Marketing Renewable Energy in the United Kingdom

This chapter focuses on the renewable energy market in the UK. First we discuss the impact of privatization, then show what preconditions might be important. The main conclusion drawn from the analysis is that in the UK, as well as in other countries, new policy frameworks need to guide the transition from an energy system designed to achieve short-term efficiencies through market operation to a long-term approach that would embrace new uncertainties. Both market interests and environmental protection need to be secured in order to guarantee the levels of investment needed in the UK’s renewable energy market

In-Situ Site Characterization Technologies Demonstrated at the INEEL in Decommissioning Projects IN-SITU SITE CHARACTERIZATION TECHNOLOGIES DEMONSTRATED AT THE INEEL IN DECOMMISSIONING PROJECTS

ABSTRACT The United States Department of Energy (DOE) continually seeks safer, more cost-effective, and better performing technologies for decontamination and decommissioning (D&D) of nuclear facilities. The Deactivation and Decommissioning Focus Area (DDFA) of the DOE Federal Energy Technology Center (FETC) sponsors Large Scale Demonstration and Deployment Projects (LSDDPs) which are conducted at various DOE sites. The Idaho National Engineering and Environmental Laboratory (INEEL) is one of the DOE sites for demonstration of these new and improved technologies. The INEEL needs statement defines specific needs or problems for their D&D program. One of the needs identified at the INEEL was for new or improved site characterization technologies. A variety of in-situ site characterization technologies have been demonstrated through the INEEL LSDDP. These technologies provide a safer means of characterization, improved documentation, real-time information, improved D&D schedules, and reduction in costs and radiation exposures to workers. These technologies have provided vast improvements to the D&D site characterizations. Some of these technologies include: • The Global Positioning Radiometric Scanner System for large-area, surface gamma radiation surveys • Remote underwater characterization system • Identifying heavy metals in painted surfaces and determining the alloy composition in metallic material • In-Situ Object Counting System for free release • Real-time radiological data acquisition with the Surveillance and Measurement's sodium iodide detector • Electromagnetic radiography to locate contaminated soils. Historically, site characterization has been a slow, costly, and tedious process. However, through these demonstrations, new technologies have provided more accurate data, real-time information, and enhanced site characterization documentation. In addition, a safer work environment has been established as a result of decreasing the worker's time (exposure) in contaminated areas. Furthermore, D&D schedules are shortened considerably. This results in a tremendous cost saving to the D&D program. INTRODUCTION As one of four major focus areas within the DOE Office of Science and Technology (EM-50), the D&D Focus Area (DDFA) is responsible for developing, demonstrating, implementing cost-effective and safe technologies. The DOE has a need complex-wide to deactivate approximately 7,000 contaminated buildings and to decommission approximately 700 contaminated buildings that are currently on the list of surplus facilities. Deactivation refers to ceasing facility operations and placing the facility in a safe and stable condition to prevent unacceptable exposure to people or the environmen

Successful Placement of Intracranial Pressure Monitors by Trauma Surgeons

BACKGROUND: The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons. METHODS: In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student\u27s t tests. RESULTS: During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951). CONCLUSION: After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV

Successful Placement of Intracranial Pressure Monitors by Trauma Surgeons

BACKGROUND: The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons. METHODS: In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student\u27s t tests. RESULTS: During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951). CONCLUSION: After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV

Successful Placement of Intracranial Pressure Monitors by Trauma Surgeons

BACKGROUND: The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons. METHODS: In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student\u27s t tests. RESULTS: During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951). CONCLUSION: After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV

Successful Placement of Intracranial Pressure Monitors by Trauma Surgeons

BACKGROUND: The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons. METHODS: In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student\u27s t tests. RESULTS: During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951). CONCLUSION: After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV

The Glucogram: A New Quantitative Tool for Glycemic Analysis in the Surgical Intensive Care Unit

Background: Glycemic control is an important aspect of patient care in the surgical intensive care unit (SICU). This is a pilot study of a novel glycemic analysis tool – the glucogram. We hypothesize that the glucogram may be helpful in quantifying the clinical significance of acute hyperglycemic states (AHS) and in describing glycemic variability (GV) in critically ill patients. Materials and Methods: Serial glucose measurements were analyzed in SICU patients with lengths of stay (LOS) \u3e30 days. Glucose data were formatted into 12-hour epochs and graphically analyzed using stochastic and momentum indicators. Recorded clinical events were classified as major or minor (control). Examples of major events include cardiogenic shock, acute respiratory failure, major hemorrhage, infection/sepsis, etc. Examples of minor (control) events include non-emergent bedside procedures, blood transfusion given to a hemodynamically stable patient, etc. Positive/negative indicator status was then correlated with AHS and associated clinical events. The conjunction of positive indicator/major clinical event or negative indicator/minor clinical event was defined as clinical “match”. GV was determined by averaging glucose fluctuations (maximal – minimal value within each 12-hour epoch) over time. In addition, event-specific glucose excursion (ESGE) associated with each positive indicator/AHS match (final minus initial value for each occurrence) was calculated. Descriptive statistics, sensitivity/specificity determination, and student\u27s t-test were used in data analysis. Results: Glycemic and clinical data were reviewed for 11 patients (mean SICU LOS 74.5 days; 7 men/4 women; mean age 54.9 years; APACHE II of 17.7 ± 6.44; mortality 36%). A total of 4354 glucose data points (1254 epochs) were analyzed. There were 354 major clinical events and 93 minor (control) events. The glucogram identified AHS/indicator/clinical event “matches” with overall sensitivity of 84% and specificity of 65%. We noted that while the mean GV was greater for non-survivors than for survivors (19.3 mg/dL vs. 10.3 mg/dL, P = 0.02), there was no difference in mean ESGE between survivors (154.7) and non-survivors (160.8, P = 0.67). Conclusions: The glucogram was able to quantify the correlation between AHS and major clinical events with a sensitivity of 84% and a specificity of 65%. In addition, mean GV was nearly two times higher for non-survivors. The glucogram may be useful both clinically (i.e., in the electronic ICU or other “early warning” systems) and as a research tool (i.e., in model development and standardization). Results of this study provide a foundation for further, larger-scale, multi-parametric, prospective evaluations of the glucogram