters can publish content without going through a workflow. Publishing times and dates can be set, and multiple pages can be published in bulk. Making an edit to published content created a revision.

  18. 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...

  19. 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.

  20. Structural Analysis of Treatment Cycles Representing Transitions between Nursing Organizational Units Inferred from Diabetes

    Science.gov (United States)

    Dehmer, Matthias; Kurt, Zeyneb; Emmert-Streib, Frank; Them, Christa; Schulc, Eva; Hofer, Sabine

    2015-01-01

    In this paper, we investigate treatment cycles inferred from diabetes data by means of graph theory. We define the term treatment cycles graph-theoretically and perform a descriptive as well as quantitative analysis thereof. Also, we interpret our findings in terms of nursing and clinical management. PMID:26030296

  1. Survey of caregivers in Kenya to assess perceptions of zinc as a treatment for diarrhea in young children and adherence to recommended treatment behaviors

    Directory of Open Access Journals (Sweden)

    Evan Simpson

    2013-06-01

    Full Text Available In 2004, the United Nations Children’s Fund (UNICEF and the World Health Organization (WHO revised their recommendations for management of acute diarrhea in children to include zinc treatment as well as oral rehydration solution (ORS. Little is known about how caregivers in low–resource settings perceive and use zinc treatment.

  2. 77 FR 58470 - Irradiation Treatment; Location of Facilities in the Southern United States; Technical Amendment

    Science.gov (United States)

    2012-09-21

    ... jointly by APHIS and the national plant protection organization (NPPO) of India as part of the required... standard \\2\\ of the International Plant Protection Convention, of which the United States is a contracting... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service 7 CFR Part 319 [Docket No...

  3. Aqueous treatment of water-sensitive paper objects: capillary unit, blotter wash or paraprint wash?

    NARCIS (Netherlands)

    Schalkx, H.; Iedema, P.; Reissland, B.; van Velzen, B.

    2011-01-01

    Blotter washing andwashing with the capillary unit are both methods used for aqueoustreatment of water-sensitive paper objects. The challenge of thistreatment is to remove water-soluble products while keeping thewater-sensitive medium in its place. In this article the two methodsare compared, along

  4. Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians.

    Science.gov (United States)

    Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís

    2003-12-01

    The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P religious beliefs of the respondents influences the way in which these decisions are made.

  5. 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.

  6. 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

  7. 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.

  8. How do physicians weigh benefits and risks associated with treatments in patients with osteoarthritis in the United Kingdom?

    Science.gov (United States)

    Arden, Nigel K; Hauber, A Brett; Mohamed, Ateesha F; Johnson, F Reed; Peloso, Paul M; Watson, Douglas J; Mavros, Panagiotis; Gammaitoni, Arnold; Sen, Shuvayu S; Taylor, Stephanie D

    2012-05-01

    To quantify the relative importance that UK physicians attach to the benefits and risks of current drugs when making treatment decisions for patients with osteoarthritis (OA). Physicians treating at least 10 patients with OA per month completed an online discrete-choice experiment survey and answered 12 treatment-choice questions comparing medication profiles. Medication profiles were defined by 4 benefits (reduction in ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) and 3 treatment-related risks [bleeding ulcer, stroke, and myocardial infarction (MI)]. Each physician made medication choices for 3 of 9 hypothetical patients (varied by age, history of MI, hypertension, and history of gastrointestinal bleeding). Importance weights were estimated using a random-parameters logit model. Treatment-related risks physicians were willing to accept in exchange for various reductions in ambulatory and resting pain also were calculated. The final sample was 475. A reduction in ambulatory pain from 75 mm to 25 mm (1.6 units) was 1.1 times as important as an increase in MI risk from 0% to 1.5% (1.5 units). The greatest importance was for eliminating a 3% treatment-related risk of MI or stroke. On average, physicians were willing to accept an increase in bleeding ulcer risk of 0.7% (95% CI 0.4%-1.7%) for a reduction in ambulatory pain of 75 mm to 50 mm. When presented with well-known benefits and risks of OA treatments, physicians placed greater importance on the risks than on the analgesic properties of the drug. This has implications for the reporting of the results of clinical research to physicians.

  9. 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)

  10. 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.

  11. 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)

  12. Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms.

    Science.gov (United States)

    Ghobadi, Kimia; Ghaffari, Hamid R; Aleman, Dionne M; Jaffray, David A; Ruschin, Mark

    2012-06-01

    The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife(®) Perfexion™ (PFX) for intracranial targets. The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was -0.12 (range: -0.27 to +0.03) and +0.08 (range: 0.00-0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V(100)) between forward and inverse plans was 0.2% (range: -2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V(100)), the mean difference in dose to 1 mm(3) of brainstem between forward and inverse plans was -0.24 Gy (range: -2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: -17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an average of 215 min. PFX inverse planning can be performed using

  13. Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Ghobadi, Kimia; Ghaffari, Hamid R.; Aleman, Dionne M.; Jaffray, David A.; Ruschin, Mark [Department of Mechanical and Industrial Engineering, University of Toronto, 5 King' s College Road, Toronto, Ontario M5S 3G8 (Canada); Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada)

    2012-06-15

    Purpose: The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife{sup Registered-Sign} Perfexion Trade-Mark-Sign (PFX) for intracranial targets. Methods: The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. Results: In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was -0.12 (range: -0.27 to +0.03) and +0.08 (range: 0.00-0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V{sub 100}) between forward and inverse plans was 0.2% (range: -2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V{sub 100}), the mean difference in dose to 1 mm{sup 3} of brainstem between forward and inverse plans was -0.24 Gy (range: -2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: -17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an

  14. Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms

    International Nuclear Information System (INIS)

    Ghobadi, Kimia; Ghaffari, Hamid R.; Aleman, Dionne M.; Jaffray, David A.; Ruschin, Mark

    2012-01-01

    Purpose: The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife ® Perfexion™ (PFX) for intracranial targets. Methods: The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. Results: In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was −0.12 (range: −0.27 to +0.03) and +0.08 (range: 0.00–0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V 100 ) between forward and inverse plans was 0.2% (range: −2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V 100 ), the mean difference in dose to 1 mm 3 of brainstem between forward and inverse plans was −0.24 Gy (range: −2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: −17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an average of 215 min

  15. 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.

  16. 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.

  17. [Preliminary study on detox in outpatient care units with 18 alcoholic patients in Directly Observed Treatment].

    Science.gov (United States)

    Lloréns Martínez, Ramón; Calatayud Francés, María; Morales Gallús, Esperanza; Añó Cervera, Consol; Adriá Caballero, Librada

    2008-01-01

    Directly Observed Treatment (TOD-DOT) has been tested in different conditions. The objective of this work is to check whether a UCA-CAB (Centre for Addictive Behaviour) can achieve detox and reduce the risk of early relapse (up to 12 weeks) in alcoholic patients. All patients had an established organic addiction and serious withdrawal syndrome, and had undergone multiple previous treatments. Furthermore, they had not managed to abstain for a 3-month consecutive period over the previous 2 years. The aim of the Directly Observed Treatment was to attain detox and reduce relapse by following a multi-method approach: medical, psychological and personal care, based on a brief daily consultation and pharmacological supervision. The results were as follows: Of the 18 patients included in the study, after 12 weeks, 13 (72 %) were still abstinent and 4 (22 %) had relapsed. Thus, 17 (94 %) were still following the treatment, with just one drop-out. We analysed the profiles of the patients abstaining, of those who relapsed (4) and of the one who dropped out. The average CIWA-Ar was 27.05 (21-36). Any value over 20 is considered to indicate serious withdrawal syndrome, though there were no negative events leading to hospitalization. Level of adherence to the treatment (94 %) meant that the most seriously affected patients and those with fewest financial resources could benefit, not only from any auxiliary social schemes, but also from basic health services, permitting them to improve the quality of their everyday life.

  18. 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.

  19. Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, A K; Schultz Hansen, K; Bygbjerg, I C

    2008-01-01

    whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. STUDY DESIGN...... of the intervention on access to malaria treatment, antenatal care, other services and related costs. RESULTS: More women (67.5%) received two doses of SP through the community approach compared with health units (39.9%; P... in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving...

  20. Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony; Hansen, Kristian Schultz; Bygbjerg, Ib

    2008-01-01

    whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. Study design...... of the intervention on access to malaria treatment, antenatal care, other services and related costs. Results: More women (67.5%) received two doses of SP through the community approach compared with health units (39.9%; P... in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving...

  1. Risk assessment analysis of the future technical unit dedicated to the evaluation and treatment of motor disabilities.

    Science.gov (United States)

    Grelier, S; Thetio, M; Quentin, V; Achache, V; Sanchez, N; Leroux, V; Durand, E; Pequignot, R

    2011-03-01

    The National Hospital of Saint Maurice (HNSM) for Physical Medicine and Rehabilitation aims at strengthening its position as a pivot rehabilitation and physical therapy center. The opening in 2011 of a new unit for the evaluation and treatment of motor disabilities meets this objective. This project includes several parts: clinical, financial, architectural, organizational, applied clinical research as well as dealing with medical equipments and information system. This study focuses on the risk assessment of this future technical unit. This study was conducted by a group of professionals working for the hospital. It started with the design of a functional model to better comprehend the system to be analyzed. Risk assessment consists in confronting this functional model to a list of dangers in order to determine the vulnerable areas of the system. Then the team designed some scenarios to identify the causes, securities barriers and consequences in order to rank the risks. The analysis targeted various dangers, e.g. political, strategic, financial, economical, marketing, clinical and operational. The team identified more than 70 risky scenarios. For 75% of them the criticality level was deemed initially tolerable and under control or unacceptable. The implementation of an action plan for reducing the level of risks before opening this technical unit brought the system down to an acceptable level at 66%. A year prior to opening this technical unit for the evaluation and treatment of motor disabilities, conducting this preliminary risk assessment, with its exhaustive and rigorous methodology, enabled the concerned professionals to work together around an action plan for reducing the risks. 2011 Elsevier Masson SAS. All rights reserved.

  2. 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.

  3. 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

    2014-08-01

    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. 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. 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. HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival rates. © 2014 by American Society of Clinical

  4. 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.

  5. 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.

  6. 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...

  7. Thermal treatment of solid residues from WtE units: a review.

    Science.gov (United States)

    Lindberg, Daniel; Molin, Camilla; Hupa, Mikko

    2015-03-01

    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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Incidence, treatment, and survival patterns for sacral chordoma in the United States, 1974-2011

    Directory of Open Access Journals (Sweden)

    Esther Yu

    2016-09-01

    Full Text Available IntroductionSacral chordomas represent one half of all chordomas, a rare neoplasm of notochordal remnants. Current NCCN guidelines recommend surgical resection with or without adjuvant radiotherapy, or definitive radiation for unresectable cases. Recent advances in radiation for chordomas include conformal photon and proton beam radiation. We investigated incidence, treatment, and survival outcomes to observe any trends in response to improvements in surgical and radiation techniques over a near 40 year time period.Materials and Methods345 microscopically confirmed cases of sacral chordoma were identified between 1974 and 2011 from the Surveillance, Epidemiology, and End Results (SEER program of the National Cancer Institute. Cases were divided into three cohorts by calendar year, 1974-1989, 1990-1999, and 2000-2011, as well as into two groups by age less than or equal to 65 versus greater than 65 to investigate trends over time and age via Chi-square analysis. Kaplan-Meier analyses were performed to determine effects of treatment on survival. Multivariate Cox regression analysis was performed to determine predictors of overall survival.Results5-year overall survival for the entire cohort was 60.0%. Overall survival correlated significantly with treatment modality, with 44% surviving at 5 years with no treatment, 52% with radiation alone, 82% surgery alone, and 78% surgery and radiation (p<.001. Age greater than 65 was significantly associated with non-surgical management with radiation alone or no treatment (p<.001. Relatively fewer patients received radiation between 2000 and 2011 compared to prior time periods (p=.03 versus surgery, for which rates which did not vary significantly over time (p=.55. However, 5-year overall survival was not significantly different by time period. Age group and treatment modality were predictive for overall survival on multivariate analysis (p<.001. ConclusionSurgery remains an important component in the

  9. Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States.

    Science.gov (United States)

    Asche, Carl V; Zografos, Panagiotis; Norlin, Jenny M; Urbanek, Bill; Mamay, Carl; Makin, Charles; Erntoft, Sandra; Chen, Chi-Chang; Hines, Dionne M; Mark Siegel, Daniel

    2016-01-01

    To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies. A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT). The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts. Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies. Copyright

  10. 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.

  11. Treatment/Disposal Plan for Drummed Waste from the 300-FF-1 Operable Unit, 618-4 Burial Ground

    International Nuclear Information System (INIS)

    Lerch, J.A.

    1999-01-01

    The objective of this plan is to support selection of a safe, environmentally responsible, and cost-effective treatment and disposal method for drums containing depleted uranium metal chips submerged in oil that have been and will be excavated from the 618-4 Burial Ground. Remediation of the 300-FF-1 Operable Unit, 618-4 Burial Ground was initiated in fiscal year (FY) 1998 as an excavation and removal operation. Routine processes were established to excavate and ship contaminated soil and debris to the Environmental Restoration Disposal Facility (ERDF) for disposal

  12. Irradiation as a quarantine treatment and the status in the United States and Hawaii

    International Nuclear Information System (INIS)

    Moy, J.H.

    1998-01-01

    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)

  13. 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

  14. 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)

  15. Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

    2017-06-01

    Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. 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.

  17. 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

  18. [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.

  19. 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.

  20. Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems.

    Science.gov (United States)

    Ronzitti, Silvia; Soldini, Emiliano; Smith, Neil; Potenza, Marc N; Clerici, Massimo; Bowden-Jones, Henrietta

    2017-11-01

    Studies show higher lifetime prevalence of suicidality in individuals with pathological gambling. However, less is known about the relationship between pathological gambling and current suicidal ideation. We investigated socio-demographic, clinical and gambling-related variables associated with suicidality in treatment-seeking individuals. Bivariate analyses and logistic regression models were generated on data from 903 individuals to identify measures associated with aspects of suicidality. Forty-six percent of patients reported current suicidal ideation. People with current suicidal thoughts were more likely to report greater problem-gambling severity (psuicidality. Logistic regression models suggested that past suicidal ideation (psuicidality. Our findings suggest that the severity of anxiety disorder, along with a lifetime history of suicidal ideation, may help to identify treatment-seeking individuals with pathological gambling with a higher risk of suicidality, highlighting the importance of assessing suicidal ideation in clinical settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. [Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review].

    Science.gov (United States)

    Göhner, Anne; Hüll, Michael; Voigt-Radloff, Sebastian

    2018-02-01

    The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.

  2. 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.

  3. Adequacy of depression treatment among college students in the United States.

    Science.gov (United States)

    Eisenberg, Daniel; Chung, Henry

    2012-01-01

    There is no published evidence on the adequacy of depression care among college students and how this varies by subpopulations and provider types. We estimated the prevalence of minimally adequate treatment among students with significant past-year depressive symptoms. Data were collected via a confidential online survey of a random sample of 8488 students from 15 colleges and universities in the 2009 Healthy Minds Study. Depressive symptoms were assessed by the Patient Health Questionnaire-2, adapted to a past-year time frame. Students with probable depression were coded as having received minimally adequate depression care based on the criteria from Wang and colleagues (2005). Minimally adequate treatment was received by only 22% of depressed students. The likelihood of minimally adequate treatment was similarly low for both psychiatric medication and psychotherapy. Minimally adequate care was lower for students prescribed medication by a primary care provider as compared to a psychiatrist (Pstudents were less likely to receive depression care (Pdepression care is a significant problem in the college population. Solutions will likely require greater availability of psychiatry care, better coordination between specialty and primary care using collaborative care models, and increased efforts to retain students in psychotherapy. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. 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.

  5. Screening and treatment for heritable thrombophilia in pregnancy failure: inconsistencies among UK early pregnancy units.

    Science.gov (United States)

    Norrie, Gillian; Farquharson, Roy G; Greaves, Mike

    2009-01-01

    The significance of heritable thrombophilia in pregnancy failure is controversial. We surveyed all UK Early Pregnancy Units and 70% responded. The majority test routinely for heritable thrombophilias; 80%, 76% and 88% undertook at least one screening test in late miscarriage, recurrent miscarriage and placental abruption, respectively. The range of thrombophilias sought is inconsistent: testing for proteins C and S deficiency and F5 R506Q (factor V Leiden) is most prevalent. Detection of heritable thrombophilia frequently leads to administration of antithrombotics in subsequent pregnancies. Thus, thrombophilia testing and use of antithrombotics are widespread in the UK despite controversies regarding the role of heritable thrombophilia in the pathogenesis of pregnancy complications, and the lack of robust evidence for the efficacy of antithrombotic therapy.

  6. First and second line drug resistance among treatment naïve pulmonary tuberculosis patients in a district under Revised National Tuberculosis Control Programme (RNTCP in New Delhi

    Directory of Open Access Journals (Sweden)

    Vithal Prasad Myneedu

    2015-12-01

    Full Text Available There is limited information of level of drug resistance to first-line and second line anti-tuberculosis agents in treatment naïve pulmonary tuberculosis (PTB patients from the Indian region. Therefore, the present prospective study was conducted to determine the antimicrobial susceptibility to first-line and second line anti-TB drug resistance in such patients. Sputum samples from consecutive treatment naïve PTB cases registered in Lala Ram Sarup (LRS district, under RNTCP containing 12 Directly Observed Treatment Centre’s (DOTS, were enrolled using cluster sampling technology. A total of 453 samples were received from July 2011 to June 2012. All samples were cultured on solid medium followed by drug susceptibility to first and second line anti-tubercular drugs as per RNTCP guidelines. Primary multi-drug resistance (MDR was found to be 18/453; (4.0%. Extensively drug resistance (XDR was found in one strain (0.2%, which was found to be resistant to other antibiotics. Data of drug resistant tuberculosis among treatment naïve TB patients are lacking in India. The presence of XDR-TB and high MDR-TB in small population studied, calls for conducting systematic multi-centric surveillance across the country.

  7. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment.

    Science.gov (United States)

    Siewiera, Jacek; Trnka, Jakub; Kübler, Andrzej

    2014-01-01

    In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.

  8. Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands.

    Science.gov (United States)

    Worm-Smeitink, M; Nikolaus, S; Goldsmith, K; Wiborg, J; Ali, S; Knoop, H; Chalder, T

    2016-08-01

    Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes after CBT in tertiary treatment centres in the Netherlands (NL) and the United Kingdom (UK), using different treatment protocols but identical outcome measures, while controlling for differences in patient characteristics and diagnostic criteria. Consecutively referred CFS patients who received CBT were included (NL: n=293, UK: n=163). Uncontrolled effect sizes for improvement in fatigue (Chalder Fatigue Questionnaire), physical functioning (SF-36 physical functioning subscale) and social functioning (Work and Social Adjustment Scale) were compared. Multiple regression analysis was used to examine whether patient differences explained outcome differences between centres. Effect sizes differed between centres for fatigue (Cohen's D NL=1.74, 95% CI=1.52-1.95; UK=0.99, CI=0.73-1.25), physical functioning (NL=0.99, CI=0.81-1.18; UK=0.33, CI=0.08-0.58) and social functioning (NL=1.47, CI=1.26-1.69; UK=0.61, CI=0.35-0.86). Patients in the UK had worse physical functioning at baseline and there were minor demographic differences. These could not explain differences in centre outcome. Effectiveness of CBT differed between treatment centres. Differences in treatment protocols may explain this and should be investigated to help further improve outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. 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.

  10. 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.

  11. 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.

  12. 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)

  13. The malleability of spatial ability under treatment of a FIRST LEGO League-based robotics unit

    Science.gov (United States)

    Coxon, Steven Vincent

    Spatial ability is important to science, technology, engineering, and math (STEM) success, but spatial talents are rarely developed in schools. Likewise, the gifted may become STEM innovators, but they are rarely provided with pedagogy appropriate to develop their abilities in schools. A stratified random sample of volunteer participants (n=75) ages 9-14 was drawn from 16 public school districts' gifted programs, including as many females (n=28) and children from groups traditionally underrepresented in gifted programs (n=18) as available. Participants were randomly divided into an experimental (n=38) and a control group (n=37) for an intervention study. All participants took the CogAT (form 6) Verbal Battery and the Project TALENT Spatial Ability Assessments. The experimental group participated in a simulation of the FIRST LEGO League (FLL) competition for 20 hours total over five consecutive days. All participants took the spatial measure another time. Experimental males evidenced significant and meaningful gains in measured spatial ability (Cohen's d = 0.87). Females did not evidence significant gains in measured spatial ability. This may be due to sampling error, gender differences in prior experience with LEGO, or differences in facets of spatial ability in the treatment or measurements. Further research studies with larger samples of females, other treatments and measurement tools, and longer treatment periods are recommended. The literature review revealed that FLL is beneficial for STEM engagement in both genders and its use in schools is recommended. The present study provides additional evidence for FLL's usefulness in increasing the number of individuals in the STEM pipeline. Keywords: spatial, gilled, talent, robotics, FIRST LEGO League, science

  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. Revising strategies for different text types

    OpenAIRE

    Roussey, JY; Piolat, A; Guercin, F

    1990-01-01

    Forty-eight children and forty-eight adults of contrasting degrees of expertise made a series of corrections in order to improve a text (narrative or description) in which three within-statement errors and three between-statement errors had been inserted. Subjects used a simplified word processor (SCRIPREV) which recorded all movements of linguistic units. The purpose of this research was to study revising strategies by examining the correction-sequencing procedures implemented by these subje...

  16. Cholera in pregnancy: outcomes from a specialized cholera treatment unit for pregnant women in Léogâne, Haiti.

    Science.gov (United States)

    Ciglenecki, Iza; Bichet, Mathieu; Tena, Javier; Mondesir, Erneau; Bastard, Mathieu; Tran, Nguyen-Toan; Antierens, Annick; Staderini, Nelly

    2013-01-01

    The association between cholera in pregnancy and negative fetal outcome has been described since the 19(th) century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011. Pregnant women with cholera were hospitalized in a specialized unit within the MSF hospital compound in Léogâne and treated using standard cholera treatment guidelines but with earlier, more intense fluid replacement. All women had intravenous access established at admission regardless of their hydration status, and all received antibiotic treatment. Data were collected on patient demographics, pregnancy and cholera status, and pregnancy outcome. In this analysis we calculated risk ratios for fetal death and performed logistic regression analysis to control for confounding factors. 263 pregnant women with cholera were hospitalized between December 2010 and July 2011. None died during hospitalization, 226 (86%) were discharged with a preserved pregnancy and 16 (6%) had live fullterm singleton births, of whom 2 died within the first 5 days postpartum. The remaining 21 pregnancies (8%) resulted in intrauterine fetal death. The risk of fetal death was associated with factors reflecting severity of the cholera episode: after adjusting for confounding factors, the strongest risk factor for fetal death was severe maternal dehydration (adjusted risk ratio for severe vs. mild dehydration was 9.4, 95% CI 2.5-35.3, p = 0.005), followed by severe vomiting (adjusted risk ratio 5.1, 95% 1.1-23.8, p = 0.041). This is the largest cohort of pregnant women with cholera described to date. The main risk factor identified for fetal death was severity of dehydration. Our experience suggests that establishing specialized multidisciplinary units which facilitate close follow-up of both pregnancy and dehydration status due to cholera could be beneficial

  17. Surgical Treatment of Subungual Squamous Cell Carcinoma by Wide Excision of the Nail Unit and Skin Graft Reconstruction: An Evaluation of Treatment Efficiency and Outcomes.

    Science.gov (United States)

    Topin-Ruiz, Solène; Surinach, Catherine; Dalle, Stéphane; Duru, Gérard; Balme, Brigitte; Thomas, Luc

    2017-05-01

    The best surgical treatment modalities for subungual squamous cell carcinoma (SUSCC) without bone invasion need to be determined. The limited available data on Mohs micrographic surgery do not demonstrate its use as a standard procedure. A previous study in a limited series of patients has shown that wide surgical excision of the nail unit was associated with a low rate of recurrence. To confirm the efficiency of wide surgical excision of the nail unit with full-thickness skin graft reconstruction on a series of patients with SUSCC with an extended follow-up and to evaluate short- and long-term postoperative morbidity and patient satisfaction. A consecutive series of 55 patients with biopsy-proven SUSCC without bone invasion treated by wide surgical excision of the nail unit followed by full-thickness skin graft reconstruction from January 1, 2000, to August 31, 2012 were included. After a minimum follow-up of 5 years, the recurrences were collected from the referring physicians. Statistical analysis was conducted from January 1 to June 30, 2016. Demographic data, pathologic characteristics of tumors, postoperative follow-up, and recurrences were collected from medical records. Patients' satisfaction with surgery, quality of life, and delayed postoperative morbidity (functional outcome and sensory disorders) were assessed from a questionnaire mailed to patients and physicians. Among the 55 patients (23 women and 32 men; mean age, 64 years), the mean follow-up was 6.6 years (range, 5.0-11.2 years), with a minimum follow-up of 5 years. Fifty-two questionnaires (95%) were returned. Two recurrences were observed. Minor early postoperative complications, such as graft infection and delayed wound healing, were seen in 6 patients; 8 patients experienced severe pain. Late postoperative complications included hypersensitivity to mechanical shocks (39 of 51 patients [76%]), mildly increased sensitivity to cold (38 of 51 patients [75%]), loss of fine touch sensation (17 of 35

  18. Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit.

    Science.gov (United States)

    Feltman, D M; Du, H; Leuthner, S R

    2012-11-01

    To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

  19. Current Capabilities and Capacity of Ebola Treatment Centers in the United States.

    Science.gov (United States)

    Herstein, Jocelyn J; Biddinger, Paul D; Kraft, Colleen S; Saiman, Lisa; Gibbs, Shawn G; Le, Aurora B; Smith, Philip W; Hewlett, Angela L; Lowe, John J

    2016-03-01

    To describe current Ebola treatment center (ETC) locations, their capacity to care for Ebola virus disease patients, and infection control infrastructure features. A 19-question survey was distributed electronically in April 2015. Responses were collected via email by June 2015 and analyzed in an electronic spreadsheet. The survey was sent to and completed by site representatives of each ETC. The survey was sent to all 55 ETCs; 47 (85%) responded. Of the 47 responding ETCs, there are 84 isolation beds available for adults and 91 for children; of these pediatric beds, 35 (38%) are in children's hospitals. In total, the simultaneous capacity of the 47 reporting ETCs is 121 beds. On the basis of the current US census, there are 0.38 beds per million population. Most ETCs have negative pressure isolation rooms, anterooms, and a process for category A waste sterilization, although only 11 facilities (23%) have the capability to sterilize infectious waste on site. Facilities developed ETCs on the basis of Centers for Disease Control and Prevention guidance, but specific capabilities are not mandated at this present time. Owing to the complex and costly nature of Ebola virus disease treatment and variability in capabilities from facility to facility, in conjunction with the lack of regulations, nationwide capacity in specialized facilities is limited. Further assessments should determine whether ETCs can adapt to safely manage other highly infectious disease threats.

  20. 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

  1. 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

  2. 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

  3. 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...

  4. Referral and Receipt of Treatment for Hepatocellular Carcinoma in United States Veterans: Effect of Patient and Non-Patient Factors

    Science.gov (United States)

    Davila, Jessica A.; Kramer, Jennifer R.; Duan, Zhigang; Richardson, Peter A.; Tyson, Gia L.; Sada, Yvonne H.; Kanwal, Fasiha; El-Serag, Hashem B.

    2014-01-01

    Background The delivery of treatment for hepatocellular carcinoma (HCC) could be influenced by place of HCC diagnosis (hospitalization vs. outpatient), subspecialty referral following diagnosis, as well as physician and facility factors. We conducted a study to examine the effect of patient and non-patient factors on the place of HCC diagnosis, referral, and treatment in Veterans Administration (VA) hospitals in the United States. Methods Using the VA Hepatitis C Clinical Case Registry, we identified HCV-infected patients who developed HCC during 1998–2006. All cases were verified and staged according to Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We examined factors related to these outcomes using hierarchical logistic regression. These factors included HCC stage, HCC surveillance, physician specialty, and facility factors, in addition to risk factors, co-morbidity, and liver disease indicators. Results Approximately 37.2% of the 1,296 patients with HCC were diagnosed during hospitalization, 31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being seen by a surgeon or oncologist was associated with surveillance (adjusted odds ratio (aOR)=1.47;95%CI:1.20–1.80) and varied by geography (1.74;1.09–2.77). Seeing a surgeon or oncologist was predictive of treatment (aOR=1.43;95%CI:1.24–1.66). There was a significant increase in treatment among patients who received surveillance (aOR=1.37; 95%CI:1.02–1.71), were seen by gastroenterology (1.65;1.21–2.24) or were diagnosed at a transplant facility (1.48;1.15–1.90). Conclusions Approximately 40% of patients were diagnosed during hospitalization. Most patients were not seen by a surgeon or oncologist for treatment evaluation and only 34% received treatment. Only receipt of HCC surveillance was associated with increased likelihood of outpatient diagnosis, being seen by a surgeon or

  5. 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

  6. 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.

  7. Establishing a clinical pharmacy technician at a United States Army military treatment facility.

    Science.gov (United States)

    Evans, Jennifer L; Gladd, Ellen M; Gonzalez, Alicia C; Tranam, Salman; Larrabee, Joni M; Lipphardt, Sarah E; Chen, Tina T; Ronn, Michael D; Spain, John

    2016-01-01

    To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. An outpatient military treatment facility located in Maryland. The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal

  8. 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

  9. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system

    International Nuclear Information System (INIS)

    Gladstone, D. J.; Li, S.; Jarvis, L. A.; Hartford, A. C.

    2011-01-01

    Purpose: The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Methods: Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Results: Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. Conclusions: The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  10. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Gladstone, D. J.; Li, S.; Jarvis, L. A.; Hartford, A. C. [Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 (United States); Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 and Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania 19104 (United States); Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 (United States)

    2011-07-15

    Purpose: The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Methods: Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Results: Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. Conclusions: The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  11. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States.

    Science.gov (United States)

    Stranges, Paul M; Hutton, David W; Collins, Curtis D

    2013-01-01

    Fidaxomicin is a novel treatment for Clostridium difficile infections (CDIs). This new treatment, however, is associated with a higher acquisition cost compared with alternatives. The objective of this study was to evaluate the cost-effectiveness of fidaxomicin or oral vancomycin for the treatment of CDIs. We performed a cost-utility analysis comparing fidaxomicin with oral vancomycin for the treatment of CDIs in the United States by creating a decision analytic model from the third-party payer perspective. The incremental cost-effectiveness ratio with fidaxomicin compared with oral vancomycin was $67,576/quality-adjusted life-year. A probabilistic Monte Carlo sensitivity analysis showed that fidaxomicin had an 80.2% chance of being cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Fidaxomicin remained cost-effective under all fluctuations of both fidaxomicin and oral vancomycin costs. The decision analytic model was sensitive to variations in clinical cure and recurrence rates. Secondary analyses revealed that fidaxomicin was cost-effective in patients receiving concominant antimicrobials, in patients with mild to moderate CDIs, and when compared with oral metronidazole in patients with mild to moderate disease. Fidaxomicin was dominated by oral vancomycin if CDI was caused by the NAP1/Bl/027 Clostridium difficile strain and was dominant in institutions that did not compound oral vancomycin. Results of our model showed that fidaxomicin may be a more cost-effective option for the treatment of CDIs when compared with oral vancomycin under most scenarios tested. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Clinical Presentation and Care of Patients with Ebola Virus Disease in the China Ebola Treatment Unit, Liberia.

    Science.gov (United States)

    Shao, Xiaoping; Ren, Weizheng; Zhou, Feihu

    2017-01-24

    In order to evaluate the clinical characteristics of confirmed Ebola Virus Disease (EVD) patients admitted to the China Ebola Treatment Unit (China ETU) between January 2015 and March 2015, we retrospectively analyzed clinical symptoms, treatment, and epidemiologic features of 5 patients with confirmed EVD, and reviewed the relevant medical literature. Of these, 3 patients survived, and 2 died. The time interval from the onset of symptoms to the negative PCR test for Ebola virus in the 3 survivors was 14-18 days. All survivors reported direct contact with confirmed EVD patients up to 21 days prior to admission. All patients developed a fever, fatigue, and anorexia. Fever was generally the first symptom to develop, followed by a gastrointestinal phase characterized by vomiting/nausea (3 cases, 60%), diarrhea (3 cases), and abdominal pain (4 cases, 80%). Three patients (60%) reported joint pain, muscle pain, and conjunctival hemorrhage, respectively, and 2 patients (40%) developed a headache. We concluded that strict isolation and interruption of the route of transmission were required for suspected or confirmed EVD patients. The main treatment strategies were supportive care, maintenance of blood volume and electrolyte balance, and the prevention of complications.

  13. Quantifying direct carbon dioxide emissions from wastewater treatment units by nondispersive infrared sensor (NDIR) - A pilot study.

    Science.gov (United States)

    Kosse, Pascal; Kleeberg, Tasja; Lübken, Manfred; Matschullat, Jörg; Wichern, Marc

    2018-08-15

    Treatment of nutrient-rich wastewater potentially results in direct release of greenhouse gases (GHGs) such as CO 2 , N 2 O or CH 4 - and thus affects Waste Water Treatment Plant's carbon footprint. Accurate CO 2 quantification is challenging due to various chemical, physical and operational conditions. A floating chamber equipped with a nondispersive infrared, single beam, dual wavelength sensor has been evaluated for a pilot approach to quantify fugitive CO 2 emissions above different wastewater treatment units. Total average CO 2 flux was 1182gCO 2 ·m -2 ·d -1 with minimum and maximum fluxes of 829gCO 2 ·m -2 ·d -1 and 1493gCO 2 ·m -2 ·d -1 , respectively. Total observed CO 2 emissions were in 7 to 17kgCO 2 ·PE -1 ·a -1 (average 12kgCO 2 ·PE -1 ·a -1 ). The nitrification tank accounted for about 94.3% of the emissions, followed by secondary clarification (ca. 4.3%) and denitrification (ca. 1.4%), based on those average annual CO 2 emissions per population equivalent (PE). Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Grey water treatment by a continuous process of an electrocoagulation unit and a submerged membrane bioreactor system

    KAUST Repository

    Bani-Melhem, Khalid

    2012-08-01

    This paper presents the performance of an integrated process consisting of an electro-coagulation (EC) unit and a submerged membrane bioreactor (SMBR) technology for grey water treatment. For comparison purposes, another SMBR process without electrocoagulation (EC) was operated in parallel with both processes operated under constant transmembrane pressure for 24. days in continuous operation mode. It was found that integrating EC process with SMBR (EC-SMBR) was not only an effective method for grey water treatment but also for improving the overall performance of the membrane filtration process. EC-SMBR process achieved up to 13% reduction in membrane fouling compared to SMBR without electrocoagulation. High average percent removals were attained by both processes for most wastewater parameters studied. The results demonstrated that EC-SMBR performance slightly exceeded that of SMBR for COD, turbidity, and colour. Both processes produced effluent free of suspended solids, and faecal coliforms were nearly (100%) removed in both processes. A substantial improvement was achieved in removal of phosphate in the EC-SMBR process. However, ammonia nitrogen was removed more effectively by the SMBR only. Accordingly, the electrolysis condition in the EC-SMBR process should be optimized so as not to impede biological treatment. © 2012 Elsevier B.V.

  15. Handling and treatment of low-level radioactive wastes from gaseous diffusion plants in the United States of America

    International Nuclear Information System (INIS)

    Wing, J.F.; Behrend, J.E.

    1984-01-01

    Gaseous diffusion plants in the United States of America currently generate very small quantities of low-level radioactive wastes. These wastes consist primarily of airborne effluent solid trapping media and liquid scrubber solutions, liquid effluent treatment sludges, waste oils and solvents, scrap metals and conventional combustible wastes such as floor sweepings, cleaning rags and shoe covers. In addition to waste emanating from current operations, large quantities of scrap metal generated during the Cascade Improvement Program are stored above ground at each of the diffusion plants. The radionuclides of primary concern are uranium and 99 Tc. Current radioactive waste treatment consists of uranium dissolution in weak acids followed by chemical precipitation and/or solvent extraction for uranium recovery. Current disposal operations consist of above ground storage of scrap metals, shallow land burial of inorganic solids and incineration of combustible wastes. With increased emphasis on reducing the potential for off-site radiological dose, several new treatment and disposal options are being studied and new projects are being planned. One project of particular interest involves the installation of a high temperature incinerator to thermally degrade hazardous organic wastes contaminated with low-level radioactive wastes. Other technologies being studied include fixation of uranium-bearing sludges in concrete before burial, decontamination of scrap metals by smelting and use of specially engineered centralized burial grounds. (author)

  16. Occurrence of disinfection byproducts in United States wastewater treatment plant effluents

    KAUST Repository

    Krasner, Stuart W.

    2009-11-01

    Effluents from wastewater treatment plants (WWTPs) contain disinfection byproducts (DBPs) of health concern when the water is utilized downstream as a potable water supply. The pattern of DBP formation was strongly affected by whether or not the WWTP achieved good nitrification. Chlorine addition to poorly nitrified effluents formed low levels of halogenated DBPs, except for (in some cases) dihalogenated acetic acids, but often substantial amounts of N-nitrosodimethyamine (NDMA). Chlorination of well-nitrified effluent typically resulted in substantial formation of halogenated DBPs but much less NDMA. For example, on a median basis after chlorine addition, the well-nitrified effluents had 57 μg/L of trihalomethanes [THMs] and 3 ng/L of NDMA, while the poorly nitrified effluents had 2 μg/L of THMs and 11 ng/L of NDMA. DBPs with amino acid precursors (haloacetonitriles, haloacetaldehydes) formed at substantial levels after chlorination of well-nitrified effluent. The formation of halogenated DBPs but not that of NDMA correlated with the formation of THMs in WWTP effluents disinfected with free chlorine. However, THM formation did not correlate with the formation of other DBPs in effluents disinfected with chloramines. Because of the relatively high levels of bromide in treated wastewater, bromine incorporation was observed in various classes of DBPs. © 2009 American Chemical Society.

  17. Occurrence of disinfection byproducts in United States wastewater treatment plant effluents

    KAUST Repository

    Krasner, Stuart W.; Westerhoff, Paul K.; Chen, Baiyang; Rittmann, Bruce E.; Amy, Gary L.

    2009-01-01

    Effluents from wastewater treatment plants (WWTPs) contain disinfection byproducts (DBPs) of health concern when the water is utilized downstream as a potable water supply. The pattern of DBP formation was strongly affected by whether or not the WWTP achieved good nitrification. Chlorine addition to poorly nitrified effluents formed low levels of halogenated DBPs, except for (in some cases) dihalogenated acetic acids, but often substantial amounts of N-nitrosodimethyamine (NDMA). Chlorination of well-nitrified effluent typically resulted in substantial formation of halogenated DBPs but much less NDMA. For example, on a median basis after chlorine addition, the well-nitrified effluents had 57 μg/L of trihalomethanes [THMs] and 3 ng/L of NDMA, while the poorly nitrified effluents had 2 μg/L of THMs and 11 ng/L of NDMA. DBPs with amino acid precursors (haloacetonitriles, haloacetaldehydes) formed at substantial levels after chlorination of well-nitrified effluent. The formation of halogenated DBPs but not that of NDMA correlated with the formation of THMs in WWTP effluents disinfected with free chlorine. However, THM formation did not correlate with the formation of other DBPs in effluents disinfected with chloramines. Because of the relatively high levels of bromide in treated wastewater, bromine incorporation was observed in various classes of DBPs. © 2009 American Chemical Society.

  18. Comparison of treatment seeking compulsive buyers in Germany and the United States.

    Science.gov (United States)

    Mueller, Astrid; Mitchell, James E; Mertens, Christian; Mueller, Ulrike; Silbermann, Andrea; Burgard, Melissa; de Zwaan, Martina

    2007-07-01

    The aim of this pilot study was to compare a German (Bavaria) and an American (North Dakota) sample of women suffering from compulsive buying. Thirty-eight German and 39 American female compulsive buyers were screened with the Compulsive Buying Scale (CBS), and the Yale-Brown Obsessive Compulsive Scale-Shopping Version (Y-BOCS-SV) prior to entering a group treatment study. Psychiatric co-morbidity was assessed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID). There were no statistically significant differences between the German sample and the American sample with regard to age (mean 43.7 and 45 years, respectively), and with regard to the scores on the CBS and the Y-BOCS-SV. A high lifetime co-morbidity rate with Axis I disorders, especially mood disorders, anxiety disorders, substance use disorders, OCD, and binge eating disorder was detected in both samples. Almost all participants met criteria for at least one lifetime Axis I disorder. However, German compulsive buyers showed significantly higher current prevalence rates of any affective disorder, and higher current and lifetime prevalence rates of any anxiety disorder and somatoform disorder. In addition, German compulsive buyers were significantly more likely to have more than one Axis I disorder. The groups did not differ with regard to age and with regard to the severity of compulsive buying and showed a high co-morbidity with Axis I disorders. However, the German compulsive buying sample presented with significantly more psychiatric co-morbidity compared to the American sample. Further research is needed to provide a better understanding of this disorder in general and cross-culturally.

  19. A Cross-National Review of Evidence-Based Psychosocial Treatments for Children and Adolescents with Autistic Spectrum Disorders in the United Kingdom, Ireland, and United States

    Science.gov (United States)

    Robinson, Lee; Bond, Caroline

    2017-01-01

    The most thoroughly researched topic in relation to autistic spectrum disorders (ASDs) is the evaluation of interventions. Educational psychology in the United Kingdom and Ireland is the most closely allied profession to school psychology in the United States. In considering what is published by and for the profession, it is important to include…

  20. Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

    Science.gov (United States)

    McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

    2016-01-01

    Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

  1. Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States.

    Science.gov (United States)

    Gubner, Noah R; Andrews, K Blakely; Mohammad-Zadeh, Ana; Lisha, Nadra E; Guydish, Joseph

    2016-12-01

    Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N=1113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-cigarettes, and 30.5% reported using e-cigarettes in the past 30days (current users). The main reasons for using e-cigarettes were (a) at times/places when smoking was prohibited (53.5%), and (b) as a way to quit/reduce cigarette smoking (50.3%). Daily vs non-daily e-cigarette users were more likely to use e-cigarettes both as a way to reduce health risks, and as a way to quit/reduce cigarette smoking. A majority of e-cigarette users (87.1%) reported dual use of e-cigarettes and tobacco cigarettes during the past month. Among current cigarette smokers, those that also used e-cigarettes smoked more cigarettes per day, were more likely to have made a past year cigarette quit attempt, and to have tried nicotine replacement therapy compared to cigarette only smokers. There was a high rate of dual e-cigarette and cigarette use by persons enrolled in addiction treatment. E-cigarette users may be heavier cigarette smokers trying to quit or reduce their cigarette smoking. However, e-cigarettes were also used at times when individuals could not smoke cigarettes. Substance abuse treatment centers developing tobacco policies need to consider these potentially conflicting reasons for using e-cigarettes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. A pharmacoeconomic evaluation of escitalopram versus citalopram in the treatment of severe depression in the United Kingdom.

    Science.gov (United States)

    Wade, Alan G; Toumi, Idris; Hemels, Michiel E H

    2005-04-01

    perspectives at all ranges of probabilities tested. A sensitivity analysis on the acquisition cost of citalopram verified that, from the societal perspective, escitalopram remained the dominant strategy, even at a cost of 0.00 British pounds for citalopram. These results suggest that escitalopram is a cost-saving alternative to citalopram for the treatment of severe depression in the United Kingdom from the perspectives of both the NHS and society. Therefore, a possible advantage may exist at the population level in the treatment of severe depression with escitalopram in the United Kingdom.

  3. Severe depression with Cotard’s phenomenon: treatment of a capacitated patient within the United Kingdom’s Mental Health Act 2007

    Directory of Open Access Journals (Sweden)

    Simon B. Menezes

    2013-02-01

    Full Text Available Treatment of Cotard’s syndrome with electroconvulsive therapy (ECT has been seen to be an effective treatment option when pharmacological options are not successful. Recent changes in the Mental Health Act 2007 used within the United Kingdom has resulted in clinicians unable to prescribe treatment for patients who have capacity but are not providing consent for treatment. We report a case of a patient in the UK with Cotard’s phenomenon and severe depression, where the only effective treatment of ECT was restricted due to changes in mental health law. The role of maintenance ECT as well as the ethical dilemma faced is discussed.

  4. Zero Health Worker Infection: Experiences From the China Ebola Treatment Unit During the Ebola Epidemic in Liberia.

    Science.gov (United States)

    Liu, Lei; Yin, Huahua; Liu, Ding

    2017-04-01

    In November 2014, a total of 164 health care workers were dispatched by the Chinese government as the first medical assistance team to Liberia. The tasks of this team were to establish a China Ebola treatment unit (ETU), to commence the initial admission and treatment of suspected and confirmed Ebola patients, and to provide public health and infection control training for relevant local personnel. Overall, during the 2-month stay of this first medical assistance team in Liberia, 112 Ebola-suspected patients presented to the ETU, 65 patients were admitted, including 5 confirmed cases, and 3 confirmed cases were cured. Furthermore, 1520 local people were trained, including health care workers, military health care workers, staff members employed by the ETU, and community residents. Most importantly, as the first Chinese medical assistance team deployed to Liberia fighting the Ebola virus on the frontline, not a single member of this team or the hired local staff were infected by Ebola virus. This highly successful outcome was due to the meticulous infection control initiatives developed by the team, thereby making a significant contribution to China's ETU "zero infection" of health workers in Liberia. The major infection control initiatives conducted in the China ETU that contributed to achieving "zero infection" of all health workers in the ETU are introduced in this report. (Disaster Med Public Health Preparedness. 2017;11:262-266).

  5. Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit.

    Science.gov (United States)

    Demirel, Nihal; Bas, Ahmet Y; Kavurt, Sumru; Celik, Istemi H; Yucel, Husniye; Turkbay, Dursun; Hekimoğlu, Emre; Koc, Orhan

    2014-11-01

    Retinopathy of prematurity (ROP) is a significant cause of childhood blindness. The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU). Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia. We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 μg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time. Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998-2006

    International Nuclear Information System (INIS)

    Mak, Kimberley S.; Lee, Leslie K.; Mak, Raymond H.; Wang, Shuang; Pile-Spellman, John; Abrahm, Janet L.; Prigerson, Holly G.; Balboni, Tracy A.

    2011-01-01

    Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding. Results: We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58). Conclusions: In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC

  7. Draft Waste Management Programmatic Environmental Impact Statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume 3, Appendix A: Public response to revised NOI, Appendix B: Environmental restoration, Appendix C, Environmental impact analysis methods, Appendix D, Risk

    International Nuclear Information System (INIS)

    1995-08-01

    Volume three contains appendices for the following: Public comments do DOE's proposed revisions to the scope of the waste management programmatic environmental impact statement; Environmental restoration sensitivity analysis; Environmental impacts analysis methods; and Waste management facility human health risk estimates

  8. A comprehensive study on HDR brachytherapy treatments of cervical cancers: using the first Co-60 BEBIG Multisource Unit in Bangladesh

    Directory of Open Access Journals (Sweden)

    Naheed Rukhsana

    2011-07-01

    Full Text Available Purpose: The report presents an extraordinary synthesis of customer acceptance procedures (CAP, quality assurance tests (QA in the treatment of cervical cancer patients, using the first Co-60 Multisource Unit® in Bangladesh. The QA and commissioning required measurements and emergency tests verifying the functional limits of parameters acceptable for the new HDR afterloader. Acceptable limits were: 1 the deviation between specified and measured source strength: ± 3%; 2 the positional accuracy and uniformity: ± 1 mm; 3 the temporal accuracy (i.e. timer error and linearity and end error: ± 1% or 30 sec.; 4 treatment planning system (digitizer and localization software: ± 3% or 1 mm; 5 the distance from line to first dwell position and all the others: 5 mm and 10 mm (± 1 mm. Material and methods: Till February 2011, 47 patients were treated with HDR with more than 140 insertions applied. Amongst them, 12 patients were in stage IIB and IIIB, 22 were postoperative (IA and IB while the remaining 13 patients were with unknown stage. All the cases with stage IIB and IIIB received concurrent chemo-radiation and brachytherapy. Postoperative patients received EBRT (50 Gy and HDR according to the institutional protocol. CT scans were completed before HDR-plus planning with a good reproducibility (± 2% and were documented in repeating the plan for the same set up of a patient. Absorbed dose (Gy to a point P, at a distance of “r” in centimeters from a source of the Reference Air Kerma Rate (RAKR has been utilized for the QA of the source, where source strength measurement was accomplished. Results: All methods and analysis applicable to the QA and commissioning of Co-60 have been investigated and systematically analyzed, measured and documented before the treatment of a patient. Studies and safety requirements of this HDR remote afterloader were carried out. Acceptance and the QA were imperative to justify functionality and dependability in

  9. A comprehensive study on HDR brachytherapy treatments of cervical cancers: using the first Co-60 BEBIG Multisource Unit in Bangladesh.

    Science.gov (United States)

    Malik, Sadiq R; Banu, Parvin A; Rukhsana, Naheed

    2011-06-01

    The report presents an extraordinary synthesis of customer acceptance procedures (CAP), quality assurance tests (QA) in the treatment of cervical cancer patients, using the first Co-60 Multisource Unit ® in Bangladesh. The QA and commissioning required measurements and emergency tests verifying the functional limits of parameters acceptable for the new HDR afterloader. Acceptable limits were: 1) the deviation between specified and measured source strength: ± 3%; 2) the positional accuracy and uniformity: ± 1 mm; 3) the temporal accuracy (i.e. timer error and linearity and end error): ± 1% or 30 sec.; 4) treatment planning system (digitizer and localization software): ± 3% or 1 mm; 5) the distance from line to first dwell position and all the others: 5 mm and 10 mm (± 1 mm). Till February 2011, 47 patients were treated with HDR with more than 140 insertions applied. Amongst them, 12 patients were in stage IIB and IIIB, 22 were postoperative (IA and IB) while the remaining 13 patients were with unknown stage. All the cases with stage IIB and IIIB received concurrent chemo-radiation and brachytherapy. Postoperative patients received EBRT (50 Gy and HDR) according to the institutional protocol. CT scans were completed before HDR-plus planning with a good reproducibility (± 2%) and were documented in repeating the plan for the same set up of a patient. Absorbed dose (Gy) to a point P, at a distance of "r" in centimeters from a source of the Reference Air Kerma Rate (RAKR) has been utilized for the QA of the source, where source strength measurement was accomplished. All methods and analysis applicable to the QA and commissioning of Co-60 have been investigated and systematically analyzed, measured and documented before the treatment of a patient. Studies and safety requirements of this HDR remote afterloader were carried out. Acceptance and the QA were imperative to justify functionality and dependability in delivering the treatment. Implications of these studies

  10. Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial.

    Science.gov (United States)

    Romanò, Carlo L; Monti, Lorenzo; Logoluso, Nicola; Romanò, Delia; Drago, Lorenzo

    2015-11-01

    The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. II.

  11. Federal Textbook on Citizenship. Our Constitution and Government: Lessons on the Constitution and Government of the United States for Use in the Public Schools by Candidates for Citizenship. Revised Edition.

    Science.gov (United States)

    Seckler-Hudson, Catheryn

    Designed especially for the use of the foreign-born who are preparing themselves for their naturalization examinations as applicants for United States citizenship, this textbook contains thirty lessons which tell about the government in the United States and about the kind of Constitution upon which it is founded. The text of each of the thirty…

  12. Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States.

    Science.gov (United States)

    Barua, Soumitri; Greenwald, Robert; Grebely, Jason; Dore, Gregory J; Swan, Tracy; Taylor, Lynn E

    2015-08-04

    The aim of this study was to systematically evaluate state Medicaid policies for the treatment of hepatitis C virus (HCV) infection with sofosbuvir in the United States. Medicaid reimbursement criteria for sofosbuvir were evaluated in all 50 states and the District of Columbia. The authors searched state Medicaid Web sites between 23 June and 7 December 2014 and extracted data in duplicate. Any differences were resolved by consensus. Data were extracted on whether sofosbuvir was covered and the criteria for coverage based on the following categories: liver disease stage, HIV co-infection, prescriber type, and drug or alcohol use. Of the 42 states with known Medicaid reimbursement criteria for sofosbuvir, 74% limit sofosbuvir access to persons with advanced fibrosis (Meta-Analysis of Histologic Data in Viral Hepatitis [METAVIR] fibrosis stage F3) or cirrhosis (F4). One quarter of states require persons co-infected with HCV and HIV to be receiving antiretroviral therapy or to have suppressed HIV RNA levels. Two thirds of states have restrictions based on prescriber type, and 88% include drug or alcohol use in their sofosbuvir eligibility criteria, with 50% requiring a period of abstinence and 64% requiring urine drug screening. Heterogeneity is present in Medicaid reimbursement criteria for sofosbuvir with respect to liver disease staging, HIV co-infection, prescriber type, and drug or alcohol use across the United States. Restrictions do not seem to conform with recommendations from professional organizations, such as the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases. Current restrictions seem to violate federal Medicaid law, which requires states to cover drugs consistent with their U.S. Food and Drug Administration labels.

  13. Revisions of K/Ar ages for the Hadar hominid site, Ethiopia

    Energy Technology Data Exchange (ETDEWEB)

    Walter, R.C.; Aronson, J.L. (Case Western Reserve Univ., Cleveland, OH (USA). Dept. of Geology)

    1982-03-11

    Conventional K/Ar age measurements are reported for two volcanic units from the hominid-bearing Hadar Formation. These ages represent revision of previously published ages for the BKT-2 tephra and the Kadada Moumou basalt. BKT-2 is revised from 2.65 to 2.9 Myr BP and the Kadada Moumou basalt is revised from 3.0 to 3.6 Myr BP.

  14. Back to the future: extended dialysis for treatment of acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Kielstein, Jan T; Schiffer, Mario; Hafer, Carsten

    2010-01-01

    On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to treat patients with AKI, enabled the Dutch physician W.J. Kolff to save the life of the 67-year-old woman. By treating her for 690 minutes (i.e., 11.5 hours) with a blood flow rate of 116 ml/min, Kolff also set the coordinates of a renal replacement therapy that has enjoyed an unsurpassed renaissance over the last decade for treatment of severely ill patients with AKI in the intensive care unit (ICU). Prolonged dialysis time with low flow rates - these days, called extended dialysis (ED) - combines several advantages of both intermittent and continuous techniques, which makes it an ideal treatment method for ICU patients with AKI. This review summarizes our knowledge of this method, which is increasingly used in many centers worldwide. We reflect on prospective controlled studies in critically ill patients that have documented that small-solute clearance with ED is comparable with that of intermittent hemodialysis and continuous venovenous hemofiltration, as well as on studies showing that patients' cardiovascular stability during ED is similar to that with continuous renal replacement therapy. Furthermore, we report on logistic and economic advantages of this method. We share our view on how extended dialysis offers ample opportunity for a collaborative interaction between nephrologists and intensivists as the nephrology staff, enabling optimal treatment of complex critically ill patients by using the skill and knowledge of 2 indispensable specialties in the ICU. Lastly, we address the problem of ED intensity, which does not seem to have an impact on survival at higher doses, a finding that might be caused by the fact that we still adhere to dosing

  15. Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal.

    Science.gov (United States)

    Agar, Nita Sally; Wedgeworth, Emma; Crichton, Siobhan; Mitchell, Tracey J; Cox, Michael; Ferreira, Silvia; Robson, Alistair; Calonje, Eduardo; Stefanato, Catherine M; Wain, Elizabeth Mary; Wilkins, Bridget; Fields, Paul A; Dean, Alan; Webb, Katherine; Scarisbrick, Julia; Morris, Stephen; Whittaker, Sean J

    2010-11-01

    We have analyzed the outcome of mycosis fungoides (MF) and Sézary syndrome (SS) patients using the recent International Society for Cutaneous Lymphomas (ISCL)/European Organisation for Research and Treatment of Cancer (EORTC) revised staging proposal. Overall survival (OS), disease-specific survival (DSS), and risk of disease progression (RDP) were calculated for a cohort of 1,502 patients using univariate and multivariate models. The mean age at diagnosis was 54 years, and 71% of patients presented with early-stage disease. Disease progression occurred in 34%, and 26% of patients died due to MF/SS. A significant difference in survival and progression was noted for patients with early-stage disease having patches alone (T1a/T2a) compared with those having patches and plaques (T1b/T2b). Univariate analysis established that (1) advanced skin and overall clinical stage, increased age, male sex, increased lactate dehydrogenase (LDH), and large-cell transformation were associated with reduced survival and increased RDP; (2) hypopigmented MF, MF with lymphomatoid papulosis, and poikilodermatous MF were associated with improved survival and reduced RDP; and (3) folliculotropic MF was associated with an increased RDP. Multivariate analysis established that (1) advanced skin (T) stage, the presence in peripheral blood of the tumor clone without Sézary cells (B0b), increased LDH, and folliculotropic MF were independent predictors of poor survival and increased RDP; (2) large-cell transformation and tumor distribution were independent predictors of increased RDP only; and (3) N, M, and B stages; age; male sex; and poikilodermatous MF were only significant for survival. This study has validated the recently proposed ISCL/EORTC staging system and identified new prognostic factors.

  16. Management of Food Allergy in Japan “Food Allergy Management Guideline 2008 (Revision from 2005” and “Guidelines for the Treatment of Allergic Diseases in Schools”

    Directory of Open Access Journals (Sweden)

    Motohiro Ebisawa

    2009-01-01

    Full Text Available In 2005, the “Food Allergy Management Guideline 2005” was published. In order to encompass food allergy from infancy to adulthood, the project committee included not only pediatricians, but also internists, dermato