Developing the radiation protection safety culture in the UK

In the UK, as elsewhere, there is potential to improve how radiological challenges are addressed through improvement in, or development of, a strong radiation protection (RP) safety culture. In preliminary work in the UK, two areas have been identified as having a strong influence on UK society: the healthcare and nuclear industry sectors. Each has specific challenges, but with many overlapping common factors. Other sectors will benefit from further consideration.In order to make meaningful comparisons between these two principal sectors, this paper is primarily concerned with cultural aspects of RP in the working environment and occupational exposures rather than patient doses.The healthcare sector delivers a large collective dose to patients each year, particularly for diagnostic purposes, which continues to increase. Although patient dose is not the focus, it must be recognised that collective patient dose is inevitably linked to collective occupational exposure, especially in interventional procedures.The nuclear industry faces major challenges as work moves from operations to decommissioning on many sites. This involves restarting work in the plants responsible for the much higher radiation doses of the 1960/70s, but also performing tasks that are considerably more difficult and hazardous than those original performed in these plants.Factors which influence RP safety culture in the workplace are examined, and proposals are considered for a series of actions that may lead to an improvement in RP culture with an associated reduction in dose in many work areas. These actions include methods to improve knowledge and awareness of radiation safety, plus ways to influence management and colleagues in the workplace. The exchange of knowledge about safety culture between the nuclear industry and medical areas may act to develop RP culture in both sectors, and have a wider impact in other sectors where exposures to ionising radiations can occur.

Cancer in Canada fact sheet series #1 - thyroid cancer in Canada

The incidence of thyroid cancer is increasing more rapidly than that of any other cancer in Canada, while mortality has remained low and stable. In the last 10 years the number of thyroid cancer cases has increased 144% from 1709 to 4172 cases per year. Thyroid cancer is three times more common in females than males. 40% of thyroid cancers are diagnosed in Canadians under 45 years of age. Some of the apparent increase in incidence is likely due to improved and more widely available diagnostic techniques.

No one likes a copycat: a cross-cultural investigation of children's response to plagiarism

Copying other people's ideas is evaluated negatively by American children and adults. The current study investigated the influence of culture on children's evaluations of plagiarism by comparing children from three countries--the United States, Mexico, and China--that differ in terms of their emphasis on the protection of intellectual property and ideas. Children (3- to 6-year-olds) were presented with videos involving two characters drawing pictures and were asked to evaluate the character who drew unique work or the character who copied someone else's drawing. The study showed that 5- and 6-year-olds from all three cultures evaluated copiers negatively compared with unique drawers. These results suggest that children from cultures that place different values on the protection of ideas nevertheless develop similar concerns with plagiarism by 5-year-olds.

A new approach to assess the dependency of extant half-saturation coefficients on maximum process rates and estimate intrinsic coefficients

The Monod equation is often used to describe biological treatment processes and is the foundation for many activated sludge models. The Monod equation includes a "half-saturation coefficient" to describe the effect of substrate limitations on the process rate and it is customary to consider this parameter to be a constant for a given system. The purpose of this study was to develop a methodology, and its use to show that the half-saturation coefficient for denitrification is not constant but is in fact a function of the maximum denitrification rate. A 4-step procedure is developed to investigate the dependency of half-saturation coefficients on the maximum rate and two different models are used to describe this dependency: (a) an empirical linear model and (b) a deterministic model based on Fick's law of diffusion. Both models are proved better for describing denitrification kinetics than assuming a fixed K(NO3) at low nitrate concentrations. The empirical model is more utilitarian whereas the model based on Fick's law has a fundamental basis that enables the intrinsic K(NO3) to be estimated. In this study data was analyzed from 56 denitrification rate tests and it was found that the extant K(NO3) varied between 0.07 mgN/L and 1.47 mgN/L (5th and 95th percentile respectively) with an average of 0.47 mgN/L. In contrast to this, the intrinsic K(NO3) estimated for the diffusion model was 0.01 mgN/L which indicates that the extant K(NO3) is greatly influenced by, and mostly describes, diffusion limitations.

Life cycle assessment applied to wastewater treatment: state of the art

Life cycle assessment (LCA) is a technique to quantify the impacts associated with a product, service or process from cradle-to-grave perspective. Within the field of wastewater treatment (WWT) LCA was first applied in the 1990s. In the pursuit of more environmentally sustainable WWT, it is clear that LCA is a valuable tool to elucidate the broader environmental impacts of design and operation decisions. With growing interest from utilities, practitioners, and researchers in the use of LCA in WWT systems, it is important to make a review of what has been achieved and describe the challenges for the forthcoming years. This work presents a comprehensive review of 45 papers dealing with WWT and LCA. The analysis of the papers showed that within the constraints of the ISO standards, there is variability in the definition of the functional unit and the system boundaries, the selection of the impact assessment methodology and the procedure followed for interpreting the results. The need for stricter adherence to ISO methodological standards to ensure quality and transparency is made clear and emerging challenges for LCA applications in WWT are discussed, including: a paradigm shift from pollutant removal to resource recovery, the adaptation of LCA methodologies to new target compounds, the development of regional factors, the improvement of the data quality and the reduction of uncertainty. Finally, the need for better integration and communication with decision-makers is highlighted.

The use of pre-operative computed tomography in the assessment of the acute abdomen

INTRODUCTION

While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy.

METHODS

Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings.

RESULTS

A total of 196 emergency laparotomies were performed over the 2-year period, with 112 patients undergoing preoperative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars.

CONCLUSIONS

On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.

Abstract B31: Single-agent pemetrexed in patients with ALK-positive NSCLC: A retrospective analysis of investigator-reported outcomes

Recent retrospective data in small patient cohorts have suggested that ALK-positive NSCLC may be particularly sensitive to pemetrexed therapy. Based on investigator-documented tumor response data, we assessed objective response rate (ORR) and time to progression (TTP; based on the Kaplan–Meier method) for patients with ALKpositive NSCLC treated with pemetrexed prior to enrolment in the PROFILE 1005 (NCT00932451; Pfizer) phase 2 multi-center single-arm study of crizotinib.

As of June 1st 2011, 439 ALK-positive patients had been enrolled into PROFILE 1005. All patients had progressed on at least one prior chemotherapy regimen for advanced/metastatic NSCLC. In total, 369 patients (84.1%) had received treatment with pemetrexed prior to enrolment with an ORR of 18.7%. In patients who received secondline single-agent pemetrexed (n=80), ORR was 12.5% and TTP was 5.3 months (95% CI: 3.0–6.6 months). In those who received pemetrexed as third-line or later therapy (n=138), ORR was 16.7%.

Retrospective ORR, TTP and progression-free survival (PFS) data in small ALK-positive patient cohorts have been reported. For example, Camidge et al (J Thoracic Oncol 2011;6:774–780) reported an ORR of 42%, with median PFS of 9 months (95% CI: 3–12 months) in 19 patients who received any-line pemetrexed for ALK-positive NSCLC (including first line combination and maintenance therapy), and Lee et al (J Thoracic Oncol 2011;6:1474–1480) found an ORR of 47%, and median TTP of 9.2 months (95% CI: 4.7–13.7 months) in 15 patients with ALK-positive NSCLC who received pemetrexed as second-line or later therapy.

These figures exceed those reported for larger populations in ALK-untested NSCLC. Scagliotti et al (The Oncologist 2009;14:253–263) reported an ORR of 12.8% and PFS of 3.5 months in 158 patients with adenocarcinoma NSCLC who received second-line single-agent pemetrexed (n=158). Hanna et al (J Clin Oncol 2004;22:1589–1597) reported similar values for second-line single-agent pemetrexed in ALK-untested all-histology NSCLC: ORR 9.1% and median TTP 3.4 months (n=283). Retrospective outcomes data in NSCLC from ALK-positive patients in PROFILE 1005 are therefore more in agreement with data from large unselected populations than from small ALK-positive patient cohorts.

There are limitations of the PROFILE 1005 analysis besides the retrospective nature of the data. These include the availability of investigator-documented rather than independently reviewed tumor response data; strict adherence to RECIST criteria for response data cannot therefore be assured. However, these limitations are countered by the large patient sample size available and narrow confidence intervals reported, supporting the credibility of conclusions drawn from these data. Preliminary efficacy data from PROFILE 1005 for crizotinib in 136 patients with ALK-positive advanced NSCLC found an ORR of 51.1% (95% CI: 42.3–59.9%), with 68.4% of patients still on-treatment at the time of analysis; median duration of response was 41.9 weeks (range 6.1–42.1 weeks; Kim et al, 2011 poster at the European Multidisciplinary Cancer Congress; abstract 9084).

Prospective randomized data are required for a definitive comparison and such a study is currently ongoing. Until these data are available, retrospective data from PROFILE 1005 suggest that the extent of benefit with pemetrexed in terms of ORR and TTP in patients with ALK-positive NSCLC is considerably less than that reported in much smaller retrospective cohorts, and is more consistent with that reported in unselected populations.

Towards a benchmarking tool for minimizing wastewater utility greenhouse gas footprints

A benchmark simulation model, which includes a wastewater treatment plant (WWTP)-wide model and a rising main sewer model, is proposed for testing mitigation strategies to reduce the system's greenhouse gas (GHG) emissions. The sewer model was run to predict methane emissions, and its output was used as the WWTP model input. An activated sludge model for GHG (ASMG) was used to describe nitrous oxide (N(2)O) generation and release in activated sludge process. N(2)O production through both heterotrophic and autotrophic pathways was included. Other GHG emissions were estimated using empirical relationships. Different scenarios were evaluated comparing GHG emissions, effluent quality and energy consumption. Aeration control played a clear role in N(2)O emissions, through concentrations and distributions of dissolved oxygen (DO) along the length of the bioreactor. The average value of N(2)O emission under dynamic influent cannot be simulated by a steady-state model subjected to a similar influent quality, stressing the importance of dynamic simulation and control. As the GHG models have yet to be validated, these results carry a degree of uncertainty; however, they fulfilled the objective of this study, i.e. to demonstrate the potential of a dynamic system-wide modelling and benchmarking approach for balancing water quality, operational costs and GHG emissions.

OP deference--Libyan crisis 2011. Non combatant evacuation operations (NEO) --role one medical experience

It is the author's belief that Role 1 GDMO led medical care continues to be a potent and adaptable force, capable of operating efficiently and with a high degree of autonomy in potentially high threat environments. The medical team was able to adapt to the operational demand and retained the full confidence of the command chain, however the MO felt acutely aware of gaps in his New Entry Medical Officer clinical training. Short duration courses such as Advanced Paediatric Life Support, Basic Surgical Skills and MIMMS provide excellent added value for medical officers and increase self confidence. NEMO training in the future may benefit from the inclusion of these. Despite the challenges faced during the NEOs the Role 1 medical team in CUMBERLAND found the experience very rewarding and an example of what they joined the Royal Navy to do.